[Design and Application of Board Game Learning: An Example for Medical-Surgical Nursing Course].

Board games are currently widely used in various courses, including in the teaching of cardiopulmonary cerebral resuscitation for neonatal and infants. They are generally deemed as useful in teaching concepts such as empathy and interpersonal communication skills that are relatively difficult to understand. However, board games have rarely been used in medical-surgical nursing courses. The main reason for this may be because of many different systems in medical-surgical nursing courses complicate the process of designing relevant / useful scheme of board games. In general, college students have a weak conception of diseases because they have not yet entered clinical practice and their knowledge construction is based on traditional teaching methods. Using different teaching methods to construct knowledge may increase students` understanding of a disease and help them better understand content. In this article, the author uses different teaching strategies to increase students` knowledge. Concept mapping, board games, and human figures were designed to construct the knowledge of students in each system and to assist students to reintegrate disease knowledge in order to reinforce learning efficacy. This learning method may help improve students` understanding of textbook-based knowledge and enhance students` self-learning and future clinical practice.

Reliability and validity of the Nurse Practitioners' Roles and Competencies Scale.

AIMS AND OBJECTIVES: The objective of this study was to test the reliability and construct validity of the Nurse Practitioners' Roles and Competencies Scale. BACKGROUND: The role of nurse practitioners has attracted international attention. The advanced nursing role played by nurse practitioners varies with national conditions and medical environments. To date, no suitable measurement tool has been available for assessing the roles and competencies of nurse practitioners in Asian countries. DESIGN: Secondary analysis of data from three studies related to nurse practitioners' role competencies. METHODS: We analysed data from 563 valid questionnaires completed in three studies to identify the factor structure of the Nurse Practitioners' Roles and Competencies Scale. To this end, we performed exploratory factor analysis using principal component analysis extraction with varimax orthogonal rotation. The internal consistency reliabilities of the overall scale and its subscales were examined using Cronbach's alpha coefficient. RESULTS: The scale had six factors: professionalism, direct care, clinical research, practical guidance, medical assistance, as well as leadership and reform. These factors explained 67·5% of the total variance in nurse practitioners' role competencies. Cronbach's alpha coefficient for the overall scale was 0·98, and those of its subscales ranged from 0·83-0·97. CONCLUSION: The internal consistency reliability and construct validity of the Nurse Practitioners' Roles and Competencies Scale were good. The high internal consistency reliabilities suggest item redundancy, which should be minimised by using item response theory to enhance the applicability of this questionnaire for future academic and clinical studies. RELEVANCE TO CLINICAL PRACTICE: The Nurse Practitioners' Roles and Competencies Scale can be used as a tool for assessing the roles and competencies of nurse practitioners in Taiwan. Our findings can also serve as a reference for other Asian countries to develop the nurse practitioner role.

The effect of cognitive appraisal in middle-aged women stroke survivors and the psychological health of their caregivers: a follow-up study.

AIMS AND OBJECTIVES: This study identified the factors that affect health-related quality of life at one and six months post-stroke in women who have undergone a mild stroke and that affect their informal caregivers' psychological health status. BACKGROUND: Middle-aged women perform the main care roles in a family. When they suffer a stroke, it upsets the equilibrium of their family life. DESIGN: This is a longitudinal design. METHODS: This prospective follow-up study recruited 41 middle-aged women stroke survivors (mean age = 54.95, SD = 9.63) and their informal caregivers (mean age = 41.56, SD = 15.93). The Short-Form Health Survey (SF-36) was used to assess stroke survivor's health-related quality of life, and the Chinese Health Questionnaire was used to measure the level of depression of the stroke survivor's informal caregiver. Data were analysed through descriptive statistics, Wilcoxon signed-rank tests and the generalised estimating equation approach for modelling repeatedly measures. RESULTS: All stroke survivors showed significant improvement in the physical component summary of the health-related quality of life at one and six months after stroke, but there was no significant difference in the mental component summary. In addition, there was no significant difference in the health of the informal caregivers of the women over time. Generalised estimating equation analysis showed that the most important determinant of mental component summary of health-related quality of life among women stroke survivors was cognitive appraisal. The informal caregivers' most important determinants of health status, as measured by level of depression, were their sense of coherence, burden and patients' mental component summary of the health-related quality of life. CONCLUSION: This study highlights the impact of cognitive appraisal in determining health-related quality of life of women stroke survivors and how it affects their caregivers' mental health. RELEVANCE TO CLINICAL PRACTICE: The findings of this study may contribute to home care nurses' understanding the importance of the psychosocial impact of the stroke for the survivor and their ability to help the surviving women to promote the confidence needed for self-care, which will contribute to their quality of life and affect their caregivers' health.

