Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
Purpose: This study aims to apply multiple teaching approach to flip the limits of professional practice schedule, provide corresponding contexts for self-preparation and scenario simulation, and thereby improves the self-learning outcomes of the nursing students.
Methods: This is a 4-month study using action research in a junior college of nursing in Southern Taiwan. The study targets on 40 nursing students and investigates their basic nursing techniques. The study procedures and data collection methods are as follows: Observing and recording the studentʼs practice conditions after class, reviewing the teacherʼs teaching diaries, and investigating the studentʼs scenario simulation performance at home through course videotape self-learning. By quantifying data and conducting post-class technical tests, the investigator could modify next week class sections and lecture techniques accordingly based on the students test scores, and thus understands and compares the differences of their learning outcomes.
Results: The teaching strategies used in this study include: 1. Encouraging studentʼs active pre-class preparation and post-class practice, and conducting post-class tests; 2. lecturing (using teaching videos and PPTs); 3. encouraging student group discussion and practice (actual practice); 4. student sharing scenario simulation outcomes; 5. repeated tests – sessional/group/personal technique tests, or textbook/flyer content written tests. The study results are shown in three aspects: 1. Learning: Multiple teaching approach increases teacher-student interactions while group practice/test helps students review operational problems and self-examine professional techniques needed to be improved; 2. Techniques: By making selfie videos, studentʼs self-learning and self-practice willingness are motivated, and the technical problems are also revealed through sharing; 3. Emotions: Teachers improve teacher-student relationships and self-examine and advance professional techniques through different teaching-learning strategies. In addition, comparing with other eight classes of the same grade, the “technique test” allows minimal exam failure rate of the class. In general, the nursing students believe that the multiple teaching approach enhances their self-learning outcomes and increases their skill dexterity. Moreover, the action research allows the teachers reviewing their teaching diaries and student comments and describing the training outcomes of student techniques through the action loop of “self-criticism and self-examination”.
Conclusion: The action research with multiple teaching approach aims to motivate the studentʼs self-learning enthusiasm through improving the teacherʼs teaching strategies. Not only repeated tests and scenario simulation can promote student operational skills, but repeated course video watching allows memory reinforcement and self-examination on professional techniques. Therefore, action research using multiple teaching approach can be considered as an optimal lecturing strategy in the future.
Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
Purpose: The aim of this article was to describe the use of root cause analysis (RCA) for identifying the possible causes of a Pre-Blood transfusion, the occurrence of cross-test misdiagnosed blood test blood group of patients involved vesicant, and provide attention & prevention.
Methods: As a serious and sentinel event, an investigation team was established. Key participants were identified and an RCA was implemented systematically with atrained facilitator guiding each analysis step. Chronological narratives were tabulated in a timeline sheet. Why tree & Barrier analysis were used to determine the root factors of this event.
Results: Three root causes of the extravasation event were identified, which included 1. Colleagues lack of vigilance, 2. The lack of short-term closure of reinstatement nurse education and training, 3. Not by standardizing the steps required for to blood transfusion. Based on the analysis, we implemented action plan to ensure safety in standardizing the steps required for to blood transfusion. After the improvement measures, we have not had similar event recurred.
Keywords: Root Cause Analysis, Blood transfusion
1,2Chang Gung University of Science and Technology, Taiwan
1,2Chang Gung Memorial Hospital, Taiwan
Diabetes mellitus has been either the fourth or fifth leading cause of death among Taiwanese adults throughout 1995–2015. Older adults with diabetes were reported to be at higher risk of developing diabetic macro- and microvascular complications. The purpose of this study was to understand the self-management experiences of middle-aged and elderly people with diabetes through focus groups. Purposive sampling was employed to recruit patients with diabetes from the metabolic outpatient clinics of medical centers and regional hospitals in Taiwan. Two focus groups, comprising a total of 23 participants, were employed to collect data, and group discussions were held a total of four times in an education room that was distant from clinical areas. Results include four themes were generated from analysis of the collected data: (1) Relationship between symptoms and glycemic change (2) Learning how to control the disease (3) Strategies for preventing the onset of symptoms and (4) Self-management implementation dilemmas. This study provided new insights into the experiences of middle-aged and elderly people in Taiwan regarding their self-management of diabetes. Health care teams should be involved in the self-management education of patients with diabetes as early as possible to reduce patients anxiety and frustrations regarding glycemic level and symptoms. In addition to monitoring patients self-management, clinicians should pay more attention to patientsʼ successful adaptation to and coexistence with the disease.
Tokiwa University, Japan
Objective: The present study involving psychiatric nurses aimed to examine the influences of their ethical sensitivity, self-efficacy, and interpersonal communication skills on their critical thinking disposition.
Methods: The subjects were 961 nurses who provided daily care for schizophrenic patients in 28 hospitals specializing in psychiatry. An anonymous, self-administered survey was conducted. The questionnaire consisted of the basic attributes of the nurses, 15 items of the Critical Thinking Disposition Scale (Tokiwa, 2010), 22 items of the Ethical Behavior Scale (Ode, 2014), 24 items of communication-skills scale ENDCOREs (Fujimoto et al., 2007), and 16 items of the General Self-efficacy Scale (Sakano, 1989). Stepwise multiple regression analysis was conducted with the critical thinking disposition of nurses as a dependent variable and their clinical experiences, qualifications as nurses, communication skills, ethical behaviors, and self-efficacy as independent variables. The present study was conducted with the approval of the research ethics committee of the university.
