Tobacco Control in Cancer Care No abstract available

Evaluating the Effectiveness of Interventions on Increasing Participation in Cervical Cancer Screening Background: Although cervical cancer is highly preventable through regular screenings using Pap smear or human papillomavirus–deoxyribonucleic acid tests, cervical cancer remains a prevalent women's health issue across the world. Therefore, encouraging women to screen for cervical cancer is very important for the early detection of cervical cancer. Purpose: The purposes of this study were to (1) assess the effectiveness of three interventions that are typically used to increase the uptake of cervical cancer screening during home visits and (2) determine the participation rate in cervical cancer screenings after invitation, the health promotion perceptions, and the cervical cancer and screening-related knowledge of women. The three interventions noted in Purpose 1 were one-on-one training accompanied by an educational brochure, providing the educational brochure only, and giving an invitation without any relevant information. Methods: This interventional study was conducted on women who were between the ages of 30 and 65 years in three Turkish provinces (Ankara, Malatya, and Trabzon). Five hundred twenty home visits were made, and 356 women who did not have a Pap smear test within the previous year were invited for cervical cancer screening. Women were randomized into one of three intervention groups, and the participants in each group were invited to attend a national cervical cancer screening program and to undergo a cervical cancer screening using the related intervention type. Results: The results showed that the interventions used during home visits and knowledge were effective in encouraging women to participate in cervical cancer screening. It was determined that the participants who had received one-on-one training accompanied by an educational brochure had a higher cervical cancer screening rate than their peers who were offered a brochure only or a verbal invitation only. Conclusions: Invitations to screenings that are made by providing training accompanied with a brochure were found to be effective in increasing the participation of women in cervical cancer screening.

Chinese Version of the Assessment of Survivor Concerns Scale for Gynecological Cancer Survivors: A Psychometric Study in Taiwan Background: Most gynecological cancer survivors outlive the acute stage, and many reach permanent survival. However, the fear of cancer recurrence (FCR) is stressful and affects quality of life. Purpose: This study was designed to validate a Chinese version of the Assessment of Survivor Concerns (ASC) questionnaire in terms of its ability to assess FCR in gynecological cancer survivors. Methods: A two-stage study procedure was employed. The first stage involved the translation of the ASC questionnaire from English into Chinese using the methods proposed by Guillemin, which include translation, back-translation, consensus meetings, and a trial of potential users. In the second stage, a pilot study was completed with 37 gynecological cancer survivors followed by a psychometric property study with 287 gynecological cancer survivors. Construct validity was determined using confirmatory factor analysis (CFA) with structural equation modeling. Convergent validity was determined using composite reliability and the average variance extracted values of the ASC model. Discriminant validity was determined by comparing the model fitness of the ASC model against the model fitness of a one-construct model. Concurrent criterion validity was assessed using the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire Core 30 as the auxiliary instrument. Reliability was determined by measuring the internal consistency reliability using Cronbach's α in addition to the 3-week test–retest reliability with a 95% confidence interval of the intraclass correlation coefficient. Results: The process of translation and back-translation was performed to ensure the conceptual equivalence of the Chinese version with the original ASC questionnaire. For CFA, the fit indices of the ASC model (χ2 = 9.87, p > .05; root mean square error of approximation = .03. comparative fit index = 1, nonnormed fit index = 1) indicated appropriate model fitness. For convergent validity, the composite reliability and average variance extracted values of the ASC model were satisfactory. For discriminant validity, the model fitness of the ASC model was significantly improved over the one-construct model. For concurrent criterion validity, the ASC scores correlated negatively with the scores of the global quality of life and the five functions (physical, role, cognition, emotions, and social) of the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire Core 30, as hypothesized. For reliability, the Cronbach's α and the 95% confidence interval of intraclass correlation coefficient for the ASC model were .91 and [.18, .68], respectively. Conclusions/Implications for Practice: The Chinese version of the ASC questionnaire is a valid and reliable instrument that is suitable for assessing FCR in gynecological cancer survivors in clinical and research settings.