[The Taiwan Nurses Association and professional diplomacy].

The Taiwan Nurses Association (TWNA) is publishing a special centenary issue to commemorate the 100th anniversary of the association in 2014. For this issue, TWNA invited the author to write a review article that addresses the involvement of the TWNA in professional diplomacy and international exchange over the past century. The author reviews the history of both TWNA and the International Council of Nurses and introduces the contributions of the association in the field of professional diplomacy and the positive contributions of many Taiwan nursing leaders to global healthcare and society. The purpose of the paper is to convey the traditions and experiences of TWNA forward to the next generation.

Nursing students' attitudes towards provision of sexual health care in clinical practice.

AIMS AND OBJECTIVES: To investigate nursing students' attitudes towards providing sexual health care in clinical practice and to identify associated factors. BACKGROUND: Sexual health care is an important component of holistic health care. Nurses' personal sexual knowledge and attitudes are shown to influence provision of sexual health care. DESIGN: This is a descriptive, cross-sectional study. METHODS: We selected 146 senior nursing students by convenience sampling from nursing schools in two medical universities in central Taiwan. Data were collected using the Nursing Attitudes on Sexual Health Care scale developed based on the 'Permission/Limited Information/Specific Suggestions/Intensive Therapy' model. Higher scores indicated more positive attitudes. RESULTS: Participants' mean age was 22.15 years. Mean total Nursing Attitudes on Sexual Health Care scores ranged from 45-75 (61.40 ± 10.17). Nursing students' most positive attitudes towards Permission/Limited Information/Specific Suggestions/Intensive Therapy sexual healthcare interventions were at the Permission level, and least positive attitudes were at levels of Specific Suggestion and Intensive Therapy. The top three positive items were as follows: accept patients' expression of sexual concerns, initiate discussions and encourage patients to talk. Male nursing students had negative attitudes towards sexual healthcare interventions, which became more positive as age increased, especially at the Limited Information level. CONCLUSIONS: Nursing students had different attitudes towards different levels of sexual health care in the Permission/Limited Information/Specific Suggestions/Intensive Therapy model. Attitudes were associated with age and gender. The Nursing Attitudes on Sexual Health Care scale is useful and reliable for identifying nurses' attitudes towards providing sexual health care. RELEVANCE TO CLINICAL PRACTICE: The Permission/Limited Information/Specific Suggestions/Intensive Therapy-based Nursing Attitudes on Sexual Health Care scale helps to identify nurses' attitudes. A better understanding of nurses' attitudes towards provisional sexual health care will provide information needed to develop appropriate education programmes to improve delivery of sexual health care.

Testing of the factor structure of the Sexual Health Knowledge Measure with young adolescent Taiwanese girls.

