Miaofen Yen

Examining test-retest reliability: An intra-class correlation approach

BackgroundThere are limitations of inter-class correlation (usually, the Pearson’s product-moment correlation) in evaluating reliability of an instrument. An intra-class correlation approach would be appropriate to examine the test-retest reliability of an instrument. ObjectivesTo introduce an intra-class correlation approach to examine the test-retest reliability of an instrument. MethodThe method of constructing an intra-class correlation coefficient was presented. ResultsThe instrument with visual analog scales to measure the perceived competence to practice breast self-examination and perceived barriers to breast self-examination was tested. The intra-class correlation coefficient was 0.640. ConclusionThe intra-class correlation is an alternative to test the reliability of an instrument and it is more sensitive to the detection of systematic error.

Group reminiscence intervention in Taiwanese elders with dementia

The purpose of this study was to evaluate the effect of structured group reminiscence therapy on behavior competence and physical functioning and to compare effectiveness of the intervention by stage of dementia in Taiwanese elders residing in institutional settings. A longitudinal experimental design was used. Seventy-seven Taiwanese elderly participants completed the study; 38 in the intervention group and 39 in the control group. Participants in the intervention group received one reminiscence therapy session weekly for 8 weeks; those in the control group received regular nursing care. Barthels index (BI) and the Clifton Assessment Procedures for the Elderly Behavior Rating Scale (CAPE-BRS) were administered pre- and post-intervention. Findings indicated that no significant differences between the intervention and control groups on overall behavioral competence (p=0.12) or physical functioning (p=0.44). However, slight overall improvement was identified, statistically significant for the social disturbance subscale of the CAPE-BRS was found (p=0.011). There were no significant changes in overall behavior competence (p=0.11) or physical functioning (p=0.30) by stage of dementia (mild vs. moderate) in the intervention group, counter to the hypothesis. Although our results did not demonstrate a significant effect of structured group reminiscence therapy on overall behavior competency or on physical functioning in elders with dementia, we identified issues related to future implementation of this intervention, such as study power, chosen outcome measures, intervention dose, timing of outcome measures, or cultural applicability issues.

Education for patients with chronic kidney disease in Taiwan: a prospective repeated measures study

AIM To investigate the physical, knowledge and quality of life outcomes of an educational intervention for patients with early stage chronic kidney disease. BACKGROUND A comprehensive predialysis education care team can be effective in slowing the progression of chronic kidney disease. DESIGN A single group repeated measures design was used to evaluate the effects of the intervention. METHODS Participants were recruited through health department community health screen data banks. A predialysis, team-delivered educational intervention covering renal function health care, dietary management of renal function and the effects of Chinese herb medication on renal function was designed and implemented. Data were collected at baseline, six and 12 months. Study outcomes included physical indicators, knowledge (renal function protection, use of Chinese herbs and renal function and diet) and quality of life. Data were analysed using repeated measure anova to test for change over time in outcome variables. RESULTS Sixty-six persons participated in this study. The predialysis educational intervention showed significant differences at the three time points in overall knowledge scores, waist-hip ratio, body mass index and global health status. Knowledge measures increased at month 6 and decreased at month 12. The primary indicator of renal function, glomerular filtration rate, remained stable throughout the 12 months of follow-up, despite the relatively older mean age of study participants. CONCLUSION A predialysis education care team can provide effective disease-specific knowledge and may help retard deterioration of renal function in persons with early-stage chronic kidney disease. The intervention dose may need to be repeated every six months to maintain knowledge effects. RELEVANCE TO CLINICAL PRACTICE A predialysis educational program with disease-specific knowledge and information is feasible and may provide positive outcomes for patients. Topics on the uses of Chinese herbs should be included for people who are likely to use alternative therapies.

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.

