Ching Huey Chen

Sensorimotor function, balance abilities and pain influence Timed Up and Go performance in older community-living people

Background and aims: The Timed up and Go Test (TUG) is recommended as a screening tool for fall risk in older people. It is assumed that this general mobility test is underpinned by physiological factors such as strength, coordination and balance. However, no studies have examined the range of physiological and psychological factors which influence performance on this test. The aim of this study was to examine the relative contributions of a range of sensorimotor, balance and psychological factors to TUG performance in a large sample of older people. Methods: 280 community-dwelling people aged 65 plus years (mean age 74.9, SD=6.4) underwent the TUG test, as well as quantitative tests of vision, peripheral sensation, strength, reaction time, balance, fear of falling, pain and vitality. Results: The time required to complete the TUG was significantly related to limitations in instrumental activities of daily living and fear of falling. Many physiological and psychological factors were significantly associated with TUG performance in univariate analyses. Stepwise multiple regression analyses identified knee strength, postural sway, reaction time, edge contrast sensitivity, MMSE score, SF12 body pain and general health scores, number of medical conditions and age as significant and independent predictors of TUG performance. Of these measures, the lower limb strength measure explained most variance in TUG times. However, other sensorimotor, balance, psychological and health measures provided important independent information. The combined set of variables explained 43.5% of the variance in TUG times (multiple r=0.65). Conclusions: Findings indicate that, in community-dwelling older people, TUG performance is influenced by lower limb strength, balance, reaction time, vision and pain, in addition to cognitive function and health status.

A model of medication-taking behavior in elderly individuals with chronic disease.

Adherence with prescription medications among elderly patients with cardiac conditions is poor. Mechanisms underlying adherence behavior have not been fully investigated. The purpose of this study was to develop a substantive model that describes medication-taking behavior in elderly individuals with chronic diseases. The study was exploratory using grounded theory. Purposive sampling was used to recruit 19 elderly cardiac patients. Four major themes were delineated from the data to describe readiness to adhere: perceived effectiveness, perceived partnership, perceived reality, and interpersonal influences. To convert perceptions into actions, 2 influencing factors, facilitating and inhibiting factors, played pivotal roles. This model could provide a useful framework for health professionals to design valid interventions for elderly patients to increase medication adherence.

Gender Differences in the Relationship of Social Activity and Quality of Life in Community-Dwelling Taiwanese Elders

This study explores the gender differences in the relationship between social activity and quality of life (QOL). A cross-sectional survey of 220 community-dwelling elderly people was conducted in southern Taiwan. Social activity was classified into six categories. The brief version of the World Health Organization QOL (WHOQOL-BREF) was used to measure QOL. Findings revealed that the associations of six types of social activities with QOL were weaker among women than men. The regression analyses further showed that for women, only religious activity was positively related to total QOL, while for men only involvement in formal group activity was positively related to total QOL.

Ionospheric data assimilation with thermosphere-ionosphere-electrodynamics general circulation model and GPS-TEC during geomagnetic storm conditions

The main purpose of this paper is to investigate the effects of rapid assimilation-forecast cycling on the performance of ionospheric data assimilation during geomagnetic storm conditions. An ensemble Kalman filter software developed by the National Center for Atmospheric Research (NCAR), called Data Assimilation Research Testbed, is applied to assimilate ground-based GPS total electron content (TEC) observations into a theoretical numerical model of the thermosphere and ionosphere (NCAR thermosphere-ionosphere-electrodynamics general circulation model) during the 26 September 2011 geomagnetic storm period. Effects of various assimilation-forecast cycle lengths: 60, 30, and 10 min on the ionospheric forecast are examined by using the global root-mean-squared observation-minus-forecast (OmF) TEC residuals. Substantial reduction in the global OmF for the 10 min assimilation-forecast cycling suggests that a rapid cycling ionospheric data assimilation system can greatly improve the quality of the model forecast during geomagnetic storm conditions. Furthermore, updating the thermospheric state variables in the coupled thermosphere-ionosphere forecast model in the assimilation step is an important factor in improving the trajectory of model forecasting. The shorter assimilation-forecast cycling (10 min in this paper) helps to restrain unrealistic model error growth during the forecast step due to the imbalance among model state variables resulting from an inadequate state update, which in turn leads to a greater forecast accuracy.

Bioethics education for practicing nurses in Taiwan: Confucian-western clash:

To understand the gaps between current bioethics education and the requirements of practicing nurses, a semistructured questionnaire was used to invite the directors of nursing departments at all 82 teaching hospitals in Taiwan to participate in this survey. The response rate was 64.6%. Through content analysis we obtained information about previous bioethical training, required themes and content, recommended teaching strategies, and difficulties with education and its application. The results suggest that Taiwanese nursing personnel need to be instilled with both self-cultivation of morality and mental cultivation to acquire nursing virtues and the right attitudes toward bioethical issues. Good communication skills to prevent damage to the harmonious relationships between patients, their families and medical team members, policies that support the provision of systematic formal knowledge of ethics, small group training, and clarification of values were also shown to be important in bioethics education.

Efficacy of guided imagery with theta music for advanced cancer patients with dyspnea: a pilot study.

