Background
Fatigue is associated with multidimensional factors in heart failure patients. Investigating longitudinal changes in fatigue and its association in patients undergoing cardiac surgery is ...needed to create interventions for improving fatigue during recovery.
Aims
This study examined the trajectory of fatigue and its associated factors over time in patients undergoing cardiac surgery.
Methods
This longitudinal study enrolled 125 patients undergoing cardiac surgery in northern Taiwan. Patients completed questionnaires before surgery, at discharge, and at 1, 3 and 6 months post‐discharge. Fatigue was measured using the General Fatigue Scale. Generalised estimating equation models were fitted to identify variables associated with fatigue over time. This study complied with the STROBE checklist.
Results
The sample (mean age = 60.70 ± 10.42) was mostly male (68%). High fatigue was found in 73.6% of patients before cardiac surgery and significantly decreased over the six months after discharge. NYHA III/IV, lower haemoglobin level, more symptom distress, poor sleep quality, higher anxiety and depression and lower social and family support were significantly associated with an increase in fatigue levels over time. Compared with before discharge, decreases in sleep quality at 1, 3 and 6 months were significantly associated with an increase in fatigue levels (p < .001). The increases in social support (B = 0.20, p = .016) and family support (B = 0.37, p = .002) at 6 months were significantly associated with an increase in the fatigue scores.
Conclusion
Fatigue was common and associated with symptoms, sleep quality, emotion and social support in patients undergoing cardiac surgery. In addition to symptom management, improving sleep quality and social support are important to manage fatigue for the long‐term care of patients undergoing cardiac surgery.
Relevance to clinical practice
Patient education on symptom management, sleep hygiene and family support is suggested to improve fatigue in patients recovering from cardiac surgery.
Pressure injuries remain a significant health care issue in various settings. The purpose of this study was to examine the relationship between a pressure redistributing foam mattress (PRFM) and the ...development of pressure injuries.
This study employed an observational prospective cohort study design. We enrolled 254 participants from the intensive care unit who were at risk of developing pressure injuries. Participants were exposed to either a nonpressure redistributing foam mattress (NPRFM), which was the standard mattress used at the study site, or a PRFM made of viscoelastic, temperature-sensitive, polyurethane memory foam. The patients' assignment to either a PRFM or NPRFM was performed upon their admission, before the study eligibility screening. The relationship between the PRFM and the development of pressure injuries was studied using a logistic regression model.
The overall incidence of pressure injuries was 5.9% (15/254) in our study, with 1.6% (2/127) for participants who used a PRFM and 10.2% (13/127) for those using a NPRFM. After adjusting for potential confounding variables, use of a PRFM was associated with an 88% reduced risk of pressure injury development (OR = 0.12, 95% CI: 0.03, 0.56, P = 0.007). The use of a PRFM also contributed to a postponed occurrence of pressure injuries by 4.2 days on average in comparison with that of a NPRFM (P = 0.041).
A PRFM is associated with a significantly reduced incidence and postponed occurrence of pressure injuries. It is recommended to use a PRFM for patients at risk of developing pressure injuries.
Aim
The aim of this study was to develop and psychometrically test a new instrument for measuring nurse’s positive energy of retention (NPER).
Background
The shortage of professional nurses is an ...unresolved global issue. Few studies explored the issue of the retention of nurses in terms of a positive psychological viewpoint.
Design
Methodological study.
Methods
Data collection was from June 2016–August 2017. Nurses (N = 947) recruited from northern, central and southern Taiwan covering different levels of hospitals were divided into three samples, which were used for explaratory factor analysis (EFA), confirmatory factor analysis (CFA) and cross‐validation respectively.
Results
EFA resulted in a three‐factor solution: proactive and persevering characteristics, nursing professional identity and passion accounting for 61.8% of total variance. The proposed three‐factor model was confirmed by CFA. Cross‐validation provided further evidence for the construct validity of the NPER instrument with 24 items. Cronbach's alpha coefficient of three subscales of the instrument were 0.95, 0.89, and 0.92 separately and 0.96 for the total scale.
Conclusion
Psychometric properties indicate that the newly formulated NPER instrument is a valid and reliable assessment tool to recruit nurses who are more likely to remain in nursing.
