Publications by authors named "Ching-Chiu Kao"

38 Publications

Machine-Based Hand Massage Ameliorates Preoperative Anxiety in Patients Awaiting Ambulatory Surgery.

J Nurs Res 2021 Apr 12;29(3):e152. Epub 2021 Apr 12.

MS, RN, Executive Director of Community Medicine, Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, and Adjunct Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan, ROC.

Background: Hand massage therapies have been used to relieve anxiety and pain in various clinical situations. The effects of machine-based hand massage on preoperative anxiety in ambulatory surgery settings have not been evaluated.

Purpose: This prospective study was designed to investigate the effect of machine-based hand massage on preoperative anxiety and vital signs in ambulatory surgery patients.

Methods: One hundred ninety-nine patients aged 18 years and older who were scheduled to receive ambulatory surgery were recruited from the Taipei Municipal Wanfang Hospital in Taipei City, Taiwan. The patients were assigned randomly to the experimental group (n = 101), which received presurgical machine-based hand massage therapy, and the control group (n = 98), which received no intervention. The patients in both groups completed the Spielberger State-Trait Anxiety Inventory short form at preintervention (baseline) and postintervention.

Results: Within-group comparisons of Spielberger State-Trait Anxiety Inventory short form scores showed significant decreases between preintervention and postintervention scores in the experimental group (44.3 ± 11.2 to 37.9 ± 8.7) and no significant change in the control group. Within-group comparisons of vital signs revealed a significant increase in mean respiration rate between baseline and postintervention in both groups (both ps < .05). Blood pressure was found to have decreased significantly only in the control group at postintervention (p < .05). No significant preintervention to postintervention change in pulse was observed in either group.

Conclusions: The findings of this study indicate that machine-based hand massage reduces anxiety significantly in patients awaiting ambulatory surgery while not significantly affecting their vital signs.
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http://dx.doi.org/10.1097/jnr.0000000000000432DOI Listing
April 2021

Correction to: Effect of interactive cognitive-motor training on eye-hand coordination and cognitive function in older adults.

BMC Geriatr 2021 Mar 20;21(1):194. Epub 2021 Mar 20.

School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 110, Taiwan, Republic of China.

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http://dx.doi.org/10.1186/s12877-021-02096-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980349PMC
March 2021

Swallowing exercises for head and neck cancer patients: A systematic review and meta-analysis of randomized control trials.

Int J Nurs Stud 2021 Feb 11;114:103827. Epub 2020 Nov 11.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan. Electronic address:

Background: Extensive surgery and chemo/radiation therapy (C/RT) to manage head and neck cancer (HNC) patients affects their ability to swallow food and liquids, risk of aspiration and greatly influences their quality of life (QOL).

Objectives: Ascertain the effectiveness of swallowing exercises on improving swallowing function, performance status, mouth opening, risk of aspiration/penetration and QOL in HNC patients.

Design: Systematic review and meta-analysis of randomized controlled trials DATA SOURCES: PubMed, Ovid-Medline, Embase, Cochrane Library, CINAHL and Web of Science and included all available RCTs.

Review Methods: We followed the PRISMA guidelines and standard methods for conducting a systematic review and meta-analysis. Comprehensive Meta-analysis 3.0 using the random effects model was used for data analysis.

Results: In total, 19 RCTs with 1100 participants were identified and included in the current review. Swallowing exercises had significant small effect on swallowing function 0.33 (95%CI = 0.00-0.65) and moderate effect on mouth opening 0.60 (95%CI = 0.21-0.99) immediately after intervention and small effect at 6-month follow-up 0.46 (95%CI = 0.11-0.81). However, non-significant effects were observed on risk of aspiration/penetration, performance status and all domains of QOL.

Conclusion: Swallowing exercises demonstrated effectiveness in improving swallowing function and mouth opening in HNC patients undergoing multimodal treatment. This is the first comprehensive systematic review and meta-analysis of RCTs to assess the effect of swallowing exercises in HNC patients undergoing multimodal treatment. Nurses can play an important role in assisting the delivery of oropharyngeal swallowing exercises including jaw exercises, tongue exercises and swallowing maneuvers with assistance and guidance from speech pathologists to help improve HNC complications and QOL for HNC survivors.
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http://dx.doi.org/10.1016/j.ijnurstu.2020.103827DOI Listing
February 2021

A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic.

Int J Ment Health Nurs 2021 Feb 27;30(1):102-116. Epub 2020 Oct 27.

Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan.

A large-scale survey study was conducted to assess trauma, burnout, posttraumatic growth, and associated factors for nurses in the COVID-19 pandemic. The Trauma Screening Questionnaire, Maslach Burnout Inventory, and Posttraumatic Growth Inventory-Short Form were utilized. Factors associated with trauma, burnout, and posttraumatic growth were analysed using logistic and multiple regressions. In total, 12 596 completed the survey, and 52.3% worked in COVID-19 designated hospitals. At the survey's conclusion in April, 13.3% reported trauma (Trauma ≥ 6), there were moderate degrees of emotional exhaustion, and 4,949 (39.3%) experienced posttraumatic growth. Traumatic response and emotional exhaustion were greater among (i) women (odds ratio [OR]: 1.48, 95% CI 1.12-1.97 P = 0.006; emotional exhaustion OR: 1.30, 95% CI 1.09-1.54, P = 0.003), (ii) critical care units (OR: 1.20, 95% CI 1.06-1.35, P = 0.004; emotional exhaustion OR: 1.23, 95% CI 1.12-1.33, P < 0.001) (iii) COVID-19 designated hospital (OR: 1.24, 95% CI 1.11-1.38; P < 0.001; emotional exhaustion OR: 1.26, 95% CI 1.17-1.36; P < 0.001) and (iv) COVID-19-related departments (OR: 1.16, 95% CI 1.04-1.29, P = 0.006, emotional exhaustion only). To date, this is the first large-scale study to report the rates of trauma and burnout for nurses during the COVID-19 pandemic. The study indicates that nurses who identified as women, working in ICUs, COVID-19 designated hospitals, and departments involved with treating COVID-19 patients had higher scores in mental health outcomes. Future research can focus on the factors the study has identified that could lead to more effective prevention and treatment strategies for adverse health outcomes and better use of resources to promote positive outcomes.
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http://dx.doi.org/10.1111/inm.12796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894338PMC
February 2021

Nursing's response to COVID-19: Lessons learned from SARS in Taiwan.

