Care Facilities In Taiwan Research Articles

Implementation and evaluation of a nursing process support system for long‐term care: a Taiwanese study

To (1) develop and implement a Nursing Process Support System in Chinese (NPSSC) enabling computerised documentation for nursing home residents, (2) evaluate the efficiency of NPSSC, (3) assess obstacles to the use of the NPSSC and (4) assess nurse users' satisfaction with the NPSSC. Long-term care facilities in Taiwan have been slow to computerise resident's medical records. The development and implementation of a computerised documentation system provides a way to enhance nursing documentation in long-term care settings and can prevent hazards that result from documentation errors. Quasi-experimental. This study used one group pre/post-test. Five nursing homes in Taiwan were included in the study. Twenty-seven nurses used the NPSSC to computerise 396 residents' medical records. Using the NPSSC allowed nurses to enter health assessment data into the computer system, which automatically triggered appropriate nursing diagnoses. The NPSSC included geriatric nursing interventions and the use of alternative Chinese therapies. Obstacles that hindered nurses' use of the NPSSC were identified and possible solutions to overcome these hindering factors were discussed. The use of the NPSSC significantly improved nursing documentation in that resident's records were organised and consistent and nurses were able to complete a comprehensive care plan within 48 hours. Nurses reported a higher satisfaction in nursing documentation after the implementation of the NPSSC than previously. This study suggested a pathway to develop and implement a computer-based, user-friendly nursing documentation system for nursing homes. This study may be used as a template for implementing computerised documentation worldwide. Relevance to clinical practice. Nursing home providers may consider implementing the NPSSC to replace the traditional hand-written documentation system. An effective use of in-service programs within the workplace helped ease the transition from hand-written documentation to the computer-based NPSSC.

Blastocystis hominis infection in long-term care facilities in Taiwan: prevalence and associated clinical factors

Blastocystis hominis is probably the most common protozoan found in the human gut worldwide. In Taiwan, the prevalence of B. hominis infection is yet to be determined but is expected to be relatively higher among foreign workers. No data is available on the prevalence of B. hominis infection in long-term care facilities in Taiwan. This study included 713 subjects (552 residents and 161 care workers) from ten long-term care facilities in Taiwan who completed stool microscopic examinations with Merthiolate-iodine-formalin stain technique. The prevalence rate of blastocystosis was the highest among foreign and domestic care workers followed by residents (12.2%, 4.6%, and 2.7%, respectively). Older age (p = 0.04) and lower educational level (p = 0.008) were significantly associated with blastocystosis among care workers. Among residents, B. hominis infection was negatively associated with prolonged use of antibiotics within 3 months prior to examination (p = 0.05) and positively associated with tracheostomy in-place (p = 0.028). In conclusion, B. hominis infection was the most prevalent intestinal parasitic infection among both care workers and residents of long-term care facilities in Taiwan. Use of antibiotics was negatively associated with B. hominis infection among residents. Additionally, appropriate preventive measures should be implemented to older care workers with lesser educational attainment in order to reduce the risk of blastocystosis infection.

Using Acupressure and Montessori‐Based Activities to Decrease Agitation for Residents with Dementia: A Cross‐Over Trial

To explore the effectiveness of acupressure and Montessori-based activities in decreasing the agitated behaviors of residents with dementia. A double-blinded, randomized (two treatments and one control; three time periods) cross-over design was used. Six special care units for residents with dementia in long-term care facilities in Taiwan were the sites for the study. One hundred thirty-three institutionalized residents with dementia. Subjects were randomized into three treatment sequences: acupressure-presence-Montessori methods, Montessori methods-acupressure-presence and presence-Montessori methods-acupressure. All treatments were done once a day, 6 days per week, for a 4-week period. The Cohen-Mansfield Agitation Inventory, Ease-of-Care, and the Apparent Affect Rating Scale. After receiving the intervention, the acupressure and Montessori-based-activities groups saw a significant decrease in agitated behaviors, aggressive behaviors, and physically nonaggressive behaviors than the presence group. Additionally, the ease-of-care ratings for the acupressure and Montessori-based-activities groups were significantly better than for the presence group. In terms of apparent affect, positive affect in the Montessori-based-activities group was significantly better than in the presence group. This study confirms that a blending of traditional Chinese medicine and a Western activities program would be useful in elderly care and that in-service training for formal caregivers in the use of these interventions would be beneficial for patients

