Abstract: Today-s healthcare industries had become more
patient-centric than profession-centric, from which the issues of quality of healthcare and the patient safety are the major concerns in the modern healthcare facilities. An unplanned extubation (UE) may
be detrimental to the patient-s life, and thus is one of the major indexes
of patient safety and healthcare quality. A high UE rate not only
defeated the healthcare quality as well as the patient safety policy but
also the nurses- morality, and job satisfaction. The UE problem in a psychiatric hospital is unique and may be a tough challenge for the
healthcare professionals for the patients were mostly lacking communication capabilities. We reported with this essay a particular
project that was organized to reduce the UE rate from the current 2.3%
to a lower and satisfactory level in the long-term care units of a psychiatric hospital. The project was conducted between March 1st,
2011 and August 31st, 2011. Based on the error information gathered
from varied units of the hospital, the team analyzed the root causes
with possible solutions proposed to the meetings. Four solutions were
then concluded with consensus and launched to the units in question.
The UE rate was now reduced to a level of 0.17%. Experience from
this project, the procedure and the tools adopted would be good reference to other hospitals.
Abstract: Leave of absence is important in maintaining a good
status of human resource quality. Allowing the employees temporarily
free from the routine assignments can vitalize the workers- morality
and productivity. This is particularly critical to secure a satisfactory
service quality for healthcare professionals of which were typically
featured with labor intensive and complicated works to perform. As
one of the veteran hospitals that were found and operated by the
Veteran Department of Taiwan, the nursing staff of the case hospital
was squeezed to an extreme minimum level under the pressure of a
tight budgeting. Leave of absence on schedule became extremely
difficult, especially for the intensive care units (ICU), in which
required close monitoring over the cared patients, and that had more
easily driven the ICU nurses nervous. Even worse, the deferred leaves
were more than 10 days at any time in the ICU because of a fluctuating
occupancy. As a result, these had brought a bad setback to this
particular nursing team, and consequently defeated the job
performance and service quality. To solve this problem and
accordingly to strengthen their morality, a project team was organized
across different departments specific for this. Sufficient information
regarding jobs and positions requirements, labor resources, and actual
working hours in detail were collected and analyzed in the team
meetings. Several alternatives were finalized. These included job
rotating, job combination, leave on impromptu and cross-departmental
redeployment. Consequently, the deferred leave days sharply reduced
70% to a level of 3 or less days. This improvement had not only
provided good shelter for the ICU nurses that improved their job
performance and patient safety but also encouraged the nurses active
participating of a project and learned the skills of solving problems
with colleagues.
Abstract: Nurses in an Armed Force Hospital (AFH) expose to stronger stress than those in a civil hospital, especially in an emergency department (ED). Ironically, stresses of these nurses received few if any attention in academic research in the past. This study collects 227 samples from the emergency departments of four armed force hospitals in central and southern Taiwan. The research indicates that the top five stressors are a massive casualty event, delayed physician support, overloads of routine work, overloads of assignments, and annoying paper work. Excessive work loading was found to be the primary source of stress. Nurses who were perceived to have greater stress levels were more inclined to deploy emotion-oriented approaches and more likely to seek job rotations. Professional stressors and problem-oriented approaches were positively correlated. Unlike other local studies, this study concludes that the excessive work-loading is more stressful in an AFH.
Abstract: According to the governmental data, the cases of oral
cancers doubled in the past 10 years. This had brought heavy burden to
the patients- family, the society, and the country. The literature
generally evidenced the betel nut contained particular chemicals that
can cause oral cancers. Research in Taiwan had also proofed that 90
percent of oral cancer patients had experience of betel nut chewing. It
is thus important to educate the betel-nut hobbyists to cease such a
hazardous behavior. A program was then organized to establish
several training classes across different areas specific to help ceasing
this particular habit. Purpose of this research was to explore the
attitude and intention toward ceasing betel-nut chewing before and
after attending the training classes. 50 samples were taken from a
ceasing class with average age at 45 years old with high school
education (54%). 74% of the respondents were male in service or
agricultural industries. Experiences in betel-nut chewing were 5-20
years with a dose of 1-20 pieces per day. The data had shown that 60%
of the respondents had cigarette smoking habit, and 30% of the
respondents were concurrently alcoholic dependent. Research results
indicated that the attitude, intentions, and the knowledge on oral
cancers were found significant different between before and after
attendance. This provided evidence for the effectiveness of the training
class. However, we do not perform follow-up after the class.
Noteworthy is the test result also shown that participants who were
drivers as occupation, or habitual smokers or alcoholic dependents
would be less willing to quit the betel-nut chewing. The test results
indicated as well that the educational levels and the type of occupation
may have significant impacts on an individual-s decisions in taking
betel-nut or substance abuse.
