Publications by authors named "Shu-Fang Vivienne Wu"

44 Publications

Factors Influencing Self-Efficacy and Self-Management among Patients with Pre-End-Stage Renal Disease (Pre-ESRD).

Healthcare (Basel) 2021 Mar 2;9(3). Epub 2021 Mar 2.

Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan.

Aim: Chronic kidney disease (CKD) is an emerging major public health issue that leads to end-stage kidney disease (ESRD). Factors influencing the self-management and self-efficacy of ESRD patients are still under investigation. The objective of this study is to evaluate the association of depression and anxiety with self-management and self-efficacy in patients with pre-ESRD.

Methods: Patients in the department of nephrology of a regional hospital in Taiwan were invited to participate and were included in our study if they had a confirmed diagnosis of early-stage CKD, were more than 20 years old, and could converse in Mandarin Chinese or Taiwanese. Patients diagnosed with depression, who could not execute self-care, or who had cognitive deficits were excluded. In total, this cross-sectional study included 112 pre-ESRD patients. We used the Chinese versions of the hospital anxiety and depression scale (HADS), the chronic kidney disease self-efficacy instrument (CKD-SE), and the chronic kidney disease self-management instrument (CKD-SM) as the questionnaire. Spearman's rank correlation and logistic regressions were used to analyze the data.

Results: The top quartile of self-management and self-efficacy scores (28 patients) was defined as high self-management and -efficacy, respectively, and the lower three quartiles as low self-management and -efficacy. The logistic regression analysis showed that having depression decreased the odds of having high self-management by 75.4% and high self-efficacy by 75.1%. Having an education level of senior high school or above increased the odds ratios for having high self-management and high self-efficacy to 4.47 and 3.56 (all p-values < 0.05).

Conclusion: Controlling depression as well as increasing the level of education can potentially increase self-management and self-efficacy in pre-ESRD patients.
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http://dx.doi.org/10.3390/healthcare9030266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000963PMC
March 2021

Injection of Lidocaine Alone versus Lidocaine plus Dexmedetomidine in Impacted Third Molar Extraction Surgery, a Double-Blind Randomized Control Trial for Postoperative Pain Evaluation.

Pain Res Manag 2021 25;2021:6623792. Epub 2021 Jan 25.

Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei City 112, Taiwan.

Objectives: Administration of medications such as dexmedetomidine as a topical anesthetic has been suggested in the pain control in dentistry. This double-blind randomized control trial study evaluated postoperative pain and associated factors following impacted third molar extraction surgery. Lidocaine alone was taken as the control and lidocaine plus dexmedetomidine as the intervention.

Materials And Methods: Forty patients undergoing mandibular third molar extraction entered the study and were randomly allocated to the control and interventional groups. 0.15 ml of dexmedetomidine was added to each lidocaine cartridge and the drug concentration was adjusted to 15 g for the intervention group while only lidocaine was used in the control group. A visual analog scale was used to measure and record pain levels at the end of the surgery and 6, 12, and 24 hours after the surgery and number of painkillers taken by the patients after the surgery was also recorded.

Results: Pain scores of the intervention group decreased significantly during the surgery and also 6, 12, and 24 hours after the surgery compared to the control group. The pain score was correlated significantly with our intervention during the surgery and also 6 and 12 hours after that (all  value < 0.05). There was a nonsignificant reduction in the number of painkillers taken by the patients at 6, 12, and 24 hours after surgery (all  value > 0.05).

Conclusion: In patients undergoing molar surgery, administration of a combination of dexmedetomidine and lidocaine is beneficial for the pain control. Compared to the injection of lidocaine alone, combination of dexmedetomidine and lidocaine can be used for a better pain control in molar surgeries.
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http://dx.doi.org/10.1155/2021/6623792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857915PMC
January 2021

Effectiveness of a self-management program in enhancing quality of life, self-care, and self-efficacy in patients with hemodialysis: A quasi-experimental design.

Semin Dial 2021 Feb 2. Epub 2021 Feb 2.

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

Background: Taiwan has the world's highest prevalence of end-stage kidney disease, as well as the world's third highest incidence. The study investigated the effectiveness of a self-management program for enhancing health-related quality of life, self-care behaviors, and self-efficacy in patients with end-stage kidney disease undergoing hemodialysis.

Methods: This was a quasi-experimental design with convenient sampling, and allocated 32 participants in the control group (conventional program) and 32 participants in the experimental group (self-management program). The self-management program intervention lasted 4 weeks, and a posttest was administered 3 months later. The questionnaire included the 36-Item Short Form Health Survey, a Chronic Kidney Disease Self-Care Instrument, and a Chronic Kidney Disease Self-Efficacy Instrument.

Results: Three months after the intervention, the self-management program had improved patients' health-related quality of life in the mental health components (p < .001), but not in the physical health components. The program also promoted patients' self-care behaviors (p < .001) and self-efficacy (p < .05).

Conclusions: This study's findings confirmed that self-management programs should be promoted in clinical practice where they will provide clinical care personnel with an alternative to conventional health education.
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http://dx.doi.org/10.1111/sdi.12957DOI Listing
February 2021

Association of Testosterone-Related Dietary Pattern with Testicular Function among Adult Men: A Cross-Sectional Health Screening Study in Taiwan.

