Journal of Nursing最新文献

Background: Poor disease control in patients with chronic obstructive pulmonary disease (COPD) is associated with suboptimal inhaler use.

Purpose: This study was designed to explore the accuracy of inhaler use and related factors in elderly patients with COPD.

Methods: A cross-sectional survey design was used to recruit patients with COPD from a medical centre in southern Taiwan who were over 65 years old and used inhalers regularly. All of the data as well as information on inhaler use accuracy were collected using a self-designed questionnaire and inhaler operation checklist. Multivariable logistic regression was used to analyse significant correlates of correct inhaler operation.

Results: The average age of the 150 participants was 75.0 years (SD = 7.5) years. Most used one type of inhaler only (86.0%). The rate of accurate inhaler operation was 40.7% (n = 61) for the sample, with dry powder inhalers associated with the highest accuracy (64%) and pressurized metered-dose inhalers associated with the lowest accuracy (1.6%). Multivariate logistic regression analysis showed that using a soft mist inhaler (adjusted odds ratio, AOR = 23.29; 95% confidence interval, 95% CI [2.84, 191.07]), using a dry powder inhaler (AOR =15.60, 95% CI [1.99, 122.26]), and higher satisfaction with the inhaler were positively and independently associated with accurate inhaler use (AOR = 1.94, 95% CI [1.09, 3.44]).

Conclusions / implications for practice: Important factors related to inhaler use accuracy include inhaler type and level of patient satisfaction with their inhaler. Healthcare professionals should regularly confirm that older patients are able to use their inhalers correctly and are satisfied with their inhalers.

The COVID-19 pandemic led to significant burnout among nurses, resulting in a shortage of nursing staff. Issues related to nursing work have received significant attention recently, and only healthy nurses are capable of providing good quality patient care. The authors employed Bronfenbrenner's Ecological System Theory to analyze the impact of the COVID-19 pandemic on nurses and proposed specific strategies and recommendations to enhance the nursing workplace. Under the Ecological System Theory, several factors, including inadequate preparedness, dangerous working environment, work-family conflicts, discrimination due to public panic, and health damage, contribute to nurse burnout. Whether during or after the COVID-19 pandemic, it is necessary to provide education programs to enhance the professional abilities of nurses, foster policies that promote a positive practice work environment, implement a triage system based on the severity of patients, elevate the image of the nursing profession, monitor the health of nurses, and advocate for transformational leadership. The nursing workplace should help nurses gain greater confidence and improve their ability to handle various workplace challenges. In the future, medical institutions should provide a better work environment for nurses and expect the public to pay more attention to the development of the nursing profession.

The most direct challenge to the healthcare system in Taiwan associated with population aging is the chronic and growing shortfall in medical and nursing practitioners. The integration of artificial intelligence, Internet of Things, and advanced 5G communication technologies is making healthcare more streamlined and intuitive to improve healthcare service efficiency, encourage cross-disciplinary cooperation to improve patient health management, and introduce and mainstream innovative service models such as telecare. To this end, the wearable smart cardiac care system 'Vipasyana', jointly developed by the interdisciplinary research team of the Departments of Electrical Engineering and Computer Science at National Yang Ming Chiao Tung University, not only has an innovative fully functional wireless wearable electrocardiograph but also uses machine learning-based detection/prediction methods to detect and monitor for emergencies such as myocardial infarction, ventricular tachycardia/ventricular fibrillation, and heart failure. To handle the real-time streaming sensing data generated during clinical trials, a big data real-time streaming framework based on Apache Storm and microservices has also been integrated. In addition, a mobile phone app and virtual reality 3D ward round system providing a user-friendly management and monitoring tool for medical staffs were developed and integrated into the system. The 'Vipasyana' system is capable of providing precision medical services to individual patients.

A nursing experience supporting parents experiencing anxiety related to their 26+2 weeks preterm infant on continued ventilator assistance at home due to bronchopulmonary dysplasia is described in this article. Data were collected from March 21st to June 1st, 2021 via observation, interviews, clinical care, medical record reviews, and discharge preparation services. A holistic nursing assessment identified the main health issues as: gas exchange disorder, inefficient infant feeding patterns, and caregiver role stress. The parents were encouraged to participate in care activities, create individualized discharge plans, and view health education videos and caregiving skill demonstrations. Kangaroo care, comfortable positioning and soothing techniques were used to stabilize the emotions of the infant and to strengthen the parent-child bond. Psychological support was provided to alleviate parental anxiety and to enhance parenting ability and confidence. This experience supports the importance of tailoring clinical care to individual needs, adopting a family-centered approach, assessing family interactions, and making early preparations to obtain appropriate continuous care after discharge to ensure proper continuum of care.

