Enhancing nurses' perceptions of having a place to reduce turnover intentions

AIM

To investigate whether education, tenure, being an advanced practice nurse, skill level, and time pressure impact perceptions of "having a place" and, further, turnover intentions.

BACKGROUND

Nursing shortages persist worldwide. Nurses' turnover intentions are negatively related to their perceptions of "having a place" (i.e., the feeling that the nursing workplace is their territory). However, the sources of nurses' perceptions of the perception of "having a place" remain unknown.

METHODS

Our research employed a cross-sectional and correlational design. This research was conducted at a large-scale hospital in northern Taiwan from December 2021 to January 2022. We used personnel data pertaining to 430 nurses as well as scales for time pressure, "having a place" and turnover intentions to assess nurses' intention to leave their place of employment. The inclusion criteria focused on full-time nurses who worked for the hospital under investigation. Most of our participants were women. The STROBE statement was used as the EQUATOR checklist (supplemental file).

RESULTS

"Having a place" was positively related to educational level, tenure, and skill level, while being an advanced practice nurse was negatively associated with perceptions of "having a place," which in turn were negatively related to turnover intention among nurses.

CONCLUSION

Our study is the first to examine the antecedents of nurses' perceptions of "having a place," which include education, tenure, and skill level.

IMPLICATIONS FOR NURSING POLICY

Nursing policymakers could encourage nurses to pursue higher degrees and update their nursing skills while instilling perceptions of "having a place" in nurses with a brief tenure and advanced practice nurses.

Enhancing Nurse-Robot Engagement: Two-Wave Survey Study

BACKGROUND

Robots are introduced into health care contexts to assist health care professionals. However, we do not know how the benefits and maintenance of robots influence nurse-robot engagement.

OBJECTIVE

This study aimed to examine how the benefits and maintenance of robots and nurses' personal innovativeness impact nurses' attitudes to robots and nurse-robot engagement.

METHODS

Our study adopted a 2-wave follow-up design. We surveyed 358 registered nurses in operating rooms in a large-scale medical center in Taiwan. The first-wave data were collected from October to November 2019. The second-wave data were collected from December 2019 to February 2020. In total, 344 nurses participated in the first wave. We used telephone to follow up with them and successfully followed-up with 331 nurses in the second wave.

RESULTS

Robot benefits are positively related to nurse-robot engagement (β=.13, P<.05), while robot maintenance requirements are negatively related to nurse-robot engagement (β=-.15, P<.05). Our structural model fit the data acceptably (comparative fit index=0.96, incremental fit index=0.96, nonnormed fit index=0.95, root mean square error of approximation=0.075).

CONCLUSIONS

Our study is the first to examine how the benefits and maintenance requirements of assistive robots influence nurses' engagement with them. We found that the impact of robot benefits on nurse-robot engagement outweighs that of robot maintenance requirements. Hence, robot makers should consider emphasizing design and communication of robot benefits in the health care context.

How do three components of professional commitment influence nurse-reported patient-centred care and care quality?

AIMS AND OBJECTIVES

To test how the three components of professional commitment (i.e. affective, continuance and normative professional commitment) are associated with nurse-reported patient-centred care and care quality.

BACKGROUND

Patient-centred care and care quality are the two critical care outcomes. However, no study has yet examined how the three components of professional commitment are related to nurse-reported patient-centred care and care quality, showing a research gap.

DESIGN

This study adopted a two-wave design (first wave in 2017 and second wave in 2019), which is known to reduce the possibility of reverse causality, and which was conducted in a large hospital in Northern Taiwan.

METHODS

Proportionate random sampling was used. Full-time nurses were surveyed, while nursing students, interns, nurse practitioners and nursing supervisors were excluded. The first wave included 524 nurses, and 438 nurses were retained in the second wave. We used confirmatory factor analysis to verify the psychometric properties of the measures. Structural equation modelling was used to implement hypothesis testing. We used the Professional Commitment Scale of Meyer et al. (Journal of Applied Psychology, 1993, 78, 538), the Patient-Centered Care Scale of Laird-Fick et al. (Patient Education and Counseling, 2011, 84, 90) and the Care Quality Perceptions Scale of Teng et al. (Journal of Nursing Management, 2010, 18, 275). The STROBE statement was chosen as the EQUATOR checklist.

RESULTS

Affective professional commitment was positively associated with nurse-reported patient-centred care (β = .18, p = .002 and .01), which was positively associated with nurse-reported care quality (β = .85, p < .001). Affective and normative professional commitment were also positively associated with nurse-reported care quality (β = .17, p < .001).

CONCLUSIONS

Our findings offer insights for nursing managers that nurses' affective and normative professional commitment could help upgrade care outcomes. Hospital managers should consider professional commitment as relevant to their workforce.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers could publicise reports documenting nurses' significant contributions to public health. This could strengthen affective professional commitment among nurses.