Int J Nurs Stud 2020 Aug 11;108:103587. Epub 2020 Apr 11.

Profesosr, School of Nursing, College of Nursing, Taipei Medical University, Taiwan; Professor, School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong. Electronic address:

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http://dx.doi.org/10.1016/j.ijnurstu.2020.103587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151482PMC
August 2020

The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: A meta-analysis of randomized controlled trials.

J Psychiatr Res 2020 04 28;123:102-113. Epub 2020 Jan 28.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan. Electronic address:

Background: Eye Movement Desensitization and Reprocessing (EMDR) has been well established as an effective treatment for post-traumatic stress disorder (PTSD). However, PTSD has been re-categorized as part of trauma and stressor-related disorders instead of anxiety disorders. We conducted the first meta-analysis on Randomized Controlled Trials to evaluate the effectiveness of EMDR on reducing symptoms of anxiety disorders.

Methods: A manual and systematic search using various databases and reference lists of systematic review articles published up to December 2018 was conducted. The symptoms of anxiety, phobia, panic, traumatic feelings and behaviors/somatic symptoms were examined. Hedges' g effect sizes were computed, and random effect models were used for all analyses.

Results: A total of 17 trials with 647 participants were included in this meta-analysis. EMDR was associated with a significant reduction of anxiety (g = -0.71; 95% CI: -0.96 to -0.47), panic (g = -0.62; 95% CI: -1.10 to -0.14), phobia (g = -0.45; 95% CI: -0.81 to -0.08), behavioural/somatic symptoms (g = -0.40; 95% CI: -0.63 to -0.12), but not traumatic feelings (g = -0.48; 95% CI: -1.14 to -0.18). Subgroup analysis revealed greater effects of EMDR if compared to passive control. However, the effects were not significantly different based on the duration, number of therapy sessions, or the number of weekly sessions.

Conclusions: Our meta-analysis indicates that EMDR is efficacious for reducing symptoms of anxiety, panic, phobia, and behavioural/somatic symptoms. Further research is needed to explore EMDR's long term efficacy on anxiety disorders.
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http://dx.doi.org/10.1016/j.jpsychires.2020.01.005DOI Listing
April 2020

Construction and evaluation of multidomain attention training to improve alertness attention, sustained attention, and visual-spatial attention in older adults with mild cognitive impairment: A randomized controlled trial.

Int J Geriatr Psychiatry 2020 05 14;35(5):537-546. Epub 2020 Feb 14.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China.

Objectives: We aimed to analyze the effects of multidomain attention training on alertness, sustained attention, and visual-spatial attention in older adults with mild cognitive impairment (MCI).

Design: The design used in this study was a two-arm, parallel group, double-blind randomized controlled trial.

Setting And Participants: The participants of the study were seventy-eight older adults with MCI (mean age: 79.5 ± 7.9 years) from retirement centers and community housing for the elderly.

Intervention: The participants were randomly assigned to an experimental group (multidomain attention training, n = 39) or an active control group (n = 39). Both groups underwent training sessions for 45 minutes three times per week for 6 weeks (18 sessions in total).

Measures: The main efficacy indicator was alertness (Trail Making Test Part B), sustained attention (Digit Vigilance Test), and visual-spatial attention (Trail Making Test Part A). The secondary outcome indicators were other cognitive functions (Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA] subscales). Measurements were obtained at pretest, posttest, and 3 and 6 months after training.

Results: The results were analyzed by a generalized estimating equation (GEE), which indicated that attention outcomes (alertness, sustained attention, and visual-spatial attention) of the experimental group did not improve after training. However, the experimental group displayed a significant improvement in the attention, memory, and orientation of MMSE and MoCA subscales over a period of 6 months and also showed superior results compared with the control group.

Conclusions: Multidomain attention training demonstrated improved alertness and visual-spatial attention for posttest after 6 months. We also outline potential future advances in attention training for improving attention in older adults with MCI.
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http://dx.doi.org/10.1002/gps.5269DOI Listing
May 2020

Effect of home-based music intervention versus ambient music on breast cancer survivors in the community: A feasibility study in Taiwan.

Eur J Cancer Care (Engl) 2019 Jul 5;28(4):e13064. Epub 2019 Jun 5.

Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

To explore the effects of home-based music intervention (HBMI) on symptom severity, pain intensity and perceived fatigue among patients with breast cancer. In this randomised controlled trial, patients with breast cancer were randomly assigned into an HBMI or control group. The HBMI group was administered 24-week HBMI involving five 30-min sessions per week. The primary outcome was symptom severity; the secondary outcomes were pain and fatigue. A generalised estimating equation was employed to compare the effects after 6, 12 and 24 weeks of intervention between the two groups. A total of 60 patients were recruited. After 6, 12 and 24 weeks, HBMI significantly reduced symptom severity, pain intensity, overall fatigue, general fatigue, emotional fatigue and vigour (p < 0.05). Additionally, HBMI significantly reduced physical fatigue after 6 (p = 0.003) and 12 (p = 0.013) weeks and mental fatigue after 6 weeks (p = 0.001). After 6, 12 and 24 weeks, HBMI reduced symptom severity, pain intensity and overall fatigue. Furthermore, HBMI instantaneously reduced physical and mental fatigue. We recommend that HBMI be administered to patients with breast cancer to reduce their negative thoughts associated with cancer.
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http://dx.doi.org/10.1111/ecc.13064DOI Listing
July 2019

Development and effectiveness of virtual interactive working memory training for older people with mild cognitive impairment: a single-blind randomised controlled trial.

Age Ageing 2019 07;48(4):519-525

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Background: memory training is a potential intervention for retaining memory and reducing dementia risk in older adults with mild cognitive impairment (MCI).

Objective: this study examined the effect of virtual interactive working memory training (VIMT) in older adults with MCI.

Design: single-blind, two-arm parallel-group, randomised controlled design.

Setting: retirement homes, institutions, and communities.

Subjects: a total of 66 older adults with MCI were recruited (mean age: 78.5 ± 7.6 years).