Knowledge of sexual health is an important indicator of the development of healthy adolescent sexuality. An evaluation instrument in nursing school practice, whose results can lead to improved sexual health in adolescents, is needed. We conducted this study to undertake rigorous testing of the Sexual Health Knowledge Scale (SHKS) as a means to ensure a reliable and valid quantitative measure of sexual health knowledge among young adolescent females. A panel of experts assessed the content validity of the 40-item measure. Initial testing involved 481 female adolescents (12-14 years old), using principal component factor analysis with varimax rotation and the determination of Cronbach's alpha coefficients. Confirmatory factor analysis (CFA) was conducted using data from an additional sample of 234 female adolescents (12-14 years old). Principal component factor analysis yielded a four-factor solution with eigenvalues greater than 1 that explained 43.40% of the variance. As a result of the analysis of the scale, 22 items were deleted, resulting in an 18-item scale. The CFA identified a second-order factor termed "sexual health knowledge." Goodness-of-fit indices showed an acceptable fit overall with the full model (χ(2)/df (131) = 1.69, RMSEA = 0.054, RMR = 0.013, CFI = 0.92, and GFI = 0.99). We determined that the SHKS is a reliable and valid measure, with good composite reliabilities and goodness-of-fit indices.

Exploring the association between nurse workload and nurse-sensitive patient safety outcome indicators.

BACKGROUND: Nurses affect patient safety. Although studies have associated patient safety with nurse staffing levels, Taiwan's Department of Health does not yet support changing nurse workforce standards for medical institutions. PURPOSE: This study was designed to gain insight into the workload of nurses employed at medical institutions and to determine the relationship between nurse workload and nurse-sensitive patient safety outcome indicators. METHODS: This study adopted a cross-sectional quantitative method and collected data using a self-designed logbook. The study population comprised nurses from acute medical institutions, including medical centers and regional and district hospitals. One thousand five hundred logbooks were distributed to participants selected by random sampling from 21 city/county nursing associations across Taiwan. One thousand three hundred seventy-three questionnaires were retrieved; the 1,358 valid responses yielded a valid response rate of 90.5%. Nurses used the logbook to record individual working conditions for 2 weeks. Descriptive statistics included mean values, standard deviations, and percentages; inferential statistics included the Spearman rho correlation and odds ratios. RESULTS: Nurse overtime working hours were positively associated with the following nurse-sensitive patient safety outcome indicators: patient falls, decubitus/pressure ulcers, near errors in medication, medication errors, unplanned extubation, hospital-acquired pneumonia, and hospital-acquired urinary tract infections; risks of patient falls, decubitus/pressure ulcers, unplanned extubation, hospital-acquired pneumonia, and hospital-acquired urinary tract infections significantly increased when the patient-nurse ratio exceeded 7:1. CONCLUSION: Nurse workforce and nurse-sensitive patient outcome indicators are positively correlated. The results of this study will help professional nursing groups define suitable nursing workforce standards for medical institutions.

[A Taiwan nursing perspective on current imbalances in educating, licensing and hiring new nurses].

Level of development in the nursing profession affects healthcare quality and safety. The nursing profession in Taiwan today faces myriad external pressures such as the global financial crisis and rapidly changing national health insurance policies and social issues. For example, cutbacks in nursing manpower at medical institutions and increasingly difficult healthcare working conditions are increasing nurse workloads and turnover, conflict in the workplace, and difficulties in recruiting new nursing staff. Such negative developments directly and negatively impact professional development, healthcare quality, healthcare safety, and workplace morale. In terms of maintaining and enhancing the quality of new nurses entering the profession, rapid growth in numbers of technology schools and nursing students have severely strained insufficient resources and resulted in teaching quality and education outcomes below expectations. Poor passing rates on the national nursing license examination and increasingly high new nurse turnover are now significant negative factors influencing clinical manpower availability. Imbalances among education, licensing, and hiring clearly and negatively impact nursing professional development and social needs and cause the inefficient allocation of limited education resources. This article discusses and analyzes the causes underlying current imbalances in nurse hiring, licensing, and education. We provide the following suggestions: (1) Integrate education and licensing activities based on professional recruitment considerations to promote nursing competent and manpower stability; (2) revise the focus and content of the national license examination to resolve the current disconnect between license examination and hiring needs; (3) redesign curricula, update teaching material, and adjust teaching methods based on professional competencies in order to resolve key education and recruitment problems. All nursing schools should prepare their students well to pass the license examination in order to resolve the current state of inconsistent educational standards, and (4) train international nursing talent to address and reflect international medical care trends and policies in Taiwan. This paper is intended to serve as reference for both policymakers and professionals in the nursing and healthcare fields.

