Journal of Nursing最新文献

Background & problems: The nursing manpower shortage intensified during the COVID-19 pandemic. Moreover, inadequate clinical internship durations during this period led to recent nursing graduates reflecting insufficient clinical skills. These issues, coupled with the inherent complexity of work in intensive care units (ICUs), have increased stress and decreased self-confidence among new staff, leading to higher turnover rates.

Purpose: This study was designed to develop and then evaluate the effectiveness of a tailored ladderized training program for improving clinical care skills and self-confidence in new ICU staff.

Resolutions: An individualized ladderized training program for new staff was developed based on the conceptual PDDRO (plan, design, do, review, outcome) framework. In addition to the program, a 3-stage critical care training regimen was implemented to strengthen technical, physical assessment and judgment, and communication and teamwork skills. A multivariate evaluation approach was employed to evaluate the level to which participants improved in terms of clinical skills and self-confidence, and a competency-related personalized training model was used to guide their progress until all of the training goals were achieved.

Results: Fifty new staff members completed the 3-stage critical care training program. In terms of program effectiveness, mean scores increased from 79.3 (pretest) to 92.3 (posttest) for awareness and 1.69 to 2.53 for work competency self-confidence. These increases were significant, and indicated the participants had collectively improved from "some self-confidence" to "a lot of self-confidence". Moreover, the retention rate of new staff increased from 75% before the intervention to 84% afterward. Interviews with the participants found the program had improved their mastery of clinical care skills and confidence in their future ability to perform care tasks.

Conclusions: Advance implementation of ladderized training can facilitate the establishment of a new nursing staff training system in hospitals to improve the post-pandemic recovery and reconstruction of nursing manpower systems in Taiwan. This program may serve as a successful model for training new staff and retaining human resources as part of the ongoing effort to promote a stable and high-quality workplace environment for nurses.

Background & problems: Inappropriate urinary catheter use not only prolongs the length of hospital stays but is also associated with increased rates of mortality. The incidence rate of inappropriate urinary catheter use in our unit was as high as 44.6%, and the incidence density of catheter-associated urinary tract infection (CAUTI) was 3.6‱ from June to October 2022. The causes of inappropriate urinary catheter use in our unit were identified as: 1) healthcare professionals were not aware of the importance of catheter removal, 2) the lack of a reminder system for catheters, 3) the lack of a standard operating procedure for catheter removal, and 4) caregivers being unclear regarding the necessity of catheter use.

Purpose: This project was designed to reduce the incidence rate of inappropriate urinary catheter use to < 31%, and the incidence density of CAUTI to < 2.8‱.

Resolutions: Using team resource management through leadership; employing the watching, mutual assistance, and communication method; establishing a reminder system for catheters and a standard operating procedure for catheter removal; issuing guidelines for patient care after catheter removal; and conducting group education for catheters.

Results: The incidence rate of inappropriate urinary catheter use decreased to 16.7%, and the incidence density of CAUTI decreased to 1.9‱.

Conclusions: Conclusion: This project adopted the team resource management method and cooperated with healthcare professional and caregiver efforts to remove catheters. This project may be referenced as an effective means of reducing the risks of inappropriate urinary catheter use and CAUTI to enhance the safety of hospitalized older patients.

Cancer incidence is closely related to age. With the sharp increase in the elderly population in recent decades, the number of older adults with cancer has increased each year. Compared to middle-aged patients, older adults with cancer have relatively more-complex health problems during treatment, with aging, debilitation, comorbidities, cognitive dysfunction, and polytherapy important factors affecting the benefit received by these patients from their treatment. In view of the prevalence and particularities of cancer in the elderly population, health professionals must focus on individual needs in treatment and care as well as provide complete assessments and appropriate care plans to enable their safe and complete care management. Health professionals may use interprofessional teamwork and comprehensive geriatric assessments to understand the functional and cognitive statuses, comorbidities, nutritional status, treatment tolerance, and personal preferences of their patients and then provide care that meets their specific physical, mental, social and spiritual needs. In addition to having professional cancer care training, oncology care specialists should have professional knowledge of geriatric care to increase their sensitivity in assessing the needs of their elderly patients with cancer, provide treatment and care plans that meet their needs, and improve quality of care.

Background: After the Coronavirus disease 2019 (COVID-19) pandemic, international medical services have continued to flourish and reconfigure, leading to the current intense competition among medical institutions. Understanding loyalty in international patients and its related factors may be referenced and used to enhance loyalty among patients visiting a hospital, thereby enhancing the competitiveness of that medical institution.

Purpose: This study was designed to explore the significant factors that influence the loyalty of international patients.

Methods: The international medical services patient database of a northern medical center was used to extract information on patients who had received services from the international medical center between 2018 and 2022 (n = 3,325). Binary logistic regression analysis was used to calculate the increase in patient loyalty at each quartile, the estimated relative odds ratio (OR) of international patient loyalty, and its 95% confidence interval (CI). Potentially relevant factors controlled in the statistical model included: age, source of information from the unit, and total medical expenses.

Results: This study found that the level of international medical service patient loyalty to the target hospital averaged approximately 15.1%. International medical service patient loyalty differed significantly by age group (45-64 years old), using non-internet sources for information, and spending at least 1 million NT dollars on medical expenses (p < .001). The information source used (OR: 1.72; p < .001; 95% CI [1.33, 2.23]) and total medical expenses (OR: 4.56; p < .001; 95% CI [3.49, 5.95]) were identified as significant predictors of loyalty.

Conclusions / implications for practice: It is hoped the results of this study provide a reference for institutions to promote international medical services, improve international competitiveness, and demonstrate the quality of medical care provided in Taiwan.