Single ability among activities of daily living as a predictor of agitation

The aims of this study were to investigate whether the interaction effect between restraint and functional ability, and single ability during activities of daily living can predict agitation among residents with dementia. Agitated behaviour is one of the most common symptoms of dementia and might endanger the patients themselves, caregivers and institutions. However, the prevalence of problem behaviours and its associated factors at long-term care facilities in Taiwan are less understood. A direct observation was used to observe the agitated behaviours of residents with dementia in special care units. Residents of dementia special care units who were diagnosed with dementia in eight long-term care facilities were recruited. Measurements included: demographic data, the Barthel Index, the Mini-Mental State Examination and the Cohen-Mansfield Agitation Inventory. The number of subjects who were identified with problem behaviours was 163 (43.5%). Significant differences in sex, being restrained, restrained time, age, family visits, functional status and mental status were found between the agitated and non-agitated groups. However, mental status, family visits, walking ability, being restrained and getting in and off toilet were five independent factors associated with agitated behaviours after controlling for all other factors. It is recommended that strategies be constructed to encourage the family to periodically visit older residents and to develop restraint-free environments in long-term care facilities. Residents with dementia require significant daily living support and behaviour management as their illness progress.

Relationship between organizational empowerment and job satisfaction perceived by nursing assistants at long‐term care facilities

The purpose of this study was to understand the relationships between organizational empowerment and job satisfaction among nursing assistants at long-term care facilities in Taiwan. Nursing assistants are the major manpower at long-term care facilities. The responsibilities of nursing assistants are complex and numerous and affect their job satisfaction. We assumed that a well-organized and pleasant work environment is an important characteristic of organizational empowerment and ought to enhance the nursing assistants' job satisfaction. However, little information exists that can be used by long-term care facilities managers when they strive to increase the nursing assistants' job satisfaction by modifying the regulations or interventions from an organizational perspective. We used a cross-sectional design with a descriptive correlation approach to understand the relationship between organizational empowerment and job satisfaction among nursing assistants at long-term care facilities in Taiwan. A total of 28 long-term care facilities and 114 nursing assistants participated in the study. The results indicated that, where there was a moderate level of organizational empowerment, a higher level of job satisfaction was found. Organizational empowerment was significantly associated with total job satisfaction (r = 0.366, p < 0.01). The variables of nationality (Vietnamese), resources, opportunity and informal power were significant predictors of job satisfaction (R(2) = 0.318, F = 12.24, p < 0.001). Organizational empowerment is significantly associated with job satisfaction among nursing assistants in this study. Nursing assistants need to receive more assistance and resources from their co-workers to enhance their job satisfaction. The manager should initiate regular meetings and activities for staff who work in long-term care facilities that will allow sharing, communication and support among the staff in terms of ideas, information and feelings.

The relationship between work empowerment and work stress perceived by nurses at long‐term care facilities in Taipei city

To explore the relationships between work empowerment, including both structural and psychological empowerment and work stress among nurses at long-term care facilities in Taiwan. Cross-sectional design with a descriptive correlation. Work empowerment includes both psychological and structural empowerment; 178 nurses participated in the study. The results of this study showed that the average age of the subjects was 35.5 years and that 56.2% of subjects had less than two years work experience in the facility. The results indicated that there was a moderate level of psychological empowerment (mean 59.9, SD 8.1) and structural empowerment (mean 59.2, SD 11.1). A moderate level of work stress was also found with an average score of 72.3 (SD 14.4). Both psychological empowerment and structural empowerment were found to be significantly associated with total work stress (r = -0.4, r = -0.5, p < 0.001, respectively). The variables of age (standardised beta = -0.1), resources (standardised beta = -1.6), meaningful work (standardised beta = -0.4) and impact (standardised beta = -1.3) were significant predictors of work stress (R(2) = 0.32, F = 17.3, p<0.001). Both psychological empowerment and structural empowerment were found to be significantly associated with work stress among nurses in this study. The four significant predictors of job satisfaction were age, resources, meaningful work and impact. The managers of the facilities should provide available resources for nurses to accomplish work and to involve nurses in the development goals of the facilities to enhance their influence in the making of important changes within the organisation to decrease their work stress.

