[[alternative]]A Study on the Use of Objective Structured Clinical Examination for Communication Competency Assessment for Nurses

[[abstract]]本研究旨在探討出院準備情境模擬溝通教學介入後，護理人員之溝通能力、溝通自我效能、客觀結構式臨床測驗評量與學習滿意度之成效探討。採實驗性研究設計(experimental design)，以台北市某醫學中心N0~N2護理人員為研究對象，共78人；實驗組40人接受情境模擬溝通教學課程，控制組38人採傳統課室案例討論教學；研究工具包括：溝通能力查檢表、溝通自我效能評量表、學習滿意度問卷及客觀結構式臨床測驗評量(出院護理指導查核表及標準化病人回饋表)。在教學課程介入前後，兩組皆接受前後測，介入後4週進行客觀結構式臨床測驗評量。以SPSS17.0電腦統計套裝軟體進行資料分析，包括描述性統計分析(次數分配、百分比、平均數與標準差)及t-tests、ANCOVA、Mann-Whitney test等統計方法。研究結果顯示：(一)溝通教學介入後，控制組與實驗組於溝通能力查檢表及溝通自我效能評量表前後測得分有顯著差異。(二)溝通教學介入後，控制組與實驗組於溝通能力查檢表及溝通自我效能評量表得分有顯著差異，且實驗組高於控制組。(三)溝通教學介入後，控制組與實驗組於學習滿意度得分有顯著差異，且實驗組高於控制組。(四)溝通教學介入後，控制組與實驗組於客觀結構式臨床測驗評量之考官評量得分有顯著差異，且實驗組高於控制組；但標準化病人評量得分無顯著差異。未來研究建議可將客觀結構式臨床測驗評量擴大至其他依實務設計不同情境教案之護理能力評量，並可進行長期追蹤及質性研究。[[abstract]]This study evaluated the effectiveness of a simulation-based intervention on enhancing nurse communication performance and communication self-efficacy in discharge planning process. The effects of the intervention on the results of an Objective Structured Clinical Examination (OSCE) assessment and a learning satisfaction survey administered to nurses were also evaluated. In this experimental design study, a total of 78 nurses within the nursing ladder N0-N2 were recruited from a major hospital in Taipei City. The experimental group (40 nurses) was given the simulation-based intervention. 38 nurses in the control group attended traditional lectures on communication. The Communication Skills Checklist, Communication Self-Efficacy Scale, Learning Satisfaction Survey, and OSCE (Discharge Checklist for Nurses and Standardized Patient Survey) were used as assessment tools for communication performance and learning satisfaction evaluation. Both groups were measured before and after the intervention. The OSCE was administered to both groups in the fourth week of intervention. Data were analyzed using SPSS 17.0, descriptive statistics (frequency distribution, percentage, mean, and standard deviation), t-tests, ANCOVA, and Mann-Whitney test. Results revealed (1) the mean scores for communication skills and communication self-efficacy for both groups showed statistically significant differences before and after intervention. (2) Significantly higher mean scores for communication skills and communication self-efficacy were seen in the experimental group compared with the control group. (3) Significant differences were found in the mean learning satisfaction scores for both groups before and after intervention, with the experimental group having higher scores. (4) Significant differences were found in mean OSCE scores for both groups before and after intervention, with the experimental group having higher scores. However, no significant differences were found in mean assessments scores from standardized patients. Further long-term follow-up or qualitative research may be conducted to investigate the use of OSCE for other types of nursing competency assessment

[[alternative]]A Study of Need Assessment to Professional LearningWeb of Nursing Stations in a Hospital

