Huei-Chuan Sung

This randomized controlled trial aimed to evaluate the effects of a dementia education using 360-degree immersive virtual reality (VR) videos on the knowledge, attitudes, and empathy toward people with dementia among nursing students. Fifty eligible nursing students were randomly assigned to VR and control groups. The VR group (n=25) engaged in 3 sessions of 360-degree immersive dementia VR videos featuring clinical scenarios with debriefings and instructor-led group discussions in addition to the conventional lecture-based dementia care course, whereas the control group (n=25) received 3 sessions of instructor-led group discussions on dementia case scenarios without exposure to VR in addition to the conventional course. Data were collected at baseline, week 8, and week 18. The VR group showed greater dementia knowledge than the control group at T1 ( P =.015) and T2 ( P =.001), as measured by the Dementia Knowledge Assessment Scale. Empathy, measured by the Jefferson Scale of Empathy, showed significant improvement at T ₂ ( P <.001) between groups. However, the Approaches to Dementia Questionnaire results showed no significant improvement in attitudes over time between groups. These findings suggest that a dementia education using 360-degree immersive VR videos filmed from the perspectives of people with dementia is an effective teaching strategy for improving nursing students’ dementia knowledge and empathy. This study findings may provide valuable insights for the development of dementia care curricula using VR technology in nursing education.

Patients with dementia often display related sleep disturbance, depression, and behavioral and psychological symptoms, which are traditionally managed through the use of antipsychotic medications or physical restraint. However, these management interventions can have negative effects on the physical and psychological health of patients. The results of several meta-analyses suggest non-pharmacological interventions, including light therapy, should be used for the first-line management of these dementia symptoms. Light therapy uses artificial light to compensate for insufficient light exposure during the daytime and to help patients with dementia properly regulate their circadian rhythms. Sleep disturbance and depression in those with dementia may be effectively relieved through the application of light therapy. Nurses should assess the needs and symptoms of patients with dementia and consider applying light therapy as a complementary care intervention to improve quality of care.

Purpose: This review was comprised of an integrative analysis of the literature on the current state of dementia and related issues in Hong Kong, Japan, South Korea, Taiwan, and Thailand. Methods: Published reports and policy documents from MEDLINE, CINAHL, PubMed, and each government’s database were used in this review. Results: All five Asian regions are projected to become super-aged societies within 12 years, and the number of people with dementia has increased in these regions. All five regions have established dementia policies, which include improving dementia awareness, risk reduction, early diagnosis, and support programs for caregivers. However, there is a lack of information systems for sharing dementia data and research funding for dementia. Conclusion: It is necessary to establish a dementia committee for Asian regions to actively address the challenges posed by the upcoming super-aged societies and to complement the insufficient research. This review provides future directions for dealing with diverse dementia-related issues and can serve as the basis for forming an Asian dementia committee.

Objectives: Home care workers who are the first‐line care workers for community‐dwelling dementia patients often have limited dementia knowledge, skills, and empathy towards those with dementia. Research is sparse on dementia care training using virtual reality (VR) technology and support network for home care workers.Methods: This cluster randomized controlled trial evaluated the effects of a dementia VR‐based training with peer support on dementia knowledge, attitude, competence, and empathy of home care workers. Each home care worker team was used as the unit for randomization. Sixteen teams were randomly assigned to either VR group or non‐VR control group There was a total of 124 participants completed the study, the VR group (n = 61) received a dementia VR‐based training consisted of 3‐month dementia care e‐book modules, dementia VR‐based activity and 1‐h monthly face‐to‐face peer support group meetings. The non‐VR control group (n = 63) only receive the 3‐month dementia care e‐book modules and 1‐h monthly regular staff meetings with no VR activity. Outcome measures were assessed at three time points: baseline, the end of the 3‐month intervention, and 1‐month post intervention.Results: Generalized estimating equations results indicate that the improvement in dementia knowledge, attitudes, competence, and empathy over time is significant in the VR group compared to the non‐VR control group. The effects remained significant 1 month after the end of the 3‐month intervention.Conclusions: Innovative and accessible dementia training using VR technology with peer support is a promising training approach to improve dementia knowledge, attitudes, competence, and empathy of home care workers.

Objective: The 43-item Stressors in Nursing Students (SINS) scale has been evaluated among nursing students in several countries, including China, Hong Kong, Japan, Pakistan, and Spain. However, the original four-factor structure has not been consistently replicated in all of these populations. The aim of this study was to develop a brief version of the traditional Chinese SINS (TC-SINS) scale and to validate it in Taiwanese nursing students. Materials and Methods: Data obtained from a cross-sectional survey study of 814 nursing students in a nursing college and a university in Taiwan were randomly divided into two parts. The first part was used to conduct an exploratory factor analysis using principal axis factoring with oblique rotation. After the removal of cross-loading items, the resulting scale was validated with the data from the second part using confirmatory factor analysis. Results: A three-factor solution (social, clinical, and education) with 23 items accounting for 54.5% of variance was obtained in the exploratory factor analysis. The confirmatory factor analysis further reduced the number of items to 20. The goodness-of-fit indexes were good (Root Mean Square Error of Approximation = 0.075 and Comparative Fit Index = 0.90). Conclusions: The number of items in the TC-SINS could be reduced from 43 to 20, without sacrificing its psychometric properties. The brief version of TC-SINS might be able to reduce respondent burden.