Nutrients 2021 Jan 18;13(1). Epub 2021 Jan 18.

Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, 365 Ming-Te Road, Beitou District, Taipei 112, Taiwan.

Diets could play an important role in testicular function, but studies on how adherence to the dietary patterns influences human testicular function in Asian countries are scarce. Herein, we examined the association between testosterone-related dietary patterns and testicular function among adult men in Taiwan. This cross-sectional study recruited 3283 men who attended a private medical screening program from 2009 to 2015. Testosterone-related dietary pattern was generated by the reduced rank regression (RRR) method. The association between adherence to quartile of dietary pattern scores with sex hormones (testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2)) and sperm quality (sperm concentration (SC), total sperm motility (TSM), progressive motility (PRM), and normal sperm morphology (NSM)) were examined by multivariable linear regression. Hemoglobin (β = 0.57, < 0.001), hematocrit (β = 0.17, = 0.002), triglyceride (β = -0.84, < 0.001), HDL-cholesterol (β = 3.58, < 0.001), total cholesterol to HDL-cholesterol ratio (β = -0.78, < 0.001), and uric acid (β = -10.77, < 0.001) were highly correlated with testosterone levels. Therefore, these biomarkers were used to construct a testosterone-related dietary pattern. Highest adherence (Q4) to dietary pattern scores were negatively associated with lower testosterone in the pooled analysis (β = -0.89, = 0.037) and normal-weight men (β = -1.48, = 0.019). Likewise, men in the Q4 of the dietary pattern had lower SC (β = -5.55, = 0.001) and NSM (β = -2.22, = 0.007) regardless of their nutritional status. Our study suggesting that testosterone-related dietary pattern (rich in preserved vegetables or processed meat or fish, deep-fried foods, innards organs, rice or flour products cooked in oil, and dipping sauce, but low in milk, dairy products, legumes, or beans, and dark or leafy vegetables) was associated with a poor testicular function.
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http://dx.doi.org/10.3390/nu13010259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830687PMC
January 2021

The effects of knowledge and self-management of patients with early-stage chronic kidney disease: Self-efficacy is a mediator.

Jpn J Nurs Sci 2021 Apr 11;18(2):e12388. Epub 2020 Nov 11.

Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan.

Aim: The purpose of this study is to investigate the relationship among knowledge, self-efficacy, and self-management of patients with early-stage chronic kidney disease (ESCKD).

Methods: This is a cross-sectional correlational study design. This study used purposive sampling to enroll a total of 130 patients with ESCKD. The research instruments included Chronic Kidney Disease Self-Care Knowledge Scale, Chronic Kidney Disease Self-Efficacy Instrument, Chronic Kidney Disease Self-Management Scale, and so on. This study used the statistical software SPSS 20.0 to perform statistical analyses, such as descriptive statistical analysis, independent samples t test, one-way analysis of variance, Pearson product-moment correlation coefficient analysis, and multiple hierarchical regression analysis.

Results: The knowledge of patients with early kidney disease was moderate (55.10%), self-efficacy was moderate (54.44%), and self-management was moderate (61.11%). The disease knowledge and self-efficacy (r = .59, p < .01) were significantly positively correlated with self-management (r = .50, p < .01); the intervening effect of self-efficacy on self-management (z = 4.58, p < .001) reached statistically significant difference. Self-efficacy was the most significant predictor for self-management and explained 49% of the total variance.

Conclusions: This study suggested that self-efficacy was a mediator and predictor for self-management. The research results may serve as reference for related administrative authorities or medical personnel to develop self-efficacy strategies with theoretical basis, as well as appropriate self-efficacy improvement schemes, to transform the methods for enhancing disease knowledge to improve the intervention with self-efficacy language or method and increase patients' disease self-management.
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http://dx.doi.org/10.1111/jjns.12388DOI Listing
April 2021

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

J Nurs Manag 2020 Oct 17;28(7):1598-1606. Epub 2020 Aug 17.

Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.

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.
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http://dx.doi.org/10.1111/jonm.13114DOI Listing
October 2020

The correct formula to calculate triglyceride-glucose index (TyG).

J Pediatr Endocrinol Metab 2020 07;33(7):945-946

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

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http://dx.doi.org/10.1515/jpem-2019-0579DOI Listing
July 2020

Is the use of triglyceride-glucose (TyG) index to recognize glucose disorders really practical?

Eur J Pediatr 2020 07 15;179(7):1169. Epub 2020 May 15.

College of Nursing, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, 112, Taiwan.

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http://dx.doi.org/10.1007/s00431-020-03642-3DOI Listing
July 2020

Letter to the editor about "Value of triglyceride-glucose index for the estimation of ischemic stroke risk: Insights from a general population".

Nutr Metab Cardiovasc Dis 2020 06 27;30(6):1044-1045. Epub 2020 Mar 27.

College of Nursing, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan.