[[abstract]]台灣已進入資訊化時代，醫院利用網路進行醫護人員專業學習，以提升病人照護品質，但受到醫療環境變遷及疾病的複雜化下，護理工作是日趨繁雜與忙碌，為了能便利護理人員工作、學習、及搜尋業務所需，規劃護理人員病房專屬學習網站是刻不容緩。本研究在探討護理人員心目中理想護理站專業學習網之內涵與功能，及了解不同背景護理人員對護理站專業學習網需求之差異性。本研究為描述性及相關性研究設計(descriptive and correlation study design)，採橫斷式調查法 (cross-sectional survey)，以某一醫學中心護理人員為調查對象，發出600份問卷，有效回收571份，回收率96%。以SPSS 15.0 for windows進行描述性統計，以次數分配、百分比、平均數及標準差說明個人背景資料，並以推論性統計，t-檢定、ANOVA、皮爾森積差相關及迴歸，分析變項之差異、相關及解釋力。護理站專業學習網需求評估之整體重要性平均4.02, SD= 0.41，整體需求性平均4.0, SD= 0.42，相關係數0.868，呈正相關。護理站專業學習網的需求前五項內涵為：疾病照護常規注意事項、藥物查詢、檢查準備事宜、侵入技術流程及診斷醫學名詞。需求預測因子有「服務科別」與「工作年資」，可解釋變異量為3.4%。本研究結果指出護理人員對護理站專業學習網有需求度，大致與病人照護有關，建議護理主管應規劃護理站專業學習網，以利護理人員資訊搜尋，提升病人照護安全。[[abstract]]Following the advent of the electronic era, hospitals in Taiwan have been using the internet as a tool for the professional development of doctors and nurses to enhance the quality of patient care. However, changes in the medical environment and the increasing complexity of diseases have made it necessary for nurses to have multitasking skills to juggle their busy schedules. This has created a demand for a professernal learning website which allows nurses to look up and search for information and case files. This study aims to explore a group of hospital nurses’ demand for access to a professional learning website at nursing stations in a hospital and understand the differences of nursing stations’ learning websites required by nurses with various backgrounds.This is a descriptive and correlational study design using cross-sectional survey. This is a descriptive and correlational study design using cross-sectional survey. There were 600 questionnaires sent out and 571were returned completed. The return rate was 96%. The suite software SPSS 15.0 for windows is employed for descriptive statistics and uses frequency distribution, percentage, mean and standard deviation to explain the distribution result of variables between personal backgrounds. Inferential statistics, including the approach of t- test, ANVA, Pearson’s correlation, and regression is also utilized to analyze variables’ differences and correlation, and explanation power of variables.The mean importance score for the professional learning website is 4.02, SD = 0.41. The mean demand score for the professional learning website is 4.0, SD = 0.42. The correlation coefficient is 0.868, suggesting a positive correlation and showing that more substantive website contents are more in-demand. The top five most in-demand website contents rated by the nurses are as follows: guidelines for standard medical care for common diseases, common medication information, preparation procedures for common physical examinations, procedures for common invasive treatments, and common diagnostic medical terms. Prognostic factors include the department at which the nurses work and the length of their service (in years). Proportion of variance explained is 3.4%.Most of the nurses need the professional learning website for looking up information to take care of patients. Therefore, hospitals should build a website as soon as possible for nurses to look up information to ensure the quality of patient care

