Wen-Yin Chang

Aims and objectives: To investigate the relationship of nurse practitioners’ social support as well as other factors associated with perceived self‐efficacy.Background: There is a growing demand for nurse practitioners in Taiwan, for whom self‐perceived efficacy is associated with performance. Nevertheless, research on the self‐efficacy and social support of nurse practitioners is limited.Design: This is a cross‐sectional survey study.Methods: Questionnaires were distributed to nurse practitioners in seven hospitals in northern Taiwan from May 2015 to March 2016. In total, data from 335 (78% return rate) certified nurse practitioners were analysed. Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS) and the Job Content Questionnaire (JCQ), and perceived self‐efficacy was measured by the General Self‐Efficacy Scale (GSE). Data were analysed by ANOVAs with post hoc test and multiple linear regression.Results: The mean score for self‐efficacy was 27.60 ± 6.17. Support scores were 11.574 ± 2.37 for supervisors, 12.795 ± 1.92 for coworkers and 64.07 ± 10.16 for family, friends and significant others. nurse practitioners in the high monthly salary group had significantly higher self‐efficacy than nurse practitioners in the medium and low monthly salary group (F = 8.99; p < .01). Social support from coworkers (β = 0.18, p < .01) and family, friends and significant others (β = 0.15, p < .01) and a higher monthly salary were significant factors.Conclusions: The self‐efficacy of nurse practitioners in hospitals in Taiwan is insufficient. Monthly salary and levels of social support were found to contribute to nurse practitioners’ self‐efficacy. Thus, to enhance nurse practitioners’ self‐efficacy and work performance, nursing leaders should address these issues.Relevance to clinical practice: The findings inform hospital administrators to be aware of the importance of salary in relation to nurse practitioners’ perceptions of social support and self‐efficacy.

Aims and objectives: To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients.Background: Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high‐risk inpatients.Design: Secondary data analysis.Methods: A subset of inpatient data for the period from June 2011–June 2014 was extracted from the nursing information system and adverse event reporting system of an 818‐bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis.Results: During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut‐off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut‐off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards.Conclusions: The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions.Relevance to clinical practice: This study highlights the needs for redefining the cut‐off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.

Despite the fact that regular physical activity is known to improve physical health and reduce absenteeism and perceived job strain, healthcare professionals currently perform inadequate physical activity. To understand and compare the differences in stages of physical activity among nurses, physicians, and allied healthcare professionals. A cross-sectional questionnaire was used to survey nurses, physicians, and allied healthcare professionals who worked at four branches of a hospital in Taiwan. Data were collected using the physical activity stage of change questionnire. Data were analyzed using descriptive analysis, Chi-square test of homogeneity of proportions and a posteriori comaparisons, and multinominal logistic regression analysis. Of the 3,260 questionnaires administrated, 2,001 valid questionnaires were returned for an effective response rate of 61.4%. In total, 1,497 (74.8%) of the nurses, 241 (12.0%) of the physicians, and 263 (13.1%) of the allied healthcare professionals completed the questionnaire. The results revealed that most of the physicans and allied healthcare professionals were in the preparation stage, while most of the nurses were in the precontemplation stage. Multinominal logistic regression analyses showed that, using the precontemplation stage as a reference value, the odds of being in the contemplation stage were lower among participants who were nurses or male or who had a master's or doctoral degree (p < .05). Further, the odds of being in the preparation stage were lower among nurses (p < .01). The odds of being in the maintenance stage were higher among participants that: lived in the Taitung area, were male, or were single (p < .01). The findings provide valuable references for future hospital leaders to develop effective individual physical activity programs for healthcare professionals.

Aims and objectives: To evaluate the effectiveness of an accessibility‐enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction with the information and materials received by patients undergoing cardiac catheterisation.Background: Cardiac catheterisation is one of the most anxiety‐provoking invasive procedures for patients. However, informational education using multimedia to inform patients undergoing cardiac catheterisation has not been extensively explored.Design: A randomised experimental design with three‐cohort prospective comparisons.Methods: In total, 123 consecutive patients were randomly assigned to one of three groups: regular education; (group 1), accessibility‐enhanced multimedia informational education (group 2) and instructional digital videodisc education (group 3). Anxiety was measured with Spielberger's State Anxiety Inventory, which was administered at four time intervals: before education (T0), immediately after education (T1), before cardiac catheterisation (T2) and one day after cardiac catheterisation (T3). A satisfaction questionnaire was administrated one day after cardiac catheterisation. Data were collected from May 2009–September 2010 and analysed using descriptive statistics, chi‐squared tests, one‐way analysis of variance, Scheffe's post hoc test and generalised estimating equations.Results: All patients experienced moderate anxiety at T0 to low anxiety at T3. Accessibility‐enhanced multimedia informational education patients had significantly lower anxiety levels and felt the most satisfied with the information and materials received compared with patients in groups 1 and 3. A statistically significant difference in anxiety levels was only found at T2 among the three groups (p = 0·004).Conclusions: The findings demonstrate that the accessibility‐enhanced multimedia informational education was the most effective informational educational module for informing patients about their upcoming cardiac catheterisation, to reduce anxiety and improve satisfaction with the information and materials received compared with the regular education and instructional digital videodisc education.Relevance to clinical practice: As the accessibility‐enhanced multimedia informational education reduced patient anxiety and improved satisfaction with the information and materials received, it can be adapted to complement patient education in future regular cardiac care.