Results: A total of 961 questionnaires were distributed and 426 of them were collected; the collection and valid response rates were 50.32 and 46.50%, respectively. The model developed as a result of the multiple regression analysis consisted of ethical behaviors, communication skills, clinical experiences of providing care for physically-ill patients, and general self-efficacy. The determination coefficient (R2) was .47 and the determination coefficient adjusted for the degrees of freedom (adjusted R2) was .47. The standard partial regression coefficient of the model for nursesʼ ethical behaviors was the highest: β=.55 (p=.00), which suggests that their ethical behaviors had the largest influence.
Discussion: Among all factors influencing the critical thinking disposition of psychiatric nurses, ethical behaviors had the largest influence. Since ethical behaviors are promoted and expressed by ethical sensitivities, the results suggest that the higher sensitivities of psychiatric nurses facilitate their critical thinking disposition.
Biography:
Shoko Ikeuchi is teaching psychiatric nursing at Tokiwa University in Ibaraki prefecture in Japan. In Japanʼs psychiatric hospital, there are a lot of chronic patients who have been hospitalized for a long time. She is thinking what kind of ability is needed for psychiatrist nurses in order not to overlook the slight signs of patients in chronic phase and make appropriate clinical judgment.
1Kanagawa Institute of Technology, Japan
2Maternity-home TAKENOKO, Japan
3Kobe Womenʼs University, Japan
1,3Kansai International University, Japan
Background and Aim: In Europe and America, since around 2004, audience response systems (ARSs) (also known as clickers) have served as tools for promoting interactivity during lectures. This technology has been adopted even in Japanese institutions of higher education. In a class using an ARS, the speed of the feedback in which the teacher grasps the intelligibility of the student and immediately provides additional explanation enhances learning efficiency, student participation, and focus and concentration. However, there are few studies on the use of ARSs in nursing education. This study aims to use an ARS in a lecture on neonatal nursing in Japan and examine its effect.
Methods: The participants consisted of 102 second-year students in the Department of Nursing, University A, who were divided into two groups: an experimental group (ARS group) and a control group (hand-lift group). Effectiveness of lectures was evaluated by 9 items developed by referring to previous research (Pamera, 2006; Takahashi, 2010; Nekota, 2012).
Ethical considerations: The survey was conducted with the approval of the Research Ethics Committee of Kansai International University (approval number 26-9).
Results: The survey form was collected from 94 participants (recovery rate=92.2%), and data from 71 participants (effective response rate=75.5%) from both groups were analyzed. The effect of the lecture was greater in the experimental group compared with the control group for all items, with a significant difference in six items (p<0.05).
Conclusions: The use of an ARS was found to be effective in a lecture on neonatal nursing, which was necessary to acquire complicated knowledge, such as changes in biological functions from the prenatal to neonatal period.
Biography:
Tamaki Hamazono is a professor with the School of Nursing at Kanagawa Institute of technology and a scholar who has worked to bring better health and health education to people in Japan. Her major research areas include nursing for children with chronic illnesses and nursing for their families. And sheʼs always consider whatʼs needed to provide support that can improve the quality of life of sick and disabled children and their families. In addition, she is recently working on research on multiple nursing education. She has published many papers in reputed journals related to child health and pediatric nursing.
Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
Purpose: Constitution not only determines the susceptibility to certain pathogens and diseases, but also closely related to the development and the prognosis of diseases. Gender, age, lifestyle, dietary habits, emotion status, history of diseases and treatments maybe also play a role in the process of constitutions development. To date few clinical investigations on the influencing factors of constitution were conducted.
Methods: A retrospective and descriptive study design was used. The participants were total of 136 lung cancer patients.
Results: There were 72 males (52.9 %) and 64 females (47.1%) in this study. The most constitution of the patients was a gentleness constitution (66.2%), followed by yin deficiency combination with yang deficiency and stasis constitution (14%), yin deficiency constitution (7.4%). The dietary habits were part vegetarian had higher proportion of yin deficiency (p= <.001), yang deficiency (p= .003), and stasis constitution (p= <.001); Tumor cell types were small cell lung cancer had higher proportion of yang deficiency (p= .023) and stasis constitution (p=.014).
Conclusions: This study found that the constitution of most of the patient was a gentleness type. The dietary habits and type of cancer cells was associated with constitutions. This can assist clinical nurses to increase relevant knowledge about traditional Chinese medicine constitution so as to get acquainted with peopleʼs constitution, offer different diet and health education. For instance, people with yin deficiency combination with yang deficiency and stasis constitution should have food such as tremella, lamb, adlay, gain under the nursesʼ guidance concept of appropriate dietary patterns, and promote and maintain health.
Biography:
Chi-Hsiang Shen is a nurse practitioner and working in chest medicine and oncology nursing in Kaohsiung Medical University Hospital for 22 years. She has a Master of Science in Nursing from Kaohsiung Medical University. She has been working hard in the clinical practice and published some Chinese and English papers in reputed journals.
1Ching Kuo Institute of Management and Health, Taiwan
2Cardinal Tien Hospital, Taiwan
Background: It is the responsibility and duty of medical and nursing personnel to treat patients. However, but the occurrence of death in patients is still inevitable in ICU. The research purposes aimed to understand the hospice and palliative care concept of ICU nurse and the status of hospice and palliative care services.
