Yea-Ing Lotus Shyu

A Pilot Investigation of the Short-Term Effects of an Interdisciplinary Intervention Program on Elderly Patients with Hip Fracture in Taiwan

Objectives: To evaluate an interdisciplinary intervention program for older people with hip fracture in Taiwan.

Interactive effects of nurse-experienced time pressure and burnout on patient safety: A cross-sectional survey

BACKGROUND Global nursing shortages have exacerbated time pressure and burnout among nurses. Despite the well-established correlation between burnout and patient safety, no studies have addressed how time pressure among nurses and patient safety are related and whether burnout moderates such a relation. OBJECTIVES This study investigated how time pressure and the interaction of time pressure and nursing burnout affect patient safety. DESIGN-SETTING PARTICIPANTS: This cross-sectional study surveyed 458 nurses in 90 units of two medical centres in northern Taiwan. METHODS Nursing burnout was measured by the Maslach Burnout Inventory-Human Service Scale. Patient safety was inversely measured by six items on frequency of adverse events. Time pressure was measured by five items. Regressions were used for the analysis. RESULTS While the results of regression analyses suggest that time pressure did not significantly affect patient safety (beta=-.01, p>.05), time pressure and burnout had an interactive effect on patient safety (beta=-.08, p<.05). Specifically, for nurses with high burnout (n=223), time pressure was negatively related to patient safety (beta=-.10, p<.05). CONCLUSION Time pressure adversely affected patient safety for nurses with a high level of burnout, but not for nurses with a low level of burnout.

Predictors of functional recovery for hip fractured elders during 12 months following hospital discharge: a prospective study on a Taiwanese sample

To examine the longitudinal changes in overall and individual physical activities of daily living (PADLs) and instrumental activities of daily living (IADLs), at 1, 3, 6, and 12 months after hospital discharge in elderly subjects, 110 hip fractured elders (mean±SD age, 79.4±7.5; 60.9% females) were enrolled in a prospective study. At 12 months following hospital discharge, 56.1% subjects had recovered their overall PADLs, 37.9% had recovered their overall IADLs, and 74.2% could walk independently or with the aide of a cane. When analyzed by generalized estimating equations (GEE), for individual PADL, bathing and climbing stairs had consistently improved at every time point throughout the 1-year follow-up period, while transferring, toileting, and walking ability only improved significantly in the first 3 months after discharge. For individual IADL, the proportion of recovery for mobility appeared to increase significantly during the first 6 months post-discharge, and the remaining IADLs appeared to be stable. These results indicated that the recovery rate is varied for performance of different activities according to the complexity and the involvement of the lower extremities. We also found that less concomitant diseases, and a shorter hospital stay could predict a better recovery trend of overall and of most individual PADLs. These findings may be applicable to other countries with Chinese populations, and could provide a reference for health care providers to develop specific interventions for Chinese hip fractured elders.

Two-Year Effects of Interdisciplinary Intervention for Hip Fracture in Older Taiwanese

OBJECTIVES: To explore the 2‐year outcomes of an interdisciplinary intervention for elderly patients with hip fracture.

International Perspectives on Nonpharmacological Best Practices for Dementia Family Caregivers: A Review

This review begins by highlighting the fact that dementia is truly a global problem at this time, with incidence and prevalence rates rising rapidly in most parts of the world and only expected to increase. Along with this comes the growing demand for programs and services targeted to support both the person with dementia and his or her family caregivers. Around the globe such programs are being developed, evaluated, and put into practice, with government funding and needed infrastructures to support them. However, the many pressing needs of family caregivers for services to reduce their burden and improve quality of life for themselves and their relative far outstrip available programs—even in highly developed countries such as the United States, United Kingdom, and Australia. This is even more so the case in less developed countries and regions such as China, India, Africa, and South and Central America. We conducted an extensive search of existing databases and publications related to this topic, and in this article we both review and critique existing programs and service models. There are descriptive sections on evidence-based programs and practices, as well as discussion of promising areas for future research. In addition, we discuss some of the formidable barriers that prevent or delay access to care in even the more developed countries. Finally, we conclude with a set of recommendations that we believe will enhance growth and productivity in this field.

Explaining and Selecting Treatments for Autism: Parental Explanatory Models in Taiwan

Parental explanatory models about autism influence the type of therapy a child receives, the child’s well-being, and the parents’ own psychological adaptation. This qualitative study explored explanatory models used by parents of children with autism. In-depth interviews were conducted with 13 parents of children with autism from a medical center in Taiwan. Despite high educational background, most of these parents attributed their child’s autism to both biomedical and supernatural etiologies without apparent conflicts. These parents chose a wide variety of treatment strategies, including biomedical and alternative treatments, which often created time/energy pressures and financial burden, and were influenced by parents’ cause attribution. Parents’ illness explanations influence their treatment selections and need to be understood and accepted by health care providers.