Health promotion lifestyle profile-II: Chinese version short form

AIM This paper is a report of an examination of the validity and reliability of the Chinese version of the Health Promoting Lifestyle Profile. BACKGROUND The Health Promotion Lifestyle Profile, a well-known instrument measuring health promotion lifestyle behaviours and developed by Walker in 1987 and later refined, has been translated into several languages. The original Chinese translated version, based on Walkers 48-item 1987 version, detected six dimensions of health promotion lifestyle behaviours. The 52-item revised Health Promotion Lifestyle Profile-II has not been tested for Mandarin-speakers. METHOD After the English version of the Health Promotion Lifestyle Profile-II was translated into Chinese using established forward-backward translation procedures, the psychometric properties of the translated version were determined with 331 Taiwanese Mandarin-speaking adults. Data were collected from August 2007 to July 2008 at outpatient clinics for health screening in Southern Taiwan. The psychometric properties of the instrument were evaluated, including the internal consistency, test-retest reliability, item analysis and factor analysis. RESULTS Neither Walkers original 6-factor model nor a forced 6-factor solution of the 52 items of the Health Promotion Lifestyle Profile-II was supported. Parallel analysis suggested that five factors be retained, with the 5-factor solution statistically and conceptually satisfactory. The 5-factor Chinese version of the Health Promoting Lifestyle Profile explained 53% of the variance in healthy lifestyles. Thirty items were retained for the Chinese version of the Health Promoting Lifestyle Profile. DISCUSSION Deletion of 22 items from the Health Promotion Lifestyle Profile-II did not impair the ability of the Chinese version of the Health Promoting Lifestyle Profile to measure a healthy lifestyle among a sample of Taiwanese adults. The data support the fact that lifestyle is influenced by culture.

Toothbrushing versus toothbrushing plus tongue cleaning in reducing halitosis and tongue coating: a systematic review and meta-analysis.

Background:Halitosis affects people of all ages. Among hospitalized patients, oral care includes toothbrushing and mouth rinses. Tongue cleaning is not included in most guidelines or nursing education curricula. Objectives:The aim of this study was to compare the effectiveness of two types of oral care, toothbrushing alone and toothbrushing plus tongue cleaning, on halitosis and tongue coating (TC). Methods:A systematic review and meta-analysis of randomized controlled trials were conducted to compare toothbrushing and toothbrushing plus tongue cleaning during oral care to reduce halitosis and TC. The databases included PubMed, ProQuest, CINAHL, the Cochrane Central Register of Controlled Trials, experts, and bibliographic review. A quality assessment of study reports and methodology was conducted using the CONSORT checklist and the Jadad Scale. The measurement of volatile sulfide compounds (VSCs) evaluated halitosis, whereas TC was measured with assessment indexes. Results:Seven experimental data sets were obtained from five randomized clinical trials. There were 188 male and 63 female subjects within an age range of 17–80 years. All intervention groups indicate a large effect size of toothbrushing plus tongue cleaning decreases volatile sulfur compounds and TC by 0.745 and 0.922, respectively, compared with toothbrushing only. Discussion:The use of toothbrushing plus tongue cleaning compared with toothbrushing alone significantly reduced the indicators of halitosis and TC. However, there is insufficient evidence to recommend frequency, duration, or delivery method of tongue cleaning. Further research is needed to articulate a comprehensive clinical guideline. Oral care is an important nursing intervention. Tongue cleaning should be incorporated into current nursing procedures.

The Effects of Tai Chi Exercise on Elders with Osteoarthritis: A Longitudinal Study

PURPOSE Tai Chi exercise has been proven to be beneficial among elders with osteoarthritis (OA). The long-term effects of this exercise remain unclear. The purpose of this study was to evaluate the effects of the Tai Chi exercise for Arthritis (TCEA) program on the physical status and quality of life of OA elders. METHODS This was a time series study with one group design. Subjects diagnosed with OA of the lower extremities, aged 60 years or over, were recruited from an outpatient clinic at a community teaching hospital. Thirteen participants joined a TCEA exercise class three times per week for 2 years. Physical status including body mass index (BMI), lean body mass, hand grasp strength, flexibility, and equilibrium were measured four times-at baseline, 3 months, 1 year, and 2 years of the TCEA exercise class. Quality of life was also measured at these time points. RESULTS Lean body mass was significantly decreased within the study period (p < .05). Participants experienced significant improvements in physical functioning, role limitations, and social functioning on the dimensions of quality of life (SF-36) (p < .05). CONCLUSION Elderly people with OA should be encouraged to exercise using Tai Chi for maintaining physical function and improving quality of life.

