專科護理師之執業現況與困境

[[abstract]]大部分專科護理師在醫師指示下執行醫療相關業務，確實對醫院因醫師不足產生之醫療照護需求有實質之助益，但目前專科護理師執業之法源依據不足為最大問題。因此建議政府宜釐清專科護理師執業範圍，短期時程內之作法，以函釋釐清專科護理師執業範圍，以解臨床實務界之渴；長期時程上，則應致力於將專科護理執業範圍明定於護理人員法中，或致力於醫師法之修法將醫師之業務部分移轉給專科護理師之授權執業範圍中

Intention to comply with post-exposure management among nurses exposed to blood and body fluids in Taiwan: application of the theory of planned behavior

[[abstract]]Nurses are at significant risk from occupationally acquired bloodborne virus infections following a needlestick and sharps injury. This study aimed to apply the theory of planned behaviour (TPB) to predict nurses' intention to comply with occupational post-exposure management. A cross-sectional survey was applied to select registered nurses who worked in human immunodeficiency virus (HIV)-designated hospitals. An anonymous, self-administered questionnaire based on the TPB was distributed to 1630 nurses and 1134 (69.5%) questionnaires were returned. From these, a total of 802 nurses (71%) reported blood and body fluid exposure incidents during 2003-2005 and this group was used for analysis. Only 44.6% of the 121 exposed nurses who were prescribed post-exposure prophylaxis (PEP) by infectious disease doctors returned to the clinic for interim monitoring, and only 56.6% of exposed nurses confirmed their final serology status. Structural equation modelling was used to test the TPB indicating perceived behavioural control (the perception of the difficulty or ease of PEP management, β=0.58), subjective norm (the perception of social pressure to adhere to PEP, β=0.15), and attitudes (β=0.12) were significant direct effects on nurses' intention to comply with post-exposure management. The hypothesised model test indicated that the model fitted with the expected relationships and directions of theoretical constructs [χ(2) (14, N=802)=23.14, P=0.057, GFI=0.987, RMSEA=0.039]. The TPB model constructs accounted for 54% of the variance in nurses' intention to comply with post-exposure management. The TPB is an appropriate model for predicting nurses' intention to comply with post-exposure management. Healthcare facilities should have policies to decrease the inconvenience of follow-up to encourage nurses to comply with post-exposure management

Parental experience of family stress during hematopoietic stem cell transplantation of pediatric patients in germ-free isolation in Taiwan

[[abstract]]This qualitative inquiry study used convenience sampling through in-depth interviews to obtain life experiences and feelings of parents while their children underwent hematopoietic stem cell transplantation. Eleven parents of children younger than 18 years undergoing hematopoietic stem cell transplantation in a medical center in north Taiwan consented to participate in this study and provide oral and written responses in Mandarin or Taiwanese. Semistructured interviews lasting 60 minutes were conducted privately and audiotaped. Verbatim transcriptions of the interviews were examined by the content analysis method. The trustworthiness of the data was examined by Lincoln and Guba (Naturalistic Inquiry. Newbury Park, Calif: Sage; 1985) principles. Results indicated that family stress experiences of parents of children undergoing hematopoietic stem cell transplants include 4 themes: parental psychological distress, family lifestyle disturbances, parents' coping patterns, and family resources. The results of this study provide evidence of the nature of parents' experiences while their children undergo hematopoietic stem cell transplantation and provide guidelines for family-centered nursing care

[[alternative]]The Relationships Between Illness Perception, Mood and Quality of Life in Myasthenia Gravis Patients

[[abstract]]本研究雨自我調整模式之理論為背景，採橫斷式、探討性和相關性研究設計，旨在探討肌無力症病患的疾病感受、情緒與生品質之相關性。研究對象為台北市某醫院之肌無力症門診病患，採方便取樣，共選取100名病患進行問卷調查。問卷內容包括：人口學特質與疾病相關資料、疾病感受問卷調查表、醫院焦慮與憂鬱量表，以及生活品質量表等五部分。研究結果顯示疾病症狀辨識與焦慮、憂鬱、生理層面和心理層面生活品質呈顯著相關；疾病原因與焦慮、生理層面和心理層面生活品質呈顯著相關；疾病時間與焦慮和生理層面生活品質呈顯著相關；疾病影響與焦慮、憂鬱、生理層面、心理層面生活品質呈顯著相關；焦慮與憂鬱呈正相關；憂鬱與生理層面、心理層面生活品質呈負相關。逐步迴歸分析結果顯示疾病期間、憂鬱和疾病影響，可有意義的解釋24.2%生理層面生理品質的變異量；焦慮、憂鬱和疾病影響共可以解釋54.1%心理層面生活品質的變異量。研究結果期能提供臨床護理人員設計護理措施之參考。[[abstract]]The purpose of this study is to test relationships among illness perceptions, mood and quality of life in patients with myasthenia gravis (MG). The conceptual model for the study is derived from Leventhal's self-regulation model. The study used a cross sectional, correlational design. One hundred patients participated in this study. Measures include Illness Perception Questionnaire, the Hospital Anxiety and Depression Scale, and Medical Outcome Study Short-Form General Health Survey MOS SF-36. Correlational results indicated that illness identity was related to anxiety, depression, and physical and mental components of quality of life (QOL). Illness cause was related to anxiety, and physical and mental components of QOL. Illness timeline was related to anxiety and physical components of QOL. Illness consequence was related to anxiety, depression, and physical and mental components of QOL. 24.2% of the variance in physical components of QOL can be explained by timeline, depression and consequence; a total of 54.1% of the variance in mental components of QOL can be explained by anxiety, depression, consequence and disability. These findings could provide vital information for nurses taking care of MG patients