Research Method: This study enrolled 102 ICU nurses in a certain regional teaching hospital in New Taipei City as the research subjects. The scale on hospice and palliative care concept includes a total of 40 items and 4 major dimensions: “physical hospice, psychological hospice, social hospice, and spiritual hospice.” The scale includes a total of 50 items and 6 major dimensions: “physical care, remains care, physiological care, spiritual care, Do not resuscitate (DNR), and family needs ”
Results:
1. Basic Information of the Research Subjects: This study enrolled a total of 102 ICU nurses as the subjects, and all of them were female. The age of most of the subjects was 18-24 years old (39 subjects; 38.2%); the educational background of most of them was junior college (49 subjects; 49%). Most of the subjects were unmarried (76 subjects; 76.5%), and non-religious believers (61 subjects; 59.8%). Most of the ICU nurses enrolled in this study had received the training of hospice and palliative care-related issues and provided hospice and palliative care. The mean seniority in ICU of the ICU nurses was 5.3 years (SD=4.79), and the mean seniority of nursing work was 7.4 years (SD=5.2).
2. Hospice and Palliative Care Concept and Current Status of Hospice and Palliative Care Services
(1) Hospice and Palliative Care Concept: For the 40-item scale on hospice and palliative care concept completed by the research subjects, the items of the top 5 highest scores were “A good death is the fulfillment of wishes at the time of death”, “A good death is the fulfillment of ideals at the time of death, ” “A good death is the freedom from worry at the time of death, ” “A good death is to die in sleep, ” and “A good death is to die without pain”. The scores of them were all above 4 points. The item of the highest score was “A good death is the fulfillment of wishes at the time of death” (4.31 points). The score of the item “A good death is to die in bed” was lower.
(2) Hospice and Palliative Care Services: For the 50-item scale on hospice and palliative care services, the items of the top 2 highest mean scores were “applying gauze to the wound of patients passing away after removing the catheter to prevent exudate from staining clothing”, “assisting patients in wearing diaper and adding extra diaper to prevent fecal from staining clothing”, The items of the bottom 2 lowest scores were “assisting end-of-life patients in reviewing the past and finding the meaning and value of life”, “arranging psychologists, consultants, and religious workers to provide care for end-of-life patients”, The services of top 2 highest scores were mainly in two aspects: “physical care” and “remains care.” suggesting that the care behaviors of ICU nurses for end-of-life patients are mainly “providing physical care”. The services of lowest scores in this study were mainly distributed in two aspects: “psychological care” and “spiritual care”.
3. Correlation between Hospice and Palliative Care Concept and Hospice and Palliative Care Services
The research results showed that there was a statistically significant positive correlation between various dimensions of hospice and palliative care concept. There was no correlation between hospice and palliative care concept and hospice and palliative care services, and neither was there a correlation between various dimensions, suggesting that the score of hospice and palliative care concept did not affect the frequency of provision of hospice and palliative care services.
Suggestions: The research results showed that the frequency of spiritual care services provided by ICU nurses was lower. The score of spiritual care of hospice and palliative care services was the lowest. These results may remind ICU nurses that in addition to paying attention to physical care that relieves pain and remains care, they should also aggressively provide care in the dimensions of “psychological care/spiritual care/DNR/family needs, ” in order to provide high-quality hospice and palliative care services. ICU nurses should pay attention to spiritual communications and overall care for family.
Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
Purpose: The author of this paper have identified issues related to nurses role at the time of the disaster. By looking back at the Kaohsiung Gas Explosion happened, we have gained insights into how to prepare for future disasters and for other hospital in disaster medicine.
Methods: This article was established for describing the disaster response experience for the reference.
Results: On July 31st of 2014, a devastating petrochemical gas explosion happened in Kaohsiung, Taiwan. Our hospital was immediately established as the mass injuries emergency response center due to the geographic proximity to the site of explosion. A total 227 hospital personnel were called on-duty immediately, including 26, 49 and 75 physicians, nurses, and administrators with other on duty staff, respectively. Our hospital received the most patients in Kaohsiung city, with 68 wounded patients within 2 hours. The patients were presented with combinations of burns, blunt force trauma, fractures, lacerations, and ruptured visceral. Our hospital was able to mobilize our staff in the shorted amount of time for aiding disaster relief and the timely and proper treatment of most of the patients.
Tao-Yuan General Hospital, Taiwan
Objective: To understand the characteristics of facilities and nursing home residents. To test the effect of the characteristics on the probability of hospitalization of nursing home residents and to analyze the predictors of readmission in order to improve the quality of nursing care and the life quality of their residents.
Methods: Retrospective cohort study was used to collect and login the medical records of each nursing family and the unplanned transfer to the residents of acute hospital in 2015 years as a data source for unplanned transfer to acute hospital in patient monitoring. The observation period is from January 1, 2015 to December 31, 2015.
Results: There were significant differences in the occurrence of indwelling catheter, nasal and gastric tube, dependence degree and unplanned transfer to acute hospital hospitalization. Correlation study found that the number of white blood cells was positively correlated with unplanned transfer to acute hospital hospitalization, negatively correlated with serum albumin value, and the higher the rate of hospitalization. The better the value of serum albumin, the lower the frequency of hospitalization. Poisson regression analysis found that the main diagnosis of nursing home CVA (odds than 2.06, p <.006), the more the number of pipe (odds than 2.44, p <.01), white blood (odds ratio 1, p <.002), albumin ( Four variables such as odds ratio. 42, p <.005) were the main predictors for predicting the hospitalization frequency.