Background: During the COVID-19 pandemic, visitation restrictions in line with infection control policies curtailed opportunities for family members to learn essential caregiving skills in the intensive care unit. This limitation decreased satisfaction among family members, possibly indicating their increased difficulties in care due to the lack of face-to-face guidance. Thus, increasing family member understanding of and ability to apply learning content without direct interaction presents a significant and urgent challenge. Moreover, because of lack of caregiving confidence, some family members may be reluctant to facilitate the discharge of critically ill patients, causing delays in discharge planning. These challenges underscore the obstacles faced by nursing health education during the pandemic.

Purpose: This study was designed to utilize cloud technology to enhance the knowledge and skills of families caring for infants with congenital heart disease at home and to assess their satisfaction with the associated homecare learning platform.

Resolution: Based on our hospital's cloud-based health education platform, a series of personalized instructional video materials was developed for families of infants with congenital heart disease. These materials cover comprehensively the entire treatment process, from diagnosis to post-discharge home care skills, for these patients. To facilitate autonomous learning, the videos in this series were made accessible to the families anytime, anywhere via personal devices such as smartphones and tablets. Concurrently, a chatbot tool was integrated to provide guidance on inpatient care for infants with congenital heart disease, including fundamental aspects of newborn care, with the aim of equipping parents and caregivers with the knowledge and skills necessary to provide basic post-discharge care. To ensure the families acquired personalized care skills, after completing the learning modules, practical bedside training sessions incorporating knowledge and skills assessments were organized for family members.

Results: After project implementation, the average knowledge score for family members increased significantly from 79.1 to 100 (perfect score). The proportion of family members proficient in executing caregiving techniques autonomously also rose impressively from 30% to 95%. Furthermore, average overall satisfaction with cloud-based technology-assisted caregiving learning among the family members rose 31.4% from 3.5 to 4.6.

Conclusions: This project represents a viable solution to providing clinical nursing guidance independent of the constraints of time and location, and effectively enhances homecare-skill-related learning outcomes in family members, especially with regard to caring for infants with congenital heart disease.

Background: Thirst is a common symptom among patients with endotracheal intubation in the intensive care unit (ICU), with an estimated prevalence of 88%.

Purpose: This study was designed to compare the effectiveness of cold saline spray and cold water spray in alleviating thirst, and to explore the maintenance and sustained effects of both groups in relieving thirst among patients with endotracheal intubation in the ICU.

Methods: Patients with indwelling tracheal tubes in the medical ICU were recruited from one medical center in northern Taiwan and randomly assigned to either the cold saline (n = 18) or cold water (n = 18) group. The cold saline group received three rounds of cold saline spray at a temperature of 2°C - 8°C. Each round consisted of 10 sprays directed toward each of the four surfaces of the oral cavity followed by a 5-minute wait period. This process was repeated three times, with 30-minute intervals between interventions. The cold water group received the same intervention steps using a cold water spray at 2°C - 8°C. Thirst intensity was measured using a numeric rating scale before and after each of the three interventions in both groups. Demographic and relevant physiological data were collected on the participants by reviewing their medical records.

Results: Both of the interventions were found to effectively alleviate thirst intensity, with no significant difference between the two groups in terms of thirst intensity reduction after each intervention detected. Only the cold water spray had a maintenance effect, while the two groups had a continuous sustained effect in alleviating thirst intensity.

Conclusions: Both of the interventions effectively alleviated thirst, and the cold water spray had both maintenance and sustained effects in alleviating thirst intensity. Based on the results, the cold water spray method may be considered as the priority treatment for thirst alleviation by healthcare providers in the clinical management of patients with tracheal intubation.

Background & problems: FloTrac is used to monitor hemodynamics in patients. Insufficient awareness of and inexperience with this machine put patients at risk.

Purpose: A project was developed to increase FloTrac cognitive accuracy from 57.6% to 85% and skill accuracy from 73.3% to 91% in ICU nurses. Also, FloTrac installation time was intended to be reduced to less than 8 minutes and 38 seconds.

Resolution: Create a pithy, easy-to-remember formula; make operation teaching videos, operation manuals, and reminder cards; arrange educational training; and monitor quality regularly.