Methods: participants were randomly assigned to the experimental group (VIMT, n = 33) or active control group (n = 33). The VIMT program used the CogniPlus (includes four training modules). Both groups attended 45 min sessions 3 times per week, a total of 36 sessions. The primary outcome was working memory; secondary outcomes were immediate memory, delayed memory, subjective memory complaints and global cognitive function. All variables were measured at pre-test, post-test, and 3-month follow-up.

Results: between group, the effect of working memory adjusted mean difference by 1.75 (95% CI: 0.56 to 2.94; P < 0.01) at post-test. The results were analysed by a generalised estimating equation, which indicated that VIMT group significantly improved working memory at post-test (P = 0.01) relative to the active control group.

Conclusions: the applied VIMT program can enable older adults with MCI to maintain their working memory and reduce the rate of cognitive deterioration.

Trial Registration: This trial was registered on ClinicalTrials.gov (no.: NCT02462135).
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http://dx.doi.org/10.1093/ageing/afz029DOI Listing
July 2019

Effect of interactive cognitive-motor training on eye-hand coordination and cognitive function in older adults.

BMC Geriatr 2019 01 28;19(1):27. Epub 2019 Jan 28.

School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 110, Taiwan, Republic of China.

Background: Poor eye-hand coordination is associated with the symptoms of the early stage of cognitive decline. However, previous research on the eye-hand coordination of older adults without cognitive impairment is scant. Therefore, this study examined the effects of interactive cognitive-motor training on the visual-motor integration, visual perception, and motor coordination sub-abilities of the eye-hand coordination and cognitive function in older adults.

Methods: A double-blind randomized controlled trial was conducted with older adults. Sixty-two older adults were randomly assigned to the experimental (interactive cognitive-motor training) or active control (passive information activity) group, and both groups received 30 min of training each week, three times a week for 8 weeks. The primary outcome was eye-hand coordination, which was further divided into the sub-abilities of visual-motor integration, visual perception, and motor coordination. The secondary outcome was cognitive function. The generalized estimating equation was used to examine differences in immediate posttest, 3-month posttest, and 6-month posttest results between the two groups. Additionally, the baseline effect sizes were compared with the effect sizes of the immediate posttest, 3-month posttest, and 6-month posttests for the experimental group.

Results: There were no statistically significant differences between the intervention and control groups. The only statistically significant difference between the groups was in the attention dimension of cognitive function (p = 0.04). The visual-motor integration results showed a small to moderate effect size for pre post comparisons.

Conclusions: The 24 sessions of interactive cognitive-motor training showed no difference to an active control intervention. In the future, this intervention could be further investigated to establish whether it can be superior to an active control group in other populations.

Trial Registration: The study protocol has been published on Chinese Clinical Trial Registry (ChiCTR) (registry no.: ChiCTR-IOR-14005490 ).
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http://dx.doi.org/10.1186/s12877-019-1029-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350349PMC
January 2019

Prevalence of workplace violent episodes experienced by nurses in acute psychiatric settings.

PLoS One 2019 24;14(1):e0211183. Epub 2019 Jan 24.

Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.

Nurses who experience workplace violence exhibit compromised care quality and decreased work morale, which may increase their turnover rate. This study explored prevalence of workplace violence, the reaction of victims, and workplace strategies adopted to prevent violence among acute psychiatric settings in northern Taiwan. A cross-sectional study was conducted, which consisted of 429 nurses who completed the Chinese version of the Workplace Violence Survey Questionnaire developed by the International Labor Office, International Council of Nurses, World Health Organization, and Public Services International. The rates of physical and psychological violence were 55.7% and 82.1%, respectively. Most perpetrator of the workplace violence were patients. Most victims responded by instructing the perpetrator to stop, followed by narrating the incident to friends, family, and colleagues. Only 4.9%-12% of the victims completed an incident or accident form, and the main reason for not reporting these violent incidents was the belief that reporting such incidents was useless or unimportant. The major strategies adopted by workplaces to prevent violence were security measures, patient protocols, and training. Institutions should train staff to handle violence, provide a therapeutic environment, simplify the reporting process, and encourage reporting of all types of violence.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211183PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345477PMC
October 2019

[Workplace Violence Against Nurses in Northern Taiwan: A Cross-Sectional Study].

Hu Li Za Zhi 2018 Dec;65(6):44-54

MS, RN, Vice Superintendent, Department of Preventive and Community Medicine, Taipei Municipal Wanfang Hospital, and Adjunct Assistant Professor, School of Nursing, Taipei Medical University, Taiwan, ROC.

Background: Nurses comprise a group in the healthcare team that is exposed to the highest levels of workplace violence. This not only causes negative emotions in nurses and adversely impacts the institution and the body and spirit of the nurses but also affects the quality of nursing care.

Purpose: The aim of this study was to determine the prevalence of physical and psychological workplace violence experienced by the nursing staff and to identify the perpetrators of violence, the reactions of the victims, and the policies developed by employers to prevent violence.

Methods: This cross-sectional study was conducted using a stratified sampling method across different levels of healthcare institutions on the nursing personnel registered with the Taipei Nurses Association. The number of subjects was allocated according to hospital level. A total of 2,931 subjects were recruited, of whom 2,627 participated in this study.

Results: Over two-thirds (70.6% ) of participants had experienced workplace violence, of whom 31.0% had experienced physical violence and 66.0% had experienced psychological violence. A multiple logistic regression analysis showed that nurses who were married, who had less than one year of work experience, or were over 50 years of age were at lower risk of physical and psychological violence. Those who had a university education or higher faced a higher risk of psychological violence. The most common perpetrators were identified as patients. The aftermath reactions from the victims were varied, with the most prevalent being "telling the perpetrator to stop the violence", "telling friends or family," and "reporting the incident to a senior staff member". The perpetrators were mostly dealt with using a verbal warning, while the second-most common strategy was taking no action. Only 2.3% ‡6.8% of the victims notified the authorities about the violence because of the following primary reasons: "useless," "not important," and "fear of negative consequences." The major strategies that were adopted by employers to prevent violence included "security measures," "improvement of surroundings," and "training."

Conclusions: Prevention of violence must be improved comprehensively using the strategies of physical facilities, management, education, and policies.
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http://dx.doi.org/10.6224/JN.201812_65(6).07DOI Listing
December 2018

Analysis of the risk and risk factors for injury in people with and without dementia: a 14-year, retrospective, matched cohort study.

Alzheimers Res Ther 2018 10 30;10(1):111. Epub 2018 Oct 30.