Nursing Practice Application: The evaluation of the risk factors and predictors might help to identify the nursing home residents who are likely to be readmitted. It is hoped that the hospitalizations from nursing home may be prevented and the results of this study might contribute to the quality of long-term care facilities.
Tao-Yuan General Hospital, Taiwan
Background: Rapid population ageing is a common problem faced by the whole world. Elderly people with dementia often make caregivers physically and mentally exhausted and frustrated. The overseas nostalgia treatment literature focuses more on how to improve the cognitive, emotional, and overall problem behaviors of dementia patients.
Research purposes: To use the reminiscence therapy to improve the overall quality of life of the dementia elderly and hope that the nurse can understand the reminiscence therapy better and provide more care for the deaf elderly.
Research Method: Nursing Home introduced reminiscence therapy on January 15, 2017. Most of the elders life experience was designed to reflect the nostalgia, the garden design of the Tianyuan Garden, and the activities of the manager of the one-day shop. The retro sound and the old records were upgraded. The elderlyʼs cognitive and realistic orientation and the delay in the progress of dementia are even more conducive to creating an overall nostalgic atmosphere.
Results: After intervention with nostalgia treatment, the average score of the elderly after MMSE was increased. After intervention with the weekly Reminiscence Therapy activities, the elderly were observed to have a significant change in depression, and the initial orientation was poor. After participating in activities for many times, they were more aware of each other. Familiar with it, will also actively talk with others in the ward, provide self help to others, and form new partnerships in hospitalization.
Research conclusions/practice applications: After treatment with nostalgia, the elderly with mild to moderate dementia were found to improve their verbal communication skills, improve their melancholic mood, increase interpersonal social interaction among members, and reduce the deterioration of cognitive function. In terms of nursing practice, nursing staff enhance the leadership skills of nostalgic groups and fully apply them to the workplace so that the elderly can obtain more effective nursing services.
Tao-Yuan General Hospital, Taiwan
Object: To explore the effectiveness of team integration care intervention on the quality of life of patients with diabetic foot ulcers.
Context: It has been found that Diabetic foot is a complex and multi-pathogenic disease. It often results in feelings, movements, circulatory functions and structural abnormalities in the feet. Therefore, it is more prone to wounds and infection than the average person. Severe cases require amputation. In view of the amputation, the impact on individuals and families is very large. Therefore, we hope to use a team-integrated care model to early intervention and active treatment of patients with diabetic foot ulcers, regardless of the integration of various subjects, wound treatment, footwear prevention and education. Home care, etc., to improve the quality of life of patients.
Methodology: In this study, the experimental study design of a single group was performed. The diagnosed diabetic foot ulcers were Gr2-5 grade, and the interventional measures of the group integrated care were taken as the object of study. A total of 31 cases participated in this research project, but actually total of 27 people completed the study. Research tools included basic data questionnaires, Cardiffʼs wound impact quality of life questionnaire. The research results were analyzed with SPSS computer software. Statistical analysis included reliability analysis, validity analysis, and variance analysis.
Result: The effects of this study on wound healing include: More assessments and options for the treatment of diabetic foot ulcers after intervention of team integration care, whether in surgical debridement, hyperbaric oxygen, vacuum suction, advanced dressings, etc. All of them have been improved, which has a significant effect on wound improvement. The overall level of quality of life results showed that in the difference in overall quality of life before and after treatment, the Z value was -2.972, and the P value was 0.003 (<0.05 = α), representing physical and mental status, physical symptoms and daily life, stress in life, There was a significant difference between the quality of life of the patient before and after treatment.
Conclusion: Team integration of care intervention can improve the wound of diabetic foot ulcers, and it can effectively improve the quality of life of patients with diabetic foot ulcers after interventional therapy.
Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
Purpose: This study discussed about the different aspect of internal struggles of a terminal patient when facing incurable illness and upcoming death. The empathy strategy was applied to allow the patient express his anxiety and fear and regain his strength of facing death.
Methods: A qualitative purposive sampling was adopted. The authors recorded the background contexts and non-verbal messages through interview, participant observation, and reflection diary. Empathy approach was applied to guide the patient narrating his account.
Results: The problems were identified: 1. Physical dimension – Life-threatening illness: The length of life isnʼt predictable, even though reasonable treatments have been applied; 2. Psychological dimension – The sense of lost: Feeling powerless and guilty as a husband/father due to his failure of returning such condition; hovering between keep fighting or give up 3. Social dimension – The threat of lost support: The financial burden has been dramatically increased; felt useless in his family; 4. Spiritual dimension – Death anxiety: Being panic and helpless when facing death.
After our empathy care, we have summarized the meaning of life to him as follows: 1. “Enable” – The love and companionship of his wife and children can be his ideological prop; 2. “Acceptance” – Accept the circumstance he is encountering and has security of his decision; and 3. “Bravery” –Bravely to face every situations. The patient is convinced that he could overcome all challenges, and unveil the meaning of life with solid love and gain the reason of never give up.
Conclusion: It is suggested nursing staffs can provide humanized care and help the patients overcome negative thoughts and discover the meaning of life by applying “empathy” technique.
University of Toronto, Canada
Introduction: Cancer treatment can have a significant impact on an individualʼs body image and sexuality. Evidence indicates conversations about these specific consequences do not happen often between cancerpatients and health care providers. Purpose: This work will contrast the perspectives of Canadian and African nurses regarding conversations about the topic of sexuality with patients and family members after a cancer diagnosis.