The Effects of a Scenario-Based Spiritual Care Course on Spiritual Care Competence among Clinical Nurses: A Quasi-Experimental Study

Across their lifespans, and in many clinical settings, patients have spiritual care needs. Many nurses lack competence related to providing spiritual care. Popular educational strategies, such as simulated educational programs and objective structured clinical examinations (OSCE), have not been widely adopted in nursing spiritual care education. The purpose of this study was to explore the effects of a scenario-based spiritual care course on spiritual care competence in nurses. This quasi-experimental study employed a repeated-measures pre-test/post-test design with assessments immediately before, immediately after, and 3 months post-intervention. Nurses providing direct patient care in diverse clinical settings were recruited from a large medical foundation in northern Taiwan. The intervention was a one day scenario-based spiritual care course and OSCE. The experimental group (n = 53) and controls (n = 85) were matched for their similar units, ages, working experience, and clinical ladder status. The Spiritual Care Competence Scale (SCCS), Spiritual Perspective Scale (SPS), Spiritual Care Perspective Scale-Revised (SCPS-R), and reflection logs were completed by both experimental and control groups. The Course Satisfaction Scale, OSCE Checklist, and Standardized Patient Feedback Scale (SPFS) were completed by the experimental group only. The experimental group had significantly higher SPS scores and self-evaluated SCCS scores, and lower SCPS-R scores (more positive spiritual perspectives), than controls at 3 months post-intervention. The experimental group showed significant within-subject effects at three time points on SPS scores, SCPS-R scores, and self-evaluated SCCS scores. Mean global performance of OSCE was 3.40 ± 0.91, and SP feedback indicated strengths and areas for improvement. In conclusion, the scenario-based spiritual care course effectively enhanced nurses' spiritual care competence, competence, and skills. Blended education techniques can therefore enhance nurses' ability to support patients with spiritual care needs.

How robots impact nurses' time pressure and turnover intention: A two-wave study

AIMS

To examine the relationships among effort ensuring robots' smooth operation (EERSO), time pressure, missed care, and nurses' turnover intention, and how robot performance moderates such relations.

BACKGROUND

Robots may reduce nurses' workload but typically still require some effort of nurses for robots' smooth operation. However, the negative impact of EERSO on nurses' workplace outcomes is unknown.

METHODS

This study used a two-wave follow-up design. Data were collected in a medical center in Taiwan, with first wave collected in 2019 and second wave collected between 2019 and 2020. A total of 331 participants were followed through the two waves.

RESULTS

EERSO is positively linked to missed care and time pressure. Time pressure is also positively linked to missed care and turnover intention. Positive robot performance weakens the positive link between EERSO and time pressure.

CONCLUSION

Using robots may help reduce nurses' workload, but it also requires nurses' efforts to maintain robots' continuous operation, that is, EERSO. It may adversely impact nursing professional workplaces.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should reduce nurses' time pressure whilst suggest hospital managers to seek robots that require minimal EERSO.

Relationship between Psychological Ownership of the Nursing Profession and Turnover Intention: A Correlational Survey among Taiwanese Nurses

AIMS

To examine the relationship between psychological ownership of the nursing profession and turnover intention.

BACKGROUND

There is a severe shortage of nurses worldwide. Research is needed to understand how nurses' intention to leave hospitals and the nursing profession can be alleviated.

METHODS

This study adopted a cross-sectional design and a survey method. Proportionate random sampling was used to ensure sample representativeness. This study surveyed 430 registered nurses in a medical center in Taiwan between December 2021 and January 2022. We used Turnover Scale and Self-Efficacy Scale, and developed Having a Place Scale.

RESULTS

Psychological ownership comprises three dimensions: self-efficacy, nurse identity, and "having a place" in the nursing profession. This research is the first to examine how these three dimensions of psychological ownership of the nursing profession are related to the intention to leave a hospital or the nursing profession. Self-efficacy and "having a place" are negatively related to nurses' intention to leave a hospital (r=-.23 and -.31, p<.001). Nurse identity is negatively related to nurses' intention to leave the nursing profession (r=-.38, p<.001). Intention to leave a hospital is positively related to nurses' intention to leave the profession (r=.76, p<.001).

CONCLUSION

The findings provide novel insights for retaining nurses. Nurse managers could use strategies such as including nurses in making workplace decisions and encouraging them to personalize their workspace. Implications for Nursing Management Nurse managers can enhance nurses' self-efficacy and sense of "having a place" to retain nurses in hospitals, while enhance nurse identity to retain nurses in the profession.

The Fall Risk Screening Scale Is Suitable for Evaluating Adult Patient Fall

(1) Background: This study aimed to test the feasibility of utilizing the screening tool for fall risk assessment in adult inpatient and verify its accuracy in a medical center in Taiwan. (2) Methods: This study retrospectively collected all adult fall cases among inpatients occurring in the general wards of a medical center between 1 January 2013 and 31 December 2015. This inpatient fall risk screening scale was measured by the sensitivity, specificity, and accuracy. (3) Results: There were 1331 (0.4%) falls among a total of 357,395 inpatients during this period. Factors predictive of falling risk included: age, consciousness, body shift assistance, use of fall risk medications, fall history, dizziness or weakness, toileting, and impaired mobility. Using the eight-factor assessment, two was the best cutoff point for identifying the fall risk group, with area under Receiver Operating Characteristic (ROC) curve (AUC) = 0.817, sensitivity = 80.93%, specificity = 73.0%, accuracy = 73.03%, and likelihood ratio = 11.48. (4) Conclusions: The accuracy of the eight-item fall risk assessment tool created for this study was validated. These results can serve as a reference for institutions to develop more effective fall risk assessment scale for inpatients, enabling clinical nurses to identify and more comprehensively assess the groups at highest risk for falling during their hospital stay.

Utility of Palliative Prognostic Index in Predicting Survival Outcomes in Patients With Hematological Malignancies in the Acute Ward Setting

BACKGROUND

The palliative prognostic index (PPI) predicts the life expectancy of patients with terminally ill cancer in hospice settings. This study aimed to evaluate PPI as a prognostic tool for predicting the life expectancy of patients with hematological malignancies admitted to the acute ward.

METHODS

A total of 308 patients with hematological malignancies admitted to the hematological ward at a medical center between January 2016 and December 2017 were consecutively enrolled. PPI was scored within 24 h of admission. All patients were categorized into 3 groups by PPI for comparing survival and in-hospital mortality rates.