Decisional Balance for Insulin Injection: Scale Development and Psychometric Testing Background Insulin-naive patients are often reluctant to receive insulin treatment, and even insulin-treated patients frequently have poor rates of adherence to their prescribed insulin injection regimes. Assessing attitudes toward insulin injection may help in the design of interventions that improve the insulin injection behaviors of patients with type 2 diabetes (T2DM). The concept of decisional balance has been associated with behavior in many studies and may be useful in assessing the attitude of patients with T2DM toward insulin injection. Decisional balance for insulin injection (DBII) has not been widely assessed in patients with T2DM. Purpose The aim of this study was to develop an insulin injection (DBII) scale that is valid for insulin-naive and insulin-treated patients and to test the psychometric characteristics of this scale based on the concept of decisional balance. Methods This cross-sectional study administered an 18-item DBII scale, including pro and con subscales, to 95 insulin-naive and 237 insulin-treated patients in Taiwan. The decisional balance score was calculated as the mean score of the pro subscale minus the mean score of the con subscale. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis; concurrent validity was assessed by examining the association between the score of the DBII scale and the stages of behavioral change and of hemoglobin A1c for, respectively, insulin-naive patients and insulin-treated patients; and reliability was assessed using internal consistency and test–retest reliability. Results A 13-item DBII scale supported by exploratory factor analysis and confirmatory factor analysis was developed. The stages of behavioral change and hemoglobin A1c levels were found to be significantly associated with the scores of decisional balance of the 13-item DBII scale for both insulin-naive and insulin-treated patients. The Cronbach's α ranged between .78 and .92. Conclusions The 13-item DBII scale is appropriately short and possesses satisfactory validity and reliability for both insulin-naive and insulin-treated patients with T2DM. Healthcare providers may use this scale as a checklist to guide clinical discussions related to insulin therapy with both insulin-naive and insulin-treated patients with T2DM across time.

The Relationship Between Work Environment Satisfaction and Retention Intention Among Nursing Administrators in Taiwan Background Nursing administrators are essential to ensuring the quality of healthcare provided in hospitals. The nursing manpower shortage that has affected hospitals in Taiwan over the past decade has weighed particularly heavily on nursing administrators, who are expected to maintain high levels of nursing care quality in frequently understaffed healthcare settings. Purpose The objective of this study was to explore the relationship between work environment satisfaction and nursing administrator retention in Taiwan. Methods This study used a cross-sectional, questionnaire-based survey to collect data from a sample population of nursing administrators. A set of indicators of quality nursing work environments was developed and included in the questionnaire. A total of 1,829 questionnaires were distributed, and the effective response rate was 95.57%. Results The average overall rate of satisfaction with the current work environment across all domains was 3.59 (SD = 0.61). The highest level of satisfaction was found in the domain of safe practice environment (M = 3.83, SD = 0.70), and the lowest was found in the domain of informatics (M = 3.38, SD = 0.91). Length of administrative position tenure was significantly correlated with retention. Each of the eight domains significantly influenced retention. The domain of support and caring was the most significant predictor of nursing administrator retention. Conclusions/Implications for Practice Length of administrator position tenure was significantly correlated with nursing administrator retention. Moreover, intention to stay among junior administrators was particularly affected by the support and caring domain. Therefore, it is recommended that nursing departments develop effective strategies to assist and encourage junior administrators to strengthen their career prospects and satisfaction.

Work-Related Predictors of Sleep Quality in Chinese Nurses: Testing a Path Analysis Model Background Good sleep is essential to human health. Insufficient quality sleep may compromise the wellness of nurses and even jeopardize the safety of patients. Although the contributors of sleep quality in nurses have been previously studied, the direct and indirect effects of modifiable work-related predictors remain uncertain. Purpose The study was designed to explore the direct and indirect effects of modifiable work-related factors on sleep quality in Chinese nurses. Methods A multistage sampling method was employed in this cross-sectional study to recruit 923 participants. An evidence-based predicting model was postulated and then subsequently tested and optimized using path analysis. Results The final model fit the data well, with the involved predictors accounting for 34.1% of the variance in sleep quality of the participants. Shift work, job demands, exposure to hazards in work environments, chronic fatigue, and inter-shift recovery were identified as direct predictors, while whereas job satisfaction, job control, support at work, and acute fatigue were identified as indirect predictors. Conclusions/Implications for Practice Sleep quality in Chinese nurses is influenced directly and indirectly by various modifiable work-related factors. Interventions such as adjusting work shifts and reducing job burdens should be prioritized by administrative staff to ensure the sleep quality and clinical performance of Chinese nurses and to subsequently improve nursing care quality.

Nursing Students' Perceptions of Nursing Metaparadigms: A Phenomenological Study Background: The paradigm is a vital concept steering the development of a scientific discipline. Paradigms that shape the education, research, and practice steps of a discipline are defined as metaparadigms. Purpose: The purpose of this study was to explore the perception of nursing students regarding metaparadigms in nursing at Akdeniz University in Antalya, Turkey. Methods: This was designed as a descriptive phenomenological study, and data were collected from 13 fourth-year students who were chosen via a purposeful sampling method and interviewed face-to-face using a semistructured format. Data were analyzed using the data analysis steps of Giorgi, who is an expert in descriptive phenomenological studies. Results: Most of the participants in this study associated nursing with humanism. Some of the participants stated that a fundamental building block of the nursing profession is conscience, whereas others stated that nursing is a way to touch people's lives and is now regarded as a professional practice. It has been reported that students have difficulties identifying metaparadigms in nursing and that they believe that human beings have the potential to widen their horizons with wisdom and social skills. According to the participants, the health metaparadigm refers to the harmony between human beings and their environment and to the autonomy of the individual. Moreover, the participants emphasized the well-being of individuals. Conclusions/Implications for Practice: The participants in this study characterized humans with well-being, transcendence, adaptation and interaction skills with their environment, and harmony beyond physiological mechanisms, which was considered to be promising for the perception of future nurses. It is recommended for nursing educators to enable their students to raise their professional awareness and to internalize professional values.