Background: Dyspnea is a frequent and devastating symptom among advanced cancer patients for which improved and low-cost palliative techniques are needed. Methods: A one-group repeated measures research design investigated the efficacy of guided imagery (GI) with theta music (θM) on dyspnea in advanced cancer patients. The intervention consisted of four periods: (a) pretest; (b) intervention with peaceful non-θM; (c) intervention with 10 min of GI with θM (GI/θM), with the first and last 3 min being θM only (i.e., the middle 4 min was GI/θM); and (d) posttest. Dyspnea outcome was measured with the Modified Borg Scale (MBS) for self-reported evaluation of dyspneic symptoms. Physiological parameters measured were pulse oxygen saturation (SpO2), end-tidal CO 2 (EtCO2), heart rate (HR), and respiratory rate (RR). Posttest qualitative data were obtained via interview for subjective patient experience. Results: Participants included 53 patients, 33% with lung cancer. GI/θM produced a significant decrease in MBS scores; 90% of the subjects gave positive qualitative reviews of GI/θM. SpO2 did not change significantly over time. GI/θM significantly increased EtCO2, decreased RR, and decreased HR. Discussion: This study demonstrates that GI/θM is a useful intervention for palliative care of patients with dyspnea. θM alone was demonstrated to be effective, while soothing non-θM was not effective. GI/θM was more effective than θM alone. GI/θM should be considered low-cost end-of-life palliative care for dyspnea.

Ionosphere data assimilation modeling of 2015 St. Patrick's Day geomagnetic storm

The ionospheric plasma disturbances during a severe storm can affect human activities and systems, such as navigation and HF communication systems. Therefore, the forecast of ionospheric electron density is becoming an important topic recently. This study is conducted with the ionospheric assimilation model by assimilating the total electron content observations into the thermosphere-ionosphere coupling model with different high-latitude ionospheric convection models, Heelis and Weimer, and further to forecast the variations of ionospheric electron density during the 2015 St. Patricks Day geomagnetic storm. The forecast capabilities of these two assimilation models are evaluated by the root-mean-square error values in different regions to discuss its latitudinal effects. Results show the better forecast in the electron density at the low-latitude region during the storm main phase and the recovery phase. The well reproduced eastward electric field at the low-latitude region by the assimilation model reveals that the electric fields may be an important factor to have the contributions on the accuracy of ionospheric forecast.

Building a bridge for nursing education and clinical care in Taiwan — Using action research and Confucian tradition to close the gap

BACKGROUND Nursing workplaces in Taiwan are unable to retain talent. An examination of this problem has revealed that the causes of this phenomenon are that nursing education fails to cultivate the skills that meet workplace requirements and that there are gap between nursing education and clinical practice. OBJECTIVES This paper is an action research that aims is to design educational programs that can close the gap between nursing education and clinical practice in Taiwan. DESIGN In this action research project, 4 action cycles were used to design educational programs including concept mapping and focused discussion strategies. SETTINGS Participants were invited to join the research in three teaching hospitals and one university. PARTICIPANTS Two groups of participants, student nurses (SN) and nursing staff personnel (NS), were sampled and invited to participate in the research. METHODS Participant observation, focus groups, and qualitative interviews were used to collect data. Qualitative data were not only profiled by content analysis, but they were also compared continuously between the two groups as well as between the 4 cycles. RESULTS The qualitative data collected for the 135 participants were analysed. The themes of an effective nursing program were summarized. CONCLUSIONS Many fundamental values of traditional Chinese education have gradually faded due to the Westernization of education. In this study, we discovered that Western educational models may play a critical role in improving traditionally taught nursing education programs.

Minimal Chair Height Standing Ability Is Independently Associated With Falls in Taiwanese Older People

OBJECTIVE To determine whether a test of minimal chair height standing (MCHS) ability is an important predictor of fall risk in community-dwelling older people living in Taiwan, and whether poor performance in this test is associated with impaired sensorimotor functioning, balance, and mobility in this group. DESIGN Cross-sectional study. SETTING Community based. PARTICIPANTS Community-dwelling participants (N=280; mean age, 74.9y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The MCHS test, which measures the lowest height from which a participant can stand; the Physiological Profile Assessment (PPA); and a range of functional balance and mobility tests. RESULTS In the 12 months before the study, 81 participants (28.9%) experienced 1 or more falls. The fallers had significantly higher MCHS scores compared with the nonfallers: 29.7±9.0 and 25.0± 9.2cm, respectively. Fallers also had significantly higher PPA fall risk scores than nonfallers and performed significantly worse in tests of reaction time, standing and leaning balance, and alternate stepping ability. Discriminant function analysis revealed that poor performance in the MCHS and high PPA scores were both independently and significantly associated with falls. These 2 variables correctly classified 64.5% of participants into faller and nonfaller groups. Participants who reported regular squatting performed significantly better in the MCHS test, and multiple regression analysis revealed that impaired knee extension strength, poor single-leg stance ability, and reduced leaning balance were independent predictors of poor MCHS. CONCLUSIONS In this study, MCHS was an independent risk factor for falls. It is a functional test similar to deep squatting and underpinned by strength and balance. Because the MCHS is quick to administer, it may have scope for clinical application.

“Does One Size Fit All?” Exploring the Cultural Applicability of NANDA Nursing Diagnoses to Chinese Nursing Practice

East Asia has historically unique concepts of health and well-being and thus is an appropriate setting for exploring the multicultural applicability of the North American Nursing Diagnosis Association’s Nursing Diagnoses (NANDA ND) system. This study aimed to explore how NANDA ND affect the growth and quality of professional nursing from the perspective of Taiwanese nurses. Grounded theory was employed in this interview-based investigation of 53 Taiwan-licensed nursing professionals at various hospitals in Taiwan. Data were analyzed using constant comparative analysis until theoretical saturation was reached. The core concept, Struggling with (the NANDA ND notion that) One Size Fits All, emerged after ongoing analysis of the effects of NANDA ND on good nursing, patient welfare, and professional development. The preliminary theoretical framework developed from this study provides evidence that NANDA ND may be incompatible with the cultural beliefs of the traditional Chinese health care setting in Taiwan, which emphasize holistic harmony and balance.