Abstract: Oral health is particular important to the hospitalized
patients with chronic schizophrenia for an extreme high potential of the respiratory infections. Due to the degeneration of physical capability, patients of this kind typically fall dependent in the activity of daily living (ADL). A very high percentage of patients had dental
problems of which mostly could be easily avoid by easy regular tooth brushing. Purpose of the project is to develop a mechanism in helping the schizophrenia patients in rebuilding a tooth-cleaning habit. The
project observed and evaluated the tooth-cleaning behavior of 100
male patients in a psychiatric hospital, and found the majority of them
ignored such an activity in a three-month period of time. In the meantime, the primary care-givers were not aware or not convinced
the importance of such a need of dental hygiene, and thus few if any
tooth cleaning training or knowledge on dental hygiene were given to
the patients. The project then developed a program based on the numerous observations and discussions. The improvement program
included patients- group education, care-givers- training, and a
tool-kit for tooth-brush holding was erected. The project launched
with some incentive package. The outcomes were encouraging with
87% of the patients had rebuilt their tooth-brushing habits against
previous 22%, and the tooth cleaning kits were 100% kept against 22%
in the past. This project had significantly improved the oral health of
the patients. The project, included the procedure and the tool-kit
holder specific for this purpose, was a good examples for psychiatric
hospitals.
Abstract: Environment today is featured with aging population,
increasing prevalence of chronic disease and complex of medical
treatment. Safe use of pharmaceutics relied very much on the efforts
made by both the health- related organizations and as well as the
government agencies. As far as the specialization concern in providing
health services to the patients, the government actively issued and
implemented the divisions of medical treatment and pharmaceutical to
improve the quality of care and to reduce medication errors and ensure
public health. Pharmaceutical sub-sector policy has been implemented
for 13 years. This study attempts to explore the factors that affect the
patients- behavior intention of refilling a prescription from a NHIB
pharmacy. Samples were those patients refilling their prescriptions
with the case NHIB pharmacies. A self-administered questionnaire
was used to collect respondents- information while the patients or
family members visit the pharmacy for the refilling. 1,200
questionnaires were dispatched in 37 pharmacies that randomly
selected from Pingtung City, Dongkang, Chaozhou, Hengchun areas.
732 responses were gained with 604 valid samples for further analyses.
Results of data analyses indicated that respondents- attitude,
subjective norm, perceived behavior control and behavior intentions
toward refilling behavior varied from some demographic variables to
another. This research also suggested adding actual behavior, either by
a self-report or observed, into the research.
Abstract: Chronic diseases prevailed along with economic
growth as well as life style changed in recent years in Taiwan.
According to the governmental statistics, hypertension related disease
is the tenth of death causes with 1,816 died directly from hypertension
in 2010. There were more death causes amongst the top ten had been
proofed that having strong association with the hypertension, such as
heart diseases, cardiovascular diseases, and diabetes. Hypertension or
High blood pressure is one of the major indicators for chronic diseases,
and was generally perceived as the major causes of mortality. The
literature generally suggested that regular physical exercise was
helpful to prevent the occurrence or to ease the progress of a
hypertension. This paper reported the process and outcomes in
detailed of an improvement project of physical exercise intervention
specific for hypertension patients. Physical information were
measured before and after the project to obtain information such as
weight, waistline, cholesterol (HD & LD), blood examination, as well
as self-perceived health status. The intervention project involved a
six-week exercise program, of which contained three times a week, 30
minutes of tutored physical exercise intervention. The project had
achieved several gains in changing the subjects- behavior in terms of
many important biophysical indexes. Around 20% of the participants
had significantly improved their cholesterols, BMI, and changed
unhealthy behaviors. Results from the project were encouraging, and
would be good reference for other samples.
Abstract: Hospitals in southern Hualien teamed with the
Hypertension Joint Care Network. Working with the network, the
team provided a special designed health education to the individual
who had been identified as a hypertension patient in the outpatient
department. Some metabolism improvements achieved. This is a
retrospective study by purposively taking 106 patients from a hospital
between 2008 and 2010. Records of before and after education
intervention of the objects was collected and analyzed to see the how
the intervention affected the patients- hypertension control via clinical
parameter monitoring. The results showed that the clinical indicators,
the LDL-C, the cholesterol and the systolic blood pressure were
significantly improved. The study provides evidence for the
effectiveness of the network in controlling hypertension.
Abstract: The incidence of oral cancer in Taiwan increased year
by year. It replaced the nasopharyngeal as the top incurrence among
head and neck cancers since 1994. Early examination and earlier
identification for earlier treatment is the most effective medical
treatment for these cancers. Although the government fully subsidized
the expenses with tremendous promotion program for oral cancer
screening, the citizen-s participation remained low. Purpose of this
study is to understand the factors affecting the citizens- behavior
intensions of taking an oral cancer screening. Based on the Theory of
Planned Behavior, this study adopted four distinctive variables in
explaining the captioned behavior intentions.700 questionnaires were
dispatched with 500 valid responses or 71.4% returned by the citizens
with an age 30 or above from the eastern counties of Taiwan. Test
results has shown that attitude toward, subjective norms of, and
perceived behavioral control over the oral cancer screening varied
from some demographic factors to another. The study proofed that
attitude toward, subjective norms of, and perceived behavioral control
over the oral cancer screening had positive impacts on the
corresponding behavior intention. The test concluded that the theory
of planned behavior was appropriate as a theoretical framework in
explaining the influencing factors of intentions of taking oral cancer
screening. This study suggested the healthcare professional should
provide high accessibility of screening services other than just
delivering knowledge on oral cancer to promote the citizens-
intentions of taking the captioned screening. This research also
provided a practical implication to the healthcare professionals when
formulating and implementing promotion instruments for lifting the
screening rate of oral cancer.