Department of Nursing, Taipei Medical University-Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, Taipei, 23561, Taiwan.

Background: Most previous studies on dementia and injuries have focused on a particular type of injury, and few studies have investigated overall injury in people with dementia. In this study, we investigated the risk factors and risk of overall injury, including the diagnosis, cause, and intentionality of injury, in people with and without dementia in Taiwan.

Methods: We collected relevant data between 2000 and 2013 from the National Health Insurance Research Database (NHIRD). Overall, 455,630 cases, consisting of 91,126 people with dementia and 364,504 people without dementia, were included in this study and we performed subgroup analysis. A multivariate Cox proportional hazards regression analysis was used to determine the risk of injuries.

Results: The 14-year follow-up data showed that people with dementia had a higher risk of injury-related hospitalization than did people without dementia (19.92% vs 18.86%, hazard ratio (HR) = 1.070, p < 0.001). Regarding the cause of injury, people with dementia were more likely to be hospitalized due to suffocation (HR = 2.301, p < 0.001), accidental drug poisoning (HR = 1.485, p < 0.001), or falls (HR = 1.076, p < 0.001), and were less likely to be hospitalized due to suicide or self-inflicted injury (HR = 0.670, p < 0.001) or a traffic accident (HR = 0.510, p < 0.001) than were people without dementia. Subgroup analysis showed that people with dementia with any of the three subtypes of dementia were at a higher risk of homicide or abuse than were people without dementia (vascular dementia, HR = 2.079, p < 0.001; Alzheimer's disease, HR = 1.156, p < 0.001; other dementia, HR = 1.421, p < 0.001). The risk factors for overall injury included dementia diagnosis, female gender, age 65-74 years, and seeking medical attention for an injury within the past year.

Conclusion: People with dementia are at a higher risk of injury-related hospitalization than people without dementia. The results of this study provide a reference for preventing suffocation, drug poisoning, and falls in people with dementia. In addition, government agencies should pay attention to and intervene in cases of abuse suffered by people with dementia.
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http://dx.doi.org/10.1186/s13195-018-0437-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208020PMC
October 2018

Effect of interactive cognitive motor training on gait and balance among older adults: A randomized controlled trial.

Int J Nurs Stud 2018 Jun 23;82:121-128. Epub 2018 Mar 23.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan. Electronic address:

Background: Aging is a normal degenerative process that results in a decline in the gait and balance performance of older adults. Interactive cognitive motor training is an intervention that integrates cognitive and motor tasks to promote individuals' physical and cognitive fall risk factors. However, the additive effects of the interactive cognitive motor training on objective quantitative data and comprehensive descriptions of gait and balance warrants further investigation.

Objectives: To investigate the effect of interactive cognitive motor training on older adults' gait and balance from immediate to long-term time points.

Design: A double-blind randomized control trial.

Settings: Four senior service centers and community service centers in Taiwan.

Participants: 62 older adults who met the inclusion criteria.

Methods: The study participants were older adults without cognitive impairment, and they were randomly allocated to the experimental group or active control group. In both groups, older adults participated in three sessions of 30-min training per week for a total of 8 weeks, with the total number of training sessions being 24. The primary outcome was gait performance, which was measured using objective and subjective indicators. iWALK was used as an objective indicator to measure pace and dynamic stability; the Functional Gait Assessment was employed as a subjective indicator. The secondary outcome was balance performance, which was measured using iSWAY. A generalized estimating equation was used to identify whether the results of the two groups differ after receiving different intervention measures; the results were obtained from immediate to long-term posttests.

Results: Stride length in the pace category of the experimental group improved significantly in immediate posttest (p = 0.01), 3-month follow-up (p = 0.01), and 6-month follow-up (p = 0.04). The range of motion of the leg exhibited significant improvement in immediate posttest (p = 0.04) and 3-month follow-up (p = 0.04). The Functional Gait Assessment result indicated that statistically significant improvement was observed in immediate posttest (p = 0.02) and 12-month follow-up (p = 0.01). The results of balance performance showed that the experimental group attained statistically significant improvement in centroid frequency in the immediate posttest (p = 0.02).

Conclusions: The research results validated that the 24 sessions of the interactive cognitive motor training intervention significantly improved gait and balance performance. Future studies should extend the sample to communities to promote the gait and balance performance of community-dwelling older adults without cognitive impairment and reduce their risk of falling and developing gait-related diseases.
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http://dx.doi.org/10.1016/j.ijnurstu.2018.03.015DOI Listing
June 2018

Effectiveness of executive function training on mental set shifting, working memory and inhibition in healthy older adults: A double-blind randomized controlled trials.

J Adv Nurs 2018 May 24;74(5):1099-1113. Epub 2018 Jan 24.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Aims: The aim of this study was to evaluate the effectiveness of executive function training on mental set shifting, working memory and inhibition for healthy older adults.

Background: Executive functions control and guide individuals' behaviours through a top-down cognitive model and have been regarded as the exhibition and integration of various high-level cognitive functions. However, prior studies have rarely focused on the subcomponent indicators of executive function, such as mental set shifting, working memory and inhibition in healthy older adults.

Design: Randomized controlled trial.

Methods: A total of 62 participants were recruited between January 2015 - March 2017, with both groups attending a 30-min training session three times per week for 8 weeks. Executive function training group received the training content that focused on the mental set shifting, working memory and inhibition. Active control group engaged in passive information activities. The primary outcome was mental set shifting, measured by the Wisconsin card sort test. The secondary outcomes were working memory measured by digit span and inhibition measured by the Stroop color word test.

Results: The executive function training group had statistically significant higher scores of mental set shifting and working memory at immediate follow-up and that its effect on mental set shifting could be maintained for 3-6 months. However, this training did not have any statistically significant results on inhibition.

Conclusion: The executive function training may be an effective preventive intervention for healthy older adults. Future studies are recommended to include a broader range of participants with different levels of cognitive function.
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http://dx.doi.org/10.1111/jan.13519DOI Listing
May 2018

[Evidence-Based Knowledge Translation: From Scientific Evidence to Clinical Nursing Practice].

Hu Li Za Zhi 2016 Dec;63(6):5-11

PhD, MD, Director, Department of Plastic Surgery, and Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, and Adjunct Associate Professor, School of Medicine, Taipei Medical University, and Chief Executive Officer, Cochrane Taiwan, Taiwan, ROC.