[[alternative]]Chemotherapy Toxicity in Non-Small Cell Lung Cancer Patients

[[abstract]]摘 要肺癌，尤其是非小細胞肺癌，是台灣及多數的歐美國家的重要健康問題。化學治療雖為治療非小細胞肺癌的重要方法，然而關於病患接受化療後的副作用，尤其是肝、腎或骨髓毒性的發生機率及影響因素等，在台灣或國外並無系統性的研究。本研究的主旨即在於描述非小細胞肺癌病患接受化療後的毒性反應發生比率，並探討其相關影響因素。本研究之對象為北部某醫學中心於2008年1月 1日至2008年12月31日間就醫之新診斷非小細胞肺癌病患，經該院之癌症登錄計畫登錄在案且接受靜脈注射化療者。病患經篩選確認後，即在該院之次級資料庫中以回溯性方式擷取其人口學、疾病及化學治療的相關資料，以及骨髓、肝及腎毒性反應相關數據。資料之分析以SPSS17.0版本統計軟體進行，先依資料類別描述病患與治療之狀況，再依化療週期先後描述其依NCI-CTCAE方式分級之肝、腎及骨髓毒性發生情形，並比較化療前後毒性之差異；最後以卡方檢定與二元Logistic 回歸探討影響毒性發生的因素。在178位可分析的病患中，發生任一肝、腎或骨髓嚴重毒性(Grade 3-4 毒性)之機會為32.0% (57/178)；其中以骨髓嚴重毒性(26.0%, 46/177)最多。腎嚴重毒性發生的機會意外的少，僅有0.6% (1/170)；肝功能嚴重毒性則可見於10.6% (18/170) 的病患。在迴歸檢定中，影響任一肝、腎或骨髓嚴重毒性發生的重要因子為給予platinum類或etoposide 藥物，以及化療前血液相異常的存在。只有化療前肝功能的異常對影響肝功能嚴重毒性的發生有邊緣性統計影響；而處方中含platinum類或etoposide 藥物，以及化療前的異常血液相則對骨髓嚴重毒性的發生有顯著影響。由上述數據可知，非小細胞癌病患接受化療後，嚴重骨髓毒性的發生最為常見，腎嚴重毒性的發生率低；而影響肝、腎或骨髓嚴重毒性發生的重要因素為化療處方之藥物(如etoposide 及platinum類藥物)及化療前的異常血液相。本研究的這些分析能幫助醫護人員針對這些毒性發展照護措施，幫助病人在接受化學治療的過程中能得到確切適當的照護，以提升病人的生活品質。[[abstract]]Background: :Lung cancer, especially non-small cell lung cancer(NSCLC), is a major problem for public health in Taiwan and many developed countries. Although chemotherapy is now an important modality to treat NSCLC, there is, however, no systemic investigation about the incidence and influencing factors for its adverse effects, especially about the toxicities of kidney, liver and bone marrow.Purpose: This study was aimed to describe the incidence of renal, hepatic and hematologic toxicities for NSCLC patients receiving chemotherapy, and also to explore the possible related factors. Methods: We enrolled all patients who were newly diagnosed to have NSCLC between Jan 1st, 2008 to Dec 31st, 2008 and registered to the Cancer Registry Project in one of the medical centers in north Taiwan, but only those who had received intravenous chemotherapy were subjected to further analysis. The data of epidemiological parameters, disease-related and chemotherapy-related factors, and renal/hepatic/hematological laboratory results for these patients were retrospectively extracted from the database in the medical center. The data was analyzed by SPSS 17.0 statistics software. The patient characters were first described by category, and the toxicities were then stated according to NCI-CTCAE grading. Finally, Chi-square test and binary Logistic regression were applied for exploring possible influencing factors. Results: In 178 analyzable patients, the incidence of any toxic events, i.e., grade 3-4 toxicities, was 32.0% (57/178). The incidence of hematological toxic event was highest (26.0%, 46/117). The hepatic toxic events was noted in 10.6% (18/170) of patients, and the incidence of renal toxic event is surprisingly as low as 0.6%(1/170). The significant influencing factors for any toxic events in Logistic regression were the use of platinum drugs, the use of etoposide, and pre-chemotherapy hematological abnormalities. In regression, only pre-chemotherapy abnormal liver functions had marginally impact on the incidence of hepatic toxic events, and hematological toxic events were easily happened in cases with etoposide or platinum-drugs in their chemotherapy, and also in cases with pre-chemotherapy abnormal hematological profiles. Conclusion: This study is the first one to explore the hepatic, renal and hematological toxicities in treating NSCLC in Taiwan. These data will help medical staffs to develop proper strategies to prevent toxicities, so that medical care could be given and the quality of cancer patient care could be improved

[[alternative]]Effectiveness of Father-Neonate Skin-to-Skin Contact on Attachment and Perception of Fatherhood

[[abstract]]研究目的：探討父親執行肌膚接觸後對父子依附關係及父育知覺的影響。研究方法：研究對象為北部某區域教學醫院與北部某婦產科診所，所出生之新生兒的父親，採實驗性研究隨機分派83位個案至實驗組（n＝41）與控制組（n＝42）。控制組採目前一般常規照護模式，實驗組除採一般常規照護外，陰道產及剖腹產皆於產後連續三天，接受至少15分鐘的父嬰親子肌膚接觸之介入措施。兩組個案於介入措施前、產後第三天進行父子依附量表及父育知覺量表問卷測試。資料以描述性統計、獨立樣本t檢定、配對樣本t檢定、卡方檢定進行推論性統計分析，以單變量分析法分析可能干擾介入措施效果的人口學、產科學資料，再以ANCOVA探討在調整干擾變項後，介入措施對父子依附關係、父育知覺的成效。 研究結果/結論：實驗組在父子依附關係前後測得分的改變量，相較於控制組有顯著上升，且達統計上顯著差異；兩組於父育知覺前後測分數皆達統計顯著差異，亦即隨著產後天數的增加，父育知覺有增加的情形。在調整干擾變項後，研究結果發現：此介入措施確實有助於新生兒出生後三天，對於父子依附關係的提升具有效果，但對於父育知覺卻不具統計上之顯著差異性。臨床實務應用：因產後新生兒最佳的子宮外生理適應，是藉著與父母間的接觸來促進，故專業之護理人員/助產人員在婦女產後住院期間，可藉由護理指導單張及實地示範協助父親參與對新生兒的照護，以增加父親與新生兒正向的互動經驗，並建立起育兒的信心。[[abstract]]Purpose: This paper explored the impact of skin-to-skin (STS) contact on the father-neonate attachment relationship and perception of fatherhood. Methods: We recruited fathers of neonates delivered at a regional teaching hospital and local obstetrics clinic located in northern Taiwan as participants. An experimental research design randomly assigned the 83 participants into either the experimental group (n = 41) or control group (n = 42). Participants in the control group received only standard postpartum routine care. The experimental group received 15-minute father-neonate skin-to-skin contact interventions for 3 consecutive postpartum days in addition to standard postpartum routine care. All participants completed the Father-Neonate Attachment Questionnaire and Perception of Fatherhood Questionnaire instruments both immediately prior to the intervention and on the third postpartum day. Descriptive statistics, independent sample t-test, paired samples t-test, chi-square test for inferential statistical analysis, and univariate analysis methods assessed the effectiveness of the intervention procedure on father-neonate attachment and perception of fatherhood. Finally, ANCOVA was used to control for potentially confounding effects. Results/Conclusion: After adjusting for confounding factors, this study revealed that the intervention had a positive effect on attachment. Participants in the intervention group earned higher post-intervention questionnaire scores than their control-group peers, indicating a stronger father-neonate attachment relationship. We found a non-significant difference between the groups in terms of fatherhood perception. Further, we found that perception of fatherhood increased with the number of postpartum days in both groups.Clinical Application: The authors suggest developing instructional leaflets or providing field demonstrations to encourage neonatal fathers to contact and care for their newborns and increase the confidence of these fathers in providing neonatal care