RESULTS

The median survival times were 38.4, 3.6, and 1.1 months for patients with good, intermediate, and poor prognostic group, respectively. The hazard ratio was 2.31 (95% CI 1.59-3.35, p < 0.001) when comparing the intermediate and good prognosis groups, and 3.90 (95% CI 2.52-6.03, p < 0.001) when comparing the poor and good prognosis groups. Forty-five (14.6%) patients died at discharge; in-hospital mortality rates among the good, intermediate, and poor prognostic groups were 9.0%, 23.4%, and 46.4%, respectively. The adjusted odds ratio for in-hospital mortality was 1.96 (95% CI, 0.80-4.82, p = 0.14) and 5.25 (95% CI, 2.01-13.7, p < 0.001) for patients in the intermediate and poor prognostic groups compared to those in the good prognostic group.

CONCLUSION

PPI is an accurate prognostic tool for predicting survival times and in-hospital mortality rates in patients with hematological malignancies in an acute ward setting. PPI could assist clinicians in discussing end-of-life issues and in referring patients with hematological malignancies to palliative care.

Reducing turnover intention to improve care outcome: A two-wave study

AIMS

To ascertain how professional turnover intention impacts nurse-assessed care outcomes, including patient-centered care and care quality.

BACKGROUND

Patient-centered care and care quality are critical to care outcomes. However, we do not know whether care outcomes would be improved by reducing nurses' professional turnover intention.

DESIGN

We implemented a two-wave correlational follow-up design.

METHODS

This study was conducted in a large-scale general in Taiwan during January and February 2018, and January and February 2019. We successfully obtained responses from 448 nurses in 2018 and subsequently followed up (in 2019). Most were women (97.5%), reflecting the profile of the local nurse population. Structural equation modeling was used to test hypotheses.

RESULTS

Our findings indicate that nurses' professional turnover intention is negatively related to nurse-assessed, patient-centered care. Nurses' professional turnover intention is also negatively related to all the five perceptions of nurse-assessed care quality: that is, assurance, reliability, responsiveness, empathy, and tangibles. Moreover, years of working as a nurse is also positively related to nurse-assessed, patient-centered care and all the five perceptions of nurse-assessed care quality.

CONCLUSION

This study examined nurses' professional turnover intention as an antecedent of nurse-assessed, patient-centered care and care quality. Our study shows that professional turnover intention may predict care outcomes. Overall, our study suggests that professional turnover intention not only impacts workforce stability but also impacts health-care outcomes.

IMPACT

Our findings suggest that reduction of nurses' turnover intentions could benefit care outcomes. Hospital managers should know that nurses' turnover negatively impacts care outcomes.

Flexible Textile-Based Pressure Sensing System Applied in the Operating Room for Pressure Injury Monitoring of Cardiac Operation Patients

Pressure injury is the most important issue facing paralysis patients and the elderly, especially in long-term care or nursing. A new interfacial pressure sensing system combined with a flexible textile-based pressure sensor array and a real-time readout system improved by the Kalman filter is proposed to monitor interfacial pressure progress in the cardiac operation. With the design of the Kalman filter and parameter optimization, noise immunity can be improved by approximately 72%. Additionally, cardiac operation patients were selected to test this developed system for the direct correlation between pressure injury and interfacial pressure for the first time. The pressure progress of the operation time was recorded and presented with the visible data by time- and 2-dimension-dependent characteristics. In the data for 47 cardiac operation patients, an extreme body mass index (BMI) and significantly increased pressure after 2 h are the top 2 factors associated with the occurrence of pressure injury. This methodology can be used to prevent high interfacial pressure in high-risk patients before and during operation. It can be suggested that this system, integrated with air mattresses, can improve the quality of care and reduce the burden of the workforce and medical cost, especially for pressure injury.

The association between psychological distress and angina pectoris: A population-based study

BACKGROUND

Psychological distress is an undifferentiated combination of symptoms that may be related to the occurrence of angina pectoris (AP). However, few studies have investigated the relationship between psychological distress and AP, particularly in Asian populations. The purpose of this study was to examine the relationship between psychological distress and AP in Taiwanese adults.

METHODS

We adopted a cross-sectional design to explore the data of the 2005-2008 Nutrition and Health Survey in Taiwan. In total, 2080 subjects (aged ≥ 19 years) responded to questionnaire interviews and underwent physical examinations. Each of the five dimensions of psychological distress (sleep disturbance, anxiety, hostility, depression, and feelings of inferiority) were scored (from 0-20) according to the Five-Item Brief Symptom Rating Scale (BSRS-5). A score ≥ 6 points indicated psychological distress. AP was evaluated using a modified Rose questionnaire.

FINDINGS

In total, 102 subjects (3.6%) had AP, and 231 subjects (8.8%) had symptoms of psychological distress. After adjusting for the basic data, metabolism, and lifestyle covariates, the BSRS-5 total score was associated with AP (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.13-1.26, p < 0.001). Subjects with psychological distress had a higher risk of AP (OR = 2.97, 95% CI = 1.76-4.99, p < 0.001).

CONCLUSIONS

The presence of AP is associated with psychological distress. Health care providers should therefore be aware of the impact of psychological distress on AP. Our study findings can serve as a reference for AP assessments. Large scale longitudinal studies are needed to confirm a causal relationship between psychological distress and AP.

A decline in the prevalence of angina pectoris: Data from the Nutrition and Health Survey in Taiwan

BACKGROUND

Angina pectoris (AP) is one of common symptoms of heart disease. The prevalence of AP varies by genders, age and ethnics. This study aimed to estimate the AP prevalence in adults and its change between surveys.