In 1992, Gordon Guyatt coined the term "evidence-based medicine", which has since attracted worldwide attention. In 2007, the Institute of Medicine's Roundtable on Evidence-Based Medicine set the goal that 90% of clinical decisions would be supported by accurate, timely, and up-to-date clinical information and would reflect the best available evidence by 2020. However, the chasm between knowing and doing remains palpable. In 2000, the Canadian Institute of Health Research applied the term "knowledge translation" to describe the bridge that is necessary to cross the gap between research knowledge and clinical practice. The present paper outlines the conceptual framework, barriers, and promotion strategies for evidence-based knowledge translation and shares clinical experience related to overcoming the seven layers of leakage (aware, accepted, applicable, able, acted on, agreed, and adhered to). We hope that this paper can enhance the public well-being and strengthen the future health care system.
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http://dx.doi.org/10.6224/JN.63.6.5DOI Listing
December 2016

The EPCOR model: a model for promoting the successful implementation of evidence-based nursing in hospital-based settings.

J Nurs Res 2015 Mar;23(1):15-24

1PhD, RN, Associate Professor, Department of Nursing, Cardinal Tien Junior College of Healthcare and Management 2MSN, RN, Vice President, Wang-Fang Hospital 3PhD, RN, Associate Professor, Department of Nursing, National Taipei University of Nursing and Health Sciences, and Nursing Consultant, Department of Nursing, Shuang Ho Hospital, Taipei Medical University.

Background: An effective organizational infrastructure is essential to successfully implement and sustain an evidence-based nursing (EBN) practice. Although EBN has been promoted in Taiwan for more than 10 years, variations in the organizational policies and strategies necessary to support EBN among healthcare organizations have prevented effective implementation. Barriers to the implementation of EBN located at the organizational level have also been reported. The need for a model that focuses on the organizational infrastructure to promote EBN in Taiwan has therefore become increasingly apparent.

Purpose: This study aims to develop a model that contains the key contextual elements of organizational infrastructure necessary to effectively promote EBN, especially in hospital settings.

Methods: A steering committee drafted the components and related strategies of the proposed model. Delphi technique was used to obtain consensus on the proposed model among a group of experts with expertise in EBN. Thirty experts participated in all three rounds of the Delphi survey. To confirm the appropriateness of the proposed model for clinical settings, the model was further reviewed by a focus group composed of experts with experience in implementing EBN or evidence-based medicine in hospitals. The strategies were then further modified based on the suggestions of this focus group, and only those strategies that best fit hospital settings were retained.

Results: Five key contextual elements and related strategic processes were identified, including equipment, policy, training courses, outcome indicators, and reward plans. The resultant model was named EPCOR, an acronym composed of the names of each identified element.

Conclusions/implications For Practice: EPCOR is a comprehensive model of organizational infrastructure and strategic procedures for implementing EBN in hospital-based settings in Taiwan. Organizations may use the EPCOR model to initiate and implement EBN practices and then to evaluate their effectiveness.
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March 2015

Psychometric testing of a Mandarin Chinese Version of the Clinically Useful Depression Outcome Scale for patients diagnosed with type 2 diabetes mellitus.

Int J Nurs Stud 2014 Dec 27;51(12):1595-604. Epub 2014 May 27.

Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Sleep Science Center, Taipei Medical University Hospital, Taipei, Taiwan. Electronic address:

Background: The Clinically Useful Depression Outcome Scale (CUDOS) is a self-report instrument that assesses symptoms and the severity of depression, but its psychometric properties in patients with type 2 diabetes mellitus in Chinese-Speaking populations are unknown.

Objectives: To examine the psychometric properties of the Mandarin Chinese version of the CUDOS (CUDOS-Chinese).

Design: A methodological research design.

Setting: Endocrinology and metabolism outpatient clinics at 2 university-affiliated hospitals in northern Taiwan.

Participants: Two-hundred and fourteen type 2 diabetic patients with the mean age of 62.6 years were enrolled, and two-hundred and twelve of them completed the study.

Methods: Internal consistency, test-retest reliability, concurrent, and contrasted-groups validity were assessed. A receiver operating characteristic curve analysis was performed to assess sensitivity and specificity. Construct validity by means of confirmatory factor analysis was conducted.

Results: Internal consistency (Cronbach α of total scale and four subscales=0.93, 0.80, 0.66, 0.80, and 0.83, respectively), test-retest reliability (intra-class correlation coefficients of total scale and four subscales=0.92, 0.89, 0.94, 0.89, and 0.91, respectively), and strong correlations with the Beck Depression Inventory-II (r=0.87) suggested good reliability and validity. The confirmatory factor analysis supported a four-factor model. A cut-off score of 19/20 yielded 77.8% sensitivity and 75.6% specificity.

Conclusions: The CUDOS-Chinese demonstrated satisfactory validity and reliability for detecting depression in type 2 diabetic patients in Taiwan.
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http://dx.doi.org/10.1016/j.ijnurstu.2014.05.004DOI Listing
December 2014

[Clinical nursing manpower: development and future prospects].

Hu Li Za Zhi 2014 Apr;61(2):13-9

Taipei Medical University - Municipal Wan Fang Hospital, Taiwan, ROC.

The significant changes in nursing manpower utilization in Taiwan over the past two decades are due in large part to the implementation of the National Health Insurance program and the rising need for long-term care. The changes have impacted clinical nursing manpower utilization in two important ways. Firstly, there has been a substantial increase in overall demand for nursing manpower. In particular, the need for clinical nurses has nearly quadrupled during this time period. Secondly, the level of difficulty involved in patient care has risen dramatically, with factors including increased disease severity and increased care quality expectations, among others. These changes, coupled with demands on nursing manpower imposed from other sectors, underpin and further exacerbate the problem of nursing manpower shortages throughout the healthcare system. To raise the quality of the nursing work environment, the Ministry of Health and Welfare (MOHW) brought together Taiwan's key professional nursing organizations to promote 10 care-reform strategies, establish the nursing-aid manpower system, and create the nursing classification system as an approach to effectively attract nurses to take positions in the medical system.
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http://dx.doi.org/10.6224/JN.61.2.13DOI Listing
April 2014

The anxiolytic effect of aromatherapy on patients awaiting ambulatory surgery: a randomized controlled trial.

