Effect of language and country of birth on the consent process and medical suitability of potential organ donors; a linked-data cohort study 2010–2015

PurposeAustralia has unmet need for transplantation. We sought to assess the impact of cultural and linguistic diversity (CALD) on family consent and medical suitability for organ donation.MethodCohort study of New South Wales donor referrals, 2010–2015. Logistic regression estimated effects of primary language other than English and birthplace outside Australia (odds ratios OR, with 95% confidence intervals, 95%CI). Outcomes were whether families were asked for consent to donation, provided consent for donation, and whether the referral was medically suitable for donation.ResultsOf 2977 organ donor referrals, a similar proportion of families had consent for donation was sought between non-English speakers and English speakers (p = .07), and between overseas-born compared to Australian-born referrals (p = .3). However, consent was less likely to be given for both non-English speakers than English speakers (OR 0.44, 95%CI:0.29–0.67), and those overseas-born than Australian-born (OR 0.54, 95%CI:0.41–0.72). For referrals both overseas-born and non-English speaking, families were both less likely to be asked for consent (OR 0.67; 95%CI:0.49–0.91) or give consent (OR 0.24; 95%CI0.16–0.37). There was no difference in medical suitability between English speakers and non-English speakers (p = .6), or between Australian-born and overseas-born referrals (p = .6).ConclusionIntervention to improve consent rates from CALD families may increase donation.     

Delivering culturally competent care to the lesbian,gay, bisexual,and transgender (LGBT) population: Education for nursing students

PurposeDespite well-documented healthcare disparities in the lesbian, gay, bisexual, and transgender (LGBT) community, nursing education has lagged other health professions in promoting culturally competent care to members of this minority group.MethodsUsing national guidelines, the author developed an educational program for BSN students to improve competency in providing care for LGBT individuals. One hundred twenty-four students completed online modules and a simulation exercise, which explored LGBT healthcare topics. One hundred eight participants completed surveys pre-, post-, and 1 month after the intervention.ResultsOverall LGB competence scores improved from pre- (M = 4.42) to post-test (M = 5.20) and did not significantly decrease at one-month (M = 5.03, p < .001). Similar findings were observed in the transgender cultural competence scores (pre- (M = 4.02); post- (M = 5.08); one-month (M = 4.92, p < .001)).ConclusionEducational content focused on cultural competency for nurses may lead to improved health outcomes among the LGBT community.     

Clinical outcomes of a nurse-led post-discharge education program for heart-transplant recipients: A retrospective cohort study

BackgroundAdvances in immunosuppressive therapeutics and medical technology have improved survival rates after heart transplantation. Although there is a rigorous schedule of outpatient visits and testing to detect early signs of rejection and other complications in the first year after transplantation, repeated unplanned readmissions of heart transplant recipients remains a challenge.ObjectiveThis study aimed to compare the effects of specialized nurse-led discharge education, including continuous post-transplant education and counselling, on heart transplant recipients' clinical outcomes, with the effects of existing discharge education.MethodsParticipants were 136 heart transplantation recipients at a university-affiliated hospital in South Korea from November 1, 1994, to November 30, 2018. Participants' electronic medical records were retrospectively analyzed. Participants were grouped according to usual care (n = 25), nurse-led program (n = 66), and nurse-led program with post-discharge education (n = 45). We assessed the number of outpatient visits with clinical problems and days to first unplanned rehospitalization within one year after transplantation.ResultsThe nurse-led program with post-discharge education was associated with significantly reduced outpatient visits with clinical problems, compared to usual care and the existing nurse-led program. We also found a significantly longer time until first unplanned rehospitalization in the nurse-led program with post-discharge education group, compared to the usual care group.ConclusionThis study identified the heart transplantation-specialized nurse-led discharge and subsequent post-discharge education as an effective strategy for positive clinical outcomes within one year after heart transplantation.     