Examining Factor Structure of Maslach Burnout Inventory Among Nurses in Taiwan

AIM To investigate the factorial structure of a Chinese version of the MBI-HSS for nurses in Taiwan. BACKGROUND Previous studies have presented different factorial structures using the Maslach burnout inventory-human services survey (MBI-HSS). METHODS Secondary data analysis was implemented to explore the factor structure of MBI-HSS using exploratory factor analysis. Confirmatory factor analysis was then performed to verify the modified structure for nurses in Taiwan. RESULTS The EFA found that three factors explaining 57% of the variance were extracted, and 20 of the 22 items were retained. The goodness-of-fit test was performed using the CFA approach, and it was verified that the modified version of MBI-HSS is a suitable instrument for measuring burnout for nurses in Taiwan. CONCLUSIONS A nationwide sample confirmed the factorial structure of MBI-HSS for nurses in Taiwan with a three-dimension, 20-item assessment, and the variance was not diminished in this sample. IMPLICATIONS FOR NURSING MANAGEMENT These findings demonstrate that the modified version of MBI-HSS provides a suitable instrument for measuring burnout for nurses in Taiwan. Therefore, the modified version of MBI-HSS can be used to compare burnout of nurses across cultures, providing valuable information for policies or preventions in the future.

Cross-Mapping ICNP Terms with Taiwanese Gynecological Nursing Records

&NA; Cross-mapping the terms of International Classification for Nursing Practice (ICNP) with the handwritten nursing records of gynecological patients at one district of private teaching hospital in the south of Taiwan was conducted in July and August, 2004. The purpose of this study was to validate the applicability of ICNP for electronic nursing records in a gynecological setting. A Chinese version of the ICNP beta 2 browser was used to code nursing record sentences. Medical charts were reviewed until data were saturated. A total of sixty-two patient records were analyzed, producing 6,327 sentences, this included 1,918 sentences on nursing phenomena (30.3%) and 4,409 sentences on nursing action (69.7%). The ratio between the two was about 1:2.3. Coded sentences were compared according to the four levels of applicability with the original records, each was identified as a “perfect fit”, “conceptual fit”, “partial fit”, or “unable to fit”. Of the 6,327 sentences, 2,041 (32.3%) were designated as “perfect fit”, 2,457 (38.8%) as “conceptual fit”, 1,663 (26.3%) as “partial fit”, and 166 (2.6%) as “unable to fit”. The top ten most described nursing phenomena included: acute pain, high temperature, conscious change, potential infection risk, state of mind change, potential risk patients mobility change endurance level, gastrointestinal function obstacles, changes in urination, anxiety, and diarrhea. The top ten most described nursing actions included: observe surgical wounds, monitor vital signs, changes of mentality, instruction on medication, arranging clinical check ups, wound infection prevention, urinary drainage tube and urine nature observation, checking for vaginal drainage, pre/post-operative healthcare, and discharge planning. Study results indicated that 71.1% of sentences could be cross-mapped. Further validation is suggested to validate ICNP in other gynecological hospitals.

Effects of Targeted Interventions on Lifestyle Modifications of Chronic Kidney Disease Patients Randomized Controlled Trial

Targeting interventions to an individual’s readiness to modify lifestyle factors, specifically diet and exercise behaviors, may delay chronic kidney disease (CKD) progression. This study examined the effects of a targeted Lifestyle Modification Program based on the readiness to change health-promotion lifestyle behaviors, renal protection knowledge, and physical indicators of patients with early CKD. A repeated-measures design randomized 160 CKD patients from four southern Taiwan outpatient nephrology clinics into control and intervention groups. Data were collected five times over a year with a participant retention rate of 64.4%. The intervention group demonstrated significant improvement with regard to diet behavior modifications. Compared with the control group, the intervention group showed a significant improving trend of renal function protection knowledge, stress management, and interpersonal relations. Targeted interventions for patients in the early phases of CKD promotes adherence to proper diet, exercise behavior, and positive lifestyle modifications.