Evid Based Complement Alternat Med 2013 17;2013:927419. Epub 2013 Dec 17.

Center for Evidence-Based Medicine, Taipei Medical University, Taipei 11031, Taiwan ; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan ; Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan ; Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan.

The aim of this study was to determine if aromatherapy could reduce preoperative anxiety in ambulatory surgery patients. A total of 109 preoperative patients were randomly assigned to experimental (bergamot essential oil) and control (water vapor) conditions and their responses to the State Trait Anxiety Inventory and vital signs were monitored. Patients were stratified by previous surgical experience, but that did not influence the results. All those exposed to bergamot essential oil aromatherapy showed a greater reduction in preoperative anxiety than those in the control groups. Aromatherapy may be a useful part of a holistic approach to reducing preoperative anxiety before ambulatory surgery.
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http://dx.doi.org/10.1155/2013/927419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877597PMC
January 2014

Measurement of physical activity in cancer survivors: a validity study.

J Cancer Surviv 2014 Jun 7;8(2):205-12. Epub 2013 Dec 7.

Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Purpose: The purpose of the study was to validate the Taiwanese version of the Physical Activity Scale for the Elderly (PASE-T) and to assess physical activity in Taiwanese cancer survivors.

Methods: One hundred twenty-seven cancer survivors participated in this study. Instruments consisted of the PASE-T, the Taiwanese version of the MD Anderson Symptom Inventory (MDASI-T), Karnofsky performance status (KPS), and actigraph. Reliability was assessed by calculating the test-retest reliability. The validity was assessed by the content validity, criterion-related validity, convergent validity, and known-group validity.

Results: The test-retest reliability of PASE-T was 0.90 over a 2-week interval, based on a sample of 30 patients. The content validity index was very acceptable at 0.91. Convergent validity was demonstrated by its significant association with MDASI-T scores (symptom severity: r = -0.23, p = 0.001; symptom interference: r = -0.21, p = 0.001) and KPS scores (r = 0.59, p < 0.001). Criterion-related validity was established by a significant relationship to the actigraph total counts per minute (r = 0.64, p < 0.001). Known-group validity was established by its ability to detect significant differences according to a patient's performance status. Moreover, KPS (β = 0.37), fatigue (β = -0.32), and age (β = -0.20) were significant predictors of physical activity (R(2) = 0.46).

Conclusions: The PASE-T is a reliable and valid instrument for measurement of physical activity among cancer survivors in Taiwan.

Implication For Cancer Survivors: This scale could be a useful measure of physical activity in cancer survivors and subsequently facilitate the quality of oncology care.
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http://dx.doi.org/10.1007/s11764-013-0325-3DOI Listing
June 2014

[The nursing shortage and nursing retention strategies in Taiwan].

Hu Li Za Zhi 2013 Jun;60(3):88-93

School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan, ROC.

A chronic shortage of working nurses has led hospitals in Taiwan to close wards and reduce bed numbers. Work overload and job stress are major causes of this shortage. The purpose of this study is to propose a solution to improve the nursing workload situation. We reviewed literature articles and conference presentations to synthesize relevant measures, which included reforming the current care model; using innovation to simplify nursing practice; and creating a culture of workplace respect and inter-team cooperation. Based on this, we proposed our nursing retention strategy after reviewing national Department of Health development policies on nursing manpower.
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http://dx.doi.org/10.6224/JN.60.3.88DOI Listing
June 2013

Nursing process decision support system for urology ward.

Int J Med Inform 2013 Jul 21;82(7):604-12. Epub 2013 Mar 21.

Department of Nursing, Chang Gung University of Science and Technology, Taiwan.

Purpose: We developed a nursing process decision support system (NPDSS) based on three clinical pathways, including benign prostatic hypertrophy, inguinal hernia, and urinary tract stone. NPDSS included six major nursing diagnoses - acute pain, impaired urinary elimination, impaired skin integrity, anxiety, infection risk, and risk of falling. This paper aims to describe the design, development and validation process of the NPDSS.

Methods: We deployed the Delphi method to reach consensus for decision support rules of NPDSS. A team of nine-member expert nurses from a medical center in Taiwan was involved in Delphi method. The Cronbach's α method was used for examining the reliability of the questionnaire used in the Delphi method. The Visual Basic 6.0 as front-end and Microsoft Access 2003 as back-end was used to develop the system. A team of six nursing experts was asked to evaluate the usability of the developed systems. A 5-point Likert scale questionnaire was used for the evaluation. The sensitivity and specificity of NPDSS were validated using 150 nursing chart.

Results: The study showed a consistency between the diagnoses of the developed system (NPDSS) and the nursing charts. The sensitivities of the nursing diagnoses including acute pain, impaired urinary elimination, risk of infection, and risk of falling were 96.9%, 98.1%, 94.9%, and 89.9% respectively; and the specificities were 88%, 49.5%, 62%, and 88% respectively. We did not calculate the sensitivity and specificity of impaired skin integrity and anxiety due to non-availability of enough sample size.

Conclusions: NPDSS can help nurses in decision making of nursing diagnoses. Besides, it can help them to generate nursing diagnoses based on patient-specific data, individualized care plans, and implementation within their usual nursing workflow.
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http://dx.doi.org/10.1016/j.ijmedinf.2013.02.006DOI Listing
July 2013

Nursing process decision support system for urology ward.

Int J Med Inform 2013 Jul 21;82(7):604-12. Epub 2013 Mar 21.

Department of Nursing, Chang Gung University of Science and Technology, Taiwan.

Purpose: We developed a nursing process decision support system (NPDSS) based on three clinical pathways, including benign prostatic hypertrophy, inguinal hernia, and urinary tract stone. NPDSS included six major nursing diagnoses - acute pain, impaired urinary elimination, impaired skin integrity, anxiety, infection risk, and risk of falling. This paper aims to describe the design, development and validation process of the NPDSS.

Methods: We deployed the Delphi method to reach consensus for decision support rules of NPDSS. A team of nine-member expert nurses from a medical center in Taiwan was involved in Delphi method. The Cronbach's α method was used for examining the reliability of the questionnaire used in the Delphi method. The Visual Basic 6.0 as front-end and Microsoft Access 2003 as back-end was used to develop the system. A team of six nursing experts was asked to evaluate the usability of the developed systems. A 5-point Likert scale questionnaire was used for the evaluation. The sensitivity and specificity of NPDSS were validated using 150 nursing chart.