Providing trans-affirming care for sexual assault survivors: An evaluation of a novel curriculum for forensic nurses

BackgroundTransgender (trans) persons experience high rates of sexual victimization, often face discrimination by healthcare providers, and may have unique and diverse needs post-victimization. However, there remains a lack of comprehensive trans-specific training among healthcare professionals, including nurses.ObjectivesOur primary objective was to develop and evaluate a novel curriculum for its efficacy in improving the competence of forensic nurses in providing sensitive, informed, and appropriate healthcare services for trans survivors of sexual assault.MethodsThe curriculum was evaluated among forensic nurses working in sexual assault treatment centres across Ontario, Canada. Forty-seven nurses participated in this study, all of whom were selected by their respective programs to receive in-depth formal Sexual Assault Nurse Examiner training. Changes in participants' perceived expertise and competence in providing trans-affirming care were assessed on a 5-point Likert scale (5 being the highest level) using pre- and post-training questionnaires. Participants were asked to indicate their level of agreement with 31 competency-based statements, which were organized thematically into four domains: Initial Assessment, Medical Care, Forensic Examination, and Discharge and Referral. A clinical vignette assessed participants' demonstrated competence in providing care across four questions.ResultsParticipants level of expertise improved significantly from pre- to post-training (Mean [M] = 1.89, Standard Deviation [SD] = 0.84 vs. M = 3.47, SD = 0.62, p< 001), as well as their competence across all content domains: initial assessment (M = 3.79, SD = 0.63 vs. M = 4.70, SD = 0.31, p < .001), medical care (M = 3.33, SD = 0.73 vs. M = 4.69, SD = 0.33, p < .001), forensic examination (M = 3.40, SD = 0.75 vs. M = 4.72, SD = 0.35, p < .001), and discharge and referral (M = 3.62, SD = 0.80 vs. M = 4.59, SD = 0.40, p < .001). There were also significant improvements in competence associated with the clinical vignette pre- to post- training (M score = 2.13, SD = 1.06 vs. M score = 3.23, SD = 0.87, p < .001).ConclusionsThe success of this curriculum may have relevance to the more than 5000 members of the International Association of Forensic Nurses who practice and support forensic nursing across the globe, as well as to other healthcare professionals.     

Effects of a nurse-led transitional care program on clinical outcomes,health-related knowledge,physical and mental health status among Chinese patients with coronary artery disease: A randomized controlled trial

BackgroundCoronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China.ObjectivesTo examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease.DesignRandomized controlled trial.MethodsThe Omaha system and Pender’s health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n = 100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n = 99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014.ResultsCompared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t = 5.762, P = 0.000; diastolic blood pressure, t = 4.250, P = 0.000; fasting blood glucose, t = 2.249, P = 0.027; total cholesterol, t = 4.362, P = 0.000; triglyceride, t = 3.147, P = 0.002; low density lipoprotein cholesterol, t = 2.399, P = 0.018; and body mass index, t = 3.166, P = 0.002), higher knowledge scores for coronary artery disease (total knowledge score, t = −7.099, P = 0.000), better physical health status (t = −2.503, P = 0.014) and mental health status (t = −2.950, P = 0.004).ConclusionsThis study provides evidence for the value of a nurse-led transitional care program using both the Omaha system and Pender’s health promoting model as its theoretical framework. The structured interventions in this nurse-led transitional care program facilitate the use of this program in other settings.     

Evaluation of an interprofessional care coordination model: Benefits to health professions students and the community served

Background/Purpose: An innovative care coordination program was developed to enhance wellness among low-income older adults living in subsidized apartment buildings and to provide rich interprofessional education experiences for health professions students.MethodsProgram effectiveness for the residents was measured through an evaluation of participation, services used, and healthcare utilization. Educational effectiveness was measured through a change in health concepts and perceptions of interprofessional practice.FindingsHealth care utilization among participating residents showed an 8.6% reduction in emergency department visits and 9.8% reduction in hospital admissions. Students demonstrated improved knowledge in motivational interviewing (p = .02); diabetes (p = .02); hypertension (p≤.01); and frailty (p≤.01). Changes in students perception of interprofessional practice were significant in two areas; Teamwork and Collaboration (p≥.00); and Person Centeredness (p = .00).DiscussionThis care coordination model may be an effective approach to reduce care resource utilization among medically complex lower income older adults and provides a rich interprofessional learning experience for students.     

The Effectiveness of Using a Nurse-Led Pain Relief Model for Pain Management among Abdominal Surgical Patients: A Single-Center,Controlled before-after Study in China