Self-efficacy training for patients with end-stage renal disease

[[abstract]]Background. Patients with end-stage renal disease often fail to follow a prescribed diet and fluid regimen, which undermines the effectiveness of care and leads to unpredictable progression of the disease and greater likelihood of complications. Aim. The purpose of this randomized controlled study was to examine the effectiveness of self-efficacy training on fluid intake compliance. Methods. This study took place in northern Taiwan. Eligible patients were receiving routine haemodialysis; 20–65 years of age; living in a community setting; able to read and write; and willing to participate. Sixty-two end-stage renal disease patients participated in the study. Those in the experimental group (n = 31) received 12 sessions of structured self-efficacy training; the control group patients (n = 31) received only routine care. The intervention was based on Bandura's theory and included an educational component, performance mastery, experience sharing, and stress management. The outcome measure was the mean body weight gain between dialysis sessions. Data were collected at baseline, 1, 3 and 6 months following the intervention and analysed by a descriptive and repeated-measures anova. Results. Experimental group mean weight gains decreased gradually following self-efficacy training. However, control group mean weight gains decreased only slightly over time. These results were statistically significant when baseline differences controlled for (P < 0·05). Conclusions. The study supports the effectiveness of the self-efficacy training in controlling mean body weight gains of end-stage renal disease patients receiving haemodialysis

Auricular Acupressure for Managing Postoperative Pain and Knee Motion in Patients with Total Knee Replacement: a Randomized Sham Control Study

[[abstract]]Background. Postoperative pain management remains a significant challenge for all healthcare providers. A randomized controlled trial was conducted to examine the adjuvant effects of auricular acupressure on relieving postoperative pain and improving the passive range of motion in patients with total knee replacement (TKR). Method. Sixty-two patients who had undergone a TKR were randomly assigned to the acupressure group and the sham control group. The intervention was delivered three times a day for 3 days. A visual analog scale (VAS) and the Short-Form McGill Pain Questionnaire were used to assess pain intensity. Pain medication consumption was recorded, and the knee motion was measured using a goniometer. Results. The patients experienced a moderately severe level of pain postoperatively (VAS 58.66 ± 20.35) while being on the routine PCA. No differences were found in pain scores between the groups at all points. However, analgesic drug usage in the acupressure group patients was significantly lower than in the sham control group (P < 0.05), controlling for BMI, age, and pain score. On the 3rd day after surgery, the passive knee motion in the acupressure group patients was significantly better than in the sham control group patients (P < 0.05), controlling for BMI. Conclusion. The application of auricular acupressure at specific therapeutic points significantly reduces the opioid analgesia requirement and improves the knee motion in patients with TKR

Acupressure and fatigue in patients with end-stage renal disease-a randomized controlled trial

[[abstract]]The purpose of the study is to investigate the effectiveness of acupressure on fatigue in patients with end-stage renal-disease (ESRD). The study was a randomized control trial; qualified patients were randomly assigned into acupressure group, sham group or control group. A total of 106 participants were included in the study. The measures included the revised Piper Fatigue Scale (PFS), VAS of Fatigue, the Pittsburgh Sleep Quality Index and the Beck Depression Inventory. Data of fatigue measures were collected at pretreatment and a week following treatment. Sleep quality and depression were collected during post-test only. The statistical methods included the descriptive statistics, one-way ANOVA, ANCOVA, and repeated-measures ANOVA. ANCOVA that adjusted for differences in baseline fatigue scores (PFS), post-test of depression and sleep quality, result was significant, F(2,100)=3.99, p=0.02. Post-hoc tests revealed that patients in the acupressure group were significantly having lower scores of fatigue than patients in the control group. ANCOVA results also significant for VAS of Fatigue among groups, F(2,100)=5.63, p=0.003. Comparisons indicated that there were significant differences between the acupressure group and the control group (p=0.01) and between the sham group and control group (p=0.003). Predialysis fatigue was assessed routinely by using a rating of 0-10. Repeated-measures ANOVA results demonstrate the group main effect was significant in the perceived fatigue (F(2,88)=19.46, p<0.001). Follow-up tests indicated there were significant differences between the acupressure group and the control group (p<0.001) and between the sham group and control group (p<0.001). The study provided an alternative method for health care providers to managing ESRD patients with fatigue