Results: The study showed a consistency between the diagnoses of the developed system (NPDSS) and the nursing charts. The sensitivities of the nursing diagnoses including acute pain, impaired urinary elimination, risk of infection, and risk of falling were 96.9%, 98.1%, 94.9%, and 89.9% respectively; and the specificities were 88%, 49.5%, 62%, and 88% respectively. We did not calculate the sensitivity and specificity of impaired skin integrity and anxiety due to non-availability of enough sample size.

Conclusions: NPDSS can help nurses in decision making of nursing diagnoses. Besides, it can help them to generate nursing diagnoses based on patient-specific data, individualized care plans, and implementation within their usual nursing workflow.
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July 2013

Nursing process decision support system for urology ward.

Int J Med Inform 2013 Jul 21;82(7):604-12. Epub 2013 Mar 21.

Department of Nursing, Chang Gung University of Science and Technology, Taiwan.

Purpose: We developed a nursing process decision support system (NPDSS) based on three clinical pathways, including benign prostatic hypertrophy, inguinal hernia, and urinary tract stone. NPDSS included six major nursing diagnoses - acute pain, impaired urinary elimination, impaired skin integrity, anxiety, infection risk, and risk of falling. This paper aims to describe the design, development and validation process of the NPDSS.

Methods: We deployed the Delphi method to reach consensus for decision support rules of NPDSS. A team of nine-member expert nurses from a medical center in Taiwan was involved in Delphi method. The Cronbach's α method was used for examining the reliability of the questionnaire used in the Delphi method. The Visual Basic 6.0 as front-end and Microsoft Access 2003 as back-end was used to develop the system. A team of six nursing experts was asked to evaluate the usability of the developed systems. A 5-point Likert scale questionnaire was used for the evaluation. The sensitivity and specificity of NPDSS were validated using 150 nursing chart.

Results: The study showed a consistency between the diagnoses of the developed system (NPDSS) and the nursing charts. The sensitivities of the nursing diagnoses including acute pain, impaired urinary elimination, risk of infection, and risk of falling were 96.9%, 98.1%, 94.9%, and 89.9% respectively; and the specificities were 88%, 49.5%, 62%, and 88% respectively. We did not calculate the sensitivity and specificity of impaired skin integrity and anxiety due to non-availability of enough sample size.

Conclusions: NPDSS can help nurses in decision making of nursing diagnoses. Besides, it can help them to generate nursing diagnoses based on patient-specific data, individualized care plans, and implementation within their usual nursing workflow.
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http://dx.doi.org/10.1016/j.ijmedinf.2013.02.006DOI Listing
July 2013

Minimising preoperative anxiety with music for day surgery patients - a randomised clinical trial.

J Clin Nurs 2012 Mar 20;21(5-6):620-5. Epub 2011 Feb 20.

School of Nursing, College of Nursing, Taipei Medical University and Department of Nursing, Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan.

Aims And Objectives: The objective of this study was to evaluate the effects of musical intervention on preoperative anxiety and vital signs in patients undergoing day surgery.

Background: Studies and systematic meta-analyses have shown inconclusive results of the efficacy of music in reducing preoperative anxiety. We designed a study to provide additional evidence for its use in preoperative nursing care.

Design: Randomised, controlled study.

Method: Patients (n = 183) aged 18-65 admitted to our outpatient surgery department were randomly assigned to either the experimental group (music delivered by earphones) or control group (no music) for 20 minutes before surgery. Anxiety, measured by the State-Trait Anxiety Inventory, and vital signs were measured before and after the experimental protocol.

Results: A total of 172 patients (60 men and 112 women) with a mean age of 40·90 (SD 11·80) completed the study. The largest number (35·7%) was undergoing elective plastic surgery and 76·7% of the total reported previous experience with surgery. Even though there was only a low-moderate level of anxiety at the beginning of the study, both groups showed reduced anxiety and improved vital signs compared with baseline values; however, the intervention group reported significantly lower anxiety [mean change: -5·83 (SD 0·75) vs. -1·72 (SD 0·65), p < 0·001] on the State-Trait Anxiety Inventory compared with the control group.

Conclusions: Patients undergoing day surgery may benefit significantly from musical intervention to reduce preoperative anxiety and improve physiological parameters.

Relevance To Clinical Practice: Finding multimodal approaches to ease discomfort and anxiety from unfamiliar unit surroundings and perceived risks of morbidity (e.g. disfigurement and long-term sequelae) is necessary to reduce preoperative anxiety and subsequent physiological complications. This is especially true in the day surgery setting, where surgical admission times are often subject to change and patients may have to accommodate on short notice or too long a wait that may provoke anxiety. Our results provide additional evidence that musical intervention may be incorporated into routine nursing care for patients undergoing minor surgery.
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http://dx.doi.org/10.1111/j.1365-2702.2010.03466.xDOI Listing
March 2012

Physical activity levels of school-age children with congenital heart disease in Taiwan.

Appl Nurs Res 2009 Aug 14;22(3):191-7. Epub 2009 Jan 14.

Department of Nursing, Taipei Medical University-Wan Fang Medical Center, Taipei 116, Taiwan.

Congenital heart disease (CHD) is a common childhood health problem. The incidence of CHD is estimated between 8 and 10 per 1,000 children in Taiwan. Evidence indicates that exercise capacity for children with CHD can reach the level of children with no CHD after surgical repair. However, it is necessary to further investigate if their physical activity is comparable to their peers who have no CHD to prevent chronic disease caused by physical inactivity. This study aimed to investigate the differences of physical activity level (PAL) between Taiwanese children with no CHD and children after total correction for CHD. A case control design was used in this study. During the study period, 68 schoolchildren were recruited: 34 children with CHD and 34 age- and gender-matched children who have no CHD. The data collection tools included three-day physical activity record (3DPAR) and RT3 triaxial accelerator. The average total energy expenditure (TEE) measured by both 3DPAR and RT3 triaxial accelerator were lower for boys with CHD than boys with no CHD (t = -3.39, p = .002; t = -3.43, p = .002). PAL was also lower for boys with CHD than for boys with no CHD (t = -2.29, p = .03). Whereas, TEE did not differ between girls with CHD and girls with no CHD (t = 0.58, p = .57; t = -0.27, p = .79). Overall, the level of moderate-to-vigorous physical activity (MVPA) was similar between children with CHD and children with no CHD. These results suggest that boys with CHD engage in less physical activity than do boys with no CHD. Both children with CHD and children with no CHD should be encouraged to engage in more physical activity especially MVPA.
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http://dx.doi.org/10.1016/j.apnr.2007.12.002DOI Listing
August 2009

Surviving a life-threatening crisis: Taiwan's nurse leaders' reflections and difficulties fighting the SARS epidemic.

