Publications by authors named "Yeu-Hui Chuang"

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

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

Effects of mobile health interventions on improving glycemic stability and quality of life in patients with type 1 diabetes: A meta-analysis.

Res Nurs Health 2021 02 25;44(1):187-200. Epub 2020 Dec 25.

School of Nursing and Institute of Hospital and Health Care Administration, Taipei Medical University, Taipei, Taiwan.

This meta-analysis aimed to examine the effects of mobile-health-based (mHealth) interventions on improving glycemic stability and quality of life (QOL) in patients with type 1 diabetes (T1D). Various databases, including PubMed, Embase, CINAHL, Cochrane Library, ProQuest, Chinese Electronic Periodical Services, and China Knowledge Resource Integrated, were used to search for relevant articles. A fixed-effects model or random-effects model was used to examine the overall effect. Various methods, including Egger's test, Begg's test, and trim-and-fill, were adopted to examine publication bias. In total, 26 studies were recruited. Results of the random-effects model showed that the use of mHealth-based interventions significantly decreased glycated hemoglobin (HbA1c) (mean difference = -0.37, 95% confidence interval (CI) = -0.53 to -0.22, p < .001), and improved life satisfaction (Hedges' g = 0.30, 95% CI = 0.10 to 0.50, p = .003), worry of diabetes (Hedges' g = -0.25, 95% CI = -0.41 to 0.08, p = .004), and mental health (Hedges' g = 0.36, 95% CI = 0.08 to 0.64, p = .012). Both adults and youths with T1D can benefit from mHealth-based interventions to improve HbA1c (Hedges' g = -0.44, p = .002 vs. -0.30, p = .003). The effect of mHealth-based interventions on improving QOL in both adults and youths could not be examined due to only one study published in adults with T1D. Moreover, those studies that included the function of feedback from professionals showed a significant effect of decreasing HbA1c compared to those without that function (Hedges' g = -0.48 vs. -0.16, p = .019). Mobile devices are convenient, instantaneous, and easy to use to communicate. Applying mHealth-based interventions with the function of feedback from professionals can be considered an alternative healthcare service to achieve optimal glycemic stability in adults and youths with T1D.
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http://dx.doi.org/10.1002/nur.22094DOI Listing
February 2021

Families of Patients With Cancer Responses and Actions to People With Cancer Who Use Complementary and Alternative Medicine: A Qualitative Study in Taiwan.

Holist Nurs Pract 2020 Dec 9. Epub 2020 Dec 9.

Discipline of Nursing, School of Health, University of New England, Armidale, New South Wales, Australia (Dr Wang) https://orcid.org/0000-0002-5235-691X; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei, Taiwan (Dr Chuang) https://orcid.org/0000-0003-2559-7184; Department of Nursing, Kuang Tien General Hospital, Taichung City, Taiwan (Ms Liu); and Department of Nursing, Puli Branch, Taichung Veterans General Hospital, Taichung City, Taiwan (Ms Chang).

This study aims to explore how the families of patients with cancer respond to and act toward complementary and alternative medicine (CAM) use. A qualitative research design based on grounded theory was adopted in this study. Semistructured and face-to-face in-depth interviews were conducted. Each participant was involved in a one-to-one individual interview. Five categories emerged regarding how the families of patients with cancer responded to and acted toward CAM use: purposes of using CAM, CAM use between patients and families, role of family caregivers, actions when using CAM, and seeking religious practice. The core category following coding emphasized the paramount importance of patients' comfort. The findings revealed that the families of patients with cancer may respond and act differently regarding patients' use of CAM. During this process, patients may not inform family members that they are using CAM. Health care professionals should consider this in their interactions with family members.
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http://dx.doi.org/10.1097/HNP.0000000000000426DOI Listing
December 2020

A qualitative exploration of the experiences of doctors, nurses and pharmacists regarding medication management in outpatient setting.

J Nurs Manag 2021 Mar 3;29(2):333-341. Epub 2020 Oct 3.

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

Aim: To understand how the medications are managed by the multidisciplinary team and their suggestions for nursing management, and to develop a framework for safe medication management in hospital-based outpatient.

Background: More than 80% of hospital-based outpatient visits involve medication prescriptions, indicating the importance of safe medication management there.

Methods: This was a qualitative study with face-to-face interviews with physicians, nurses and pharmacists from 11 medical outpatient units.

Results: Four themes elicited were categorized as follows: unclear professional roles and functions in outpatient medication management; intertwined communications; moving from data to wisdom; and ambiguous culture of safety. The resulting model is a collaboration of physicians, nurses, pharmacists, and patients and families integrated with hospital administrative support and information technology in a culture of safety.

Conclusions: Medication management in outpatient is critical but usually overlooked. Nursing leaders should develop a culture of safety and provide more support and training for nurses to provide comprehensive medication management for outpatients.

Implications For Nursing Management: It is important to develop outpatient nurses' role and competence in managing patient medication safety. Nurses in management would benefit from applying the 'framework of efficient and safe medication management for outpatients' to assess and identify weak areas for improvement.
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http://dx.doi.org/10.1111/jonm.13158DOI Listing
March 2021

Nurses' Late-Life Depression Knowledge and Attitudes Toward Depression: A Cross-Sectional Study.