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http://dx.doi.org/10.1016/j.numecd.2020.02.005DOI Listing
June 2020

Prophylactic anticoagulant therapy for reducing the risk of stroke and other thrombotic events in COVID-19 patients.

J Formos Med Assoc 2020 07 11;119(7):1230-1231. Epub 2020 May 11.

College of Nursing, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, 112, Taiwan.

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http://dx.doi.org/10.1016/j.jfma.2020.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211643PMC
July 2020

Using the Cardio-Ankle Vascular Index (CAVI) or the Mathematical Correction Form (CAVI) in Clinical Practice.

Int J Mol Sci 2020 Mar 31;21(7). Epub 2020 Mar 31.

Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, Taipei City 112, Taiwan.

Tonhajzerova et al [...].
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http://dx.doi.org/10.3390/ijms21072410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178179PMC
March 2020

Use of the triglyceride-glucose index (TyG) in cardiovascular disease patients.

Cardiovasc Diabetol 2020 01 15;19(1). Epub 2020 Jan 15.

College of Nursing, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, 112, Taiwan.

Da Silva et al. showed that the triglyceride-glucose (TyG) index was positively associated with a higher prevalence of symptomatic coronary artery disease (CAD). TyG has been used in healthy individuals as a marker of insulin resistance. The use of this index as a marker of atherosclerosis in cardiovascular disease (CVD) patients might be influenced by diabetes and the hyperlipidemic state that led to CVD. Certain considerations might be necessary before we conclude that the TyG index can be used as a marker of atherosclerosis in CVD patients. These factors can highlight the role of fasting blood glucose and triglyceride levels that are used in the TyG formula. Comparing the fasting blood glucose and/or triglyceride levels with the TyG index in these patients to show how much value the TyG index can add to clinical practice seems to be necessary. Conclusions of such studies might be biased by these facts. Stratification by CAD disease category cannot help achieve an understanding of the role of TyG in CVD. Correlations do not imply causation, so the use of the TyG index as an index in CAD patients is questionable.
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http://dx.doi.org/10.1186/s12933-019-0982-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963998PMC
January 2020

Comment on Lecca, L.I.; Portoghese, I.; Mucci, N.; Galletta, M.; Meloni, F.; Pilia, I.; Marcias, G.; Fabbri, D.; Fostinelli, J.; Lucchini, R.G.; Cocco, P.; Campagna, M. Association between Work-Related Stress and QT Prolongation in Male Workers. 2019, , 4781.

Int J Environ Res Public Health 2020 01 10;17(2). Epub 2020 Jan 10.

Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, Taipei City 112, Taiwan.

Lecca et al., in a recent publication in the had made some mistakes in the statistical analysis and interpretation of the results. Age was not a clear contributing factor in the prolongation of QT interval in the electrocardiogram (ECG), as there were strong confounders in their study. The effects of age were mainly faded out because of the age range of the participants. The use of Pearson's correlation is questionable because of the normality assumptions was not met on the studied variables. They also made some conclusions about the effects of long and night shifts on the QT prolongation that were not appropriate based on their study type. All of these mentioned issues might completely change the validity of the conclusions they made.
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http://dx.doi.org/10.3390/ijerph17020461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013602PMC
January 2020

Association of Kidney Function Tests with a Cardio-Ankle Vascular Index in Community-Dwelling Individuals with a Normal or Mildly Decreased Estimated Glomerular Filtration Rate.

Medicina (Kaunas) 2019 Sep 29;55(10). Epub 2019 Sep 29.

Research Center For Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, Taipei City 112, Taiwan.

: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease (CVD). Previous studies reported controversial results about the independence of CKD as a risk factor for atherosclerosis. In this study, we tried to determine whether the estimated glomerular filtration rate (eGFR) and other renal function tests are independent factors associated with arterial stiffness in community-dwelling individuals with a normal (≥90) or slightly decreased eGFR (60-90). : Data of 164 community individuals were analyzed, and demographic information, related disease history, atherosclerosis risk factors, certain laboratory tests, the estimated eGFR, and urine albumin creatinine ratio (UACR) were recorded for each individual. : The age, systolic blood pressure (SBP), hypertension (HTN), and cardio-ankle vascular index (CAVI) significantly differed between individuals with a normal and those with a slightly decreased eGFR. Blood urea nitrogen (BUN), glycated hemoglobin (HBA1c), and the eGFR significantly differed between the high- and low-CAVI groups and were also significantly correlated with the CAVI. The relationship between the eGFR and CAVI was shown to be independent of other atherosclerosis risk factors in a multiple linear regression model. : We concluded that evaluations of the eGFR, HTN, body-mass index, and SBP can be used in a model for arterial stiffness risk assessments for community-dwelling individuals with a normal or slightly decreased eGFR.
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http://dx.doi.org/10.3390/medicina55100657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843344PMC
September 2019

Health-promotion interventions enhance and maintain self-efficacy for adults at cardiometabolic risk: A randomized controlled trial.

Arch Gerontol Geriatr 2019 May - Jun;82:61-66. Epub 2019 Jan 24.