Methods: Data were collected through interviews with Canadian nurses (n=34) and through small group discussions with African nurses (n=25). Data were analyzed using a descriptive qualitative approach, identifying significant themes.
Results: The participants acknowledged treatment has an impact on patientsʼ sexuality. Conversations mostly occur during consent processes before treatment or when a patient raised a question about a specific side effect. These conversations rarely covered more than physical changes and didnot focus on the impact of changes on emotional and personalrelationships or intimacy. Participants expressed personal discomfort andlack of training for holding these conversations. They perceivedthe conversations as difficult for themselves as well as for patients. Sexuality was often described as a taboo topic, particularly in Africa, and one that was influenced strongly by cultural perspectives. Having time and privacy were also seen as barriers.
Implications: Findings support the need to clarify role expectations for all team members abouttalking with patientsregarding sexuality and provide education tosupport the expected roles.
Biography:
Dr. Fitch RN PhD is Professor (Adjunct) in the Bloomberg Faculty of Nursing and Professor in the School of Graduate Studies at the University of Toronto. Dr. Fitch is also the Editor-in-Chief for the Canadian Oncology Nursing Journal and served as Advisor on Cancer Survivorship to the Person-Centered Portfolio of the Canadian Partnership Against Cancer. She provided leadership across Canada in implementing a person-centered approach for cancer patients. Dr. Fitch was the Founding President of the Canadian Association of Nurses in Oncology and served as a Board member and the President of the International Society of Nurses in Cancer Care.
The Nairobi Hospital, Kenya
Introduction: It has been a common practice for many years to build ICUs as a ward. The number of beds vary from a few up to many. However, it has recently been shown that patients may suffer from sleep disturbances and restlessness due to high level of noise in ICUs. On the other hand, private rooms with closed doors can provide quiet environment. In a study performed by Dennis et al., patients were significantly more likely to be observed sleeping when noise and light was reduced. An important factor for consideration is to design an ICU where the rooms do not remind a hospital but enable the patient to feel at home. Natural furniture like clock, armchair and lamp can be used for this purpose. Soft wall and ceiling colors should be used in each room with as few irregularities as possible. Delirium often occurs in patients in the intensive care. Recently, Zaal et al. studied the incidence of delirium in an ICU designed to reduce noise and with improved exposure to daylight, in comparison to patients admitted to an open ward ICU.
Objectives: The study examined the impact of improving ICU environment from eight bedded including two isolation rooms and six ward beds, to 16 self-contained rooms. Specifically, the study will correlate the hand washing compliance in an old ICU and transformed ICU. We also compared the customer loyalty index before and after improving the hospital environment.
Methodology: The study will utilize Case control study design as it is easy to conduct, can be done retrospectively. The study will sample from Infection Control Units, hands washing compliance audit and customer service loyalty index of patients admitted in the critical care unit during the periods before the intervention (January - April 2018) and those after the intervention (May – August 2018)
Results and Discussion: For the first variable, CSI before intervention and CSI after intervention, the P-value is 0.000 which is less than 0.05 which implies that the two means are statistically different for the two categories (before intervention and after).
In the second variable, HHC before intervention and HHC after intervention, the p-value is 0.006 which is less than 0.05 implying that the two variables are statistically different.
We therefore conclude that the intervention in the ICU at the facility has a positive impact.
Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan
Background: During the admission, the Department of Discharge Planning Service has already involved in the care of the case, including the in-depth assessment of the physiological, psychological, economic, family and environmental factors and the introduction of the medical team intervention depending on the needs of the case, so the case and his/her family can make subsequent care plans accordingly. However, the family often choose institutional placement due to the short of caregiver, insufficient capacity for caring, the requirement of professional care skills or the use of medical devices.
Purpose: Apply data analysis to understand the considerations of institution selection and the satisfaction to the referral, in order to provide a more appropriate institution selection, shorten the preparation period and enhance the service satisfaction.
Methods: The descriptive statistics of the options, considerations and satisfaction regarding the types of the institutional placement by the discharge planning service between 2013~2016 were analyzed using the statistical software.
Results: Among the institutional placement after discharge, the long-term care instituteranked first (up to 54.7%). According to the statistical data provided (mostly derived from the Department of Discharge Planning Service, 55.3%), the selection of institutions were mainly based on the distance between the household (35.1%). The service provided by the referral institute to the clientʼs satisfaction was up to 53%. Moreover, the emergency re-visit rate within 3 days after discharge was 3.7% while the re-admission rate within 14 days after discharge was 2.8%. Based on the analysis, it was found that most of the patients re-visited the emergency room within 3 days or were re-admitted in the hospital within 14 days after discharge were due to short of breath. Of which, patients from nursing home accounted for the majority of patients re-visited the emergency room within 3 days (57.7%) while patients from the long-term institute accounted for the majority of being re-admitted in the hospital within 14 days (55%).
Conclusion: Home-based caregivers nowadays are insufficient due to the changes in social structures, and institutional placement may relieve the pressure of care and the shortage of caregivers. In addition, the emergency re-visit rate within 3 days after discharge and the re-admission rate within 14 days after discharge vary between institutions, suggesting that it may be correlated with the completeness of the environment and the facilities in the institutional settings. By analyzing the overview status of the institutional placement, a more appropriate institution selection advice may be provided to shorten the preparation period and enhance the service satisfaction.