[[alternative]]A study of marital conflict strategies, young children’s emotional regulation and interpersonal relationship.

[[abstract]]本研究主要目的在探討夫妻間婚姻衝突因應策略對年幼子女情緒調節及人際關係的影響。以台北市幼兒園所4～6歲的幼兒及其母親為研究對象，依行政區抽樣後進行家長問卷調查及幼兒照片式社交計量，有效樣本為322對親子。研究結果顯示，幼兒母親最常使用「理性溝通」因應婚姻衝突；母親的情緒智力越佳時，越常採用「理性溝通」和「委婉懷柔」的衝突因應策略，其子女的情緒調節表現及親子互動關係也越佳。相反地，若母親經常採用「嘮叨爭吵」、「傷己傷物」的衝突因應方式，子女的情緒調節和親子互動關係較差。幼兒情緒調節及人際關係以女性幼兒表現較佳，與是否為獨生子女則無關聯。整體而言，親子互動關係對幼兒情緒調節的預測力最高，而情緒調節良好的幼兒較受歡迎。[[abstract]]The main purpose of this study is to explore the effects of marital conflict strategies on young children’s emotional regulation and interpersonal relationships. The sample was 322 children from 4 to 6 years of age and their mothers from kindergartens and preschools of Taipei city. Mothers completed a questionnaire while children were assessed using the picture-board sociometric interview. Results show that mothers of young children used “reason appeal” strategy most often when having marital conflict. Mothers’ emotional intelligence was positively correlated with their use of “reason appeal” and “roundabout appeal” strategies, their children’s emotion regulation as well as parent-child interaction. On the other hand, mothers who reported using more “nagging” and “self-harm” strategies dealing with marital conflict had children scored lower in emotion regulation and less positive parent-child interaction. Girls scored higher in emotion regulation, were more popular and less likely to be rejected. There was no difference in children’s emotion regulation and interpersonal relationships between only children and non-only children. In all, parent-child interaction was a strong predictor of children’s emotion regulation and children who scored higher in emotion regulation were more popular

[[alternative]]Using Exploratory Data Analysis Approach to develop Cardiovascular Disease Prognosis Models for Clinical Decision Assistance