Psychometric Testing of the Social Support Survey on a Taiwanese Sample

Background: The Medical Outcomes Study Social Support Survey (MOS-SS) is a multidimensional, self-administered instrument used to assess various functional dimensions of social support. Less is known regarding its value for a Chinese population. Objective: The aim of this study was to assess the psychometric properties of the MOS-SS on an adult sample in Taiwan. Methods: A total of 265 adult family caregivers of patients with cancer from four different hospitals in the north, middle, and south regions of Taiwan completed the MOS-SS. Results: In the original five-factor model, unsatisfactory item discriminant validity was found in almost half of the items; the item-own subscale correlation was lower than the item-other subscale correlation. A two-factor model accounting for 68.98% of the variance was found using exploratory factor analysis. The first factor (emotional support) accounted for 62.28% of the total variance, whereas the second factor (tangible support) accounted for 6.7%; the interfactor correlation was .71. The two-factor model seemed to have satisfactory reliability and validity and better discrimination between different subscales than did the original five-factor model. Discussion: Good reliability and validity were demonstrated in the MOS-SS when applied to an adult sample in Taiwan. A two-factor model, instead of a five-factor model as found in the Western countries, was found for this sample. Confirmation of the two-factor model and exploration of the two-factor model in related concepts are suggested for future studies.

Changes in quality of life among elderly patients with hip fracture in Taiwan

To examine the longitudinal change in health related quality of life (HRQoL) during 1 year following hospital discharge in elderly subjects, 110 hip fractured subjects (age, mean±SD: 79.3±7.4 years) were enrolled in a prospective study. Face-to-face interviews with the patients were conducted, using Short Form 36 (SF-36) at 1, 3, 6, and 12 months after they were discharged from the hospital. The GEE approach was employed to evaluate changes in the variables of interest among different time points. Subjects in this study appeared to have lower scores in most dimensions of SF-36, with physical function and role limitation being the lowest due to physical problems (mean±SD=10.97±16.19; 6.32±20.60) during the 1st month after hospital discharge, compared to community dwelling subjects (mean±SD=77.5±20.5; 63.8±45.30). Most of the dimensions of SF-36, except general health (6th month versus 3rd month=57.56±21.90 versus 61.75±23.46, P>0.05) improved significantly from the 1st month to the 3rd month (range of means of improved scores from 12.81 to 30.76, P<0.01). After the 3rd month after discharge, physical functions kept improving significantly until 6 months after hospital discharge (3rd month versus 6th month=25.18±23.66 versus 40.30±25.94, P<0.05). Role limitation due to physical problems reached a plateau between the 3rd and 6th month, and then again improved significantly during the 6th month and the 1st year after hospital discharge (6th month versus 1st year=17.69±31.78 versus 32.22±44.47, P<0.05). The rest of the dimensions of SF-36 remained stable from the 3rd month to 1 year after discharge. These results indicated that different aspects of SF-36 recovered differently for the hip fractured patients in Taiwan. Similar studies may be helpful for health-care providers in other countries with Chinese populations to develop specific intervention programs.

Professional Commitment, Patient Safety, and Patient‐Perceived Care Quality

PURPOSE To examine how professional commitment influences patient safety and patient-perceived care quality. DESIGN Investigators for this study used a cross-sectional design with questionnaires. A total of 348 pairs of nurses and inpatients were contacted at two medical centers in Taiwan during the period from August 2007 to January 2008, yielding 284 pairs of completed questionnaires. METHODS Frequencies of six adverse patient events were used to measure patient safety; and the Service Quality Scale was used to measure patient-perceived care quality. Four items of the Professional Commitment Questionnaire were used to measure professional commitment. Regressions were used for the analyses. FINDINGS Professional commitment positively influenced overall patient safety (ss=.19, p=.00) and overall patient-perceived care quality (ss=.13, p=.03). Furthermore, professional commitment positively influenced all patient safety indicators (ss>or=.12, p<or=.04), except frequency of nosocomial infections, the coefficient of which reached borderline significance (ss=.11, p=.07). Professional commitment also positively influenced care quality in terms of responsiveness (ss=.16, p=.01) and empathy (ss=.14, p=.03). CONCLUSIONS Professional commitment may enhance patient safety and patient-perceived care quality. CLINICAL RELEVANCE This study indicates that nurse professional commitment can enhance patient safety and patient-perceived care quality.

Implicit Exchanges in Family Caregiving for Frail Elders in Taiwan

In this study, the authors use in-depth interviews with inductive analysis to develop a conceptual framework for exploring social exchanges and their implicit calculations for care-givers in Taiwan. They interviewed 12 caregivers, based on theory-based sampling and maximum variation. They found some components of implicit exchanges of the caregivers, and drew a framework to describe it. At the beginning of care, motivations were mostly from obligation accompanied by reciprocity or repaying motives. In the process of caregiving, some unique, implicit cultural implicit exchanges were found, such as karma, a demonstrative behavior to investment, equitable share of responsibility, and the pressure or rewards from public opinion. These implicit exchanges might be intermediary factors in helping caregivers cope with their burden or even in influencing their continuation of care. The findings are implicated to help family caregivers continue their care and not damage their quality of care.