METHODS

Data was derived from the Nutrition and Health Survey in Taiwan (NAHSIT) between 1993 and 1996, and between 2005 and 2008. Participants aged ≥19 years old and grouped according to sex and age range (19-44.9, 45-64.9, and ≥65 years). The national weight prevalence rates in three types of AP (possible, definite, and confirmed) were estimated and we also estimated its change between surveys.

RESULTS

A total of 5031(1993-1996) and 4686 (2005-2008) adults were enrolled for this study. The aged-adjusted prevalence of possible, definite, and confirmed AP was 9.2%, 5.6%, and 2.1%, respectively, in 1993-1996, and 4.7%, 3.5%, and 1.1%, respectively, in 2005-2008. The age-adjusted prevalence of definite AP significantly declined from 5.6 (1993-1996) to 3.5 (2005-2008). Women had greater decline in the prevalence for possible (5.8% vs. 3.2%), definite (2.9% vs. 1.3%) and confirmed (1.6% vs. 0.5%) AP than men in both surveys. All AP prevalence rates increased by age in men in both surveys, however, the positive association between AP prevalence and age groups among women only was in 1993-1996.

CONCLUSIONS

The AP prevalence significantly declined from 1993 to 1996 to 2005-2008. The AP prevalence in women was higher. The prevalence increased with age in men, but not in women. Continuous monitoring of AP prevalence is recommended to better understand the disease burden.

The effects of the flipped classroom in teaching evidence based nursing: A quasi-experimental study

Background

Evidence-based nursing (EBN) has been an important training mechanism for improving the quality of clinical care. At present, the pedagogy focuses on the application of e-learning and team-based learning to enhance learners’ engagement and learning effectiveness.

Objectives

This study applied the flipped classroom approach to conduct evidence-based nursing (EBN) teaching. The aim of this study is to elevate the learning effectiveness of the flipped classroom group to the traditional teaching group in terms of knowledge and self-efficacy in practice.

Design

A pretest-posttest nonequivalent control group with a quasi-experimental quantitative design.

Methods

The study recruited 151 nurses, of whom 75 were in the control group and 76 were in the experimental group. During the EBN course, the control group received training via traditional pedagogy while the experimental group engaged the flipped classroom approach. The learning effectiveness of EBN knowledge and self-efficacy in practice were evaluated across the three time points: pre-course, post-course, and one month after the course.

Results

In both group the scores of the EBN knowledge and self-efficacy in practice improved after training. The scores of the experimental group increased significantly than in the control group. However, the scores declined in both groups one month after the course. Even so, the experimental group’s score of self-efficacy in practice was still higher than that of the control group.

Conclusion

The implementation of the flipped classroom approach and team-based learning effectively enhanced the learners EBN knowledge accumulation and self-efficacy in practice. The research results can be used as an important reference for improving clinical nursing teaching quality.

Music listening alleviates anxiety and physiological responses in patients receiving spinal anesthesia

OBJECTIVE

The aim of this study was to explore the effects of listening to music on the anxiety levels and physiological responses of surgical patients receiving spinal anesthesia.

METHODS

An experimental design was used in the study with an experimental group (n=50) and a control group (n=50). The experimental group received 30min of musical intervention and routine nursing care in the Post-Anesthesia Care Unit (PACU) while the control group received only routine nursing care.

RESULTS

The study found significant differences in both anxiety and physiological indices between the two groups. The mean score of the State-Trait Anxiety Inventory (STAI) in the study group decreased from a pre-test score of 59.0 to a post-test score of 31.20 (t=28.63, p<0.001). Physiological indices such as heart rate (t=2.61, p=0.012), respiration rate (t=2.29, p=0.026), systolic blood pressure (t=2.30, p=0.026), and diastolic blood pressure (t=3.02, p=0.004) decreased significantly as well. Control group was not seeing significant changes from pre-op values.

CONCLUSION

Listening to music while in the recovery room may decrease the level of anxiety in surgical patients receiving spinal anesthesia. The results of this study can serve as a reference for PACU nurses in utilizing music listening programs to achieve the goal of holistic care.

[The Effectiveness of Pulmonary Rehabilitation for Critical-Care Ventilator Patients: A Systematic Review]

BACKGROUND

Prolonged of use mechanical ventilators results in respiratory muscle atrophy and difficulties in weaning, which increase mortality rates and psychlogical distress. While pulmonary rehabilitation has been shown to improve respiratory muscle strength, the effects of this intervention in critical-care patients who use mechanical ventilation remain uncertain.

PURPOSE

The present paper uses a systematic review of the literature to evaluate the effects of pulmonary rehabilitation on the rate of ventilator weaning and on the physical performance of ventilator patients receiving critical care.

METHODS

A systematic review was used. Searches were conducted in databases including: Cochrane Library, Embase, MEDLINE, PubMed and Airit Library. Keywords that were used included: "mechanical ventilation", "pulmonary rehabilitation", "exercise", "weaning", and "activities of daily living". The search focused on articles that were published prior to February 2015. Based on inclusion and exclusion criteria, 7 articles addressing relevant randomized controlled trials were extracted.

RESULTS

All of the 7 studies supported that pulmonary rehabilitation interventions improve mechanical ventilation weaning and functional independence activities. Several studies were limited by small sample size and differences in the types of rehabilitations used. Thus, the generalizability of the findings of this review is limited. and further research is required to verify the effects of pulmonary rehabilitation.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The results of this systematic review support that pulmonary rehabilitation interventions improved the weaning rate, activities of functional independence, and maximal inspiratory pressure (MIP) in critical patients who had used mechanical ventilators for over 48 hours. Under hemodynamic-stablized and pressure-support mode, inspiratory muscle training is suggested as useful for patients with limited ability to participate in rehabilitation programs.