The aging population in Taiwan increases the demand for care services for older adult patients with cancer, presenting significant challenges to both healthcare and social systems. Family caregivers perceive caregiver burden since they assist patients with daily activities, health management, and medical decision-making face physical, psychological, economic, and social stressors that impact their overall well-being. Taking care of older patients causes more complicated caregiving tasks because of the treatments and care related to cancer and multiple chronic conditions. Caregiver burden is known to be influenced by age, health, education, and disease awareness. Furthermore, in Taiwan, the participation of foreign spouses and migrant workers in family care increases cultural and resource-related challenges and highlights the need for integrated long-term care resources and social support. Using family caregiver assessments testing caregiver burden and quality of life can specify family caregiver needs that assist healthcare teams in developing family care plans. Interventions, including cancer education, psychological support, caregiving training, and collaborative models involving both patients and caregivers, may alleviate caregiver stress, improve quality of life, and enhance coping abilities. Moving forward, nursing professionals should advocate for integrated care models that incorporate comprehensive geriatric assessments and design interventions tailored to the specific needs of diverse family caregivers of older cancer patients. These approaches will help improve the quality of life for both caregivers and older cancer patients and foster a supportive care environment through interdisciplinary collaboration to address the health challenges of an aging society.

The treatment decision-making process used by elderly cancer patients is crucial because, with advancing age, patients experience a decline in physical function and often face multiple comorbidities, reducing their tolerance to cancer treatments and increasing toxic reactions. Therefore, in considering multiple factors such as treatment effectiveness, quality of life, and survival time, the treatment of elderly cancer patients must take into account individualized factors and utilize relevant assessment tools to help minimize treatment-related risks. However, understanding and assessing treatment decisions by nursing staff regarding elderly patients are issues that have rarely been discussed. Thus, in this paper, the principled considerations, challenges, and evaluation strategies related to treatment decision-making in elderly cancer patients are discussed. It is hoped that this paper will assist future clinical healthcare professionals to fully utilize the roles and functions of nurses in the treatment decision-making process when caring for elderly cancer patients. The objectives are to enhance understanding of the considerations and challenges specific to this demographic and to implement relevant assessment content in order to better guide treatment decision-making processes and positively impact the decisions made.

Increasing average life expectancy has been accompanied by a steady increase in the number of older patients with cancer. Notably, age-related declines in cognitive function are further exacerbated by cancer-related cognitive impairment in this patient population. Therefore, cancer-related cognitive impairment in older patients with cancer has attracted increasing attention, and care recommendations for this population are needed. The diverse factors affecting cognitive function present significant challenges for clinical healthcare providers and researchers caring for this population. In this article, the current status of cognitive dysfunction and its related factors in older patients with cancer are introduced and recommendations for clinical care and future research are discussed based on empirical evidence to provide appropriate clinical care and develop future interventions for older adults with cancer.

Background: The National Comprehensive Cancer Network recommends qigong as an aerobic exercise for reducing cancer-related fatigue in breast cancer survivors. However, findings regarding the effects of qigong on cancer-related fatigue, sleep disturbance, cognitive impairment, and quality of life in this population remain inconclusive and contradictory. Further study is warranted to better understand the impact of this exercise.

Purpose: The aim of this study was to assess the effects of qigong on cancer-related fatigue, sleep disturbance, cognitive impairment, and quality of life in breast cancer survivors using a systematic literature review and meta-analysis.

Methods: The search of the literature was conducted in accordance with PRISMA 2020. The databases searched included PubMed, EMBASE, Cochrane Library, CINAHL, and Airiti Library, and relevant articles published between inception and March 2024 were retrieved systematically. The quality of the retrieved articles was assessed using the Risk of Bias 2.0 tool, and statistical analyses were performed using Comprehensive Meta-Analysis Version 2.0.

Results: Eight randomized controlled trials with a total of 469 participants were analyzed. Qigong was shown to significantly reduce cancer-related fatigue (SMD = -0.86, 95% confidence interval, 95% CI [-1.24, -0.48], p < .001) and sleep disturbance (SMD = -1.03, 95% CI [-1.36, -0.69], p < .001) and to improve overall quality of life (SMD = 0.59, 95% CI [0.27, 0.92], p < .001).

Conclusions / implications for practice: Qigong exercises that include specific "moving meditation" and "dynamic posture" components and are performed for session durations of 60 to 90 minutes with 3 to 5 sessions per week for a period of 8 to 12 weeks may reduce cancer-related fatigue and sleep disturbance in survivors of breast cancer. Furthermore, the overall effects of these improvements were shown to enhance survivor quality of life.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of oxaliplatin in colorectal cancer patients that may impact both physical and mental well-being significantly. When Western medical care alone is unable to satisfy patient needs, integrative care combining traditional Chinese and Western medicine approaches is an alternative option. This article shares the integrative care experience of a post-operative rectal cancer patient who suffered from chemotherapy-induced peripheral neuropathy. An intervention that followed a holistic assessment approach in traditional Chinese medicine (TCM; i.e., observation, auscultation, inquiry, and pulse feeling) combined with listening and communication was conducted between April 11th and May 27th, 2022. The patient's health problems were identified as chronic pain syndrome, sleep disturbances, and death anxiety. During the caring process, evidence-based practices were applied, the scientific literature was systematically reviewed using an evidence-based approach, and an integrative care plan was developed in collaboration with the medical team. Exercise, acupuncture, aromatherapy massage, music, and auricular acupressure therapies were administered to reduce the severity of the patient's health problems. It is hoped that this experience combining evidence-based knowledge with integrative care offers a reference for providing alternative patient care in a broad range of clinical settings.