Aging and Health Research Center, National Yang Ming University, Taipei City, Taiwan, ROC; Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei City, Taiwan, ROC; Department of Geriatric Medicine, Taipei Veterans General Hospital Yuanshan branch, YiLan County, Taiwan, ROC. Electronic address:

Objectives: To investigate whether a community-based intervention program, based on self-efficacy theory, might improve older adults' self-care behaviors as well as health outcomes related to hypertension and dyslipidemia.

Methods: This randomized controlled trial was conducted in Taipei, Taiwan, From October 16, 2011 to July 31, 2014. Residents identified during community screening for the over 50 s were invited to participate if their blood pressure was 120-139/80-89 mmHg, high-density lipoprotein cholesterol was <40 mg/dL (men) or <50 mg/dL (women), or low-density lipoprotein cholesterol was 130-159 mg/dL. The intervention group participated in a special health promotion program; the control group received conventional health education. Participants' demographic and anthropometric data were recorded, and each completed semi-structured questionnaires about hypertension and cholesterol management, and gave blood samples for biochemical analyses before the intervention and 6 months after it ended.

Results: From 90/98 eligible subjects who enrolled, 84 completed the study: 41/43 and 43/47 respectively in intervention and control groups. Body mass index, blood pressure, hyperglycemia, and high-density lipoprotein cholesterol in the intervention group improved significantly from baseline. The Self-Efficacy Scale (P = 0.020), Self-Care Activities Questionnaire (P = 0.014) and Perceived Therapeutic Efficacy Scale (P = 0.023) scores improved significantly.

Conclusion: This health promotion intervention program enhanced self-efficacy among older adults, with sustained effect through 6-months' follow-up. These findings are consistent with studies that evaluated the effect of a diabetes education program on self-efficacy. The beneficial effect on a population at high-risk for hypertension and hypercholesterolemia, may serve as a model for developing and implementing such interventions.
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http://dx.doi.org/10.1016/j.archger.2019.01.009DOI Listing
February 2020

Caring behavior perceived by nurses, patients and nursing students in Indonesia.

J Prof Nurs 2018 Jul - Aug;34(4):314-319. Epub 2017 Nov 28.

School of Nursing, University of Maryland, Baltimore, USA.

Caring as a term in nursing, represents all factors used by nurses to provide health services to patients. The aim of this study was to compare the differences of caring behaviors as perceived by nurses, patients and nursing students and to explore the relationship between sociodemographic variables and the perception of caring. This was a descriptive comparative research study. Data were collected from August to September 2015 in Indonesia by using Caring Behavior Inventory-42 composed of five domains: respect, assurance, connectedness, knowledge and skills, and attentiveness. A total of 158 respondents were sought for three study groups and each group had 53 respondents. Results indicated that nurses, patients and nursing students have the same perception regarding caring behaviors. Patients' age was positively correlated with respect (r=0.282, p<0.05) and connectedness (r=0.307, p<0.05) domains. Male students had a higher mean score than female students in assurance (t=2.230, p<0.05), knowledge and skills (t=3.885, p<0.001), and attentiveness (t=3.267, p<0.01), Students with 8-week clinical experiences scored higher in the caring behavior domain of connectedness (t=3.504, p<0.05) than students with 4-week experiences. This study can be used as an additional resource to enhance knowledge about caring behavior and for application in the fields of nursing practice and nursing education.
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http://dx.doi.org/10.1016/j.profnurs.2017.11.013DOI Listing
October 2018

Self-Management Programs on eGFR, Depression, and Quality of Life among Patients with Chronic Kidney Disease: A Meta-Analysis.

Asian Nurs Res (Korean Soc Nurs Sci) 2016 Dec 13;10(4):255-262. Epub 2016 May 13.

Department of Long Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.

Purpose: Chronic kidney disease (CKD) is a condition characterized by the gradual loss of kidney function over time. Self-management programs have been widely applied to chronic disease education programs, which are designed to delay deteriorating kidney functions, preclude depression, and improve quality of life. This study aims to analyze effectiveness of self-management programs in bettering CKD patients' eGFR, mitigating depression symptoms and improving quality of life in randomized control or clinical trials.

Methods: Using key terms, a search was conducted in English-language, peer-reviewed journals on CKD that were published between 2002 and 2014 on databases including CINAHL, Cochrane Library, MEDLINE. The measurable variables included CKD patients' eGFR, depression, and quality of life. Random and fixed effects meta analysis were applied with standard error and correlation based measure of effect size.

Results: Eight studies met the inclusion criteria. A self-management program significantly impacted CKD patients' depression and mental quality-of-life dimensions, with an effect size of .29 [95% confidence interval (CI) (0.07, 0.53)] and -.42 [95% CI (-0.75, -0.10)]. However, the intervention of a self-management program had no significant effect on patients' eGFR as well as physical quality-of-life dimensions, with effect sizes of .06 [95% CI (-0.69, 0.81)] and -.16 [95% CI (-0.81, 0.50)].