[The Experiences of Obstructive Sleep Apnea in Women]

BACKGROUND

Obstructive sleep apnea (OSA) is a potentially lethal respiratory sleep disorder. However, few studies have studied OSA women.

PURPOSE

The purpose of the current study was to explore the life experiences of women with OSA.

METHODS

A qualitative study using the grounded theory method was used to establish a descriptive theory.

RESULTS

The results were expressed in terms of three stages with related categories. Stage 1: No interest days due to poor sleep, including "uncontrollable sleep", "perceived health deteriorates", and "poor female image harmed by snoring"; Stage 2: Indecision and disappointments during treatment seeking, including "doctor shopping", "being urged by others to seek medical help", and "being shocked by the severity of disease"; and Stage 3: Accepting a new lifestyle with a continuous positive pressure respirator, including "adaptation of the new sleep", "adequate sleep", and "secret worry of being an OSA woman".

CONCLUSIONS

Based on the findings of the present study, medical knowledge and treatments related to OSA should be widely promoted with appropriate professional education and counseling services in order to enhance the awareness of patients and to facilitate their acceptance of the healing process using a continuous positive airway pressure respirator.

[A Project to Improve the Time-Effectiveness of Routine Morning Blood Tests]

BACKGROUND & PROBLEMS

Morning blood sampling, conducted around 4am to 5am, is routinely ordered due to nothing-by-mouth (NPO) requirements and clinical practice norms. However, this routine may interrupt the normal sleep of patients and decrease the satisfaction of patients with the care received. However, our night-shift staff is not able to take all blood samples during this time, resulting in a high rate of overdue reporting.

PURPOSE

To reduce the overdue rate of laboratory result from 62.3% to less than 19.3%.

RESOLUTION

In 2013, we performed interventions including the process reengineering of blood sampling to meet the needs of laboratory result flows and the upgrading of equipment in our neurology ward. The reengineering strategies used included the redistribution of blood sampling times in order to decrease testing for unnecessary items. The equipment upgrades improved the ability of the carrier in the pneumatic tube systems to carry the chilled blood samples. An independent two-sample t-test was used to compare the overdue rate before and after the interventions.

RESULTS

The overall overdue rate for the blood sampling to laboratory flow improved from 62.3% before the intervention to 18.0% (t = 7.07, p < .001) after the intervention. Furthermore, the overdue rate for the testing done at the stat laboratory improved from 66.9% to 21.3% (t = 7.36, p < .001), while the overdue rate for the testing done at the non-stat laboratory improved from 52.4% to 17.8% (t = 5.37, p < .001). Besides, the satisfaction of both inpatients and nurses with regard to blood-sampling flow improved from 51% and 54.2%, respectively to 93% (t = 51.10, p < .001) and 94% (t = 12.26, p <.001).

CONCLUSIONS

Our process reengineering strategies and the upgrading of the pneumatic tube system successfully reduced the overdue rate for the blood sampling and increased the satisfaction of inpatients.

The effectiveness of the newly designed thermal gown on hypothermic patients after spinal surgery

AIMS AND OBJECTIVES

To develop the newly designed thermal gown to test the effectiveness in relieving postoperative hypothermia as compared to traditional cotton cloth.

BACKGROUND

Hypothermia is a common problem after spinal surgery. A patient's safety and comfort are significant. Currently, most research is focused on instruments that relieve a patient's hypothermia. Studies have rarely considered a patient's comfort while caring for their body temperature.

DESIGN

This study employed an experimental design. The participants were assigned randomly to two groups: the experimental group (N = 50) and the control group (N = 50).

METHODS

The experimental group received the newly designed thermal gown intervention. The control group received the standard postanaesthesia care unit re-warming intervention. The material used to collect data included demographic data, postoperative management and comfort level. Nurses measured patients' vital signs and asked for patients' subjective comfort level on admission to the postanaesthesia care unit every 10 minutes until their discharge from the postanaesthesia care unit.

RESULT

The accumulated percentage for thermal gown group patients in reaching 36 °C during the first 20 minutes of admission was significantly higher than that of the cotton cloth group. The thermal gown group individuals showed significantly higher comfort levels (score = 4) at 10 minutes, when compared to the cotton cloth group.

CONCLUSION

Results suggested that the newly designed thermal gown had effectively improved postoperative temperature and comfort level with an evidence-based intervention.

RELEVANCE TO CLINICAL PRACTICE

Maintaining a patient's body temperature is a major task for nurses working in the post-anaesthesia care unit. With the newly designed thermal gown, the duration of a patient's stay in the postanaesthesia care unit was shortened and the patient's comfort was increased.

[Effects of head posture on oxygenation saturation, comfort, and dyspnea in patients with liver cirrhosis-related ascites]

BACKGROUND

Chronic liver disease and cirrhosis are collectively ranked as the ninth most prevalent cause of death in Taiwan. Ascites is the most common comorbidity associated with liver cirrhosis. Different body postures affect pulmonary ventilation and arterial oxygen partial pressure. Thus, ensuring proper body posture in patients is an important clinical nursing intervention that significantly affects the recovery of patients.

PURPOSE

This study investigates the effects of head posture on oxygenation saturation, comfort, and dyspnea in patients with liver cirrhosis-related ascites.

METHODS

A quasi-experimental study design was used. A total of 252 participants were recruited from a medical centre hospital in Taiwan. Participants were allocated randomly into three groups of bed-elevation angles: 15 degrees, 30 degrees, and 45 degrees. The physiological indices were measured at 5, 10, 15, 20, 25, and 30 minutes in order to investigate the change in oxygenation saturations that were attributable to the different angles. Data were analyzed using descriptive statistics. The generalized estimating equation (GEE) was used for statistical analysis, with the level of significance set at: α = .05.