Inquiry 2020 Jan-Dec;57:46958020945179

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

Depression in older population is more common now. Due to increasing numbers of older patients in hospitals, nurses have more opportunities to care for these patients. Therefore, nurses should have correct knowledge of late-life depression and more favorable attitudes about depression. The study aimed to understand hospital nurses' knowledge level of late-life depression and attitudes about depression. A cross-sectional research design was used. A convenience sample of 307 nurses from 3 hospitals in Taiwan was recruited. Nurses scored 55.15% in the Late-Life Depression Quiz. The average score of the Revised Depression Attitude Questionnaire was 71.76 (SD = 6.13). The study also found that hospital nurses had more favorable attitudes about depression when their late-life depression knowledge was higher; their interest level in providing care for older patients with depression was greater; they had ever taken care of older patients with depressive symptoms or depression; they had never received in-service training on depression in the past year; and they had ever attended lectures about depression in school. Hospital nurses' knowledge about late-life depression was limited, and they had neutral to slightly favorable attitudes about depression in Taiwan. It is suggested to carefully examine and evaluate in-service training related to depression for nurses in hospitals. In addition, developing appropriate interventions to increase hospital nurses' knowledge level of late-life depression and attitudes toward depression is recommended.
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http://dx.doi.org/10.1177/0046958020945179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391434PMC
July 2020

Sleep Disturbances Following Traumatic Brain Injury in Older Adults: A Comparison Study.

J Head Trauma Rehabil 2020 Jul/Aug;35(4):288-295

Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan (Drs Wei and Wen); Graduate Institute of Injury Prevention and Control, College of Public Health (Dr Wei), School of Nursing, College of Nursing (C.-Y. Liu, C.-Y. Chen, and Drs Chuang and H.-Y. Chiu), and Research Center of Sleep Medicine (Dr H.-Y. Chiu), Taipei Medical University, Taipei, Taiwan; Biobehavioral Nursing and Health Informatics (Dr Thompson) and Harborview Injury Prevention and Research Center (Dr Thompson), University of Washington, Seattle, Washington; Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan (Dr Su); Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan (Dr P.-Y. Chen); School of Medicine, Chang Gung University, Taoyuan, Taiwan (Dr P.-Y. Chen); Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Taiwan (Drs Lin, C.-T. Chen, and C.-C. Chen); and Department of Rehabilitation, Sinwu Branch, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan (H.-T. Chiu).

Objectives: To compare the prevalence of sleep disturbances in older adults with traumatic brain injury (TBI) with that of age- and gender-matched controls and to determine the risk factors for post-TBI sleep disturbances and the effects of post-TBI disturbances on quality of life (QOL).

Design: Cross-sectional case-comparison study.

Participants: Eighty older adults (aged ≥65 years) with first-time TBI more than 3 months since injury and 80 older adults controls without TBI who completed sleep and health-related QOL questionnaires.

Results: Older adults with TBI showed a higher prevalence of obstructive sleep apnea (OSA), insomnia, and daytime sleepiness than older adult controls. Being male, having higher levels of depression and pain, and the presence of insomnia were significantly correlated with the risks of OSA, insomnia, and daytime sleepiness following TBI, respectively. Both OSA and insomnia were significantly correlated with low QOL in older adults with TBI.

Conclusions: Sleep disturbances are highly prevalent in older adults with TBI. Gender differences, depression severity, and pain level are correlated with the occurrence of post-TBI sleep disturbances. Both OSA and insomnia are regarded as major contributors to low QOL in older people with TBI. Interventions targeted at post-TBI sleep disturbances may improve QOL of older adults.
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http://dx.doi.org/10.1097/HTR.0000000000000563DOI Listing
February 2020

Multiple brief training sessions to improve nurses' knowledge, attitudes, and confidence regarding nursing care of older adults with depression in long-term care facilities.

Res Nurs Health 2020 01 2;43(1):114-121. Epub 2019 Dec 2.

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

In long-term care facilities (LTCFs), nurses are key healthcare providers for older residents who have depressive symptoms or depression; therefore, they need accurate knowledge of late-life depression, positive attitudes towards depression, and confidence in providing depression care. This cluster-randomized trial was designed to examine the effectiveness of multiple, face-to-face, brief training sessions in improving nurses' knowledge, attitudes, and confidence in providing late-life depression care in LTCFs. Nine LTCFs were included in the study. In total, 30 nurses from the four LTCFs assigned to the intervention group received three 30-min training sessions and 36 nurses in the five comparison group LTCFs did not. A self-report questionnaire was administered before and after the intervention. There were significant differences between groups concerning improvement in nurses' knowledge of late-life depression, attitudes towards depression, and confidence in providing depression care. The effect size (Cohen's d) was 1.55 for knowledge, 1.38 for attitudes, and 0.89 for confidence. This training program was effective in improving LTCF nurses' knowledge, attitudes, and confidence in providing depression care. On the basis of these findings, we recommend that nurse managers and directors implement similar training programs for nurses in LTCFs to enhance the care quality for older residents.
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http://dx.doi.org/10.1002/nur.21997DOI Listing
January 2020

Nurses' perceptions regarding providing psychological care for older residents in long-term care facilities: A qualitative study.

Int J Older People Nurs 2019 Sep 9;14(3):e12242. Epub 2019 May 9.

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

Aims And Objectives: To explore nurses' perceptions regarding providing psychological health care for older residents in long-term care facilities (LTCFs).