Conclusions: Self-management programs of patients with chronic kidney disease can improve the depression and mental quality of life. Aside from providing more objective evidence-based results, this study provides a reference for clinical health care personnel who tend to patients with CKD.
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http://dx.doi.org/10.1016/j.anr.2016.04.002DOI Listing
December 2016

Prediction of self-care behaviour on the basis of knowledge about chronic kidney disease using self-efficacy as a mediator.

J Clin Nurs 2016 Sep 1;25(17-18):2609-18. Epub 2016 Jul 1.

Department of Long-TermCare, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.

Aims And Objectives: This study was to investigate: (1) the important factors in the self-care of chronic kidney disease (CKD) patients and (2) the mediating effects of self-efficacy on knowledge and self-care.

Background: Chronic kidney disease has become a major global health issue and is one of the top 10 leading causes of death in Taiwan where the dialysis population ranks first in the world. The number of patients with poor self-care behaviours continues to rise despite ongoing health education. Knowledge and self-efficacy are important factors that influence self-care behaviour; however, very few articles have examined the relationships among them.

Design: Cross-sectional and correlational design.

Methods: Subject recruitment was conducted by purposive sampling in the renal outpatient clinics and dialysis centres of two teaching hospitals in northern Taiwan. A total of 247 patients with chronic kidney disease (stages 1-5) were enrolled.

Results: (1) Knowledge was positively correlated with self-efficacy (r = 0·41, p < 0·01) and with self-care (r = 0·18, p < 0·01). Self-efficacy (r = 0·44, p < 0·01) as well as age (r = 0·15, p < 0·01) were positively correlated with self-care. (2) The relationship between knowledge and self-care was fully mediated by self-efficacy (z = 4·82, p < 0·001) and the effect was 50%.

Conclusion: The results showed that self-efficacy was a crucial mediator between knowledge and self-care. In addition to providing knowledge to chronic kidney disease patients, healthcare professionals should also offer strategies that can enhance self-efficacy to increase self-care behaviours in chronic kidney disease patients and implement effective disease management.

Relevance To Clinical Practice: Incorporate self-efficacy strategies into the process of health education to improve knowledge and the effectiveness of self-care. The findings of this study provide evidence of effectiveness of the use of group activity through self-management and self-efficacy enhancement programmes and may influence the policy makers to consider adding or modifying the reimbursement criteria.
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http://dx.doi.org/10.1111/jocn.13305DOI Listing
September 2016

[The Development of a Care Protocol for Postoperative Pressure Sore Prevention].

Hu Li Za Zhi 2015 Dec;62(6):98-104

PhD, RN, Professor, Department of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan, ROC.

Pressure sores are a common complication caused by long periods of bed rest following major surgery. These sores may increase patient postoperative pain, increase the risk of infections, lengthen the pe-riod of hospitalization, and increase the duration and costs of nursing care. Therefore, maintaining the skin integrity of surgical patients is an important responsibility for operating room nurses and an indicator of nursing care quality. While pressure-sore risk assessment tools and interoperative strategies are available and used in foreign countries, there has been little related research conducted in Taiwan. After examining the relevant literature and considering the current postoperative pressure sore situation in Taiwan, the author developed a postoperative pressure sore care protocol as a reference for clinical staff. Protocol procedures include major breakthrough developments in areas such as post-survey risk assessment for pressure ulcers, pressure ulcer prevention strategies that take surgery-related risk factors into consideration, extra care and protection measures for surgical supine patients, and post-pressure sores. The developed postoperative pressure sore protocol may be incorporated into surgical care procedures during the post-surgical care period in order to effectively prevent the occurrence of post-surgery pressure ulcers. Furthermore, the developed protocol offers the potential to improve and strengthen the quality of surgical care in terms of both healthcare and post-surgical care.
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http://dx.doi.org/10.6224/JN62.6.98DOI Listing
December 2015

Biofeedback relaxation for pain associated with continuous passive motion in Taiwanese patients after total knee arthroplasty.

Res Nurs Health 2015 Feb 30;38(1):39-50. Epub 2014 Dec 30.

Professor, Department of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan, ROC.

Effective pain management is crucial for patient recovery after total knee arthroplasty (TKA). Biofeedback therapy, which encourages relaxation and helps alleviate various conditions associated with stress, may help to decrease postoperative pain in patients undergoing TKA. A quasi- experimental design was used to investigate the efficacy of a biofeedback relaxation intervention in reducing pain associated with postoperative continuous passive motion (CPM) therapy. Sixty-six patients admitted to a general hospital in Taiwan for TKA were recruited and randomly assigned to the intervention or control group. The intervention group received biofeedback training twice daily for 5 days, concurrent with CPM therapy, whereas the control group did not receive the biofeedback intervention. Pain was measured using a numeric rating scale before and after each CPM therapy session on postoperative days 1 through 5. The CPM-elicited pain score was calculated by subtracting the pre-CPM pain score from the post-CPM pain score. Results of repeated-measures analysis of variance showed intervention group reported significantly less pain caused by CPM than did the control group (f = 29.70, p < 0.001). The study results provide preliminary support for biofeedback relaxation, a non-invasive and non-pharmacological intervention, as a complementary treatment option for pain management in this population.
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http://dx.doi.org/10.1002/nur.21633DOI Listing
February 2015

Rapid Screening of Psychological Well-Being of Patients with Chronic Illness: Reliability and Validity Test on WHO-5 and PHQ-9 Scales.