RESULTS

After controlling for confounding variables, the results showed that patients in the three groups earned similar scores for the degree of difficulty in the oxygen values. The supine group earned significantly different scores than the other two groups in terms of blood oxygen values related to time to change the angle of the three groups at five minutes after adjusting the angle (p < .01). This study found no differences among the three groups in terms of comfort. In terms of breathing, this study found a significant difference between 45-degree and 15-degree supine dyspnea (p < .05). Therefore, patients with ascites at 15 degrees supine and with better access to better oxygen saturation had superior results to their peers at 30 degrees and 45 degrees supine. Furthermore, this group was less likely to perceive breathing difficulties.

CONCLUSIONS / IMPLICATIONS FOR PRACTICE

The results of this study may guide health education and care for nurses in order to improve the quality of care for patients with chronic liver disease / cirrhosis with concomitant ascites.

Medical conditions and medications as risk factors of falls in the inpatient older people: a case-control study

OBJECTIVE

The majority of inpatient falls are older people who have various medical conditions and are on several medications. The purpose of this study was to examine the association between medical conditions and medications and falls in older people in hospital.

METHOD

Using a case-control design, we selected older people (aged 65 or over) who were reported to the Taiwan Patient-Safety Reporting System for the fall incidents in a large academic hospital in 2006 (n = 165). They were individually (1:1) matched for gender, age, and period of hospitalization with the control non-faller group. Bivariate and multivariate logistic regressions were used to compare the cases and controls to examine the association of medical conditions and medication exposure within 24 h before the falls.

RESULTS

Bivariate analyses showed that older people with cancer, or exposure medications such as zolpidem, benzodiazepines, narcotics, and antihistamines were significantly more likely to have falls during hospitalization. After controlling for cancer, zolpidem, narcotics, and antihistamine, we found benzodiazepine (Odds ratio (OR) = 2.26, 95% confidence interval (CI) = 1.21-4.23) and benzodiazepine doses ≥1 mg/day in diazepam equivalents (OR = 2.14, 95%CI = 1.04-4.39) were still significantly associated with the falls of older people in the hospital.

CONCLUSIONS

Strategies to prevent falls in older people in hospital should include minimizing the use of zolpidem, benzodiazepine, narcotics, and antihistamines, especially in cancer patients.

Caspase-2 is required for cell death induced by cytoskeletal disruption

Caspase-2 is one of the most conserved caspases, yet its biological function remains a matter of controversy. In the present article we analysed mouse embryonic fibroblasts (MEFs) from caspase-2 knockout mice for their sensitivity to various apoptosis inducing agents. We found that cell death induced by drugs that disrupt cytoskeleton is significantly inhibited in Casp2(-/-) MEFs. These drugs included zoledronic acid, vincristine, cytochalasin D and paclitaxel. We demonstrate that MEFs lacking Casp2 show clonogenic survival following drug treatment, whereas all Casp2(+/+) MEFs die, indicating that caspase-2 is required for apoptosis induced by cytoskeletal disruption. We further found that caspase-2 mediates apoptosis via Piddosome, Bid and Bax activation, and cytochrome c release. In the absence of caspase-2, Bid and Bax activation, and cytochrome c release are significantly delayed following drug treatment. Our data provide strong support for a context-dependent function of caspase-2 in apoptosis.

0.7 Structure and zero bias anomaly in ballistic hole quantum wires

We study the anomalous conductance plateau around G=0.7(2e2/h) and the zero bias anomaly in ballistic hole quantum wires with respect to in-plane magnetic fields applied parallel B parallel and perpendicular B perpendicular to the quantum wire. As seen in electron quantum wires, the magnetic fields shift the 0.7 structure down to G=0.5(2e2/h) and simultaneously quench the zero bias anomaly. However, these effects are strongly dependent on the orientation of the magnetic field, owing to the highly anisotropic effective Landé g-factor g* in hole quantum wires. Our results highlight the fundamental role that spin plays in both the 0.7 structure and zero bias anomaly.

Zeeman splitting in ballistic hole quantum wires

We have studied the Zeeman splitting in ballistic hole quantum wires formed in a (311)A quantum well by surface gate confinement. Transport measurements clearly show lifting of the spin degeneracy and crossings of the subbands when an in-plane magnetic field B is applied parallel to the wire. When B is oriented perpendicular to the wire, no spin splitting is discernible up to B = 8.8 T. The observed large Zeeman splitting anisotropy in our hole quantum wires demonstrates the importance of quantum confinement for spin splitting in nanostructures with strong spin-orbit coupling.

Fatal hemolytic transfusion reaction due to anti-Ku in a Knull patient

A fatal transfusion reaction due to anti-Ku in a Knull (Ko) patient is reported. The patient was transfused with 34 units of incompatible RBCs during 44 days of hospitalization. Apart from the first transfusion, all subsequent transfusions failed to raise the patient's Hb. No serum antibody was identified until he was transferred to another hospital for dialysis. A compatibility test demonstrated a weak antibody and autocontrol reacting at room temperature by a manual polybrene method. The antibody was considered to be a "cold agglutinin." A blood sample was sent to a reference laboratory where the patient was found to be Knull and the antibody was identified as anti-Ku.

Application of a computerized nursing care plan system in one hospital: experiences of ICU nurses in Taiwan

AIM OF THE STUDY

The purpose of this paper is to present ICU nurses' experiences with a computerized nursing care plan system at a medical centre in Taiwan.

BACKGROUND

Computerized nursing care plans have been implemented in recent years, but users' perceptions of this technology have not been comprehensively explored. It is believed that by taking into consideration users' experiences with computer use, strategies and programs can be developed to help users adapt to new systems.