Background: Loneliness and depressive symptoms are commonly observed among older residents living in LTCFs. Nurses are expected to provide holistic care including physical, psychological and social care for older residents in LTCFs to fulfil their needs. Therefore, understanding nurses' feelings and thoughts regarding providing care for older residents who feel lonely, sad, unhappy or depressed is important for delivering better care.

Design: A qualitative research design was employed. The Standards for Reporting Qualitative Research (SRQR) was used to enhance for reporting quality.

Methods: Purposive sampling and snowball sampling were applied in Northern Taiwan. One-to-one in-depth interviews were conducted using a semi-structured interview guide. Twenty-one nurses with a mean age of 38.4 years were interviewed. Content analysis was performed for data analysis.

Findings: Four themes were generated from the data: "insufficient psychological healthcare competency," "having a willing heart but not adequate support," "families playing an essential role in residents' mood" and "physical-oriented care model."

Conclusions: Long-term care facilitie nurses felt that they were not adequately prepared for taking care of older adults' psychological problems before their nursing career or during their practice. Unreasonable nurse-to-resident ratios and an absence of care consensus among healthcare providers can make nurses feel that they have a willing heart but not adequate support. Family members are essential in older residents' emotional status within the Taiwanese cultural context. Physical care evaluation indicators emphasised by LTCF accreditation resulted in the current care practice model.

Implications For Practice: This study provides valuable information for LTCF nurses, managers and directors to develop appropriate strategies to assist nurses in providing better psychological health care for older residents. Evaluation indicators required by LTCF accreditation in Taiwan must be re-examined at the earliest stage.
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http://dx.doi.org/10.1111/opn.12242DOI Listing
September 2019

[Introduction to Games for People With Dementia].

Hu Li Za Zhi 2019 Feb;66(1):101-106

PhD, RN, Associate Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan, ROC.

Dementia is typically classified into mild, moderate, and severe stages based on symptom severity. Prevention and early diagnosis is one of the care goals for dementia. Mild cognitive impairment (MCI) is a transitional stage between the cognitive changes of normal aging and dementia. Initiating an appropriate treatment regimen and methods at a sufficiently early stage has been shown to be effective in postponing the onset of dementia. Previous studies have confirmed the effectiveness of non-pharmacological treatments in improving the cognitive functions, reducing the onset of the behavioral and psychological symptoms of dementia, and training the physical functions of daily living in patients diagnosed with MCI. Game therapy, in addition to reminiscence therapy, music therapy, cognitive training, cognitive stimulation, and aromatherapy, is one of these non-pharmacological treatments. Moreover, game therapy may be used as a tool to screen individuals for symptoms of dementia. Using easily accessible, user-friendly, and affordable games, patients with dementia and their caregivers may receive their therapy in a more relaxed and enjoyable manner. Patients and their caregivers who perceive a prescribed therapy as a game are expected to exhibit higher motivation to use, which should result in better treatment outcomes. This paper will introduce and compare several games for people with dementia, providing valuable information for caregivers and healthcare professionals who are responsible for caring for patients with dementia.
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http://dx.doi.org/10.6224/JN.201902_66(1).12DOI Listing
February 2019

[Kahoot: Applications and Effects in Education].

Hu Li Za Zhi 2018 Dec;65(6):13-19

PhD, RN, Associate Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan, ROC.

Stimulating learning motivation and enhancing learning effectiveness are particularly difficult challenges for nursing educators in educating Generation Z learners, who are part of the first generation of true "digital natives". In response, teachers are beginning to integrate gamification techniques into their classrooms in order to motivate classroom participation and to conduct learning evaluation. Kahoot is a free, online quiz platform and instant feedback system that helps teachers create a fun competitive-gaming environment. Learners may access the platform using a mobile phone or tablet to answer multiple-choice questions. The platform may be introduced at different stages of learning activities or combined with the flipped classroom model in order to achieve various teaching goals. This article provides a brief introduction of the gamification of learning and then discusses the operational skills needed to use Kahoot and the effectiveness of this platform, including advantages, limitations, and user feedback. Finally, the authors share their Kahoot-related teaching designs and experiences. It is suggested that nurse educators may apply Kahoot in their innovative teaching practices.
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http://dx.doi.org/10.6224/JN.201812_65(6).03DOI Listing
December 2018

Nurses' confidence in providing and managing care for older persons with depressive symptoms or depression in long-term care facilities: A national survey.

Int J Ment Health Nurs 2018 Dec 24;27(6):1767-1775. Epub 2018 May 24.

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

The prevalence of depressive symptoms among older residents in long-term care facilities (LTCFs) is high. Nurses are the main healthcare providers in LTCFs and also the persons responsible for detecting changes in residents' mental function and providing subsequent care. Therefore, it is necessary to understand nurses' knowledge, attitudes, and confidence regarding care for older residents with depressive symptoms or depression. This study aimed to understand nurses' level of knowledge of late-life depression, attitudes towards depression, and confidence levels in caring for older adults with depressive symptoms or depression in LTCFs. A cross-sectional descriptive and correlational research design was used. A nationwide self-report survey was conducted in 2016. Ultimately, 556 valid questionnaires were returned. The study found that LTCF nurses' knowledge about late-life depression was poor, and they also lacked confidence in managing and caring for older persons with depressive symptoms or depression, but nurses' attitudes towards depression were neutral or slightly positive. Moreover, nurses who had greater confidence in providing care for older persons with depression were those with more positive attitudes towards depression, a greater interest level in taking care of older adults with depression, less late-life depression knowledge, longer nursing experience in LTCFs, and a greater interest level in late-life depression issues, and who had read late-life depression pamphlets or taken courses or classes in late-life depression. The findings suggest an urgent need to develop strategies to improve nurses' late-life depression knowledge and increase their confidence in providing care to older residents with depressive symptoms or depression.
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http://dx.doi.org/10.1111/inm.12483DOI Listing
December 2018

Effects of a skill demonstration video delivered by smartphone on facilitating nursing students' skill competencies and self-confidence: A randomized controlled trial study.