Kanagawa Institute of Technology, Japan
Purpose: This research aimed to examine the factors that affect the initial presentation of sudden illness and injuries in nursery school children.
Methods: A questionnaire survey was administered at 608 randomly selected institutions in A-prefecture. Analysis (descriptive statistics, variance analysis) was performed on 284 valid collected responses (301 responses, response rate 24.8%) using SPSS (ver. 24). The project was implemented with the approval of Kanagawa Institute of Technology Human Ethics Committee (No. 20160920-12).
Results: The average frequency of initial presentation for ten scenarios of sudden illness or injury of children was 3 (‘almost possible’) level. The scenario of ‘whole body allergic reaction’ was somewhat lower (2.63, SD 1.303).
The analysis of variance showed that the influence of ‘arrangement of nurses’ was significant in 8 scenarios of initial presentation, and the average was higher when there was nurse placement. The scenes where there was a significant difference were as follows: ‘Fever’ F (1, 282) = 4.381, p<. 05, ‘Convulsion’ F (1, 282) = 5.442, p <.05, ‘Wheezing/Coughing’ F (1, 282) = 4.64, p<. 05, ‘Abdominal pain’ F (1, 282) = 4.828, p <.05, ‘diarrhea’ F (1, 282) = 4.029, p<.05, ‘Rash’F (1, 282) = 3.892, p< .05, ‘Whole body allergic reaction’ F (1, 282) = 14.402, p<. 01, and ‘Head bruise’ F (1, 282) = 8.009, p <.05. The years of experience was significant with the influence of ‘Convulsion’ F (2, 279) = 10.491, p<. 01, and ‘Whole body allergic reaction’ F (2, 279) = 7.489, p<.05. The mean value of the group with many years of experience was significantly higher than that of the other two groups.
Discussion: Factors influencing the initial presentation of sudden diseases and injuries in nursery school were ‘arrangement of nurses’ and ‘years of experience’. In particular, in the nurse arrangement, the frequency of initial presentation was high for 8 scenes. From this, it is suggested that the response to sudden illness and injuries of children in nursery school is improved by existence of nurse placement and where nursery teachers have many years of experience on which to draw.
Biography:
Masako Kawashima is a lecturer in the department of nursing at Kanagawa Institute of Technology, Japan. Her research theme is “support for experts that support childʼs growth”, and so far she has investigated the perception of the practice of infant school nurses and nursery teachers. This research also worked as one source to examine support for experts to support the childʼsgrowth such as sudden illness of child in childcare center and correspondence to injury.
Far-Eastern Memorial Hospital, Taiwan
Objectives: The purpose of this study was to investigate the relevance of using multiple strategies and satisfaction of rehabilitation services in rehabilitation wards.
Methods: This is a cross-sectional, randomized study to enroll 200 patients in physical medicine and rehabilitation ward receiving rehabilitation services (50 before and after the intervention in 2015 and 50 cases each year in 2016 and 2017). This study focused on low score items for improvement, including 1. Rehabilitation contents and procedures; 2. Rehabilitation environment and equipment; 3. Professional ability and service attitude. These measures included: 1. Formulating a service system for specialized rehabilitation workers; 2. Developing standard operating procedures for in-hospital rehabilitation; 3. Setting up rehabilitation scheduling and delivery mechanisms; 4. Re-arrangement of the sequence of rehabilitation treatments and route planning; 5. Deployment of ward rehabilitation equipment and additional management practices. After the intervention, we conducted a questionnaire survey on patient satisfaction with in-patient rehabilitation services, We applied descriptive statistics to analyze the satisfaction of our rehabilitation services before and after the implementation.
Results: After introduction of the improvement measures, the overall satisfaction score of rehabilitation service was increased from 2015 pre-intervention 3.92 to 2015 post –intervention 4.61(P< 0.05) and continued to achieve good results in 2016 (4.78) and 2017 (4.77 ) with compared with 2015 pre-intervention (P< 0.05).
Conclusion: Using multiple strategies for rehabilitation services in rehabilitation wards, description of rehabilitation content, process arrangements, and environmental equipment, were positively correlated with patients satisfaction. Standard operating procedures improved nursing work consistency and service satisfaction.
Keywords: Multiple Strategies, Rehabilitation, Satisfaction, Nursing Quality
Biography:
Jun-Fen Wei is working as a nurse practitioner in the Department of Rehabilitation of Far-Eastern Memorial Hospital, New Taipei City, Taiwan. Other than during routine clinical work, she is also interested in the continuous improvement of nursing care quality and has been participating in the program in her hospital for more than 20 years.
1The Chinese University of Hong Kong, China
2The Chinese University of Hong Kong, China
3Shenzhen Research Institute of the Chinese University of Hong Kong, China
4City University of Hong Kong, China
5Sungkyunkwan University, South Korea
Background: Children are more susceptible to influenza becausethey lack prior immunity and exposure. Studies showed that influenza in childhood has remarkable socio-economic impact on childrenʼs households as they spread the virus efficiently. Despite the benefits induced by influenza vaccination, its uptake rate, depending primarily on parents, remained low in a local context. While existing studies studied parental perception itself, not many of them investigated factors which shaped such perceptions. We therefore conducted this study to investigate the factors influencing parental perceptions.