Depress Res Treat 2014 18;2014:239490. Epub 2014 Nov 18.

School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan.

This study intended to test the reliability and validity of two simple psychological screening scales, the World Health Organization Well-being Index (WHO-5) and the 9-item Patient Health Questionnaire (PHQ-9), in patients with chronic illness in Taiwan and to understand the psychological well-being of patients with chronic illness (e.g., metabolic syndrome) in Taiwan and the incidences of psychological problems that follow. The research design of this study was a descriptive cross-sectional study. The sample comprised 310 patients with metabolic syndrome (MS), aged 20 years or more, from the outpatient clinic of a municipal hospital in Taiwan. This study used questionnaires to collect basic information, including physiological indices, WHO-5 and PHQ-9 that were used. "Hospital Anxiety and Depression scale (HADS)," and "World Health Organization Quality of Life-Short-form Version for Taiwan (WHOQOL)". Results are as follows: (1) compared to PHQ-9, the reliability and validity of WHO-5 are better for screening the psychological well-being of patients with chronic illness. (2) The features of WHO-5 are high sensitivity, briefness, and ease-of-use. The incidence of depression in patients with metabolic syndrome was approximately 1.0-6.5%, which is significantly lower than that of western countries.
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http://dx.doi.org/10.1155/2014/239490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254072PMC
December 2014

[The use of systematic review to develop a self-management program for CKD].

Hu Li Za Zhi 2014 Dec;61(6):66-77

Department of Nursing, National Yang-Ming University Hospital, Taiwan, ROC.

Background: Chronic kidney disease (CKD) has become a public health issue of international concern due to its high prevalence. The concept of self-management has been comprehensively applied in education programs that address chronic diseases. In recent years, many studies have used self-management programs in CKD interventions and have investigated the pre- and post-intervention physiological and psychological effectiveness of this approach. However, a complete clinical application program in the self-management model has yet to be developed for use in clinical renal care settings.

Purpose: A systematic review is used to develop a self-management program for CKD.

Method: Three implementation steps were used in this study. These steps include: (1) A systematic literature search and review using databases including CEPS (Chinese Electronic Periodical Services) of Airiti, National Digital Library of Theses and Dissertations in Taiwan, CINAHL, Pubmed, Medline, Cochrane Library, and Joanna Briggs Institute. A total of 22 studies were identified as valid and submitted to rigorous analysis. Of these, 4 were systematic literature reviews, 10 were randomized experimental studies, and 8 were non-randomized experimental studies. (2) Empirical evidence then was used to draft relevant guidelines on clinical application. (3) Finally, expert panels tested the validity of the draft to ensure the final version was valid for application in practice.

Results: This study designed a self-management program for CKD based on the findings of empirical studies. The content of this program included: design principles, categories, elements, and the intervention measures used in the self-management program. This program and then was assessed using the content validity index (CVI) and a four-point Liker's scale. The content validity score was .98. The guideline of self-management program to CKD was thus developed.

Conclusions / Implications For Practice: This study developed a self-management program applicable to local care of CKD. It is hoped that the guidelines developed in this study offer a reference for clinical caregivers to improve their healthcare practices.
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http://dx.doi.org/10.6224/JN.61.6.66DOI Listing
December 2014

Differences in the perceptions of self-care, health education barriers and educational needs between diabetes patients and nurses.

Contemp Nurse 2014 ;46(2):187-96

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

This study examined the differing perceptions of diabetic patients and their nurses regarding the completion of self-care activities, barriers to participation in diabetes health education, and diabetic patients' educational needs to promote better health care for patients with diabetes in Taiwan. This study employed a cross-sectional survey. The data were collected during 2009. Questionnaires were developed to collect data on a convenience sample of 312 patients with type 2 diabetes and 202 nurses recruited from diabetes clinics in Taiwan. Perceptions of self-care behavior were statistically significantly different between patients and nurses (t = -5.05, P < 0.000). The patients perceived themselves to be more successful at completing self-care tasks whereas nurses perceived patients to be less successful at completing self-care tasks. Nurses perceived patients to experience greater difficulties in diabetes health education (t = 18.36, P < 0.000). Nurses perceived there to be a greater need for health education as compared with patients (t = 9.03, P < 0.000).
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http://dx.doi.org/10.5172/conu.2014.46.2.187DOI Listing
July 2014

Hand hygiene compliance among the nursing staff in freestanding nursing homes in Taiwan: a preliminary study.

Int J Nurs Pract 2014 Feb 18;20(1):46-52. Epub 2013 Jun 18.