Nurse Educ Today 2018 Jul 7;66:63-68. Epub 2018 Apr 7.

Division of Educational Technology, Office of Information Technology, Taipei Medical University, 250 Wu-Xing St., Taipei 110, Taiwan. Electronic address:

Background: The correct and appropriate performance of nursing skills by students can ensure patient safety and care quality. However, developing appropriate teaching and learning strategies to enhance nursing students' nursing skills and knowledge are challenging tasks for nursing faculty members. Nowadays, smartphones are popular mobile devices that are used on campuses by students and could be considered a potential tool to deliver learning materials to nursing students.

Objectives: This study aimed to examine the effects of a skill demonstration video delivered by smartphone on facilitating nursing students' nursing skill competency and confidence.

Design: A randomized controlled trial study design was used.

Settings And Participants: A convenience sample of nursing students at a university was recruited.

Methods: After receiving a regular nursing skills lab demonstration, pre-test data were collected from nursing students in an intervention group (n = 44) and a comparison group (n = 43). Then, students in the intervention group downloaded the skill demonstration video onto their smartphones, while the comparison group did not. Post-test data were collected at 2 weeks after the intervention.

Results: There were significant differences in students' urinary catheterization knowledge (F = 4.219, p = 0.04) and skills (F = 6.739, p = 0.013), but there was no difference in students' confidence level (F = 2.201, p = 0.142) between the two groups after the intervention. Furthermore, the average score of the satisfaction level regarding the intervention was 4.46 (SD = 0.43) on a scale of 1-5.

Conclusions: This study found that delivering learning materials through smartphones to nursing students is suitable. Although there was no significant difference in students' self-confidence level, students' knowledge and skills were improved by the intervention. Smartphones can serve as a supplemental tool for learning nursing skills.
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http://dx.doi.org/10.1016/j.nedt.2018.03.027DOI Listing
July 2018

Prevalence of depressive symptoms in older nursing home residents with intact cognitive function in Taiwan.

Res Nurs Health 2018 Jun 25;41(3):292-300. Epub 2018 Mar 25.

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

The investigators aimed to explore the prevalence of depressive symptoms and associated factors among older residents with intact cognitive function in nursing homes in Taiwan. A cross-sectional descriptive and correlational research design was used. A convenience sample of 178 older residents without cognitive impairment was recruited from 36 nursing homes in Southern Taiwan. The questionnaires included demographic data; the Barthel Index, which assesses the ability to perform activities of daily living; and the Geriatric Depression Scale Short Form. Among older residents in nursing homes with intact cognitive function, 39.3% had depressive symptoms. Age, religion, previous living status, previous working status, being totally dependent in physical function, and being severely dependent in physical function were significant predictors of depressive symptoms among cognitively intact older residents. The findings highlight the critical mental healthcare issues among older residents with intact cognitive function in nursing homes. Practical strategies for preventing the occurrence of depressive symptoms and caring for those who have depressive symptoms should be developed, especially for younger or dependent older residents or residents who have never been employed, have no religious beliefs, or have lived alone before they moved into an institution.
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http://dx.doi.org/10.1002/nur.21873DOI Listing
June 2018

Ischemic Stroke Patients' Decision-Making Process in Their Use of Western Medicine and Alternative and Complementary Medicine.

Holist Nurs Pract 2018 Jan/Feb;32(1):17-26

Department of Nursing, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan (Ms Hsieh and Mr Chen); Department of Nursing, Hungkuang University, Taichung, Taiwan (Dr Wang); and School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan (Dr Chuang).

Stroke is ranked third among the top 10 causes of death in Taiwan. Besides a high mortality rate, stroke survivors are often left with physical or functional sequela. This study aimed to explore ischemic stroke patients' decision-making process using Western medicine (WM) and complementary and alternative medicine (CAM). This study is a qualitative study based on grounded theory. A total of 12 participants were recruited. Findings revealed that the participants accepted WM and CAM treatments following the onset of ischemic stroke. Three categories and several subcategories emerged from stroke patients' decision-making process. These are "uncertainty of stroke," "delicate balance between WM and CAM," and "reestablishing confidence and faith." Eventually, they exhibited the core category of "breakthrough and the pursuit of a sense of rebirth." This study also found that the participants were unwilling to inform their health care professionals on their use of CAM. Therefore, health care professionals should empathize with the views and needs of their patients and respect their decision to combine WM with CAM. The views of other medical teams concerning CAM into their analysis of patients' decision-making process are recommended. Therefore, comprehensive insight into ischemic stroke patients' decision-making process for using CAM can be further explored.
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http://dx.doi.org/10.1097/HNP.0000000000000243DOI Listing
May 2018

Palliative care for advanced dementia: Knowledge and attitudes of long-term care staff.