Sexual self-concept as influencing intended sexual health behaviour of young adolescent Taiwanese girls.

AIMS AND OBJECTIVES: The purpose of this study was to test a process model that assesses the relationship of sexual health knowledge and normative beliefs to sexual health behavioural intention, with sexual self-concept as a mediating variable. The model is intended to assist in the prediction of which adolescents would exhibit a lower intention to engage in protective sexual health behaviour. BACKGROUND: Previous research has shown that sexual-related behaviours are associated with sexual self-concept, sexual health knowledge and perceived parental/peer approval of sexual behaviour. DESIGN: This study is a cross-sectional research. METHODS: This study was conducted with 545 adolescent girls, aged 12-15 years, from eight junior high schools in Taiwan. Participants were assessed using the Sexual Self-Concept Inventory, the Sexual Health Behavior Intention Scale, the Parental Approval of Sexual Behavior Scale (PASB), the Friends' Approval of Sexual Behavior Scale and the Sexual Health Knowledge Scale. Data were analysed using structural equation modelling, with the maximum likelihood estimate determined by the LISREL 8.52 program. RESULTS: The model exhibited adequate fit (goodness-of-fit index = 0.96, adjusted goodness-of-fit index = 0.94, normed fit index = 0.96, comparative fit index = 0.98, standardised root mean square residual = 0.049 and root mean square error of approximation = 0.048) and the findings indicate that sexual self-concept was a significant influence on the relationship of sexual health knowledge and normative beliefs to sexual health behavioural intention. CONCLUSIONS: The results of this study revealed the importance of sexual self-concept for adolescent girls' sexual health behaviour. RELEVANCE TO CLINICAL PRACTICE: Evidence-based strategies that reinforce and clarify sexual self-concept as a mediating factor may aid in adolescent females' intention to engage in protective sexual health behaviour.

Nursing interventions on sexual health: validation of the NISH Scale in baccalaureate nursing students in Taiwan.

INTRODUCTION: No widely accepted tool is available to assess nursing interventions on patient's sexual health among nursing students. Consequently, nursing school faculty cannot determine the sexual healthcare-related skills of nursing students. AIM: The aim of this article was to develop and test a scale to assess nursing interventions on sexual health. METHODS: A 19-item instrument Nursing Interventions on Sexual Health (NISH) was developed using 10 semi-structured interviews of senior nursing students, expert review, and comparative analysis of text and field notes. A total of 198 senior nursing students were recruited from two nursing schools in central Taiwan to test the instrument. Exploratory factor analysis (EFA) was used to measure construct validity and Cronbach's alpha to measure internal consistency. MAIN OUTCOME MEASURES: Validity and reliability of the NISH scale based on the Permission, Limited Information, Specific Suggestion, and Intensive Therapy (PLISSIT) model. RESULTS: Three factors (permission, limited information, and specific suggestion) were retained after EFA of the 19 items of NISH. Cronbach's alpha for the subscales increased from 0.71-0.93 to 0.74-0.94 and from 0.93 to 0.95 for the total scale, with 72.42% of the cumulative variance explained by these three factors. Nursing students' age (P=0.019) correlated positively with total score. CONCLUSIONS: NISH is a useful and reliable scale for assessing the frequency of PLISSIT-related behaviors used by nursing students to address patient's sexual health concerns. Nursing faculties can use this scale to assess students' performance and find their omitted behaviors in clinical practice regarding sexual health care.

The effect of sexual self-concept on sexual health behavioural intentions: a test of moderating mechanisms in early adolescent girls.