Effects of Smoking and Physical Activity on the Pulmonary Function of Young University Nursing Students in Cáceres (Spain) Background: The simultaneous effect of physical activity (PA) and smoking on pulmonary function in young people remains unclear. Propose: The aim of this study was to determine the influence of smoking and PA on pulmonary function in young university students in Cáceres, Spain. Methods: A sample of 120 young nursing students was studied (60 smokers and 60 nonsmokers). All subjects underwent spirometry with a COPD-6 portable device, and their level of PA was quantified using the International Physical Activity Questionnaire. The influence of PA and smoking on pulmonary function was determined by comparing hypotheses. Results: Significant differences were observed between smokers and nonsmokers in terms of percent forced expiratory volume in 1 second, percent forced expiratory volume in 6 seconds, lung age, and the difference between lung age and chronological age (LA–CA) in those who practiced mild PA. In the subjects who performed moderate and vigorous PA, these differences were not noted. In the intragroup analysis, significant differences were observed in smokers in terms of percent forced expiratory volume in 1 second, percent forced expiratory volume in 6 seconds, lung age, and LA–CA; however, in the control group, differences were only observed in terms of lung age and LA–CA. These findings were confirmed in the multivariate analysis. Conclusions/Implications for Practice: Our findings confirmed a deterioration in pulmonary function in smokers who did not perform moderate or vigorous PA. The level of PA performed was positively related to pulmonary function in smokers, whereas in nonsmokers, improvements were only significant in LA–CA.

An Exploration of Factors Related to Quality of Life in Indonesian Care Workers in Home-Based Care Settings Background Indonesians constituted 79% of foreign care workers for long-term care in Taiwan in 2015. Therefore, it is crucial to explore the effect of work stress and quality of life (QoL) on this population. Purpose This study aims to explore stress levels, social support requirements, and perceived QoL among Indonesian care workers (ICWs) who work in home care settings. Methods A cross-sectional design was used. Data were collected between 2014 and 2016 from a convenience sample of ICWs working in eastern Taiwan using a self-administered questionnaire that comprised the Stress Perception Scale (SPS), Social Support Scale (SSS), and World Health Organization Quality of Life-Brief scale. One hundred fifty-seven valid questionnaires were collected. The response rate was 80.51%. Data were analyzed using descriptive statistics, one-way analysis of variance, Pearson's correlation coefficient, and multiple regression analysis. Results The results found that the average SPS of the sample was 70.50, with low QoL scores and requirements for more social support. In addition, significant and positive correlations were found between QoL and SPS, SSS, duration of patient care, and hours of care per week. Stepwise regression analysis showed that the most predictive variables for QoL were time spent caring, preservice training, psychological stress, and emotional support, which together accounted for 60.9% of the total variance. Conclusions/Implications for Practice This study facilitated understanding of the stress on ICWs and the impact of social support on their QoL. The findings suggest that new immigrants in Taiwan should be introduced to foreign care workers or nursing attendants. Moreover, long-term-care-related teachers should work with home care institutions or agencies to develop a teaching model for innovative care skills to relieve the perceived stress of ICWs.

What Are the Barriers at Home and School to Healthy Eating?: Overweight/Obese Child and Parent Perspectives Background: Most studies that have investigated factors influencing eating habits among obese children have focused mainly on individual or interpersonal factors and applied quantitative research methods. Purpose: This study was undertaken to identify the barriers in home and school settings that hamper healthy eating in overweight and obese children in South Korea. Methods: Focus group interviews were conducted with 15 overweight/obese children and 15 parents. A standard manual with open-ended questions was developed. Content analysis was used to identify key findings. Results: Participants were aware of the importance of home and school environments in shaping children's eating habits. Five major barriers, respectively, at home and at school emerged from the data. At home, the food preferences of parents affected the eating habits of their children. Moreover, parents worried about providing differentiated diets for siblings and about the permissiveness of grandparents toward grandsons. Furthermore, working parents preferred easy-to-prepare instant foods and said that their children ate overly quickly. At school, children cited time pressures, poor cafeteria environments, and ineffective nutrition education as barriers, whereas parents worried about inconsistent management by teachers and the unsafe food environment around the school. Conclusions: These environment-related barriers may be resolved through changes in the behavior of children, parents, and teachers as well as through the continued efforts of schools, community stakeholders, and policymakers, all of whose cooperation is essential to fostering a healthy food environment for children.