[[abstract]]本研究是以心臟血管疾病為範圍，針對資料探勘中的分類問題做為研究主軸，希望以探索性資料分析技術，發展出一套合理與有效的臨床輔助預知模型(Prognosis model)。方法為：使用子集合屬性選擇(subset attribute selection)演算法做為特徵選取，以基本模型(base model)方法與集成方法(ensemble methods)的計算結果做比較。當中，基礎模型，選擇以人工智慧類神經網路(Artificial Neural Network)、支援向量機(Support Vector Machine)、決策樹(Decision Tree)等方法為主。接著以組合異質模型的方式，來建立心臟血管疾病術後的預測模型。研究結果為：發展出之模型在準確度，或者是AUC(Area under the Receiver Operating Characteristic curve)上，有顯著之效能改善。結論為：本研究所建構出的預知模型，用於心臟血管疾病診斷來說，具有良好自動化之預期效能。其可應用於決策支援系統，用於提供外科醫師作為診斷預測術後的併發症(Como3)、術後病人在加護病房的時間(T_ICU)、術後住院時間(Length of hospital stay)、術後第1次心臟超音波檢查的左心室功能(Echo 2 Lvef)、術後心臟的分類等級(Alive_Fc)的參考。[[abstract]]This study focuses on using exploratory data analysis to develop cardiovsacular disease prognosis models for making clinical decisions. Method: used the subset attribute selection as the feature selection algorithm, and compared the prognosis models performance by using base model methods and ensemble methods. For the basic models, we choose Artificial Network Neural intelligence (ANN), Support Vector Machine (SVM), and Decision Tree (DT) as the main test models; followed by using ensemble method to build a prediction model for post-operative cardiovascular surgery. The results have shown significant improvements in the accuracy of the prediction model, and in the AUC (Area under the Receiver Operating Characteristic curve). Conclusion: the post-operative prediction model for cardiovascular disease diagnosis constructed by our study has shown satisfactory prediction ability. It can be used in decision analysis system to assist surgeons in predicting Como3, T_ICU, length of hospital stay, Echo 2 Lvef and Alive_Fc

Health Promotion Behaviors of People with Diabetes in Kiribati

[[abstract]]The purpose of the study is to investigate health promoting behaviors of diabetes patients in Kiribati. A descriptive and correlational study was conducted in a convenience sample of 111 adults with type II diabetes. Participants were recruited from the only diabetic clinic located in the capital atoll of Kiribati. HPLP II questionnaire was used to assess health promoting behaviors of people with type II diabetes. The results showed that participants were not engaging in health promoting behaviors on regular basis. Marital status, number of hospitalization, health in general, comorbidity, smoking history, routine measurement of blood glucose, routine taking of medication, and received advises from doctor/nurse to watch diet, lose weight, and do more exercise were significantly associated with health promoting behavior participation. The study suggested that health care professionals should develop health promoting programs that tailored to fit the individuals’ priorities, resources, culture and lifestyle

[[alternative]]An Investigation on Environmental Loads and Tourism Impact of Green Island

[[abstract]]本研究主要探討綠島地區環境負荷量及居民對於觀光衝擊經濟、社會文化、環境加上健康四構面之衝擊認知情形。在環境負荷量部分，研究結果發現：(1)遊客至綠島地區旅遊交通、住宿及遊憩活動的耗能，以交通所佔的耗能最多(39.72%)；(2)交通工具污染物排放則以機車所排放之一氧化碳、碳氫化合物最多，而氮氧化物的主要排放來源為遊覽車；(3)綠島地區環境負荷量大於管理承載量；(4)綠島旺季(7月份)尖峰環境負荷量為淡季的9.4倍。在居民觀光衝擊認知部分，研究發現綠島居民會因為年齡、職業、在綠島居住時間、是否世居綠島、是否滿意觀光發展而影響到對於觀光衝擊認知的看法，特別是在觀光衝擊的經濟構面上。而在SF-36量表的部分發現，居民生理、心理健康情形較佳者，對於觀光衝擊較呈正面看法；生理、心理健康情形較差者，對於觀光衝擊較呈負面看法。研究發現綠島地區因觀光發展所衍生之環境負荷量極大，不但已造成當地居民在環境面向呈現較負面的看法，更深入影響當地居民在社會文化面向的負面看法。[[abstract]]The major purposes of this research were to calculate the environmental loads resulted from tourists and discuss the residents’ perceptions of tourism impact on four categories: economy, social culture, environment and health in the Green Island. In the first part of this study (environmental loads calculations), the following results were identified: (1) the transportation consumed the most energy (39.72%); (2) CO and HC pollutants were major emitted from the motorcycles, while the emissions of NOx were mainly from the tour buses; (3) environmental loads exceeded the management capacity of the Green Island; (4) environmental loads during high visitation season (July) was 9.4 times in comparing to low visitation season. In the second part of this research (the residents’ perceptions of tourism impact), the following results were found: (1) the residents in Green Island perceived more positive impacts on economic sector, and more negative impacts on social culture and environment sector; (2) the Green Island residents’ self-perceived health status (SF-36) were worse than that in Taiwan; (3) tourism impact perceptions and self-perceived health status were affected by demographics data of the Green Island residents; (4) there has positive relationship between the Green Island residents’ tourism impact perceptions and their self-perceived health status. In summary, the huge environmental overloads resulted from tourists may cause the negative attitudes of the residents toward tourism development and affect their self-perceived health status