AIM: The purpose of this study was to examine whether normative beliefs would act as a moderator of the main relationship between sexual self-concept and sexual heath behavioural intentions. BACKGROUND: Sexual self-concept has been defined as an individual's evaluation of his or her own sexual feelings and actions. Research has shown that sexually related behaviours are associated with sexual self-concept and perceived parental/peer approval of sexual behaviour. METHODS: We conducted cross-sectional research, using face-to-face interviews, to assess sexual self-concept, normative beliefs and sexual health behavioural intention. This study was conducted with 534 adolescent female participants, aged 12-15 years, in Taiwan. Data was collected between September and December 2009. We conducted structural equation modelling to examine the proposed conceptual model. FINDINGS: We found that individuals with a high score on sexual self-concept (i.e. who had stronger erotic feelings) were less likely to believe that they would behave in ways that would protect their sexual health (i.e. low behavioural intention, ß = -0·44, t = -8·43, P < 0·001). The hypothesized moderating role of normative beliefs was also supported. Those with a greater tendency to believe that their parents/peers approved of sex (i.e. normative beliefs) were more likely to have a positive sexual self-concept (ß = 0·57, P < 0·001), and were less likely to protect their sexual health (ß = -0·19, P < 0·01). The findings showed that, together, normative beliefs and sexual self-concept accounted for 24·9% of the variance in girls' sexual health behavioural intentions. CONCLUSIONS: We recommend that interventions that target sexual health behavioural intentions for this population would be more effective if such interventions targeted normative beliefs and helped adolescent females to clarify their sexual self-concept.

[The spirit of humanism should be cultivated in the nursing profession].

As nursing is an art that emphasizes the nature of caring it should have humanistic attributes. Humanistic education of a nursing professional should emphasize a person-centered perspective in order to foster cultivation of the humanities and infuse the spirit of humane care into medical practice. Cultivation of humanism refers to the emotional level of personal-affective experience that blends humanistic science and aesthetic experience to enhance nurse observational abilities. The ability generated by self-awareness and reflection can trigger deep empathy and empathetic performance, which is ideal humanistic-nursing behavior in nursing staff. Traditional nursing education focuses on acquiring professional knowledge and largely ignores the cultivation of a humanist spirit. To help nurses adjust to the rapidly changing environment of nursing care and demonstrate a professional and humane character, in addition to advocating for a humane medical environment, the six Es of humanistic-nursing education (Example, Explanation, Exhortation, Environment, Experience, Expectation) should be promoted. The six Es are essential to building a framework to cultivate humanistic education strategies and strengthen humanist content in nursing education. In order to instill deeply the spirit of humanistic care in nursing and make the nursing-care process more humane, these ideals must be emphasized in nursing education to raise the level of humanism.

[Promoting aesthetics to enhance nursing services].

Nursing is a client-oriented profession dedicated to helping people. Nurses are responsible to both help relieve client physical and psychological symptoms and assist clients as necessary to die with dignity. As such, nursing schools should strengthen not only science and professional skills, but also student aesthetics. Today, fast changing medical technology is improving the treatment of diseases and extending average life spans. The National Health Insurance System in Taiwan, however, is increasingly restricting nursing manpower and raising staff workloads. Nurses are increasingly required to sacrifice ethical principles and conduct technical operations in medical settings defined by stringent cost controls. Nursing aesthetics cannot provide appropriate levels of care dignity and quality to clients under severe time and emotional distress constraints. Burnout, dissatisfaction, strained doctor-nurse relationships and lower quality care are all-too-frequent results. Under the circumstances, nursing functions are negatively influenced and fine nursing service is difficult to achieve. This article reviewed the literature to discuss the definition and meaning of aesthetics and relative factors that are difficult to define in clinical settings. This article may assist nurses to present aesthetics, upgrade care quality and further enhance nursing services.

Risk factors for workplace violence in clinical registered nurses in Taiwan.