Impact
The study addressed the personal intrinsic factors, which are very important for nurses’ retention. The NPER instrument consisted of three subscales is a reliable and psychometrically valid new instrument. Managers could apply the NPER instrument to recruit nurses possessing the attributes of positive energy of retention. Furthermore, researchers could use the rigorous process provided in the study to establish a new instrument.
目的
本研究的目的是开发一种从积极心理学角度进行的测量护士护理人员留任意愿(NPER)的新型工具并对该方法进行心理测量。
背景
专业护士短缺是一个尚未得到解决的全球性问题。很少有研究从积极心理学角度探讨护士留任问题。
设计
方法研究。
方法
本研究收集了2016年6月至2017年8月期间的数据,将来自台湾北部、中部及南部不同层级医院的护士(N = 947)分为三个样本,对样本分别进行了解释性因子分析(EFA)、验证性因子分析(CFA)及交叉验证。
结果
解释性因子分析的结果显示为三因子解:积极和坚持的特点,护理专业认同和激情共占总方差的61.8%。提出的三因素模型得到了验证性因子分析的验证。交叉验证为24项NPER工具的结构有效性提供了进一步的证明。量表三个方面的克朗巴哈系数分别为0.95、0.89和0.92,总分为0.96。
结论
心理测量学特性表明,新编制的NPER量表是一种有效、可靠的评估工具,可用于招聘更有可能继续留任的护士。
影响
本研究探讨了个人内在因素对护士留任意愿的影响。NPER量表由三个分量表组成,是一种可靠的、心理测量有用的新型量表。管理者可以应用NPER量表招聘具有更愿意留任的护士。此外,研究人员可以利用研究中提供的严谨结果以编制其他新型量表。
Objective:
To evaluate the effect of a 12-week breathing-based leg exercises program on quality of life under stabilizing heart rate variability and reducing fatigue in regular hemodialysis patients.
...Design:
Randomized controlled trial.
Setting:
A 94-bed hemodialysis department at a medical center in northern Taiwan.
Participants:
Eighty-six patients with end-stage renal disease undergoing hemodialysis were recruited and randomly assigned to the ExBr or control groups.
Interventions:
The breathing-based leg exercises program comprised abdominal breathing and low-intensity leg exercise, including leg lifts, quadriceps femoris contraction and knee flexion, and lasted for 15 minutes at one time, three times a week for 12 weeks.
Main measure:
Data was collected by using the World Health Organization quality of life assessment-brief, physiological signal recorder for heart rate variability and hemodialysis-related fatigue scale at baseline and on Week 4, Week 8, and Week 12.
Results:
Average (standard deviation) age was 53.70 (10.04) years in the ExBr group and 61.19 (10.19) years in the control group. The linear mixed model with adjusted age, creatinine, heart rate variability and fatigue revealed that the ExBr group had significantly higher quality of life than did the control group (P = 0.01), especially on Week 12 (P = 0.04). Fatigue was significantly correlated with quality of life (P < 0.001).
Conclusion:
This study supported the benefits of the continued breathing-based leg exercises during hemodialysis for at least 12 weeks, which improved the quality of life of patients with end-stage renal disease and did not affect the stability of their vital signs.
Aim
To identify the ‘positive energy’ that inspires nurses' retention in the profession.
Background
Previous studies focused on the negative extrinsic factors associated with nurses leaving the ...profession. However, scant research explored the personal intrinsic essence regarding why nurses remain in the profession.
Method
This study used a qualitative descriptive design. Ten focus groups including 53 participants were recruited by purposive sampling from five hospitals in Taiwan. Data were collected between March 2015 and January 2016 through semi‐structured focus group interviews. The data were examined by content analysis.
Results
Six themes were identified, including sense of mission, achievement, passion, meaning of nursing, personal characteristics and intrinsic coping.
Conclusion
Findings emerged from this study characterizing ‘positive energy’ as a steady inner strength, not easily changed with the external environment, which inspires the retention of staff nurses.
Implications for Nursing Management
The themes identified in this study can be used to develop an instrument for assessing nurses' inner attributes which may help managers recruit nurses possessing ‘positive energy’ of retention. Future researchers may develop an intervention programme to cultivate nurses ‘positive energy’ and further test its effect on nurse retention.
Aim
This study examined the effect of underlying contextual factors on the intention to stay in nurses.