J Clin Nurs 2018 Feb 13;27(3-4):848-858. Epub 2017 Dec 13.

School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Aims And Objectives: To investigate the knowledge of and attitudes towards palliative care for advanced dementia and their associations with demographics among nursing staff, including nurses and nursing assistants, in long-term care settings.

Background: Nursing facilities are places where persons with dementia die; therefore, providing quality end-of-life care to residents with advanced dementia is crucial. To date, little attention has been paid to palliative care practice for patients with advanced dementia.

Design: A descriptive, cross-sectional, survey design was used.

Methods: In total, a sample of 300 nurses (n = 125) and nursing assistants (n = 175) working in long-term care settings in Taiwan participated in this study. Two instruments were administered: demographic characteristics and responses to the Questionnaire of Palliative Care for Advanced Dementia. Descriptive statistics and multiple regression were used for data analysis.

Results: Overall, the nurses and nursing assistants had moderate mean scores for both knowledge of and attitudes regarding palliative care for advanced dementia. Additionally, nursing staff who were nurses with greater work experience and those who had received palliative care and hospice training had greater knowledge of palliative care. In addition, nursing staff who had received dementia care training and who had worked in nursing homes had higher levels of positive attitudes towards palliative care.

Conclusions: This study indicates the need to provide nurses and nursing assistants with more information about palliative care practice for people with advanced dementia. Particularly, providing education to those who are nursing assistants, who have less working experience, who have not received palliative and dementia care training, and who have not worked in nursing homes can improve overall nursing staff knowledge of and attitudes towards palliative care.

Relevance To Clinical Practice: Continuing education in principles of palliative care for advanced dementia is necessary for currently practicing nursing staff and should be developed according to their educational background and needs.
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http://dx.doi.org/10.1111/jocn.14132DOI Listing
February 2018

The care needs of postpartum women taking their first time of doing the month: a qualitative study.

Contemp Nurse 2017 Oct 20;53(5):576-588. Epub 2017 Oct 20.

d School of Nursing , National Quemoy University , No.1, Dasyue Rd., Jinning Township , Kinmen County 89250 , Taiwan (ROC).

Background: In contemporary Taiwan, after giving birth, many women undertake a traditional postpartum practice called 'doing the month', which occurs in the medical context of postpartum nursing centres instead of at home. Thus, healthcare workers must identify and address the care needs of new mothers in this setting to improve the care of new mothers and their baby and family.

Aim: To explore new mothers' care needs from their own perspectives during the period of doing the month.

Methods: A qualitative study was performed. Eligible participants recruited through purposive sampling were interviewed comprehensively.

Results: Twenty-seven primiparous women participated (mean age: 32 years; mean marriage length: 3.4 years). Four themes were identified: the need to increase energy to gain more yang force, the need to internalise mothering, the need to be supported by the family and friends, and the need to be understood.

Conclusions: For effective care, sufficient support and guidance must be provided to first-time mothers and their families, especially when mother-baby rooming-in is the standard of care.
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http://dx.doi.org/10.1080/10376178.2017.1389615DOI Listing
October 2017

Effects of Messages Delivered by Mobile Phone on Increasing Compliance With Shoulder Exercises Among Patients With a Frozen Shoulder.

J Nurs Scholarsh 2017 07 20;49(4):429-437. Epub 2017 Jun 20.

Pi, Associate Professor, Post-Baccalaureate Program in Nursing, College of Nursing, and School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Purpose: The aim of this study was to examine the effects of reminders, encouragement, and educational messages delivered by mobile phone on shoulder exercise compliance and improvements in shoulder function among patients with a frozen shoulder.

Design And Methods: A randomized controlled trial design was used. A convenience sample of patients with a frozen shoulder in an orthopedic outpatient clinic was recruited. All participants were instructed on how to do shoulder exercises and were provided with a printed pamphlet about shoulder exercises. Then, the intervention group received reminders, encouragement, and educational messages by mobile phone daily for the next 2 weeks, while the comparison group did not.

Findings: The intervention group had higher compliance with shoulder exercises than did the comparison group (t = 2.263, p = .03) and had significant improvements in shoulder forward flexion (F = 12.067, p = .001), external rotation (F = 13.61, p = .001), and internal rotation (F = 5.903, p = .018) compared to those in the comparison group after the 2-week intervention.

Conclusions: The text messages significantly increased patient compliance with shoulder exercises and thus improved patients' shoulder range of motion.

Clinical Relevance: Hospital or clinics can send appropriate messages to patients via text message platforms in order to remind and encourage them to do shoulder exercises.
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http://dx.doi.org/10.1111/jnu.12308DOI Listing
July 2017

Nursing Students' Willingness to Care for Older Adults in Taiwan.

J Nurs Scholarsh 2016 Mar 29;48(2):172-8. Epub 2016 Jan 29.

Pi, Associate Professor, School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Background: The possibilities that nurses will take care of persons 65 years of age or older in hospitals and communities are increasing due to a growing aged population. Nursing students should be prepared to face the challenges of their future practice. Therefore, factors associated with nursing students' willingness to care for older adults need to be identified.

Aim: This study aimed to explore Taiwanese nursing students' willingness to work with older persons and factors associated with this.