AIMS AND OBJECTIVES: The purpose of this study was to determine the risk factors and mental health consequences of physical and psychological violence for clinical nurses working in healthcare settings in Taiwan. BACKGROUND: Registered nurses working in hospitals in Taiwan report high incidences of workplace violence. However, previous studies rarely report psychological abuse among nursing staff, while the relationships between personal factors and workplace violence remain unclear. DESIGN: This is a cross-sectional study. METHODS: Participants were invited to complete the Workplace Violence Questionnaire, an instrument designed to assess types of workplace violence (physical violence, verbal abuse, bullying/mobbing and sexual harassment), the characteristics of perpetrators and victims and victims' reactions to their abuse. RESULTS: A total of 521 nurses completed the questionnaire. Of the participants, 102 (19.6%) indicated that they had experienced physical violence, 268 (51.4%) had experienced verbal abuse, 155 (29.8%) had experienced bullying/mobbing and 67 (12.9%) had experienced sexual harassment. Multiple logistic analyses indicated that age under 30 years (odds ratio = 2.4; 95% confidence interval = 1.34-4.46) and anxiety (odds ratio = 4.7; 95% confidence interval = 1.24-18.12) increased the odds of verbal abuse, while bullying was associated with anxiety (odds ratio = 2.7, 95% confidence interval = 1.09-6.93). Night work shift increased the odds of experiencing sexual harassment (odds ratio = 2.3, 95% confidence interval = 1.29-4.16), while physical violence was associated with bachelor's degree (odds ratio = 2.8, 95% confidence interval = 1.20-6.73). The most serious psychological harm was post-traumatic stress disorder. CONCLUSIONS: Exposure to psychological violence often has a great impact on clinical nurses. RELEVANCE TO CLINICAL PRACTICE: For violence prevention, interventions should be sensitive to personal factors. Healthcare institutions should initiate counselling programs to help nurses cope with the stress related to workplace violence.

A confirmatory factor analysis of the Clinical Nursing Practice Environment Scale with hospital registered nurses in Taiwan.

AIMS AND OBJECTIVES: The purpose of this study was to develop and evaluate the Clinical Nursing Practice Environment Scale in Taiwan. BACKGROUND: Many nurses are faced with an unsatisfying clinical nursing work environment in Taiwan. Thus, there is a need for an evaluation instrument that can lead to improvement in the clinical nursing practice workplace strategy index. DESIGN: This is a cross-sectional study. METHODS: A total of 687 nurses completed the Clinical Nursing Practice Environment Scale. Based on a randomised split of the data, two groups were formed. For the group 1 (n = 344) data, exploratory factor analysis was used to examine the factor structure of the instrument. A second-order confirmatory factor analysis was then used to test the framework of the group 2 (n = 343) data, based on structural equation modelling. RESULTS: The exploratory factor analysis of 29 items yielded a five-factor structure. The five factors explained 62·87% of the total variance. Cronbach's alpha coefficients for the five Clinical Nursing Practice Environment Scale subscales ranged from 0·80-0·93. A second-order confirmatory factor analysis identified a second-order factor termed 'clinical nursing practice environment.' CONCLUSIONS: The Clinical Nursing Practice Environment Scale model was judged to fit the data adequately. RELEVANCE TO CLINICAL PRACTICE: The Clinical Nursing Practice Environment Scale model provides the hospital manager with information that can be used to evaluate the organisational situation and to develop an intervention to improve the workplace environment in Taiwan.

The development and testing of a scale of Taiwanese caregiver meaning.