BackgroundEffective pain management is closely related to the prognosis of patients after surgery. Setting up acute pain service is among the effective strategies to control pain. The operation of acute pain service is mostly dominated by anesthesiologists; however, control of postsurgical pain is still unsatisfactory. Nurses are the main force for providing postoperative care of patients, and their role in acute pain service is crucial. Therefore, in the current study, we have developed a nurse-led pain relief model that emphasizes the central role of nurses during the entire surgical procedure. However, the effect of using this model for pain management among abdominal surgical patients remains unknown.AimsThe current study was conducted to investigate the effect of using a nurse-led pain relief model for pain management among abdominal surgical patients.DesignA single-center, propensity score-matched, controlled before–after study.MethodsThe patients, hospitalized for abdominal surgery in a university-affiliated hospital from January 2015 to December 2017, were enrolled and divided into group A (hospitalized before nurse-led pain relief model implementation, from January, 2015 to October, 2016) and group B (hospitalized after nurse-led pain relief model implementation, from October, 2016, to December, 2017) using propensity score match assay. The researchers compared the quality of acute pain management, the main side effects of pain management, and nurses’ pain knowledge and attitude between group A and group B.ResultsA total of 2851 patients undergoing nonemergency abdominal surgery were enrolled in the current study and were propensity matched 1:1 into two groups with 1,127 subjects in each group. The quality of acute pain management postsurgery was better after implementation of the nurse-led pain relief model. More patients received higher numerical rating scales cores (≥4 points) at indicated time points after surgery in group A compared with group B (14.20% vs. 12.24% 6 hours postsurgery, p = .001; 12.33% vs. 8.52% 12 hours postsurgery, p = .004; 12.95% vs. 3.99% 24 hours postsurgery, p = .036; 16.06% vs. 7.19% 48 hours postsurgery, p = .001). Furthermore, the occurrence of nausea and vomiting during pain management were significantly decreased in patients from group B (nausea: X² = 38.926, p < .05; vomit: X² = 39.302, p < .05). Additionally, after using the nurse-led pain relief model, nurses were more open to improving their knowledge and attitudes to pain management (p < .05).ConclusionOur study demonstrated that a nurse-led pain relief model can enhance the quality of acute pain management among post-abdominal surgical patients, suggesting that such a model can be an effective intervention for providing a better pain control among postsurgical patients.     

Evaluation of a multicomponent restraint reduction intervention in care homes

ProblemPhysical restraints have been widely applied as a means to prevent accidents among care home residents with cognitive impairment.BackgroundEvidence has shown the risks and harms of physical restraints to the physical and psychosocial health of care home residents. Research on reducing restraint use has been sporadic with inconclusive results.QuestionCan a multicomponent program reduce inappropriate use of physical restraints in care home settings?MethodsA pretest–post-test study was conducted in two care homes in Hong Kong. The multicomponent program comprised staff education, case conferences, and consultation. Data were triangulated using self-administered questionnaires, observations of restraint use practice, and documentary reviews. The following study outcomes were evaluated at baseline and 12-month follow-up: care home staff's use of restraints, knowledge of physical restraints, and perceived competence in dementia care.FindingsRestraint use was reduced by 30.9% in 12 months (p < .001), but no significant difference in the mean scores of knowledge of physical restraints and perceived competence in dementia care was noted among care home staff between baseline and the 12-month follow-up (p = .387 and p = .287, respectively).DiscussionThe findings suggest that our multicomponent program, underpinned by organisational support, was instrumental in reducing the use of physical restraints in care home settings, but its effects on care home staff and residents remain unclear.ConclusionThis study suggests the feasibility and preliminary effects of using a multicomponent program to reduce restraint use in care homes. A more robust study design is needed to evaluate the sustained effects of our multicomponent program and also its effects on the outcomes of care home staff and residents.     

A nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to intensive care: A stepped-wedge cluster randomised trial

BackgroundDelirium is an acute change in behaviour, characterised by a fluctuating course, inattention, and disorganised thinking. For critically ill adults in the intensive care, the incidence of delirium has been reported to be at least 30% and is associated with both short-term and long-term complications, longer hospital stay, increased risk of mortality, and long-term cognitive problems.AimThe objective of this study was to determine the effectiveness of a nurse-led delirium-prevention protocol in reducing the incidence and duration of delirium among adults admitted to intensive care.MethodsA hybrid stepped-wedge cluster randomised controlled trial was conducted to assess the effectiveness of the implementation and dissemination of the nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the four adults intensive care units in the southwest of Sydney, Australia.ResultsBetween May 2019 and February 2020, over a 10-month period, 2618 admissions, among 2566 patients, were included in the study. After an initial 3-month baseline period, each month there was a random crossover to the nurse-led intervention in one of the four intensive care units, and by the 7th month of the trial, all units were exposed to the intervention for at least 3 months. The incidence of acute delirium was observed to be 10.7% (95% confidence interval [CI] = 9.1–12.4%), compared to 14.1% (95% CI = 12.2–16.2%) during the preintervention (baseline) period (adjusted rate ratio [adjRR] = 0.78, 95% CI = 0.57–1.08, p = 0.134). The average delirium-free-days for these preintervention and postintervention periods were 4.1 days (95% CI = 3.9–4.3) and 4.4 days (95% CI = 4.2–4.5), respectively (adjusted difference = 0.24 days [95% CI = −0.12 to 0.60], p = 0.199).ConclusionFollowing the introduction of a nurse-led, nonpharmacological intervention to reduce the burden of delirium, among adults admitted to intensive care, we observed no statistically significant decrease in the incidence of delirium or the duration of delirium.     