Method: During March 2018 to May 2018, an online survey was conducted among parents of children aged 6 months to 12 years. Responses were collected via multiple social media platforms in a snowball sampling framework. The questionnaire includes sociodemographics of both parents and their children, vaccination uptake information of children in the 2017/2018 season, parental perception towards influenza vaccination.
Results: Among the 230 respondents providing complete data, most were mothers (80%), with mean age 35.4 years (SD=4.82), and were responsible for making the vaccination decision for children (87%). The reported 2017/18 influenza vaccination uptake rate was 26% (59/230). Both physicians (OR:2.79; 95% CI: 1.37, 6.19) and trusted individuals (OR:1.98; 95% CI: 1.00, 3.88) were influentialin encouraging parental decisions to have children vaccinated. Proximity to available vaccine (OR: 15.93; 95% CI: 6.95, 43.32), family support (OR: 25.0; 95% CI: 8.8, 106), recommendations from medical staff (OR: 16.2; 95% CI:4.8, 101.0), and new flu cases (OR:10.1; 95% CI:3.5, 42.6) could boost children vaccination uptake.
Discussion: Strong influence of trusted individuals suggested that promotion from medicalstaffshould extend to the whole household of the children in order to increasethe vaccination uptake rate. With close proximity to available vaccine being important parental consideration, our findings provided the empirical basis for launching outreach vaccination programs in local schools as an effective infection control strategy for influenza.
Taitung MacKay Memorial Hospital, Taiwan
Background: Intensive care unit nurses often encounter end-of-life decisions regarding the withdrawal of patientsʼ life-sustaining treatment.
Purpose: To understand the experiences of intensive care unit nurses participating in the withdrawal of patientsʼ life-sustaining treatment.
Method: Data were collected through face-to-face in-depth interviews and semi-structured interviews with a total of 15 nurses who had been working in intensive care units for at least half a year. The interview data were analyzed by qualitative content analysis.
Results: The experiences of nurses participating in the withdrawal of patientsʼ life-sustaining treatment covered the following three themes:
(1) The impact of withdrawing patientsʼ life-sustaining treatment on nurses: Witnessing the dilemma of family members and nurses led to negative effects of varying degrees, such as anxiety due to moral conflict, depression, and other issues.
(2) The quality of assistance in the withdrawal of patientsʼ life-sustaining treatment: The team lacked experience and education, the standard procedure was inconsistent making it difficult for the staff to follow, and there were cognitive differences among doctors.
(3) Effects on the nursesʼ attitude towards life: respected patientsʼ decisions, referring particularly to patientsʼ self-actualization after careful consideration; changed in their attitude towards life, and learned to respect, cherish, and face life optimistically.
Conclusion/Practical Application: The results of this study provide a better understanding of the degree of pressure and psychological conflict faced by nurses while assisting in the withdrawal of patientsʼ life-sustaining treatment. To improve the quality of end-of-life care, we recommend establishing a code of practice for providing care, developing a clinical application for establishing team consensus, and providing an appropriate work environment through the development of education and training.
Biography:
Yuen Fang Chin is graduated from the Department of Nursing at Tajen University. She had been a nurse in the ward and operating room for 15 years, a head nurse for 5 years. Now she have been the nursing supervisor of emergency department for 5 years. She have a strong interest in nursing work.
Taitung MacKay Memorial Hospital, Taiwan
Background: Job performance refers to not only positive task performance and organizational citizenship behaviors, but it also includes workplace deviance. Although workplace deviance commonly exists in workplace, it has been rarely discussed in previous researches when it comes to clinical nursing subordinates.
Purpose: The purpose of the current study aimed to examine the effect of workplace deviance on task performance and organizational citizenship behaviors.
Methods: We conducted a hospital-based, cross-sectional, survey based on purposive sample of four regional teaching hospitals in Taiwan. All primary research subjects were clinical nursing supervisors. Data were collected by using structured questionnaire, addressing different aspects of employee deviance, task performance and organizational citizenship behaviors. Significance levels between two continuous variables were assessed by Pearsonʼs correlation. All reported p-values with an alpha level of 0.05 corresponded to two-tailed analysis.
Result: A total of 242 valid questionnaires were collected from 6th August to 6th September 2018, for a retrieved rate of 93.08%. Our results exhibited a negative correlation between workplace deviance and task performance (p<0.001) as well as workplace deviance and organizational citizenship behavior (p<0.001).
Conclusion/ Practical Application: The current study suggests that the subordinate workplace deviance related to task performance and organizational citizenship has a negative impact on the overall work performance. This information may assist nursing supervisors in making decisions regarding task performance.
Biography:
Yun Tui Lin graduated from the Department of Nursing at Tajen University, and worked as a nurse in the general ward and operating room for 18 years. For slightly more than two years ago, she became a nursing supervisor in charge of a hospital unit.
Cardinal-Tien Hospital, Taiwan
Background: Sudden stroke and subsequent sequelae often cause patients to be unable to accept the disability and return to the previous life or work patterns, plus the need to rely on others to feel pain and helpless. Resilience is the ability of a stress event to adapt to the process. It is also a buffer for adapting stress. When faced with a major disease crisis, resilience will affect its impact and reduce the damage caused by stressors, which will help the disease adapt and maintain well as features.
The main research objectives of this study include: Understand the distribution of demographic variables and resilience of patients with stroke recovery. Understand the differences in influence demographic variables and resilience of patients with stroke recovery, and the factors that the resilience of patients during stroke recovery.