Edinburgh Feeding Evaluation in Dementia (EdFED) scale: cross‐cultural validation of the Chinese version

This paper is a report of an assessment of the construct validity of the Chinese version of the Edinburgh Feeding Evaluation in Dementia scale. The Edinburgh Feeding Evaluation in Dementia scale has previously been translated and back-translated and to determine the equality of the Chinese and English versions. However, the construct validity of the Chinese version has not been investigated. Participants (n = 477) were selected from residents with dementia in licensed long-term care facilities in Taiwan in 2006-2007. Data collectors received training before observing feeding for 2 days during lunch and dinner. Data were analysed using principal component analysis, Mokken scaling and correlation. A two-factor structure was demonstrated for the 11 items of the Chinese version of the scale and six items conformed to a Mokken scale. The Chinese version of the scale correlated with external constructs such as weight and body mass index, as predicted by the unmet needs model. A confirmatory factor analysis is needed to confirm that the Chinese version measures the same qualities, in the same proportions, and with the same factor structure as the original Edinburgh Feeding Evaluation in Dementia scale.

Use of oseltamivir during an outbreak of influenza A in a long-term care facility in Taiwan

We studied the effectiveness of oseltamivir during an outbreak of influenza A among previously vaccinated patients and staff in a long-term care facility. Seven of 14 staff members and 14 of 41 residents developed either influenza-like illness (ILI) or other respiratory symptoms during a 14-day period from late January to 8 February 2004. On 9 February, therapeutic oseltamivir (75 mg twice daily for five days) was administered to one staff member and seven residents who had developed ILI within the previous 48 h (treatment group). Prophylactic oseltamivir (75 mg once daily for seven days) was administered to 12 staff members and 30 residents who were asymptomatic or whose respiratory symptoms did not meet the diagnosis of ILI (prophylaxis group). The remaining four residents and one staff member had had ILI for more than two days (with subsiding symptoms) and did not receive oseltamivir ('no-oseltamivir' group). None of the 42 subjects in the prophylaxis group developed ILI. Presence of influenza A virus was demonstrated in 24 subjects: seven out of eight in the treatment group, 12 of 42 in the prophylaxis group and all five in the no-oseltamivir group. For confirmation of diagnosis, real-time reverse transcription-polymerase chain reaction was more sensitive than antigen detection and virus isolation. In-time therapeutic and prophylactic oseltamivir successfully interrupted an outbreak of influenza A in a long-term care facility.

Psychological Abuse Behavior Exhibited by Caregivers in the Care of the Elderly and Correlated Factors in Long-Term Care Facilities in Taiwan

This study explored the state and the correlated factors of psychological abuse behavior among caregivers in long-term care facilities in Taiwan. A cross-sectional design utilizing a descriptive-correlational approach was conducted. A sociodemographic sheet, Caregiver Psychological Elder Abuse Behavior Scale (CPEAB), and Caregiver's Burden Scale (CBS) were employed to collect data. A total of 114 caregivers completed the study, of whom 16.1% returned an CPEAB score greater than 40. The potential range of CPEAB scores ranged from 20 to 80, with the highest score indicating the greatest tendency toward psychological abuse behavior. Among the total of 20 CPEAB indicators, "Accuse him/her verbally", "Ignore his/her request", and "Insult him/her" received the highest item mean scores (M = 2.18, 2.12, 2.02; SD = 0.83, 0.84, 0.91). Significant relationships between the CPEAB and subject age, professional status, educational level, geriatric care training, and CBS score were found (p < .05 - .001). These results indicate that caregivers who are younger in age, less educated and lacking in geriatric training had a greater burden and displayed a tendency toward more abusive behavior. Another important finding was that nurses displayed more abusive behavior than their care attendant counterparts. Results of this study provide important information that may be used in medical and social interventions and policies aimed at improving quality of life for the institutionalized elderly.