The effects of abdominal-based early progressive mobilisation on gastric motility in endotracheally intubated intensive care patients: A randomised controlled trial

ObjectiveTo examine whether an abdominal-based early progressive mobilisation program improves gastric motility and reduces feeding intolerance in critically ill patients with endotracheal intubation.Design and MethodsA randomised controlled trial was designed. Adult patients admitted to the intensive care unit who were intubated and had an order for enteral nutrition were randomly assigned to partake in an three stages of abdominal-based progressive mobilisation program (passive abdominal massage, bed-side bicycle and ambulating) or standard of care. Gastric antral motility was measured by bedside ultrasound.ResultsA total of 83 critically ill patients were included in the study. The intervention group displayed a statistically significant improvement in the antral motility index than the control group (p < .001), as well as in complications of feeding intolerance, including the incidence of abdominal distention (9.8% vs 33.3%, p = .009), vomiting (0% vs 16.7%, p = .019) and diarrhoea (22% vs 50%, p = .008). However, no significant difference for the full enteral feeding rate on the third day was observed between the groups. Furthermore, time on mechanical ventilation (4.52 ± 2.77 days vs 6.24 ± 3.90 days, p = .023) was shorter in intervention group, but no significant difference of length of intensive care unit stay was observed between the groups.ConclusionsImplementation of an abdominal-based early progressive mobilisation program can improve gastric motility and feeding intolerance in critically ill patients with an endotracheal tube.     

Web-based experiential learning strategies to enhance the evidence-based-practice competence of undergraduate nursing students

BackgroundEvidence-based practice (EBP) is considered a key competence for practicing high-quality and safe nursing. However, undergraduate nursing programs continue to provide traditional classroom teaching strategies that have limitations in facilitating the development of critical competences for engaging in EBP in real clinical contexts.Objective and designThe purpose of this study was to develop a web-based experiential learning program aimed at improving the engagement and experience of nursing students in EBP. A quasi-experimental research with non-equivalent control-group with non-synchronized design was used to describe the process of program development and the innovative learning method, and discuss the outcomes of the program.MethodsThe experimental group was exposed to a web-based experiential learning program, while the control group received traditional learning with written material. Self-reported EBP scores (knowledge and skills, attitude, and practice) and clinical-questioning confidence were evaluated to assess the effects of the program.ResultsThe result showed that web-based experiential learning strategies were effective in significantly improving the EBP knowledge and skills score (F = 12.29, p = .001) and the score for confidence in asking clinical questions (F = 12.14, p = .001). The attitudes toward EBP (F = 0.75, p = .389) and practice score (F = 3.22, p = .076) did not show a significant difference between the experimental group and the control group.ConclusionThe web-based experiential learning was found to be an effective method for enhancing the EBP competence of nursing students. Based on the study results, we suggest using web-based experiential learning to supplement the traditional learning method or as the mainstream learning method for nursing students.     