Results: FloTrac cognitive accuracy increased from 57.6% to 90.4%; FloTrac skill accuracy increased from 73.3% to 99.7%; and installation time was shortened from 8 minutes and 38 seconds to 5 minutes and 42 seconds.

Conclusions: After implementation of the project, nurses improved their professional knowledge and were better able to help doctors obtain hemodynamic data efficiently to provide patients with accurate and rapid treatment.

Background: The multiple symptoms of Sjögren's syndrome lead patients affected by this disease to seek medical advice from different medical disciplines and specialists. Diagnoses are often made many years after initial onset, resulting in mental and physical exhaustion and misunderstandings.

Purpose: This study was designed to explore the health-seeking experiences of patients with Sjögren's syndrome.

Methods: Qualitative research methods and purposive sampling were used. Fourteen patients with Sjögren's syndrome were interviewed by the first author, and the collected data were analyzed using content analysis.

Results: Four themes were revealed from the data, including: (1) distressing symptoms; (2) difficulty in diagnosis; (3) concerns about drug side effects; and (4) facing the disease. The participants initially sought medical attention when they began experiencing early onset symptoms that caused discomfort or annoyance. Their doctors' failure to provide proper diagnoses during the long health-seeking process caused a great deal of suffering to the participants. Although related medications should be taken for life, the participants reported taking lower-than-prescribed dosages out of fear of side-effects. The participants explored their process of coping with the disease, which began with denial and ended with acceptance. By learning from their health-seeking process, participants realized that they needed to take proper care of themselves, adapt to life with their disease, and control related symptoms.

Conclusions / implications for practice: To facilitate the early diagnosis of Sjögren's syndrome, healthcare professionals should improve their awareness of this condition and refer patients with related symptoms to rheumatologists and immunologists. Effective early diagnosis and treatment can help these patients reduce the time and effort involved in unproductive doctor's visits, allowing them to better continue as productive members of society and to maintain a good quality of life.

Background: Approximately 70% of postpartum women in Taiwan choose postpartum care institutions for their postpartum confinement. However, few studies have explored the follow-up relationship between confinement location and, respectively, maternal psychological and role adaptation.

Purpose: To explore the differences in psychology and maternal role adaptation between postpartum women in two different confinement locations and to analyze the predictors of maternal confidence and maternal competence at six-months postpartum.

Methods: A comparative and follow-up research design was adopted. We recruited a convenience sample of two groups of women confined, respectively, at postpartum nursing centers and at home. One hundred fifty-seven mothers recruited after G-power estimation were enrolled as participants and completed demographic data and six scales at one-week, one-month, and six-months postpartum. The statistical analysis was performed mainly using generalized estimating equations.

Results: For all participants, maternal confidence was positively associated with time, being multipara, having religious beliefs, and having better mother-infant bonding (p < .05). In addition, being confined at home, being unemployed, having religious beliefs, perceiving lower levels of stress and depression, having better sleep quality, and having better mother-infant bonding were associated with higher maternal competence (p < .05).

Conclusions / implications for practice: Based on the findings of this study, postpartum nursing institutions should actively promote strategies to improve maternal competence to help mothers staying in postpartum nursing centers strike an optimal balance between recuperation and parenting preparation. Furthermore, obstetric health professionals should implement policies related to mother-infant bonding to increase maternal confidence and competence and, subsequently, facilitate maternal role adjustment.

This case involved a 17-month-old toddler with Cohen's syndrome and cerebral palsy who had experienced multiple hospitalizations and operations since birth. During hospitalization, the patient suffered from tracheomalacia and poor swallowing and coughing abilities and had experienced two cardiopulmonary resuscitation events, after which a tracheotomy was suggested. Decision-making regarding the tracheotomy placed the mother under tremendous pressure, who was facing both the life-threatening disease of her son and her burden of care. During the nursing care period from 19th September to 6th December 2022, the author identified the main nursing problem as "decision-conflict: decision-making in relation to tracheotomy procedure" and distinguished the nursing process into (1) escape period, (2) conflict period, and (3) coping period after decision-making. Adopting the ten carative factors in Watson's Caring Theory as the core of her care approach, the author was able to establish a mutually trusting relationship with the mother and to understand her needs by means of listening, consistency, and empathy. This involved providing sufficient information and holding family meetings to facilitate communication in combination with palliative medical resources to provide follow-up care support as well as helping the family find meaning in their lives.