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BACKGROUND AND OBJECTIVES: Nurses tend to exhibit higher rates of presenteeism compared to other professions. Presenteeism can cause the work performance of nurses to suffer, jeopardizing their own and their patients' safety and leading to decreased quality of care and increased risks of errors. However, there is a lack of a validated assessment tool for presenteeism in Taiwan. Thus, the purpose of this study was to develop a Nursing Staff Presenteeism Scale (NSPS). METHODS: To develop questionnaire items, participants from three medical centers in Taiwan were recruited. Through convenience sampling, 500 nurses who met the selection criteria were recruited from November 1, 2022 to January 18, 2023. The scale was developed based on a systematic literature review, a previous study, and expert consultation, and 50 items were initially generated. After removing three items that lacked discriminative power, the reliability and validity of the remaining 47 items were evaluated. An exploratory factor analysis was used to establish the construct validity. A confirmatory factor analysis and structural equation modeling for cross-validation were used to assess relationships of factors with items and the overall NSPS. RESULTS: The final scale consisted of 44 items assessed on a five-point Likert scale that loaded onto three different factors of physical or mental discomfort (18 items), work performance (15 items), and predisposing factors (11 items). These three factors were found to explain 63.14% of the cumulative variance. Cronbach's alpha for the overall final scale was 0.953. The item-to-total correlation coefficients ranged 0.443 to 0.795. CONCLUSIONS: The NSPS exhibited satisfactory reliability and validity. It can be applied to assess the level of presenteeism among clinical nurses and provide medical institutions with information regarding the causes of presenteeism, predisposing factors, and the impacts of presenteeism on their work performance to enhance the safety and quality of clinical care.

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The outbreak of COVID-19 poses an immense global threat. Visitors to hospitalized patients during a pandemic might themselves be carriers, and so hospitals strictly control patients and inpatient companions. However, it is not easy for cancer patients to adjust the times of their medical treatment or to suspend treatment, and the impact of the pandemic on cancer inpatients and inpatient companions is relatively high. The objectives for this investigation are to study the correlations among emotional stress, pain, and the presence of inpatient companions in cancer patients during the COVID-19 pandemic. This study was a retrospective descriptive study. The participants were cancer inpatients and inpatient companions in a medical center in Taiwan. The data for this study were extracted from cross-platform structured and normalized electronic medical record databases. Microsoft Excel 2016 and SPSS version 22.0 were used for analysis of the data. In all, 75.15% of the cancer inpatients were accompanied by family, and the number of hospitalization days were 7.87 ± 10.77 days, decreasing year by year, with statistical significance of p < 0.001. The daily nursing hours were 12.94 ± 10.76, and the nursing hours decreased year by year, p < 0.001. There was no significant difference in gender among those who accompanied the patients, but there were statistical differences in the length of hospitalization, nursing hours, and pain scores between those with and without inpatient companions, with p < 0.001. The inpatient companions were mostly family members (78%). The findings of this study on cancer patient care and inpatient companions should serve as an important basis for the transformation and reform of the inpatient companion culture and for epidemic prevention care in hospitals.

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OBJECTIVES: This evidence implementation project aimed to identify barriers leading to needle-stick injuries (NSIs) and to develop implementation strategies to prevent NSIs in the acute ward of a hospital in central Taiwan. INTRODUCTION: The incidence rate of NSIs was 5.6% in the acute ward of a hospital in Taiwan. NSIs commonly occur during the drawing of blood, intravenous insertion, needle recapping, or performing any procedure involving sharp medical devices. NSIs are critical occupational risks among healthcare workers, possibly leading to transmission of infectious diseases, especially blood-borne viruses, such as HIV, hepatitis B, and hepatitis C. METHODS: A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) approach. Five audit criteria that represented best practice recommendations for prevention of NSIs were used. Baseline data were collected from 177 nurses in five acute wards, followed by the implementation of multiple strategies during a 20-week period of the project. Both baseline and postimplementation audits were undertaken to determine changes in practice. RESULTS: According to the pre-audit concerning the use of safety-engineered injection devices and safe use and disposal of needles, there was 14-15% compliance, which indicated poor compliance with current best-practice criteria. Following the project implementation, the nursing staff were educated about the well tolerated use and disposal of sharps and the improved compliance rate ranged from 40 to 96.6%, with safety needle use increasing from 16 to 95.5%, safety needle operation procedure awareness increasing from 14 to 96%, needles not recapped after use increasing from 47 to 85%, and placing used needles in the sharps collection box increasing from 75 to 80%. CONCLUSION: This article suggests that standardized puncture prevention education and training enhanced nurses' awareness in the acute ward.