Methods: A cross-sectional research design was used. Stratified sampling was applied to recruit participants from seven nursing schools in northern, central, southern, and eastern areas of Taiwan. There were 612 nursing students who successful completed the questionnaire including demographic data, the Attitudes Toward the Elderly Scale, and the Willingness Toward the Elderly Care Scale. Data were collected between November 2012 and January 2013. A stepwise regression analysis was conducted to identify predictors of nursing students' willingness to care for older adults.

Findings: The mean score of nursing students' attitudes toward older people was 73.86 (SD = 8.9), with a range of 44-106. The mean score on the willingness to care for older adults was 55.01 (SD = 6.4), with a range of 36-75. The length of time with older adults per week (r = 0.12, p = .003) and grandparents having served as caregivers during the students' childhood (t = -2.147, β = .032) were both positively associated with the willingness to care for older adults. The best predictors of nursing students' willingness to care for older adults were students' attitudes toward older adults (β = 0.38, p < .001), paying attention to issues related to older adults (β = 0.24, p < .001), and having the experience of being a volunteer who served older people (β = 0.10, p = .005), which explained 26.8% of the total variance.

Conclusions: Taiwanese undergraduate nursing students had neutral to slightly favorable attitudes toward working with older adults. Nursing students' positive attitudes about older adults, paying attention to issues related to older adults, and having been a volunteer that served older people were predictors of their willingness to care for older persons. Appropriate and practical strategies should be developed for students in order to increase their preference for caring for older people.

Clinical Relevance: The findings of this study can provide information for faculty members and clinical preceptors for designing curricula and related activities or arranging practicum in the future.
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http://dx.doi.org/10.1111/jnu.12197DOI Listing
March 2016

A multi-perspective focus-group approach to revise items in a dietary self-efficacy scale for older Taiwanese adults.

Collegian 2015 ;22(1):83-90

Aim: To revise items in the Cardiac Diet Self-Efficacy Scale, Chinese version (CDSE-C) using focus groups.

Background: There is limited literature on using focus groups with older adults as well as nursing and nutrition professionals to revise a questionnaire.

Methods: A qualitative research with multi-perspective focus-group approach was used from February through June 2009. Four serial focus groups were conducted including two focus groups of older adults from Taipei County (n = 6) and Yilan County (n = 6), one group of 5 nursing professionals, and one group of 4 nutritionists.

Results: Serial focus group discussions added one category to the CDSE-C (reducing salt) and 3 items, resulting in an 18-item scale with six categories: healthy eating behaviors, reducing fat and cholesterol, resisting relapse, increasing fiber and vegetable, reducing sugar, and reducing salt.

Conclusions: This revised measure can serve as a reliable tool for assessing older Chinese adults' healthy eating self-efficacy to evaluate and improve nutritional status in this population.
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http://dx.doi.org/10.1016/j.colegn.2013.11.007DOI Listing
September 2015

As they see it: A qualitative study of how older residents in nursing homes perceive their care needs.

Collegian 2015 ;22(1):43-51

Objectives: Meeting care needs of nursing home residents is a significant element in providing the best quality care. A literature review revealed that there is poor understanding of the care needs of older residents from their own viewpoints within a nursing home context. Therefore, this study aimed to explore the older nursing home residents' care needs from their own perspectives.

Methods: This was a qualitative study. In-depth interviews were conducted by a purposive sample of 18 nursing home residents with a mean age of 80.7 years in Taiwan. All data was transcribed and coded for emerging themes.

Results: A qualitative data analysis generated six themes including the body, economics, environment, mind, preparation for death, and social support, referred to subsequently as BEEMPS.

Conclusions: These findings can provide nursing home managers with information on how to improve nursing home care protocols to accommodate residents' expressed needs and also inform healthcare professionals about the care needs of older residents, thus fostering better care.
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http://dx.doi.org/10.1016/j.colegn.2013.11.001DOI Listing
September 2015

Stressors and coping strategies of 20-45-year-old hemodialysis patients.

Collegian 2014 ;21(3):185-92

Objectives: This study attempted to describe stressors, levels of stress, and coping strategies of 20-45-year-old Taiwanese patients undergoing chronic hemodialysis.

Methods: A cross-sectional descriptive design was used. A convenience sample of 88 patients with a mean age of 38.55 years was recruited at six dialysis centers in southern Taiwan. Data were collected using the Hemodialysis Stressor Scale and the Jalowiec Coping Scale.

Results: The results show that this group of patients had higher levels of stress than those reported in previous studies. The three most frequently reported stressors were limitations of liquids, limitations of food, and fatigue. The two most frequent coping methods were trying to find meaning in the situation and trying out different ways of solving problems to see which works the best. These patients had more physiological stressors than psychosocial stressors and used more problem-oriented coping strategies than affective-oriented ones. Additionally, the longer the patients had received hemodialysis, the lower stress level they had, and patients with jobs, with partners, or with children used significantly more coping strategies than those without jobs, partners, or children. Gender differences were not found in the total stress level or coping strategies of these patients, except that female patients had greater psychosocial stressors than male patients.

Conclusions: The 20-45-year-old hemodialysis patients experienced considerable levels of stress and had a unique ranking order of stressors and coping strategies. These findings will provide healthcare professionals with detailed information to identify priority areas for future intervention development.
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http://dx.doi.org/10.1016/j.colegn.2013.02.003DOI Listing
February 2015

Nutritional status and its health-related factors among older adults in rural and urban areas.