METHODS

A qualitative study, involving one-to-one interviews, was conducted with 12 Registered Nurses. Data were analysed according to Miles and Huberman's data reduction, data display and conclusion verification process.

FINDINGS

Themes related to the clinical impact of system use were: 'saves paper/time', 'time-consuming for print-outs', 'de-individualization of care plan', 'routine/paperwork requirement', 'no consensus for nursing diagnoses', and 'guidelines for the novice'.

CONCLUSIONS

Nurses prefer tools that can help them save time with paperwork and focus on targeting patient problems. With careful assessment and evaluation of nurses' experiences in the use of clinical computer systems, the success of computer implementation can be enhanced.

Inhibition of IgE-mediated mast cell activation by the paired Ig-like receptor PIR-B

The potential of the paired Ig-like receptors of activating (PIR-A) and inhibitory (PIR-B) types for modifying an IgE antibody-mediated allergic response was evaluated in mouse bone marrow-derived mast cells. Although mast cells produced both PIR-A and PIR-B, PIR-B was found to be preferentially expressed on the cell surface, where it was constitutively tyrosine phosphorylated and associated with intracellular SHP-1 protein tyrosine phosphatase. PIR-B coligation with the IgE receptor (FcepsilonRI) inhibited IgE-mediated mast cell activation and release of serotonin. Surprisingly, the inhibitory activity of PIR-B was unimpaired in SHP-1-deficient mast cells. A third functional tyrosine-based inhibitory motif, one that fails to bind the SHP-1, SHP-2, and SHIP phosphatases, was identified in parallel studies of FcepsilonRI-bearing rat basophilic leukemia (RBL) cells transfected with constructs having mutations in the PIR-B cytoplasmic region. These results define the preferential expression of the PIR-B molecules on mast cells and an inhibitory potential that can be mediated via a SHP-1-independent pathway.

Cellular zinc fluxes and the regulation of apoptosis/gene-directed cell death

The maintenance of discrete subcellular pools of zinc (Zn) is critical for the functional and structural integrity of cells. Among the important biological processes influenced by Zn is apoptosis, a process that is important in cellular homeostasis (an important cellular homeostatic process). It has also been identified as a major mechanism contributing to cell death in response to toxins and in disease, offering hope that novel therapies that target apoptotic pathways may be developed. Because Zn levels in the body can be increased in a relatively nontoxic manner, it may be possible to prevent or ameliorate degenerative disorders that are associated with high rates of apoptotic cell death. This review begins with brief introductions that address, first, the cellular biology of Zn, especially the critical labile Zn pools, and, second, the phenomenon of apoptosis. We then review the evidence relating Zn to apoptosis and address three major hypotheses: (1) that a specific pool or pools of intracellular labile Zn regulates apoptosis; (2) that systemic changes in Zn levels in the body, due to dietary factors, altered physiological states or disease, can influence cell susceptibility to apoptosis, and (3) that this altered susceptibility to apoptosis contributes to pathophysiological changes in the body. Other key issues are the identity of the molecular targets of Zn in the apoptotic cascade, the types of cells and tissues most susceptible to Zn-regulated apoptosis, the role of Zn as a coordinate regulator of mitosis and apoptosis and the apparent release of tightly bound intracellular pools of Zn during the later stages of apoptosis. This review concludes with a section highlighting areas of priority for future studies.

Involvement of intracellular labile zinc in suppression of DEVD-caspase activity in human neuroblastoma cells

Age-related tissue Zn deficiency may contribute to neuronal and glial cell death by apoptosis in Alzheimer's dementia. To investigate this, we studied the effects of increasing or decreasing the levels of intracellular labile Zn on apoptosis of human neuroblastoma BE(2)-C cells in vitro. BE(2)-C cells were primed for 18 h with butyrate (1 mM) before addition of staurosporine (1 microM), an effector enzyme of apoptosis, for a further 3 h to induce DEVD-caspase activity. An increase in intracellular Zn using Zn ionophore pyrithione suppressed DEVD-caspase activity, while a decrease in intracellular Zn induced by Zn chelator TPEN mimicked staurosporine by activating DEVD-caspase in butyrate-primed cells. The distribution of intracellular Zn in the cells was demonstrated with the UV-excitable Zn-specific fluorophore Zinquin. Confocal images showed distinct cytoplasmic and cytoskeletal fluorescence. We propose that Zn decreases the level of apoptosis in neuronal cells exposed to toxins, possibly by stabilizing their cytoskeleton.

Constitutive tyrosine phosphorylation of the inhibitory paired Ig-like receptor PIR-B

PIR-A and PIR-B are activating and inhibitory Ig-like receptors on murine B lymphocytes, dendritic cells, and myeloid-lineage cells. The inhibitory function of PIR-B is mediated via its cytoplasmic immunoreceptor tyrosine-based inhibitory motifs, whereas PIR-A pairs with the Fc receptor common gamma chain to form an activating receptor complex. In these studies, we observed constitutive tyrosine phosphorylation of PIR-B molecules on macrophages and B lymphocytes, irrespective of the cell activation status. Splenocyte PIR-B molecules were constitutively associated with the SHP-1 protein tyrosine phosphatase and Lyn protein tyrosine kinase. In Lyn-deficient mice, PIR-B tyrosine phosphorylation was greatly reduced. Unexpectedly, tyrosine phosphorylation of PIR-B was not observed in most myeloid and B cell lines but could be induced by ligation of the PIR molecules. Finally, the phosphorylation status of PIR-B was significantly reduced in MHC class I-deficient mice, although not in mice deficient in TAP1 or MHC class II expression. These findings suggest a physiological inhibitory role for PIR-B that is regulated by endogenous MHC class I-like ligands.