Accessible summary: Self‐efficacy is known as an effective model used to predict the self‐care ability and self‐care outcomes of patients diagnosed with schizophrenia. This descriptive comparative design study compared differences in scores of self‐efficacy and self‐care behaviours between outpatients with comorbid schizophrenia and type 2 diabetes and outpatients with only type 2 diabetes. The study revealed that outpatients with coexisting schizophrenia and type 2 diabetes scored significantly lower on self‐efficacy and self‐care measures compared with outpatients affected only by type 2 diabetes; thus, a self‐efficacy education programme must be developed to assist them in successfully managing their dual illnesses. Self‐efficacy, the haemoglobin A1C level and cigarette smoking were significant predictors of self‐care behaviours in outpatients with comorbid schizophrenia and type 2 diabetes; therefore, these outcome variables should be monitored regularly in outpatient settings. People with schizophrenia show higher‐than‐normal rates of type 2 diabetes mellitus (T2DM); however, research on their understanding of diabetes self‐efficacy and self‐care behaviours is lacking. This study compared differences in scores of self‐efficacy and self‐care behaviours between outpatients with comorbid schizophrenia and T2DM and outpatients with T2DM alone. Data were collected using the Diabetes Management Self‐Efficacy Scale and Summary of Diabetes Self‐Care Activity questionnaire. In total, 105 outpatients with schizophrenia and T2DM and 106 outpatients with T2DM returned completed questionnaires. Results of this study revealed that outpatients with schizophrenia and T2DM had significantly lower total self‐efficacy and self‐care scores than outpatients with only T2DM. The stepwise regression analysis revealed that self‐efficacy, the haemoglobin A1C level and current smoking were significant predictors of self‐care behaviours in outpatients with comorbid schizophrenia and T2DM, which explained 33.20% of the variance. These findings help mental health professionals improve patient care through a better understanding of self‐care behaviours among outpatients with comorbid schizophrenia and T2DM.

Aims To assess the level of and the differences in managerial competencies, research capability, time management, executive power, workload and work‐stress ratings among nurse administrators (NAs), and to determine the best predictors of managerial competencies for NAs. Background Although NAs require multifaceted managerial competencies, research related to NAs’ managerial competencies is limited. Method A cross‐sectional survey was conducted with 330 NAs from 16 acute care hospitals. Managerial competencies were determined through a self‐developed questionnaire. Data were collected in 2011. Results All NAs gave themselves the highest rating on integrity and the lowest on both financial/budgeting and business acumen. All scores for managerial competencies, research capability, time management and executive power showed a statistically significant correlation. The stepwise regression analysis revealed that age; having received NA training; having completed a nursing project independently; and scores for research capability, executive power and workload could explain 63.2% of the total variance in managerial competencies. Conclusion The present study provides recommendations for future administrative training programmes to increase NAs’ managerial competency in fulfilling their management roles and functions. Implications for Nursing Management The findings inform leaders of hospitals where NAs need to develop additional competencies concerning the type of training NAs need to function proficiently.

This paper is a report of a study conducted to (a) to compare hospitalized patients' and nurses' perceptions of the hospital environment, nurse-physician relationships and quality of care; (b) to determine which factors best predict the quality of care from hospitalized patients' and nurses' perspectives; and (c) to assess the relationships among all variables. Quality of care is a function of many factors and includes elements of the hospital environment and nurse-physician relationships. However, comparisons between patients' and nurses' perceptions are relatively limited. This was a cross-sectional study, and 575 patients and 220 nurses across 13 units completed questionnaires. Data were collected in 2009 and analysed using descriptive statistics, independent t-tests, stepwise regression and path analysis. Overall, patients' mean scores were statistically significantly higher than those of nurses on perception of hospital environment (3·05 vs. 2·65 points), nurse-physician relationships (7·88 vs. 6·53 points) and quality of care (7·91 vs. 6·63 points) (P < 0·001). Both the hospital environment and nurse-physician relationships were statistically significant predictors of quality of care. Path analysis showed that quality of care was affected by the hospital environment, nurse-physician relationships and years of education for patients (P < 0·05). However, for nurses, quality of care was only directly affected by the hospital environment and nurse-physician relationships (P < 0·05). These findings may help nursing leaders to ensure future excellent patient care by helping them to see which areas need improvement. They may also help nursing leaders to develop strategies to meet patients' and nurses' expectations.