Journal of Nursing最新文献

Population aging has become a prevalent societal trend in the 21st century, giving rise to intricate challenges for healthcare systems. Taiwan is expected to become a "super-aging society" in 2025. In 2020, the Health Promotion Administration, referencing World Health Organization (WHO) guidelines on integrated care for older people (ICOPE), began promoting person-centered functional assessments for older adults to prevent and delay disability, reduce reliance on formal healthcare, and promote healthy aging, aging in place, and active aging. Pingtung County faces a healthcare gap between urban and rural areas. To address this, the county's executive team integrated community and healthcare systems into a single Age-Friendly Health Network to help older adults self-detect intrinsic functional decline problems at an early stage and receive early treatment. The implementation of this network is being done in the following four phases: preparation, action, implementation and revision, and promotion. As of August 2024, ICOPE intake in the county reached 11,873, representing a coverage rate of 7.42%. In addition to inadequate training opportunities for community healthcare professionals, rural communities are currently confronted with a dearth of referral mechanisms for post-ICOPE screening aftercare services for anomalous cases, representing a significant challenge that demands collaboration between industry, government, academia, and research. In light of the expanding older adult population, community nursing can be a formidable undertaking, necessitating the provision of ongoing nursing professional training and psychosocial support.

Background: Obstructive sleep apnea (OSA) is a common sleep disorder shown to be significantly correlated with metabolic syndrome (MS). Healthcare professionals affected by both MS and OSA may suffer from poor sleep quality, raising potential concerns about patient safety. Currently, there remains a gap in research specifically addressing the relationship between MS and OSA in healthcare professionals.

Purpose: This study was conducted to examine the prevalence of employees with MS concomitant with OSA and to identify the factors of influence affecting MS employees with OSA in the workplace.

Methods: A cross-sectional study design and convenient sampling were used, and participants were recruited from a district hospital in northern Taiwan. Data were collected using a structured questionnaire and a home sleep apnea test. Multiple logistic regression analysis was used to determine the significant factors influencing OSA in employees with MS.

Results: A total of 89 participants completed the assessment, with 65.2% of those with MS also found to have OSA. The main factors found to be associated with these employees with MS having OSA as well include gender, job position, body mass index, neck circumference, waist circumference, oxygen desaturation index, and snoring frequency.

Conclusions / implications for practice: In light of the high percentage (65.2% in this study) of MS employees affected by OSA, regular health screenings should include a home sleep apnea test for high-risk employees to assess their risk of developing OSA. In addition, promoting a healthy lifestyle to improve MS and prevent OSA is needed.

Background & problems: Oral administration is the most common mode of medical treatment for pediatric patients. Although over 98% of the patients in the targeted pediatric unit require oral medication, the oral administration adherence rate in 2022 was 43.9%. The reasons for this low rate were identified as: (1) no relevant oral administration educational materials, (2) no relevant continued nursing education provided, and (3) lack of assistive tools and feeding aids to help administer oral medication to young children.

Purpose: This project was developed to increase the adherence rate of oral administration of preschool pediatric inpatients in our hospital.

Resolutions: The improvement strategies included the design of patient-centered oral medication care guidance leaflets and QR code (quick response code) video links, the development of therapeutic play aids, adding cartoon characters to medicine feeders, and the creation of a "Rescue the Forest" picture book and video and reward stickers.

Results: The oral medication adherence rate increased from 43.9% pretest to 91.9% posttest.

Conclusions: This project and its positive effect on the rate of oral medication adherence may be referenced by other pediatric units.

In line with global population aging, the number of lesbian, gay, bisexual, and transgender (LGBT+) older adults is expected to continue to increase. Compared to their heterosexual peers, LGBT+ older adults have poorer physical and psychological health status, experience less social support, and face more barriers when accessing healthcare services, which may lead to higher health disparities and a lower quality of life within LGBT+ older populations. Healthcare providers have been shown to be inadequately prepared to address the unique healthcare needs and challenges of LGBT+ older adults, often leaving these individuals forced to receive care that does not meet their health needs and expectations. Based on the Declaration on Universal Health Coverage proposed by the United Nations and the World Health Organization, medical care and long-term care facilities must provide to healthcare providers training courses in culturally competent care and foster LGBT-friendly care environments to achieve health equity and universal health coverage for LGBT+ populations.