Psychological Abuse Behavior Exhibited by Caregivers in the Care of the Elderly and Correlated Factors in Long-Term Care Facilities in Taiwan

Psychological Abuse Behavior Exhibited by Caregivers in the Care of the Elderly and Correlated Factors in Long-Term Care Facilities in Taiwan

Dimensions of quality in long‐term care facilities in Taiwan

This article presents the results of a qualitative study designed to explore the perceptions of Taiwanese elders about the quality of their care while in residence at a long-term care facility. As the population of elders in Taiwan is increasing rapidly, quality long-term care has become both a necessity and social responsibility. Research related to quality of care has focused on structure, process and outcomes as well as perceptions of quality of care and life satisfaction. Few authors have considered residents' perspectives within a cultural context. A convenience sample of 22 residents, aged between 61 and 86 years and living in four Taiwanese care facilities, participated in semi-structured interviews. The data were generated during 2001/2002 and were analysed using content analysis. Six key dimensions of quality care were elicited. The dimensions were: a caring attitude, respect for individual differences, emotional support, social interaction, a supportive environment, and accessible care. These dimensions are discussed within a cultural context supportive of family connectedness and filial piety, values underpinning care expectations of elders. The findings provide a foundation for increased understanding of the perceived gaps between residents' aspirations about quality care and priorities identified in other studies. Additional studies based on these data are planned in order to generate a culturally relevant, psychometrically sound resident assessment tool to evaluate the quality of care from a resident perspective in long-term care facilities in Taiwan.

Care needs of residents in community‐based long‐term care facilities in Taiwan

The purpose of this study is to gain an understanding both of the characteristics of residents who receive the services of nursing assistants and the service intensity (service tasks, service time and cost) of nursing assistants as a means of developing a patient classification based upon resource consumption. Most people in Taiwan send their disabled older family members to community-based long-term care facilities instead of nursing homes because they are much cheaper, and because they are generally closer to their homes, making visits more convenient. Nursing assistants make up the largest group of personnel in long-term care facilities. To determine resource use, both the service time and the actual activities performed for a resident by nursing assistants need to be assessed and this will help to develop a patient classification system to predict resource use and patient outcomes. A descriptive survey method was used to identify the tasks performed by nursing assistants in community-based long-term care facilities in Taiwan. Nursing assistants were recruited from 10 long-term care facilities in the Shihlin and Peitou Districts of Taipei City. Thirty-four nursing assistants and 112 residents participated in this study. Findings showed that each nursing assistant spent 5.05 hours per day doing direct service care, which is much higher than the 2.08 hours for nursing assistants in the United States. Among service tasks provided by nursing assistants, personal care consumed 35.1% of their time. Non-complex treatments were second (33.3%). Skilled nursing and medical services were third (31.6%). The service intensity required of nursing assistants was strongly related to the residents' activities of daily living and their needs. Complex nursing procedures are normally provided by Registered Nurses in nursing homes and consumed almost as much of the nursing assistants' time as did personal care activities in this study. It is suggested that a training program for nursing assistants, especially for foreigners in community-based long-term care facilities, should be mandated to assure the quality of service.