Background
Workplace promotion, social support, work stress, job satisfaction and ...organisation‐based self‐esteem (OBSE) are psychosocial factors influencing the intention to stay in nurses. However, few studies have analysed the relationships among these factors.
Method
A cross‐sectional survey was conducted and a sample was recruited in convenience sampling method from a medical centre in Taiwan. A total of 791 nurses completed a self‐report questionnaire over a 3‐month period in 2013.
Results
Social support, work stress, job satisfaction and OBSE significantly affected the intention to stay in nurses. Furthermore, social support and job satisfaction showed a positive direct effect on the intention to stay and an indirect effect on the intention to stay; the indirect effect was mediated by OBSE.
Conclusion
Organisation‐based self‐esteem mediates the effects of social support and job satisfaction on the intention to stay in nurses.
Implications for Nursing Management
The results showing the influence of OBSE on the intention to stay in nurses can serve as insight for hospital managers to make decisions when encouraging and managing employees.
Cancer-related fatigue is one of the most common and persistent issues experienced by cancer patients. Cancer-related fatigue is a distinct form of fatigue that is subjective, long-lasting and ...unalleviated by rest or sleep. Studies have shown that almost all cancer patients experience severe fatigue that disrupts the quality of life and physical function, but cancer-related fatigue remains under-addressed in clinical care, and only about half of all patients receive treatment.
To increase the awareness of cancer-related fatigue and improve current management, the Taiwan Society of Cancer Palliative Medicine and the Taiwan Oncology Nursing Society convened a consensus committee to develop recommendations for the screening, assessment and treatment of cancer-related fatigue.
Thirteen consensus recommendations were subsequently developed based on the best available evidence and the clinical experience of committee members.
These recommendations are expected to facilitate the standardization of cancer-related fatigue management across Taiwan and may also serve as a reference for other clinicians.
Background
The purpose of this study was to review the risks and benefits of concurrent chemoradiation therapy (CCRT) with esophageal self‐expandable metal stents (SEMS) for the treatment of locally ...advanced esophageal cancer.
Materials and Methods
Between January 2014 and December 2016, the data from 46 locally advanced esophageal cancer patients who received CCRT at our institution were retrospectively reviewed. Eight patients who received CCRT concomitant with SEMS placement (SEMS plus CCRT group) and thirty‐eight patients who received CCRT without SEMS placement (CCRT group) were identified. The risk of developing esophageal fistula and the overall survival of the two groups were analyzed.
Results
The rate of esophageal fistula formation during or after CCRT was 87.5% in the SEMS plus CCRT group and 2.6% in the CCRT group. The median doses of radiotherapy in the SEMS plus CCRT group and the CCRT group were 47.5 Gy and 50 Gy, respectively. SEMS combined with CCRT was associated with a greater risk of esophageal fistula formation than CCRT alone (hazard ratio HR, 72.30; 95% confidence interval CI, 8.62–606.12; p < .001). The median overall survival times in the SEMS plus CCRT and CCRT groups were 6 months and 16 months, respectively. Overall survival was significantly worse in the SEMS plus CCRT group than in the CCRT group (HR, 5.72; 95% CI, 2.15–15.21; p < .001).
Conclusion
CCRT concomitant with SEMS for locally advanced esophageal cancer results in earlier life‐threatening morbidity and a higher mortality rate than treatment with CCRT alone. Further prospective and randomized studies are warranted to confirm these observations.
Implications for Practice
Patients treated with SEMS placement followed by CCRT had higher risk of esophageal fistula formation and inferior overall survival rate compared with patients treated with CCRT alone. SEMS placement should be performed cautiously in patients who are scheduled to receive CCRT with curative intent.