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BACKGROUND: Intensive care unit (ICU) patients experience multiple uncomfortable symptoms, which may be alleviated using music-based intervention, a nondrug treatment. This umbrella review aims to combine the data of systematic reviews and/or meta-analyses to evaluate the effectiveness of music-based intervention in improving uncomfortable symptoms in ICU patients. METHODS: A comprehensive literature search was performed on the PubMed, Embase, Cochrane Library, Airiti Library, CINAHL, ProQuest, and Web of Science databases, and Epistemonikos. The search had no language restrictions, and articles on the improvement of symptoms using music-based intervention in adult ICU patients were included. This review protocol was registered on PROSPERO (CRD42021240327). RESULTS: This umbrella review retrieved 5 systematic reviews and 41 original studies, including 39 randomized controlled trials, and 2 nonrandomized controlled trials. Diverse music was the most common music type used for music-based intervention, the intervention music was typically decided by the study participants (61%), and most subjects underwent one intervention session (78%). Furthermore, most music intervention sessions lasted for 30 min (44%). The positive results included decreased anxiety, decreased pain, decreased agitation, decreased anesthesia dose and sedative use, decreased chances of delirium, decreased feelings of uncomfort, and improved sleep quality. CONCLUSIONS: A systematic review on the effectiveness of music-based intervention in improving uncomfortable symptoms in ICU patients revealed that 20-30 min intervention sessions showed the best improvement in the uncomfortable symptoms in patients. This study provides a basis for using music-based intervention to relieve the uncomfortable symptoms in critically ill ICU patients, and a reference for empirical clinical practice.

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BACKGROUND: This study formulated clinical guidelines for assessing nasogastric tube placement and for health education guidance according to evidence-based recommendations. METHOD: This study used a single group, pre- and postintervention design. Purposive sampling was used to recruit participants from nursing institutions in Taiwan. RESULTS: Sixty-two individuals in charge of nursing institutions were recruited to participate in the in-service training program. Statistically significant differences were observed in the four major items in the self-directed learning readiness scale (t = 3.85, p < .00; t = 3.99, p < .00; t = 2.94, p < .01; t = 4.13, p < .00). With regard to program satisfaction, the mean score was 4.88 to 4.9 points. The mean score for teaching satisfaction was 4.94 to 4.9 points. Furthermore, the participants scored more than 80 points in the online course test and the nasogastric tube placement skill. CONCLUSION: The individuals in-charge are expected to be willing to apply and promote methods of literature collation and recommendation in their respective institutions. [J Contin Educ Nurs. 2021;52(7):326-334.].

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AIM: To determine the efficacy of vascular closure devices (VCDs) for hemostasis following transfemoral percutaneous coronary interventions (PCIs). METHODS: This two-group pre-post-test observational study with purposive sampling enrolled 73 patients between January, 2014 and February, 2015. The patients were allocated to either the intervention (vascular closure devices group, n = 34) or the control group (manual compression [MC] group, n = 39). Questionnaires were used to assess their demographic and clinical characteristics, vascular complications, visual analogue scale score for pain, and discomfort levels. Pain and discomfort were measured before and after the PCI. RESULTS: Vascular complications were observed in 15 (44.1%) VCD patients and 13 (33.3%) MC patients, with no significant between-group difference. However, the VCD patients had a higher relative risk of bruising, hematomas, and need for further treatment. After the PCI, the pain scores and discomfort levels increased significantly in both groups, but the VCD patients had more successful hemostasis, less pain, and less physical and psychological discomfort (lower-limb numbness, shoulder pain, restlessness, and worrying about walking ability, being unable to lift heavy objects in the future, and taking time off from work). CONCLUSION: The VCDs seem to be superior to the MCs, providing more successful hemostasis, less pain and discomfort, and earlier ambulation after a transfemoral PCI. These findings aid clinical nurses in understanding the risk of vascular complications, discomfort, and pain that are associated with VCD use for improving the quality of clinical care and help clinicians in determining the appropriate hemostatic method for patients undergoing a transfemoral PCI, particularly in the Chinese population.

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BACKGROUND: Depression is known to adversely affect coronary heart disease patients in western countries; however, no study of social support and depression has been conducted in the Chinese population. OBJECTIVE: The aim of this study was to investigate the predictors of depression in patients with coronary heart disease. METHODS: Between January and December 2015, a cross-sectional sample of 105 Taiwanese patients from cardiology units completed a demographic and clinical characteristics questionnaire, Enhancing Recovery in Coronary Heart Disease Social Support Inventory, and Patient Health Questionnaire-9. RESULTS: Thirty-nine percent of the participants reported low social support, and 61.0% had depression symptoms. Eight factors predicted depression. Social support was significantly and adversely correlated with depression (r = -.481, P < .01). The other 7 factors were positively correlated with depression: age (r = .212, P < .05), reported monthly income of less than US $600 (F = 4.98, P = .001), lack of exercise (F = 3.75, P = .027), history of stroke (t = -2.45, P = .016) and kidney disease (t = -2.41, P = .018), unstable angina (F = 3.56, P = .031), and groin puncture (F = 3.27, P = .042). A hierarchical regression model explained 43.7% of the variance in depression. CONCLUSION: Social support, unstable angina, and stroke may be important predictors of depression in patients with coronary heart disease. These findings help clinical staff to understand physical and mental health problems in cardiovascular patients. Thus, we suggest that early depression prediction and sufficient social support can help patients to face their disease and thus improve depression and health care quality.