Background: The process of aging is associated with the deterioration of normal body functions as well as lower health awareness due to a reduced ability to acquire and understand health-related information. The subjects of this study were older adults with diabetes mellitus living in community settings. Visual-learning-based Steno diabetes dialogue cards were used to strengthen the learning and knowledge absorption capabilities of the subjects to improve diabetes health knowledge and increase compliance with blood sugar control protocols to achieve blood sugar control goals and delay / reduce the severity of complications.

Purpose: This study was designed to assess the comparative effects of Steno diabetes dialogue cards and conventional health interventions on self-perceived health, health literacy, glycated hemoglobin (HbA1c) level, and fasting blood glucose level in older adults with diabetes.

Methods: An experimental study was conducted in an outpatient clinic of the department of metabolism in a hospital in northern Taiwan. The subjects were randomized into the experimental group (receiving the Steno diabetes dialogue cards intervention) and control group (receiving conventional health education). Individual health education interventions of 15-20 min each were conducted once a month for 3 consecutive months in both groups.

Results: There were 51 subjects in the experimental group and 47 in the control group, with an attrition rate of 10.91%. The changes in the experimental group and the control group before the intervention and three months after the intervention were analyzed, with significant between-group differences found in health literacy and self-perceived health (p < .001). The experimental group's three-month post-test scores were both greater than the pre-test. Significantly, there were significant, positive differences between pre- and post-test values for self-perceived health (p = .005), health literacy (p < .001), glycated hemoglobin (p < .001) and fasting blood glucose (p = .002). Moreover, the improvements were greater in the experimental than the control group.

Conclusions / implications for practice: The individual health education interventions improved glycemic control efficacy in all of the subjects. However, the experimental group showed more significant improvements in all measures. Therefore, Steno diabetes dialogue cards offer a clear benefit in enhancing older adults' knowledge regarding self-glycemic control and improving compliance with disease behaviors.

The intensifying trend of population aging has made geriatric healthcare a key concern for countries worldwide. According to the United Nations, the global elderly population is projected to increase to 1.6 billion by 2050 at which time persons above 65 years old are expected to account for 16% of the world's population (United Nations, 2023). To address this challenge, proactive and systematic approaches as well as innovative models are needed to implement practices, education, research, and policy measures (Mohd Tohit & Haque, 2024). Innovative healthcare models and policies are being continuously developed that address aspects such as interdisciplinary collaboration, diverse gender needs, talent cultivation, community assessment and management, and home-based emergency care. For the column in this issue, we invited experts from various fields of geriatric healthcare to share their significant developments and application experiences. Their articles highlight several key related points.

The concept of family management has gained increasing acceptance in the United States for over two decades and is today applied in care worldwide. However, this concept is still largely novel to clinical professionals in Taiwan. This article was written to present the history and current application of family management to promote greater recognition of the related opportunities and potentials in the nursing field. Understanding the family management style framework helps nursing professionals better grasp the dynamic situation in families while dealing with the primary health issues of patients. Awareness of adjustability and regulation of the family allows nursing professionals to understand and provide care to the entire family unit rather than to individual family members. Adapting family management measures and identifying the typology of family management may also be an efficient approach to conducting family evaluations and developing appropriate interventions. We reflect on these issues and offer suggestions on family management to inspire nursing professionals to pursue related research and clinical practicums to improve family nursing capabilities in the nursing field.

With population aging, dementia has become a significant global health issue. Most people with dementia live in the community, are cared for by family members, and face complex and multifaceted care challenges. In line with Taiwan's Long-Term Care 2.0 policy, the Integrated Dementia Care Centers now established in many hospitals and linked with dementia clinic systems at the local level provide home care consultations and referrals. However, the primary focus of these centers remains on basic health education and post-diagnosis resource referral services. Thus, they lack an interdisciplinary approach, making it difficult to offer tailored, integrated care for people with dementia and their families. Therefore, integrating care intervention strategies from various fields to provide tailored and continuous care services is important. This article explores existing domestic and international dementia care consultation modules, introduces the integrated "Dementia Interdisciplinary Care Consultation Module" developed by our team, and discusses the applicability of and offers recommendations regarding this module. The developed module is intended to serve as a reference resource for outpatient medical staff and dementia case managers during health education consultations, and may be adopted into the training materials used by dementia care professionals and referenced in future domestic dementia care policy formulation work. The overall goal is to enhance the efficiency of outpatient dementia care consultations by ameliorating / resolving issues such as resource fragmentation, poor coordination, and service overlap, thereby improving the quality of family care provided to people with dementia.

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.