Regulation of caspase activation and apoptosis by cellular zinc fluxes and zinc deprivation: A review

Non-toxic agents that target intracellular signalling pathways in apoptosis may have potential therapeutic use in many diseases. One such agent is the transition metal Zn, a dietary cytoprotectant and anti-oxidant, which stimulates cell proliferation and suppresses apoptosis. Zn is maintained in discrete subcellular pools that are critical for the functional and structural integrity of cells. The present review initially describes the current state of knowledge on the cellular biology of Zn, especially the critical free or loosely bound (labile) pools of Zn, which are thought to regulate apoptosis. We then review the evidence relating Zn to apoptosis, including studies from our laboratory showing potent synergy between intracellular Zn deficiency and the short chain fatty acid butyrate in induction of caspase activation and the downstream events of apoptosis. Our studies have also reported the suppressive effects of micromolar concentrations of Zn on caspase-3 activation in cell-free models. Other key issues that will be discussed include the identification of the putative molecular targets of Zn and the evidence that systemic changes in labile Zn levels are sufficient to alter susceptibility to apoptosis and lead to physiopathological changes in the human body. Finally, we propose that labile Zn may serve as a coordinate regulator of mitosis and apoptosis to regulate tissue growth.

Biochemical nature and cellular distribution of the paired immunoglobulin-like receptors, PIR-A and PIR-B

PIR-A and PIR-B, paired immunoglobulin-like receptors encoded, respectively, by multiple Pira genes and a single Pirb gene in mice, are relatives of the human natural killer (NK) and Fc receptors. Monoclonal and polyclonal antibodies produced against a recombinant PIR protein identified cell surface glycoproteins of approximately 85 and approximately 120 kD on B cells, granulocytes, and macrophages. A disulfide-linked homodimer associated with the cell surface PIR molecules was identified as the Fc receptor common gamma (FcRgammac) chain. Whereas PIR-B fibroblast transfectants expressed cell surface molecules of approximately 120 kD, PIR-A transfectants expressed the approximately 85-kD molecules exclusively intracellularly; PIR-A and FcRgammac cotransfectants expressed the PIR-A/ FcRgammac complex on their cell surface. Correspondingly, PIR-B was normally expressed on the cell surface of splenocytes from FcRgammac-/- mice whereas PIR-A was not. Cell surface levels of PIR molecules on myeloid and B lineage cells increased with cellular differentiation and activation. Dendritic cells, monocytes/macrophages, and mast cells expressed the PIR molecules in varying levels, but T cells and NK cells did not. These experiments define the coordinate cellular expression of PIR-B, an inhibitory receptor, and PIR-A, an activating receptor; demonstrate the requirement of FcRgammac chain association for cell surface PIR-A expression; and suggest that the level of FcRgammac chain expression could differentially affect the PIR-A/PIR-B equilibrium in different cell lineages.

Hydrophilic-hydrophobic biodegradable polymers: release characteristics of hydrogen-bonded, ring-containing polymer matrices

Biodegradable hydrogen-bonded, ring-containing polymers were prepared. These included poly(enolketones) by the controlled oxidation of poly(vinyl alcohol), and poly(amide-amines) and poly(amide-enamine-esters) by the reaction of diketene with diamines. These polymers had both hydrophilic and hydrophobic properties and are potentially matrix materials for the controlled release of drugs.

Human biliary beta-glucuronidase: correlation of its activity with deconjugation of bilirubin in the bile

Total and conjugated bilirubin contents of gall-bladder and hepatic biles before and after 24-h incubation at 37 degrees C and beta-glucuronidase activity of hepatic biles were determined in forty-eight patients divided equally into four groups: no stones or control (C), cholesterol stones (CS), black pigment stones (black PS), and brown pigment stones (brown PS). The percent conjugation of bilirubin is lower in gall-bladder biles and hepatic biles after incubation, particularly in black PS and brown PS, when compared with hepatic biles before incubation. Mean endogenous beta-glucuronidase activities at pH 5.2 were 12.0, 15.5, 44.5 and 147.7 nmol min-1 ml-1 for C, CS, black PS, and Brown PS, respectively, which correlated well with the degree of deconjugation of bilirubin in gall-bladder and hepatic biles and with the rate of deconjugation of hepatic bile incubated at 37 degrees C. Only four biles in brown PS exhibited bacterial enzyme activity. We concluded that though bacterial beta-glucuronidase might be responsible for deconjugation of bilirubin in some patients in brown PS, endogenous biliary beta-glucuronidase could play a key role in the pathogenesis of pigment cholelithiasis.

Human hepatic beta-glucuronidase: an enzyme kinetic study

beta-Glucuronidase (EC 3.2.1.31) was purified from human liver and its activity was determined by enzyme kinetic method employing phenolphthalein glucuronic acid (PGA) and conjugated bilirubin, primarily bilirubin diglucuronide purified from human bile, as substrates in the absence or presence of D-glucaro-1,4-lactone. The enzyme was capable of acting on both PGA and conjugated bilirubin with Michaelis constants of 0.435 mmol/l at 56 degrees C and 1.02 mmol/l at 37 degrees C, respectively. Both reactions were beta-glucuronidase-specific because both were inhibited by D-glucaro-1,4-lactone in a competitive fashion. Conjugated bilirubin acted as a noncompetitive inhibitor of the enzyme for PGA in a two-substrate system. The study indicates that these two substrates bind at different catalytic sites of the enzyme and, on molar base, conjugated bilirubin had higher affinity for the enzyme and less degree of inhibition by D-glucaro-1,4-lactone than PGA. Whether such catalytic sites are also common for other beta-D-glucuronid ethers and esters remains to be proven.