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

This study aimed to explore the hand hygiene compliance among the nursing staff in Taiwanese freestanding nursing homes. A descriptive observational research design was used. A total of 782 opportunities for hand hygiene were observed by one trained research assistant in two freestanding nursing homes. The hand-hygiene observation tool was used to assess hand hygiene practice. The overall hand hygiene compliance among nursing staff in nursing homes was only 11.3%. Results further showed that the compliance was greater after contact with body fluids (odds ratio = 6.9, confidence interval (CI) = 3.75-9.88, P = 0.000) and lower before the performance of aseptic procedures (odds ratio = 0.15, CI = 0.04-0.63, P = 0.003) when compared with other activities. Hand hygiene compliance was relatively low among the nursing staff in freestanding nursing homes in Taiwan. To comprehensively analyze this issue, further research involving a larger number of nursing homes and strategies to improve compliance with hand hygiene among the nursing staff at these institutions is needed.
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http://dx.doi.org/10.1111/ijn.12120DOI Listing
February 2014

Effects of daily energy expenditure on academic performance of elementary students in Taiwan.

Jpn J Nurs Sci 2014 Jan 14;11(1):1-9. Epub 2012 Oct 14.

Kaohsiung Municipal Jhuang Jing Elementary School, Kaohsiung, Taiwan.

Aim: The objective of the study was to investigate the potential effects of daily energy expenditure on the academic performance (AP) of elementary schoolchildren, the results of which will be used as the basis of planning physical activity (PA) for children in the future.

Methods: Participants were collected from 4th to 6th grade children at an elementary school in southern Taiwan. The effective sample data size was 1065 (79.8%; 528 boys and 537 girls). Daily mean energy expenditure was obtained using the 3 Day Physical Activity Recall (3-DPAR), and the intensive activities degrees of physical activity were categorized into lowest PA, middle PA, and highest PA group, and academic performance assessed with weighted academic score.

Results: The significant effect on the academic performance of schoolchildren was only in energy expenditure but not for sexes and tutorials attended. All students in the middle PA group performed better academically than those in the highest PA group. After controlling sexes, male students in the middle PA group performed better than other groups; female students in the lowest PA group performed better than other groups.

Conclusion: These results may be consulted by schools, academic faculties, and parents in setting up exercise plans for children.
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http://dx.doi.org/10.1111/j.1742-7924.2012.00230.xDOI Listing
January 2014

The efficacy of a self-management programme for people with diabetes, after a special training programme for healthcare workers in Taiwan: a quasi-experimental design.

J Clin Nurs 2014 Sep 20;23(17-18):2515-23. Epub 2013 Dec 20.

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

Aims And Objectivies: To analyse the efficacy of improving disease management after implementing a self-management programme for people with type 2 diabetes administered by healthcare workers who have received special training.

Background: The needs for diabetic care include increased training for healthcare providers to enhance their confidence and skills in managing patients, both physically and mentally.

Design: Quasi-experimental design.

Methods: This study recruited participants from outpatient clinics in 10 hospitals in Taiwan. In 2010, purposive sampling was used to recruit 228 participants from two medical centres, five regional hospitals and three district hospitals. Participants were enrolled in a 'diabetes self-management programme' (watching patient videos, reading a diabetes self-care handbook, participating in four consultation courses of diabetes self-efficacy improvement, telephone follow-up and positive reinforcement). Efficacy analysis of post-test diabetes outcome variables of the experimental group was carried out. Sex, age and pretest score were used as the control variables for ancova test.

Results: Patients in the experimental group had significant improvement in body mass index (p < 0·01), waistline circumference (p < 0·001), haemoglobin A1C levels (p < 0·001), degrees of anxiety and depression (p < 0·001), self-efficacy (p < 0·001) and levels of self-care (p < 0·001).

Conclusion: Self-efficacy of people with diabetes can be effectively improved by planned implementation of a 'diabetes self-management programme' by trained healthcare workers.

Relevance To Clinical Practice: The diabetes care professionals are provided the self-management programme to strengthen the awareness and importance of self-management in diabetes care.
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http://dx.doi.org/10.1111/jocn.12440DOI Listing
September 2014

Health literacy, self-efficacy, and self-care behaviors in patients with type 2 diabetes mellitus.

J Am Assoc Nurse Pract 2013 Sep 4;25(9):495-502. Epub 2013 Mar 4.

Department of Nursing, College of Marshall Islands, Majuro Atoll, Marshall Islands.

Purpose: The study purpose was to explore the relationships among health literacy, self-efficacy, and self-care behaviors of patients with type 2 diabetes.

Data Sources: A cross-sectional study with a descriptive correlational design was conducted. Patients (N = 150) with type 2 diabetes were recruited from diabetes clinics in the Marshall Islands. Levels of health literacy, self-efficacy, and self-care behaviors were assessed by a questionnaire.

Conclusions: Health literacy, receiving diabetes education, and employment status together explained 11.8% of the variance in self-efficacy (F((3,147)) = 7.58, p < .001). Patients who had higher health literacy, received more diabetes-related education, were currently employed and had better self-efficacy. Self-efficacy and marital status together explained 16.7% of the variance in self-care behaviors (F((2,148)) = 15.96, p < .001). Patients who had higher self-efficacy and who were married had better self-care behaviors.