Post-traumatic stress disorder, depression, anxiety and quality of life in patients with traffic-related injuries

[[abstract]]Keywords: anxiety; depression; nursing; post-traumatic stress disorder; quality of life; traffic injuries Aims.  This paper reports a study to investigate and follow-up relationships between post-traumatic stress disorder, anxiety, depression and quality of life in patients after traffic-related injuries. Background.  Worldwide, traffic accidents kill 1·2 million people and injure 50 million people per year. Accidental injuries are fourth in the top five causes of death in Taiwan. For survivors, traffic accidents not only cause physical impairments, but also psychological trauma, such as post-traumatic stress disorder, depression and anxiety, all of which affect the quality of life. Methods.  An exploratory, correlational design was used, and participants were recruited consecutively. Data were collected at 1 and 6 weeks post-injury for 64 patients from two major medical centres in Taiwan. Instruments were the New Injury Severity Scale, Post-traumatic Stress Disorder Reaction Index, Beck Depression Inventory, State Anxiety Inventory and Medical Outcomes Study Questionnaire. The data were collected in 2002. Results.  Statistically significant improvements occurred in depression, anxiety and the quality of life between week 1 and week 6 (P < 0·05); high levels of post-traumatic stress disorder symptoms at week 1 (87·5%) and at week 6 (82·8%) showed no statistically significant improvement. There was a positive correlation between post-traumatic stress disorder and depression (r = 0·70, P < 0·001) and between post-traumatic stress disorder and anxiety (r = 0·57, P < 0·001), and a negative correlation between post-traumatic stress disorder and quality of life (r = −0·47, P < 0·001). Depression was the most important variable to predict post-traumatic stress disorder at week 6, with depression levels at week 6 being a more powerful predictor than those at week 1. Regression analysis revealed that depression (19%) at week 1, depression at week 6 (45%), anxiety (3·8%) at week 6 and post-traumatic stress disorder (5·8%) explained a statistically significant amount of the variance at week 6. Conclusions.  The findings suggest that traffic accidents have an impact on people's psychosocial wellbeing. Healthcare professionals need to implement interventions to decrease post-traumatic stress disorder, depression and anxiety to increase the quality of life for patients following traffic injuries

Relationships between pain intensity and heart rate variability in patients after abdominal surgery: a pilot study

[[abstract]]Background A link between postoperative pain intensity and heart rate variability (HRV) had not been well established. This study aimed to investigate the correlation between post-operative pain intensity and HRV. Methods The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009–November 2009. The visual analogue scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) were used to measure post-operative pain. HRV was measured as the standard deviation of normal RR interval, and by power spectral analysis that included high frequency (HF), low frequency (LF), very low frequency power, and LF/HF ratio. Results A total of 34 subjects were included in this study. We found that the day after the surgery, the mean VAS score was 47.50±20.98 and the mean SF-MPQ score was 18.06±8.90, indicating a moderate degree of pain. Moderate to severe degrees of tenderness were reported by 70.6% of the patients, moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients, moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients, and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel. The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried (P <0.05). The correlation of the standard deviation of normal RR interval, high frequency, very low frequency value and patient’s age were negative (P <0.05). The total SF-MPQ pain scores positively correlated with the LF/HF ratio (P <0.05). Conclusions The multidimensional pain assessment tool (SF-MPQ) reflects better the patients’ post-operative pain than the single-dimensional assessment tool (VAS). HRV positively correlated with SF-MPQ scores in patients after abdominal surgery

Development and Validation of a Scale Measuring Clinical Teaching Quality

[[abstract]]The purpose of this study was to develop and to validate a scale for nursing students to evaluate clinical teaching quality. The conceptual model for this study was derived from the system theory. The scale was developed by a group of experts in the area of course evaluation. The tool included: input, process and outcome. The psychometric property of the measure was tested in a sample of 166 practicum students. Instrument reliability was supported with the internal consistency alpha of .93 and the test-retest reliability of .83. The content validity agreement was established by three experts in nursing education. The results of the exploratory factor analysis revealed that the scale was a two-factor structure and explained up to 68.92% of the variance. These results suggested that the psychometric property of the instrument was supported