Organ donation within the intensive care unit: A retrospective audit

BackgroundDespite many Australians supporting organ donation, national posthumous organ donation rates have not increased as expected over the last three decades. Little is known about the barriers to organ donation for patients in intensive care that meet the criteria for organ donation.ObjectiveThe aim of this study was to describe the characteristics of patients identified as potentially suitable for organ donation and to explore the variables associated with the success, or failure, of solid organ donation within the context of an Australian public hospital intensive care unit (ICU).MethodsA retrospective audit examined electronic records of 280 potential organ donors aged 18–80 years, admitted into the ICU between 1 July 2012 and 30 June 2016. Data extracted from three separate electronic hospital databases were amalgamated for analysis.ResultsOf the 280 potential organ donors identified, conversations with families of 182 (65%) patients resulted in their agreement to organ donation. Consent to organ donation was most often provided by the patient's spouse (65, 35.7%); however, only 63.7% (n = 116) were successful organ donors. The remaining 36.3% (n = 66) of patients did not donate organs for medical reasons. Compared with those who did not donate, the typical organ donor was significantly younger (M 49.9 years, p = 0.020), Australian-born (p = 0.031), and had a shorter length of ICU stay (M 64.9 h, p = 0.002). The most frequently donated organs were kidneys (103, 88.8%), lungs (59, 50.9%), and livers (52, 44.8%).ConclusionThis study provided insights into patient, family, and organisational factors contributing to the success of organ donation outcomes in the ICU. Two factors that adversely impacted donation outcomes were the following: (1) the family did not consent to organ donation on behalf of the patient and (2) consent was provided, but donation did not proceed for medical reasons. Although the focus on the consenting process has been raised, this study highlights the additional impact of medical suitability on rates of organ donation. Family members may experience significant disappointment after consent that may have repercussions on their health and also future donation considerations. This study also highlighted some deficiencies in the databases that, if addressed, could better inform organisational processes in the consent and support of those making decisions about consent.     

Investigation of Factors Associated With Pain Intensity in Office Workers With Non-Specific Low Back Pain

BackgroundLow back pain is an important health problem causing serious physical, psychological, and economic losses in developed and developing countries.AimThe aim of this study is to investigate comprehensively the factors related to the intensity of pain in office workers with non-specific low back pain (NSLBP).MethodsThe study included 71 university office workers with NSLBP, aged 21-55 years. In addition to evaluating the sociodemographic and clinical characteristics of office workers with NSLBP, visual analog scale (VAS), Short-Form 36 (SF-36), Minnesota Satisfaction Questionnaire (MSQ), Oswestry Disability Index (ODI), Tampa Kinesiophobia Scale (TKS), Beck Depression Inventory (BDI), and Timed Up and Go (TUG) outcome measurements were applied.ResultsThere was a statistically significant association between the intensity of pain and TUG test (p = .000), job satisfaction (p = .015), percentages of disability (p = .000), quality of life (role difficulty due to physical limitation, p = .010; pain, p = .000; social the function, p = .044), and depression (p = .004).ConclusionsWhile the functional performance, job satisfaction level, and quality of life in office workers with NSLBP with severe-intensity pain were lower, level of disability, depression were higher in office workers with NSLBP with mild-to-moderate-intensity pain.     

The effects of an intimate partner violence educational intervention on nurses: A quasi-experimental study

Nurses play a unique role in responding to the needs of intimate partner violence survivors. However, nurses are not adequately prepared to manage intimate partner violence. This study assessed the effects of intimate partner violence educational interventions on nurses’ knowledge, attitudes, and practice. A non-randomized controlled trial was conducted with a convenience sample of nurses (n = 104). Nurses in both the intervention and control groups completed pre- and post-test surveys using the self-reported Physician Readiness to Manage Intimate Partner Violence Survey. An intimate partner violence educational program based on World Health Organization guidelines was administered. The multilevel analysis controlling for pre-test results revealed a significant effect of the intervention on perceived intimate partner violence preparation (p = .000) and knowledge (p = .000), actual knowledge (p = .000), intimate partner violence opinions (attitudes and beliefs) related to preparation (p = .000), legal requirements (p = .00), workplace issues (p = .000), self-efficacy (p = .000), victim understanding (p = .000), victim autonomy (p = .000), and constraints (p = .000). However, the intervention did not affect self-reported practices (p = .583). Intimate partner violence educational programs must be integrated into nursing curricula and in-service training through a system approach.     

Resilience as a mediator between compassion fatigue,nurses' work outcomes,and quality of care during the COVID-19 pandemic

BackgroundNurses in the frontline of the battle against COVID-19 are highly vulnerable to compassion fatigue (CF), which may affect their mental health, work effectiveness, and patient safety outcomes. However, no studies have investigated nurses' CF in relation to job outcomes and care quality during the pandemic.AimsThis study aims to examine the mediating role of resilience in the relationship between CF and frontline nurses' job outcomes (job satisfaction and turnover intention) and care quality.DesignAn online, cross-sectional survey containing five self-report scales was used to collect data from 270 frontline nurses in selected hospitals in the Philippines.ResultsOverall, 38.5% of frontline nurses experienced medium to high CF during the second wave of the pandemic. Increased CF was associated with poorer nurse-reported quality of care (β = −0.145, p = 0.019), lower job satisfaction (β = −0.317, p = 0.001), and higher organizational turnover intention (β = 0.301, p = 0.001). Moreover, resilience fully mediated the relationship between CF and quality of care (β = −0.088, p = 0.169), and partially mediated the relationship between CF and job satisfaction (β = −0.259, p = 0.001), and CF fatigue and organizational turnover intention (β = 0.272, p = 0.001).ConclusionFrontline nurses are at risk of developing CF during the pandemic. Psychological resilience reduces the negative impact of CF on frontline nurses' job satisfaction, turnover intention, and the quality of care in their assigned unit. Proactive measures to reduce CF should be prioritized by nursing administrators. Resilience-promoting interventions could foster job satisfaction and retention in nurses and, hence, the quality of care delivered in their units.     