Patients with chewing disorders and dysphagia often take nutrition via nasogastric tube feeding. Patients with indwelling nasogastric tubes often experience discomfort, resulting in increased incidences of self-extubation and slippage. Frequent changes or misplacement of the nasogastric tube may also cause patient safety issues such as aspiration pneumonia, gastrointestinal trauma, and pneumothorax. Collaboration within the interdisciplinary team is needed to provide proper nasogastric tube care prior to placement, during the indwelling process, and during the removal of the nasogastric tube. Interdisciplinary teams should develop standardized procedures for nasogastric tube care, initiate swallow screening, oral care and training early, and develop a care plan for nasogastric tube removal. An evidence-based, practical example of nasogastric tube care implemented by an interdisciplinary team in a neurology unit is presented in this article. Interdisciplinary teams may assist patients to prepare to return to a normal tube-free life using individualized, safe, and dignified nasogastric tube care to improve quality of life.

Background: The Dementia Knowledge Assessment Scale (DKAS) is a reliable and valid measurement of dementia knowledge for diverse allied health professionals but its traditional Chinese version has not been formally validated yet. The purpose of this study was to translate the DKAS from English to traditional Chinese and evaluate its psychometric properties among home care workers in Taiwan. Methods: The DKAS scale was translated into traditional Chinese through a forward translation and back translation process following the cross-cultural translation guideline. A total of 285 home care workers in eastern Taiwan were recruited using convenience sample. A total of 252 participants completed the questionnaires, giving a response rate of 88.4%. We tested the construct validity by confirmatory factor analysis (CFA) and evaluated the reliability by internal consistency. Results: The results of the CFA supported the 25-item, four-factor model for the DKAS-TC. The DKAS-TC achieved a good overall Cronbach’s alpha of .93 and McDonald’s omega of 0.94 with acceptable subscales McDonald’s omega ranged from .77 to .82. Conclusions: The DKAS-TC has adequate construct validity and reliability and can serve as an assessment tool to evaluate the knowledge level of home care workers in a dementia training program in Taiwan. The dementia knowledge level among home care workers in Taiwan was inadequate. There is a need for developing suitable dementia care training tailored to their learning needs and educational levels, and to improve their quality of care for those with dementia.

Background: Caring of older adults with dementia at home can be challenging for home care workers. There is a need to develop suitable training for home care workers to improve the quality of dementia care. We evaluated a 12-week dementia care training including mobile e-learning, social networking, and mentoring support group meetings on the dementia care knowledge, attitude, and competence of home care workers. Methods: This controlled study involved 140 home care workers from two home care agencies, which were selected from 12 home care agencies in eastern Taiwan. The two home care agencies were randomly allocated either the intervention group or the control group. The intervention group received mobile e-learning, mentor-led online social support networking, and monthly face-to-face mentoring support group meetings. Participants in the control group received 8-h conventional lectures. The primary outcomes were knowledge, attitude, and competence in dementia care. Questionnaires consisting of the Dementia Knowledge Assessment Scale, Approaches to Dementia Questionnaire, and Sense of Competence in Dementia Care Staff scale were administered to the participants at three time points (baseline, end of the 12-week intervention, and 12 weeks after the end of the intervention). Results: Generalized estimating equation analyses showed that the intervention significantly improved the knowledge, attitude, and competence of home care workers on dementia care. The effects remained significant even 12 weeks after the end of the intervention. Conclusions: A 12-week dementia care training program consisting of mobile e-learning, social networking, and face-to-face mentoring support group meetings were found to a feasible approach in improving the knowledge, attitude, and competence of home care workers. Mobile e-learning and online environment provides a platform that is self-directed, flexible, accessible, and cost-effective for training home care workers. The findings provide a call to action for nurse educators and policy makers to re-design existing dementia care training for home care workers to meet the critical home care needs of a growing dementia population. Trial registration: ClinicalTrials.gov. NCT03822286. Registration date: 27/01/2019. Posted date: 31/01/2019.

Depressive symptoms are common psychiatric comorbidities among individuals receiving long-term hemodialysis. The aim of this two-arm parallel design study is to assess the effects of bright light therapy (BLT) on depressive symptoms among middle-aged and older adults receiving long-term hemodialysis. Study participants are recruited using convenient sampling from four dialysis clinics in eastern Taiwan. The eligible participants are block-randomized to either the BLT group (n = 30), with 30 min sessions of BLT five times a week for six weeks at their own home, or to the routine care control group (n = 30). The Beck Depression Inventory-II (BDI-II) scores and the salivary cortisol levels are obtained from the participants at three time points: baseline (T₀), week 3 (T₁), and week 6 (T₂). The results, from the generalized estimating equations, indicate that the decline in the BDI-II scores over time is significant in the BLT group at T₁ (β = −7.57, p < 0.001) and at T₂ (β = −6.20, p = 0.002) compared to the control group. The decrease in salivary cortisol levels at each visit is also significant in the BLT group at T₁ (β = −7.37, p = 0.017) and at T₂ (β = −12.22, p = 0.005) compared to the control group. Our findings support the hypothesis that a six-week program of BLT is able to alleviate depressive symptoms in middle-aged and older patients who receive long-term hemodialysis.