Implications For Practice: Strategies are needed to incorporate the concept of self-efficacy in the design of diabetes education to promote patients' self-care behaviors, with an emphasis on dealing with hyper- or hypoglycemia, following the diet plan, and checking blood sugar levels as recommended. Diabetes education material that requires a lower literacy level may be needed for older or unemployed adult populations.
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http://dx.doi.org/10.1111/1745-7599.12017DOI Listing
September 2013

Efficacy of narrowband ultraviolet phototherapy on renal pruritus.

J Clin Nurs 2014 Jun 17;23(11-12):1593-602. Epub 2013 Oct 17.

Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.

Aims And Objectives: To test the efficacy of narrowband ultraviolet B phototherapy in reducing renal pruritus.

Background: Renal pruritus is a disabling symptom affecting approximately 50% of patients undergoing maintenance haemodialysis. Managing refractory pruritus can be a great challenge for healthcare providers and patients as well. For patients who do not respond to conventional treatments, ultraviolet B phototherapy is considered the treatment of choice. Few investigators, however, have studied the efficacy of narrowband ultraviolet B phototherapy in this condition.

Design: The study was based on a quasi-experimental design with repeated measures.

Methods: A convenience sample of 42 haemodialysis patients with pruritus was recruited from haemodialysis units of a general hospital in Taipei, Taiwan. Two groups were created according to the dates of haemodialysis. The intervention participants received narrowband ultraviolet B phototherapy three times a week for two weeks. The control participants were maintained on their prior pruritus treatment. The pruritus intensity was measured with a numerical rating scale at baseline and on alternating days for seven times. Data were collected during the year 2008.

Results: The generalised estimating equation showed statistically significant group-by-time interactions in pruritus intensity. Using the control group as the reference group and baseline as the reference time, the intervention group had significantly lower pruritus intensity than the control group: 3·14 (p < 0·001) at time seven, 1·71 (p < 0·001) at time six and 1·24 at time five (p < 0·001). The group-by-time interactions were statistically significant after four sessions of narrowband-UVB irradiation.

Conclusion: The study findings support the efficacy of narrowband ultraviolet B phototherapy in alleviating renal pruritus.

Relevance To Clinical Practice: Clinicians may consider prescribing phototherapy for haemodialysis patients who have intractable renal pruritus and do not respond to conventional treatments.
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http://dx.doi.org/10.1111/jocn.12252DOI Listing
June 2014

Differences in the perceptions of self-care, health education barriers and educational needs between diabetes patients and nurses.

Contemp Nurse 2013 Aug 4. Epub 2013 Aug 4.

School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan E-mail:

Abstract This study examined the differing perceptions of diabetic patients and their nurses regarding the completion of self-care activities, barriers to participation in diabetes health education, and diabetic patients' educational needs to promote better health care for patients with diabetes in Taiwan. This study employed a cross-sectional survey. The data were collected during 2009. Questionnaires were developed to collect data on a convenience sample of 312 patients with type 2 diabetes and 202 nurses recruited from diabetes clinics in Taiwan. Perceptions of self-care behavior were statistically significantly different between patients and nurses (t=-5.05, P<0.000). The patients perceived themselves to be more successful at completing self-care tasks whereas nurses perceived patients to be less successful at completing self-care tasks. Nurses perceived patients to experience greater difficulties in diabetes health education (t=18.36, P<0.000). Nurses perceived there to be a greater need for health education as compared with patients (t=9.03, P<0.000).
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http://dx.doi.org/10.5172/conu.2013.2767DOI Listing
August 2013

Correlations among social support, depression, and anxiety in patients with type-2 diabetes.

J Nurs Res 2013 Jun;21(2):129-38

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

Background: Social support is related to patient self-care and health status. Patients' psychosocial issues play an important role in diabetes care.

Purpose: This study investigates correlations among social support, depression, and anxiety in patients with diabetes.

Methods: A cross-sectional study design and purposive sampling were used. One hundred eleven patients with type-2 diabetes were recruited from three regional teaching hospitals in northern, central, and southern Taiwan, respectively. Questionnaires used included the social support and psychological referral inventory, Beck depression inventory, and Beck anxiety inventory.

Results: Approximately 12.6% of the study population had depression, and 27.0% had anxiety. Depression and anxiety were positively correlated (r = .65, p < .01), whereas depression was negatively correlated with the sum of disease control types (r = -0.26, p < .01) and social support (r = -0.27, p <.01). The sum of disease control types and social support were the most important explanatory factors for depression in patients, explaining 45.5% of variance. Anxiety was correlated positively with age (r = .26, p < .01), total number of complications (r = .31, p < .01), and depression (r = .65, p < .01). Anxiety correlated negatively with weight (r = -0.20, p < .05) and sum of disease control types (r = -0.25, p < .05). The above variables were important explanatory factors for anxiety, accounting for 15.2% of variance.

Conclusions/implications For Practice: Psychological factors, such as depression and anxiety, are common symptoms in patients with diabetes. If social support can be strengthened in these patients, then psychological factors can be improved. Professional care providers should focus on reducing the patient depression and anxiety levels, strengthening social support, and providing referrals to psychology-related professionals.
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http://dx.doi.org/10.1097/jnr.0b013e3182921fe1DOI Listing
June 2013