Comfort and religious-spiritual coping of intensive care patients’ relatives

ObjectivesTo identify the level of comfort and religious-spiritual coping of family members of intensive care unit patients and to analyse the sociodemographic/clinical variables that influence this association.MethodsCross-sectional study on the adult and paediatric intensive care units of two public hospitals in the state of São Paulo, between January and September 2016. Participants were divided into two groups: adult (n = 96) and paediatric (n = 70). We used the religious-spiritual coping brief (RSC-Brief) and the comfort scale for relatives of people in critical states of health (ECONF).ResultsComfort was low in both groups and the family members used limited strategies in the RSC-Brief. The multiple linear regression analysis indicated that the variable length of hospitalization (β = 0.69; p < 0.01) influenced comfort and was also associated with the RSC-Brief (β = -0.18; p < 0.01).ConclusionFamily members’ comfort was low in both groups. It increased with the hospitalisation time of the patients' relative and tended to decrease with the severity of the disease.     

The effectiveness of a career efficacy enhancement program for KOREAN nursing students: A quasi-experimental study

BackgroundNursing students tend not to consider their career paths during their college years but if they enter nursing without having established a career identity during college, they will have low job satisfaction and high turnover intentions.ObjectivesThis study aimed to evaluate the effects of a career efficacy enhancement program on nursing students' career decision, identity, preparation behavior, and efficacy.DesignA two-group, quasi-experimental design was used.SettingThe study took place at two universities in South Korea.ParticipantsOverall, 69 baccalaureate nursing students participated.MethodsTwo program booklets and a workbook were developed for a career efficacy enhancement program that ran in 2018. Data were collected at three timepoints and analyzed using a Chi-square test, Fisher's exact test, and a repeated measures ANOVA.ResultsCareer identity differed significantly between groups (p = 0.005), measurement times (p = 0.000), and in the interaction between groups and measurement times (p = 0.000). Career decision differed significantly between groups (p = 0.009), measurement times (p = 0.013), and in the interaction between groups and measurement times (p = 0.002). Career preparation behavior did not differ significantly between groups (p = 0.550) but did differ significantly between measurement times (p = 0.000) and in the interaction between groups and measurement times (p = 0.001). Career efficacy did not differ significantly between groups (p = 0.213) but did differ significantly between measurement times (p = 0.000) and in the interaction between groups and measurement times (p = 0.000).ConclusionThe career efficacy enhancement program improved nursing students' career decision skills, identities, preparation behavior, and efficacy.     

Factors associated with comfort as perceived by older people living in long-term care facilities

BackgroundPerceived comfort levels of older people living in long-term care facilities (LTCFs) influence their health and wellbeing.AimThis study aimed to investigate the comfort levels and factors that contributed to comfort among older people living in LTCFs.MethodsA cross-sectional research design was used. Sociodemographic profile, physical function, pain, depressive symptom, social support, and comfort levels were collected. Stepwise multiple regression was utilised to identify the factors of residents’ comfort level in the LTCFs.FindingsA total of 114 residents were recruited in the study. Depressive symptom (β = -0.630, p < 0.001), social support (β = 0.260, p < 0.001), and pain (β = -0.128, p < 0.01) were the factors identified associated with perceived comfort among older people living in LTCFs (adjusted R²=88.2%). Older people with less depressive symptoms, greater social interaction and lower levels of pain showed higher comfort levels while living in long-term care facilities.DiscussionComfort, as perceived by older people living in LTCFs, is influenced by a combination of physiological and psychological factors. For older people to live comfortably in LTCFs, clinicians need to consider early detection of potential mental health issues such as depression, enhance the social support networks within and external to LTCFs and effectively manage pain.ConclusionThe findings inform gerontological nurses in assessing comfort levels of the residents and in implementing interventions to increase the comfort levels of older people living in long term care facilities.