J Adv Nurs 2015 Jan 3;71(1):42-53. Epub 2014 Jun 3.

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

Aim: To compare health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban counties of Taiwan.

Background: The older adult population of Taiwan is increasing. Furthermore, older people living in rural areas have shorter life expectancy and more chronic diseases than their urban counterparts. However, little is known about the health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban areas of Taiwan, limiting nurses' ability to identify and care for older adults at risk of poor nutritional health.

Design: Cross-sectional, comparative.

Methods: Older adults were randomly selected from names of residents of an adjacent rural and urban area of northern Taiwan and having completing the 2009 health evaluation. From March-July 2010, older adult participants (N = 366) provided data on demographic and health-related information, nutritional self-efficacy, health locus of control and nutritional status. Data were analysed by descriptive statistics and compared using chi-square and t-test.

Results: Older rural participants had significantly lower educational level, less adequate income, higher medication use, lower scores on self-rated health status and researcher-rated health status and lower self-rated healthy eating status than their urban counterparts. Moreover, rural participants had significantly lower nutritional self-efficacy, higher chance health locus of control and poorer nutritional status than their urban counterparts.

Conclusions: Our results suggest that nurses should assess older adults living in rural areas for nutritional health and nutrition knowledge. Based on this assessment, nurses should develop easy, practical and accessible nutritional programmes for this population.
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http://dx.doi.org/10.1111/jan.12462DOI Listing
January 2015

Depression in older residents with stroke living in long-term care facilities.

J Nurs Res 2014 Jun;22(2):111-8

1PhD, RN, Lecturer, Department of Nursing, Chung Hwa University of Medical Technology 2PhD, RN, Assistant Professor, College of Nursing, Taipei Medical University 3BSN, RN, Psychiatric Center Bali, Ministry of Health and Welfare 4PhD, RN, Associate Professor, National Tainan Junior College of Nursing 5PhD, RN, Associate Professor, Department of Nursing, Chiayi Campus, Chang Gung University of Science and Technology 6PhD, RN, Professor, Institute of Allied Health Sciences and Department of Nursing, College of Medicine, National Cheng Kung University.

Background: Stroke is the third leading cause of death in Taiwan. Poststroke older adults are often admitted to long-term care facilities. The impacts of the two concurrent life events of stroke and relocation may increase the risk of depression in stroke survivors. Depression in elderly stroke survivor residents of long-term care facilities has not been studied.

Purpose: This study explores the factors associated with depression in older residents with stroke living in long-term care facilities.

Methods: A cross-sectional design was used. Twenty-three institutions in southern Taiwan participated in this study, including seven nursing homes, 11 intermediate-care facilities, and five domiciliary-care facilities. Purposive sampling enrolled 111 participants who met the following inclusion criteria: 65 years or older, experienced a stroke that did not cause cognitive defects, and capable of verbal communication. Data were collected using a sociodemographic data questionnaire, Barthel's Index, and the Taiwan Geriatric Depression Scale.

Results: Depression was experienced by 41 of the 111 participants (36.9%). Prevalence of depression was 45.7% in nursing homes, 36.2% in intermediate-care facilities, and 22.2% in domiciliary-care facilities. Participants living in nursing homes and intermediate-care facilities and illiterate participants with low Barthel's Index scores showed more depressive symptoms.

Conclusions/implications For Practice: Healthcare providers should conduct depression screening for elderly residents with stroke on admission to long-term care facilities. Regular assessment and monitoring of depressive symptoms, especially in residents with less formal education and limited physical functions, are important in nursing homes and intermediate-care facilities.
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http://dx.doi.org/10.1097/jnr.0000000000000028DOI Listing
June 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

Case management knowledge and preparedness among public health nurses.

J Nurs Res 2013 Dec;21(4):289-96

1PhD, RN, Assistant Professor, College of Nursing, Taipei Medical University 2PhD, RN, Associate Professor, College of Nursing, Graduate Institute of Nursing, Taipei Medical University 3PhD, RN, Associate Professor, School of Nursing, National Taipei University of Nursing and Health Sciences.

Background: Taiwanese public health nurses are increasingly required to act as case managers. However, little is known about nurses' knowledge and preparedness levels in assuming the responsibilities of case management.

Purpose: This article explores the knowledge and preparedness levels of experienced public health nurses related to case management.

Methods: A cross-sectional survey of Taiwanese public health nurses was conducted. A structured questionnaire was used to collect data on participants' knowledge of case management and perceived preparedness levels in performing role activities. The questionnaire consisted of three sections: Section One featured 20 multiple-choice items, Section Two included case manager role activities, and Section Three gathered demographic information.

Results: One hundred seventy-eight public health nurses were recruited from 10 health offices, with a 99% valid response rate. The overall average correct response rate for case management knowledge was 49%, which fell significantly below the minimum acceptable average score of 60%. Participants held neutral opinions regarding their preparedness levels for performing case management role activities, with a mean score of 3.2 (SD = 0.5, range = 1-5). In addition, this study unexpectedly found that the higher knowledge level group was significantly younger on average than the lower knowledge group. More than three quarters (82%) of participants had no prior education in case management.