J Clin Nurs 2009 Dec 8;18(24):3391-400. Epub 2009 Jan 8.

School of Nursing, National Yang-Ming University, Taipei, Taiwan.

Aim: This study explored Taiwan's nurse leaders' reflections and experiences of the difficulties they encountered and survival strategies they employed fighting the severe acute respiratory syndrome epidemic and the background context framing these phenomena.

Background: On several continents in 2002-2003, the highly infectious severe acute respiratory syndrome overwhelmed health care systems and health professionals who had to provide care in situations involving high personal risk and stress, some becoming infected and dying. Nurse leaders in Taiwan had to develop new strategies and support systems for nursing care.

Design: A two-step within-method qualitative triangulation research design.

Methods: Focus group in-depth interviews held with 70 nurse leaders from four Northern Taiwan hospitals involved in the severe acute respiratory syndrome epidemic. Participants then completed an open ended questionnaire. Content analysis was undertaken with data and stages and themes generated. Data were then analysed using Hobfall's concepts of conservation of resources to further discuss participants' reactions and actions in the severe acute respiratory syndrome crisis.

Results: Participants worked under incredible stress to lead the profession through a period of crisis. Five stages arose in the participants' involvement against severe acute respiratory syndrome over 12 weeks: facing shock and chaos; searching for reliable sources to clarify myths; developing and adjusting nursing care; supporting nurses and their clients; and rewarding nurses.

Conclusion: Nurse leaders become important executors of intervention in this health disaster, requiring emotional intelligence to manage their internal conflicts and interpersonal relationships effectively. They developed sociopolitical and analytical abilities and crucial requirements for planning and implementing strategies in areas where none previously existed. Building support systems was an important resource for managing conflicts between familial and professional roles. Relevance to clinical practice. Findings will assist nurse leaders to prepare themselves and the profession to better deal with disaster management in similar infectious outbreaks in the future.
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http://dx.doi.org/10.1111/j.1365-2702.2008.02521.xDOI Listing
December 2009

Prevalence and impact on quality of life of lower urinary tract symptoms among a sample of employed women in Taipei: a questionnaire survey.

Int J Nurs Stud 2009 May 19;46(5):633-44. Epub 2009 Jan 19.

College of Nursing, Taipei Medical University, 250 Wu-Xin Street, Taipei 110, Taiwan.

Background: Previous studies about the prevalence and impact of lower urinary tract symptoms (LUTS) were focused on urinary incontinence or overactive bladder in the general population. Little research has been focused on the role that the workplace has in employed women's experiences with LUTS or the impact of LUTS on their health-related quality of life (HRQL).

Objectives: To estimate the prevalence of LUTS among employed female nurses in Taipei and to compare the HRQL for nurses with and without LUTS.

Design: This study was a cross-sectional, questionnaire survey.

Settings: Three medical centers and five regional hospitals in Taipei were selected randomly.

Participants: In the selected hospitals, 1065 female nurses were selected randomly. Data analyses were based on 907 usable surveys. All participants were native Taiwanese; most of the female nurses were 26-35 years of age (mean=31.02, SD=6.32), had normal body mass index, and had never given birth. Most nurses' bladder habits were poor or very poor and their personal habits of fluid consumption at work were inadequate.

Methods: Data were collected using the Taiwan Nurse Bladder Survey and the Short Form 36 Taiwan version. Chi-square tests were used to compare the prevalence rates of different LUTS for nurses in different age groups. Student's t-tests were conducted to compare the mean scores of HRQL for nurses with and without LUTS.

Results: Based on 907 usable surveys, 590 (65.0%) experienced at least one type of LUTS. The prevalence for different LUTS ranged from 8.0% to 46.5%. Nurses who reported LUTS also reported lower HRQL, more so on physical health than mental health, than nurses who did not report LUTS.

Conclusions: Although most of the nurses in this study were young (< or =35 years) and nulliparous, LUTS were common among this group. The high prevalence rate of LUTS leads to concerns about nurses' possible dysfunctional voiding patterns and possible effects of working environment and poor bladder and personal habits on LUTS. Study results showed a possible negative impact of LUTS on nurses' physical health. Designing a continence-related education program for this group is essential for delivering information about LUTS prevention and management.
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http://dx.doi.org/10.1016/j.ijnurstu.2008.12.001DOI Listing
May 2009

Effectiveness of a nosocomial infection control training in improving knowledge in patient-hired attendants and outsourced workers in Taiwan.

J Nurs Res 2008 Sep;16(3):187-94

College of Nursing, Taipei Medical University, Taiwan, ROC.

Nosocomial infection represents an important indicator of healthcare quality and patient safety. Based on the experience gained during the outbreak of Severe Acute Respiratory Syndrome (SARS) in Taiwan in 2003, we gained greater awareness of the potential threat from patient-hired attendants and outsourced workers as bacteria carriers and transmitters. This study built a training model and evaluated training effectiveness in terms of improved knowledge. The training model included nosocomial infection control guidelines, a training CD, training program, evaluation form, and descriptive procedures for conducting training and evaluation. The training course for this study was conducted in 17 hospitals in Taiwan, with a total of 1,467 participants attending 27 seminars and 1,265 effective samples (return rate = 86.2%). Results of the study showed a statistical difference of < .001 before and after the training course on participant understanding of nosocomial infection control. Advantages of applying this training model include knowledge enhancement and reduced implementation time, manpower input and budget outlay. In addition to greater flexibility, the model can also positively influence clinical practice, improve patient safety and reduce hospital nosocomial infection rates. This program is worth promoting in hospitals and other healthcare institutions.
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http://dx.doi.org/10.1097/01.jnr.0000387305.96622.5bDOI Listing
September 2008