Methods: This study adopts cross-sectional research design and conducts research by means of sampling. The research tools include: personal basic data questionnaire, Chinese version of the resilience scale and ADL daily function activity scale for data collect. Descriptive statistics, independent t-test, Analysis of variance (ANOVA), Pearson correlation were used for data analysis. Result: A total of 100 hospitalized patients with stroke were collected, with an average age of 62.87±12.07 years old and more men. The first stroke, ischemic stroke, and right limb hemiplegia were mostly. Overall, the higher the age, the married and the spouseʼs children, the higher the resilience; the stroke patients, the higher the ADL score, the lower the psychological toughness scale (136.57 ± 16.47) than the ADL score ( 121.81±14.31), there was a statistically significant difference (P < 0.0001). Patients with stroke, those with high ADL scores, had a statistically significant difference (P = 0.0017) in the psychological intensity of individual strength (26.51 ± 3.96) compared with the ADL score (23.55 ± 5.16).
Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan
Purpose: This article describes a patient of End-Stage Chronic Obstructive Pulmonary Disease (COPD), the desire gets along with his family and compete time to God, nursing experience of to realize the returning home, but must need to use non-invasive positive pressure breathing device (NIPPV).
Methods: The author collected data through a direct observations, interviews, medical records, and applied Gordonʼs 11 Functional Health Patterns to comprehensively assess the patient.
Results: The health problems of the patient were identified and were as follow: low effective breathing pattern, anxiety, and nutrition imbalanced less than body requirements and caregiver role stain. The End-Stage of COPD is not easy to judgment and the medical treatment uncertainty is absolutely advantageous, we implant solicitude and empathy fostered stronger nurse-patient relationships, we give assistance of both the patient and the family experience a series of challenges in the face, through family conference to succeed in shared decision making in the patient with nurses and physicians, hospice team, respiratory therapy team, discharge preparation service inter-professional practice, this allowed the patient wished discharge and achieve homecoming.
Keywords: End-Stage of lung disease, Non-invasive positive pressure respirator (NIPPV)
Far Eastern Memeriol Hospital, Taiwan
Hospitalization is a very unusual experience for children because the concept of disease and death are still very vague to them. This article explores the nursing experience of a school-aged child with scald by cognitive development, social development and other theories. During the hospitalization of the case, the author used observation and interviewing methods to collect data and concluded that the case had nursing problems as follows: impaired skin integrity, body Activity dysfunction, anxiety, and nutrition are less than the body needs. In combination with the theory of development, formulate nursing measures suitable for this age group, and use this understanding of the age group and special skills to help the individual to overcome anxiety and illness in hospitalization and provide a complete care
Massachusetts College of Pharmacy and Health Sciences University, USA
Effective professional role transition is necessary for successful entry into advanced practice asa graduate nurse practitioner. Both personal and professional attributes can effect successful transition into the advanced practice role as a nurse practitioner. The integrative research review will address how transition theories, graduate school preparation and internships or mentorships can be incorporated into the graduate school and professional practice settings resulting in effective transition into the nurse practitioner role. The integrative research will focus on the various emotions encountered related to role transition from graduate nurse to advanced practitioner (Barnes, 2015). The study will further investigate the emotions related to novice vs. expert nurse and the graduate nurse beginning their career path as again a novice in the newly acquired role of advanced practitioner (Hart & Bowen, 2016). The integrative study will investigate how Transition Theory can provide the necessary tools and overall concepts needed by the advanced graduate practice nurse that is transitioning into the new role of a nurse practitioner (Poronsky, 2013).
Universiti Malaysia Sabah (UMS), Malaysia
Introduction: The assessment on the functional capacity of an elderly is conducted by getting information about their basic activities of daily living (ADL), such as bathing, feeding, moving in and out of a bed, toileting, dressing and continence status. It is also assessed through their ability in performing tasks such as preparing meals, managing money, going outside within walking distance or via transport, shopping, using the telephone, doing light housework, doing laundry and managing own medication. These tasks are known as the instrumental activities of daily living (IADL). Functional status of elderly population is interconnected with the quantity and quality of food consumed. Individual who is malnourished is likely to experience progressive decline in health and increased mortality.
Methodology: This is a descriptive study done in Sabah, Malaysia and employing a systematic random sampling method. Mini Nutritional Assessment (MNA) was used to evaluate the nutritional status of 197 elderly recruited in this study. To assess the functional status, the 8-item Instrumental Activities of Daily Living (IADL) and 6-item Activities of Daily Living (ADL) Scales were used. Data was collected through face-to-face interview or self-administering questionnaire at the Medical and Surgical outpatient department in a general hospital. The magnitude of being malnourished is determined by the MNA scoring with the cut off of 17.
Result: The MNA scores revealed that those at risk for malnutrition and well-nourished were 45.2% and 39.1% respectively, and 15.7% respondents were malnourished. In the malnourished group, the IADL and ADL scores found to have significant correlation with the MNA scoring, p < 0.05. Specific analysis on nutritional-related item in IADL scale demonstrates that malnourished elderly were dependent on others in meal preparation and shopping for groceries.
Conclusion: Functional level affects the ability of elderly to support their nutritional needs. It is recommended that nurses need to involve actively in screening for malnutrition among community-dwelling or institutionalized elderly. The intervention implementation is not only needed for those identified as malnourished but also to those who are at risk for malnutrition. Further exploration is needed to find effective interventions in improving the elderly functional capacity especially those nutritional-related daily activities.
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