Conclusions/implications For Practice: The results reflect substantial gaps in Taiwanese public health nurses' knowledge and preparation for the practice of case management. There is an urgent need to strengthen case management continuing education for public health nurses and address knowledge deficits and the role activities identified with lower preparedness levels.
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http://dx.doi.org/10.1097/jnr.0000000000000005DOI Listing
December 2013

Gender differences associated with pain characteristics and treatment in taiwanese oncology outpatients.

Asian Pac J Cancer Prev 2013 ;14(7):4077-82

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

The purpose of this descriptive and comparative study was to examine gender differences relevant to pain intensity, opioid prescription patterns and opioid consumption in Taiwanese oncology outpatients. The 92 participants had been prescribed opioid analgesics for cancer-related pain at least once in the past week and were asked to complete the Brief Pain Inventory - Chinese questionnaire and to recall the dosage of each opioid analgesic that they had ingested within the previous 24 hours. For opioid prescriptions and consumption, all analgesics were converted to morphine equivalents. The results revealed a significant difference between males and female minimum pain thresholds (t = 2.38, p = 0.02) and current pain thresholds (t = 2.12, p = 0.04), with males reporting a higher intensity of pain than females. In addition, this study found that males tended to use prescribed opioid analgesics more frequently than females on the bases of both around the clock (ATC) (t = 1.90, p = 0.06) and ATC plus as needed (ATC + PRN) (t = 2.33, p = 0.02). However, there was no difference between males and females in opioid prescriptions on an ATC basis (t = 0.52, p = 0.60) or at an ATC + PRN basis (t = 0.40, p = 0.69). The results suggest that there may be a gender bias in the treatment of cancer pain, supporting the proposal of routine examination of the effect of gender on cancer pain management. These findings suggest that clinicians should be particularly aware of potential gender differences during pain monitoring and the consumption of prescribed opioid analgesics.
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http://dx.doi.org/10.7314/apjcp.2013.14.7.4077DOI Listing
March 2014

Relationship between belief about analgesics, analgesic adherence and pain experience in taiwanese cancer outpatients.

Asian Pac J Cancer Prev 2013 ;14(2):713-6

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

Social and behavioral scientists have proposed that a person's belief system crucially influences his or her behaviour, and therefore may affect outcomes of pain management. The purpose of this study was to explore the relationship between analgesic beliefs, analgesic adherence and pain experience amongst Taiwanese cancer outpatients. The cross-sectional study included 92 oncology outpatients in two teaching hospitals in the Taipei area of Taiwan. The research instruments included the Pain Opioid Analgesic Beliefs Scale-Cancer (POABS- CA), opioid adherence, and the Brief Pain Inventory-Chinese (BPI-Chinese). Beliefs about pain and opioids demonstrated a significant relationship with patients' opioid adherence (r = -0.30, p < 0.01). The more negative beliefs regarding opioids and pain the patient had, the worse their adherence to around the clock (ATC) analgesic regimen. However, there was no significant correlation between opioid belief and pain experience. As well, there were no significant relationships between adherence to opioid regimen and any of the measures of pain experience. The study highlights the potential importance of a patient's pain and opioid beliefs in adherence to pain medication.
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http://dx.doi.org/10.7314/apjcp.2013.14.2.713DOI Listing
July 2014

Self-efficacy, professional commitment, and job satisfaction of diabetic medical care personnel.

Contemp Nurse 2012 Dec;43(1):38-46

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

The purpose of this study was to investigate the relationships among the self-efficacy, professional commitment, and job satisfaction of diabetic health-care personnel. The research design was cross-sectional. Three teaching hospitals, one from each of northern, middle and southern parts of Taiwan, were selected for data collection and used questionnaires to collect data; 202 participants were recruited. The demographic data for job title and job satisfaction were not significantly different (F = 2.13, P = 0.090). Self-efficacy was significantly positively correlated with professional commitment (r = 0.29, P = 0.000) and with job satisfaction (r = 0.14, P = 0.041). A total of 34.1% of the variance in job satisfaction was explained by age, years of service in the medical or nursing field, the actual number of years caring for patients with diabetes, self-efficacy, and professional commitment. Understanding the self-efficacy and professional commitment of medical and nursing personnel can help increase job satisfaction and improve the quality of medical and nursing care.
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http://dx.doi.org/10.5172/conu.2012.43.1.38DOI Listing
December 2012

[Preliminarily application of content analysis to qualitative nursing data].

Hu Li Za Zhi 2012 Oct;59(5):84-90

Department of Nursing, National Taipei University of Nursing and Health Sciences, Republic of China.

Content analysis is a methodology for objectively and systematically studying the content of communication in various formats. Content analysis in nursing research and nursing education is called qualitative content analysis. Qualitative content analysis is frequently applied to nursing research, as it allows researchers to determine categories inductively and deductively. This article examines qualitative content analysis in nursing research from theoretical and practical perspectives. We first describe how content analysis concepts such as unit of analysis, meaning unit, code, category, and theme are used. Next, we describe the basic steps involved in using content analysis, including data preparation, data familiarization, analysis unit identification, creating tentative coding categories, category refinement, and establishing category integrity. Finally, this paper introduces the concept of content analysis rigor, including dependability, confirmability, credibility, and transferability. This article elucidates the content analysis method in order to help professionals conduct systematic research that generates data that are informative and useful in practical application.
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http://dx.doi.org/10.6224/JN.59.5.84DOI Listing
October 2012