Depressive symptoms in long‐term care residents in Taiwan

This paper reports a study to investigate the prevalence of and risk factors for depressive symptoms in elders in long-term care facilities in Taiwan. Depression has been identified as a major health concern and is very common among frail elders in Western nursing homes. It is under-diagnosed, and may be associated with eating difficulties and subsequent malnutrition, functional ability and sociodemographic factors. There have been no previous studies of these issues in Taiwan. Residents of 18 long-term care facilities were recruited. Those able to communicate in the Mandarin or Taiwanese dialect, resided in long-term care facilities including skilled nursing facilities and intermediate care facilities, and who scored three or above on the Short Portable Mental Status Questionnaire were selected. Data were collected using the Geriatric Depression Scale, Barthel Index and Masticatory Index, and age, duration of institutionalization, and level of impaired swallowing were also measured. The number of participants identified as depressed was 267 (52.05%). There was no significant difference noted relating to age, gender, duration of institutionalization, type of institution, mental status and masticatory ability between the depressed and non-depressed groups, but significant differences of functional status and impaired swallowing between the two groups were found. However, functional status, impaired swallowing, and type of institution were three independent factors associated with depressive symptoms after controlling for all other factors. Future studies on the detection of symptoms of depression should use a validated observational measure to overcome under-reporting of symptoms by the frailest residents.

Working in long‐term care settings for older people with dementia: nurses’ aides

This paper reports a study exploring the reasons for continuing to work among nurse aides who cared for older people with dementia in long-term care settings in Taiwan. High nurse aide turnover has been a major problem for many managers of long-tem care facilities in Taiwan. Most studies on nurse aide turnover have focused on the factors on why they left, but little is known about their reasons for continuing to work in long-term care settings in Taiwan. A qualitative research design was used. Sixteen nurse aides were interviewed individually using a semi-structured interview guide and content analysis was used to identify the major themes in the data. Five major themes emerged from interview data: monetary needs, relationships with residents, working environment, training opportunities and gratification (listed in order of frequency of occurrence). Nurse aides face challenges in caring for the increased number of older people with cognitive impairment and it is important to assess their perspectives towards their work in the changing environment. The findings suggest that it is essential for nursing managers to assess nurse aides' needs to increase job retention and to improve the quality of resident care in long-term care settings. Careful appraisal of prospective nurse aides' attitudes, regular training programmes in dementia care, adequate staffing and equipment, performance-based pay rises and subsidized training are practical retention strategies for these nurse aides.

Functional independence of residents in urban and rural long-term care facilities in Taiwan

Purpose: To compare the score of functional independence measure (FIM) between urban and rural residents living in long-term care facilities (LTCF) in Taiwan.Methods: A total of 437 subjects in 112 licensed LTCF in Taiwan were randomly selected by stratification strategy. Physical therapists interviewed the subjects in nursing homes (NH) and intermediate care facilities (ICF) to obtain the basic data, and the FIM score.Results: (1) There was no significant difference in basic demographic data between urban and rural LTC subjects. (2) Most of the subjects in urban and rural LTCF were males, less than 80 years old, single/widowed, having multiple diseases, using more than one assistive devices, and having social welfare financial support. (3) Motor abilities (eating, grooming, and transfer) and cognition (comprehension, social interaction and problem solving) in rural LTCF subjects were significantly (p < 0.05) higher than those in urban areas as revealed by the FIM assessment. (4) The median of FIM total score of rural LTCF subjects was 90.5, which was significantly (p < 0.05) higher than that of urban LTCF subjects (median = 76).Conclusions: Some of the functional performance of subjects in rural long-term care institutions is better than those in urban areas. Our results may provide guidelines for the manpower and equipment supply estimation.

Learning needs of Taiwanese nurses caring for patients with irritable bowel syndrome.

This study, building on work on irritable bowel syndrome conducted by Letson and Dancey (1996), explores Taiwanese nurses' knowledge, perceptions and beliefs about caring for patients with irritable bowel syndrome (IBS). A 46-item questionnaire was completed voluntarily by 120 registered nurses from a large tertiary acute care facility in Taiwan. The study used a descriptive research design and a questionnaire was developed that used a five-point Likert scale (strongly agree = 5, to strongly disagree = 1). The questionnaire consisted of six categories: demographic information; nurses' sources of IBS information; nurses' knowledge about IBS; nurses' perceptions about patients with IBS; nurses' beliefs about IBS; and learning requirements for nurses. Overall, the results indicted that Taiwanese nurses who participated in this study had little specific knowledge of IBS. The researchers developed a booklet containing information on the condition of IBS that may be used by the participants in this study to fill the knowledge gaps about this condition and provide useful information.