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BACKGROUND: Most studies on hematopoietic stem cell transplantation (HSCT) have focused on patients, survivors, or their family members, such as siblings and parents. Little attention has been paid to nurses caring for HSCT pediatric patients and in particular in a Taiwanese context. OBJECTIVE: The objective of this study was to explore nurses' lived experience caring for HSCT children in isolation within a general pediatric ward. METHOD: A Husserlian phenomenological approach informed the exploration of the meaning and essence of the nurses' caring experience. Data were collected using semistructured interviews. RESULTS: Twelve nurses were interviewed. Analysis of interviews yielded 3 main themes: being worried about ruining transplantation success, feeling loss of control in handling suffering, and reflecting upon the value of HSCT. CONCLUSIONS: Nurses felt the stress of caring for HSCT children because of the heavy workload and the pressure of responsibility. Witnessing the suffering of patients/families was particularly stressful. However, nurses were helped to overcome this stress by looking at the value and meaning of HSCT. IMPLICATIONS FOR PRACTICE: Nurses need practical support from nursing leaders in terms of carefully organizing patient care, controlling the nurse-to-patient ratio, and offering a safe work environment by providing systematic formal training on HSCT and receiving proper supervision. Understanding and learning are gained from nurses who are able to seek meaning from HSCT through appreciating every caregiving effort and through valuing how their nursing role contributes to the quality of patients' care.

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Several studies have reported the prevalence of depression in shift nurses to be 15%, and in some cases it may even be as high as 23%. Depression is a major cause of poor sleep quality and can impede efforts to overcome the chronic fatigue that commonly affects shift nurses. Adverse mental health issues have been confirmed in shift nurses, but few studies have investigated the underlying cause of poor mental health in different shift-nurse populations. Therefore, the aim of this study was to investigate the relationship of serum trace element levels to mental health and the tendency toward depression in shift nurses. We collected blood samples from 90 shift nurses (day, evening, and night shift) who worked in intensive care units and asked them to complete a general data questionnaire as well as the Chinese version of the Beck Depression Inventory, second edition. The night-shift nurses showed mild-to-moderate depression levels, which were significantly higher than those of the control group and other shift nurses. Night-shift nurses also had higher levels of plasma copper, ferritin, interleukin (IL)-6, and alanine aminotransferase (p < .05) than the control group and other nurses. Elevated concentrations of ferritin and IL-6 are considered important markers for the onset of depression. The results of this study suggest that plasma copper concentrations in nurses should be monitored.

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BACKGROUND: The link between melamine-contaminated daily foodstuffs and urolithiasis formation has drawn an international concern. However, detection of melamine levels in urine may not completely represent external melamine exposure. Thus, finding an additional analytical method for the study of environmental melamine exposure and its adverse effect in humans is crucial. METHODS: Eleven adult patients diagnosed with uric acid urolithiasis were retrospectively analyzed. Melamine levels in their overnight one-spot urine samples were measured by a triple quadrupole liquid chromatography tandem mass spectrometry (LC-MS/MS). The compositions of stone samples were analyzed by the Fourier transform infrared (FTIR) spectrophotometer and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). RESULTS: Seven (63.6%) out of 11 patients had detectable melamine levels in their urine specimens (method of detection limit: 0.8 ng/ml). Three patients (27.3%) were highly suspected of having melamine-containing urolithiasis in FTIR spectra. In one of those three cases who still had available stored stone specimens, MALDI-TOF MS further confirmed melamine components in this male patient's stone specimens. In contrast, his urinary melamine level was below the detection limit by LC-MS/MS. CONCLUSIONS: Direct analysis of melamine in the composition of urolithiasis by MALDI-TOF MS can be an additional analytical method to evaluate for external melamine exposure.