摘要
背景。本次研究的目的是回顾分析同步放化疗(CCRT) 伴随食管自膨式金属支架 (SEMS)用于治疗局部晚期食管癌的风险和益处
材料和方法。2014年1月至2016年12月,回顾性分析了在我院接受CCRT的46名局部晚期食管癌患者的数据。共选择8名接受CCRT 伴随SEMS植入的患者(SEMS+CCRT组)和38名仅接受CCRT、未植入SEMS的患者(CCRT组)。分析了两组患者的食管瘘发生风险和总生存期
结果。在CCRT期间或之后,SEMS+CCRT组和CCRT组的食管瘘发生率分别为87.5%和2.6%。SEMS+CCRT组和CCRT组的中位放疗剂量分别为47.5 Gy 和50 Gy。与单纯CCRT治疗相比,SEMS联合CCRT会导致食管瘘形成风险升高风险比 (HR), 72.30; 95% 置信区间(CI), 8.62–606.12; p<0.001。SEMS+CCRT组和 CCRT组的中位总生存期分别为6个月和16个月。SEMS+CCRT组的总生存期显著低于CCRT组(HR, 5.72; 95% CI, 2.15–15.21; p<0.001)
结论。与单独采用CCRT治疗相比,CCRT伴随SEMS用于治疗局部晚期食管癌可导致更早发生危及生命的疾病和更高的死亡率。未来需要展开进一步前瞻性随机研究,以证实这些观察结果。
实践意义:与单独接受CCRT治疗的患者相比,接受SEMS植入伴随CCRT治疗的患者食管瘘形成的风险更高,总生存率也较低。对计划接受CCRT治疗以实现根治目的的患者,应慎用SEMS植入
This article reports on the effects of esophageal self‐expandable metal stents placement on the risk of esophageal fistula formation and clinical outcomes in patients undergoing concurrent chemoradiation therapy.
This study aimed to review clinical experiences using whole-field simultaneous integrated boost (SIB) intensity-modulated radiotherapy (IMRT) and sequential IMRT in postoperative patients with oral ...cavity cancer (OCC). From November 2006 to December 2014, a total of 182 postoperative patients with OCC who underwent either SIB-IMRT (n = 63) or sequential IMRT (n = 119) were enrolled retrospectively and matched randomly according to multiple risk factors by a computer. The differences were well balanced after patient matching (P = .38). The median follow-up time was 65 months. For patients treated with the SIB technique and the sequential technique, the respective mortality rates were 36.8% and 20.0% (P = .04). The primary recurrence rates were 26.3% and 10.0% (P = .02), respectively. The respective marginal failure rates were 26.7% and 16.7%. A multivariate logistic regression analysis showed that patients who received the SIB technique had a 2.74 times higher risk of death than those who received the sequential technique (95% confidence interval = 1.10-6.79, P = .03). Sequential IMRT provided a significantly lower dose to the esophagus (5.2 Gy, P = .02) and trachea (4.6 Gy, P = .03) than SIB-IMRT. For patients with locally advanced OCC, postoperative sequential IMRT may overcome an unpredictable geographic miss, potentially with a lower marginal failure rate in the primary area. Patients treated by sequential IMRT show equal overall survival benefits to those treated by SIB-IMRT and a lower mortality rate than those treated by SIB-IMRT. Additionally, a reduced dose to the esophagus and trachea compared to sequential IMRT was noted.
It is pertinent to understand the perceptions of healthcare workers (HCWs) with their associated personal protective equipment (PPE) usage and heat strain symptoms experienced to effectively combat ...the negative effects of heat stress during treatment and care activities.
We evaluated the associated heat stress perceived by HCWs across Asia and validated a questionnaire on perceptions of heat stress, associated PPE usage, and heat strain symptoms experienced. The questionnaire was administered to 3,082 HCWs in six Asian regions. Factor analyses, including Cronbach's alpha, assessed the questionnaire's validity and reliability. Structural equation modelling analysed the effects of knowledge, attitudes and practices, and heat strain symptoms.
The questionnaire was found to be reliable in assessing HCWs' knowledge, and attitudes and practices towards heat stress and PPE usage (both Cronbach's alpha = 0.9), but not heat strain symptoms (Cronbach's alpha = 0.6). Despite knowledge of heat stress, HCWs had negative attitudes and practices regarding PPE usage (β1 = 0.6, p < 0.001). Knowledge (path coefficient = 0.2, p < 0.001), and negative attitudes and practices (path coefficient = 0.2, p < 0.001) of HCWs towards heat stress and PPE usage adversely affected symptoms experienced.
The questionnaire was not reliable in assessing symptoms. HCWs should, nevertheless, still self-assess their symptoms for early detection of heat strain. To effectively attenuate heat strain, understanding HCWs' attitudes and practices towards PPE usage should guide policymakers in implementing targeted heat management strategies.
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