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BACKGROUND: Chair-sitting may allow for more readily activated scalene, sternocleidomastoid, and parasternal intercostal muscles, and may raise and enlarge the upper thoracic cage, thereby allowing the thoracic cage to be more easily compressed. OBJECTIVE: To evaluate the effect of chair-sitting during exercise training on respiratory muscle function in mechanically ventilated patients. METHODS: We randomized 16 patients to a control group and 18 patients to a chair-sitting group. The patients in the chair-sitting group were transferred by 2 intensive care unit nurses from bed to armchair and rested for at least 30 min, based on the individual patient's tolerance. We measured heart rate, blood pressure, S(pO(2)), and respiratory rate. In the treatment group, before transferring the patient from bed to armchair, and 30 min after the completion of chair-sitting we measured respiratory muscle function variables, including the ratio of respiratory rate (f) to tidal volume (V(T)), S(pO(2)), maximum inspiratory pressure (P(Imax)) and maximum expiratory pressure (P(Emax)). In the control patients we took those same measurements while the patient was in semirecumbent position, before and after treatments, for at least 6 days or until the patient was discharged from the intensive care unit or died. RESULTS: The 2 groups did not significantly differ in age, sex, or clinical outcomes. Respiratory rate, V(T), f/V(T), S(pO(2)), P(Imax), and P(Emax) were not significantly better in the chair-sitting group. The study period significantly improved respiratory rate, V(T), P(Imax), and P(Emax) (all P < .001), but not f/V(T). CONCLUSIONS: Six days of chair-sitting exercise training did not significantly improve respiratory muscle function in mechanically ventilated patients.

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Melamine is commonly used to manufacture tableware, and this could be one of the important exposure sources in humans. The study aims to measure melamine migrated from different material-made tableware by the most sensitive technique of liquid chromatography-tandem mass spectrometry (LC-MS/MS). The test samples were filled with pre-warmed designated-temperature (from room temperature (∼20 °C), 30 °C, 40 °C, 50 °C, 60 °C, 70 °C, 80 °C, to 90 °C) simulant (either distilled water or 3% acetic acid) up to 20 ml and immersed in a water bath at that designated temperature for 15 or 30 minutes (min). High melamine migration levels, ranging from 6.97 to 19.03 µg/ml, can be measured from all melamine-made samples containing 20 ml 3% acetic acid in water bath of 90 °C for 30 min, whereas melamine cannot be detectable in all other material-made samples in the same condition. In addition, the cheaper the melamine-made tableware samples, the higher the melamine migration levels. The migration of melamine amount is dependent on different temperatures, contact times, simulant, and prices of tableware. Since tableware is used in daily life, it is prudent to cautiously select materials that contain foodstuffs.

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To establish animal models with diet-induced metabolic disorders similar to human metabolic syndrome, 2 unhealthy dietary habits featuring a high fat content and a sucrose-containing beverage intake, alone or in combination, were tested on Wistar rats and C57BL/6J mice. The 2 dietary habits were, respectively, simulated by feeding a high-fat diet (regimen A) or additionally providing 30% sucrose (wt/vol) in the drinking water (regimen B). Using a 2 x 2 factorial design, 4 groups of animals were fed chow diet plus plain water (group C), high-fat diet (30% [wt/wt] fat) plus plain water (group A), chow diet plus sucrose in drinking water (group B), and high-fat diet plus sucrose in drinking water (group AB) for 26 weeks. In Wistar rats, regimen B caused a significant increase in visceral fat; serum levels of lipids, glucose, insulin, and uric acid; insulin resistance; and blood pressure, whereas regimen A only caused a significant increase in visceral fat and serum insulin levels (P < .05). In contrast, regimen A induced a full array of metabolic syndrome in C57BL/6J mice; but regimen B only caused slight obesity and hyperlipidemia. In both Wistar rats and C57BL/6J mice, there were no additive effects of the 2 regimens, indicated by significant interactions between regimens A and B on the metabolic indexes measured. These results show that, in terms of inducing metabolic syndrome, Wistar rats are more responsive to sucrose water regimen, whereas C57BL/6J mice are more responsive to the high-fat diet regimen.

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Multilocular cystic nephroma is an unusual entity of uncertain etiology that can affect children and adults equally. This lesion is believed to be part of a spectrum of renal cystic disorders with multilocular cyst and cystic Wilms' tumor representing the two extremes and usually presents with a benign character. We report a 22-year-old female who presented with a painful right renal mass and gross hematuria. After a series of examinations including abdominal ultrasound, computed tomography, and angiography, she underwent partial nephrectomy under the impression of benign lesion. The pathologic examination showed that it was a multilocular cystic nephroma. At the 11-month follow-up, the patient was completely asymptomatic and free of recurrence and metastasis.

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The process of being weaned from mechanical ventilation is a stressful transition for critically ill patients who are taken off ventilation assistance and regain spontaneous breathing. Degree of weaning success is being increasingly used as an outcome indicator in clinical practice and lay literature. However, "successful weaning" remains a largely undefined concept in nursing practice. Following the concept analysis framework of Walker and Avant (1995), any such analysis that targets development of an operational definition of successful weaning should focus on two distinct sets of indicators, namely objective physiological and subjective psychological. Listing defining attributes and developing a model case will accurately reflect underlying relationships between weaning concepts.

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