AIMS: The purpose of this study was to develop and test a scale of Taiwanese caregiver meaning. BACKGROUND: The meaning of care-giving is defined as the beliefs one holds about oneself and the care-giving experiences that affect adjustment to the care-giving role. An existing tool, the Meaning in Care-giving Scale, has been tested in Taiwan, but it showed that the construct validity was unreliable. DESIGN: The study was a cross-sectional study with purposive sampling. METHOD: The instrument was developed through 20 semi-structured interviews of caregivers of mentally ill patients. A comparative method was used to analyse the text and field notes. According to the results, 29 items were designed and 318 caregivers of mentally ill patients were recruited from a psychiatric outpatient department in central Taiwan. Content and back direct content validity tests were conducted. Internal consistency, Chronbach's alpha, was used to examine the reliability, and exploratory factor analysis was used to examine the construct validity. RESULTS: Twenty items were kept after exploratory factor analysis. They represent four factors: the benefits of care-giving, a belief in Karma, personal responsibility and a reflection on life. Cronbach's alpha value for a subscale increased from 0·68-0·84, and the total scale was 0·84. A sixty per cent (59·55%) cumulative variance can be explained by four factors. CONCLUSION: A Taiwanese caregiver meaning can be considered a useful scale for assessing the meaning of care-giving for Taiwanese caregivers of mentally ill patients. A good scale and instrument take years to develop. This study takes the first step to examine the structure of the scale, and it is worth continued testing, modification and improvements. RELEVANCE TO CLINICAL PRACTICE: The scale of Taiwanese caregiver meaning was developed based on certain aspects of contemporary Taiwanese culture. It can be used to provide mental health professionals new counselling knowledge to assist caregivers of mentally ill patients to adjust to their circumstances.

Sexual self-concept and intended sexual behavior of young adolescent Taiwanese girls.

BACKGROUND: People begin to become aware of their sexual drive and erotic feelings as young adolescents. Such activity often has been overlooked in Taiwan, a traditional society, because sexuality is viewed as a private issue. OBJECTIVES: The purpose of this study was to explore the sexual self-concept and intended sexual behavior of young adolescent girls in Taiwan. METHODS: Participants included 372 girls, 12 to 14 years old, from junior high schools in Taiwan who completed two questionnaires on sexual experience and sexually related items: the Sexual Self-Concept Inventory, the Parental Approval of Sexual Behavior Scale, and the Friends' Approval of Sexual Behavior Scale, which were combined into one scale, with separate scores. RESULTS: Girls' self-reports showed low (negative) sexual self-concept, high perceived parental disapproval, and somewhat high perceived friends' disapproval of sexual activities. Sexual self-concept is associated with perceived parental and peer approval of sexual activities, and it is associated with sexual experience and intended sexual activities as well. A young adolescent girl who has a high score on the perceived sexual arousability factor of the Sexual Self-Concept Inventory is more likely to report the strongest intention toward sexual behavior. DISCUSSION: Sexual self-concept may play a key role in girls' intended sexual activities, including engaging in low-level sexual activities (e.g., kissing and breast fondling) that occur before intercourse, even when associated with intercourse intention. The research suggests that addressing sexual self-concept needs to be a priority to prevent young girls from engaging in sexual intercourse.

Stress and stress-related factors of patients after renal transplantation in Taiwan: a cross-sectional study.

AIMS: The aim of this study is to quantify the amount and causes of stress in renal transplant recipients. BACKGROUND: After renal transplantation, patients may encounter physical and psychosocial problems. Through patient collaboration with healthcare professionals, treatment after transplantation is aimed at restoring and maintaining a 'normal' life. To achieve quality of life, research needs to quantify the amount and causes of stress of renal transplant recipients, from a patient-centred perspective. DESIGN: A cross-sectional, descriptive study. METHODS: The study was conducted in the outpatient department of a medical centre in northern Taiwan from September 2005-February 2006. The recipients were a convenience sample of 153 participants who had undergone renal transplantation. RESULTS: The results showed that renal transplant recipients had low to moderate stress in four areas. Gender (male), self-efficacy and hospitalisation for infection explained 17% of the variance found for the stress of uncertainty; hospitalisation for rejection and infection explained 22% of the variance for complications; and gender (male) and self-efficacy explained 8% of the variance for the interactions with others. Post-transplant time was not found to be a predictor of stress. CONCLUSION: After renal transplantation, patients experience multi-dimensional stresses that previous research has not explored. Self-efficacy was shown to be a significant predictor of the stress of uncertainty and interactions with others. Enhancing recipients' self-efficacy of self-care behaviour can lower the stress that found in three areas. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should develop an evidence-based programme for stress management for renal transplantation patients that incorporates strategies to enhance patient's self-efficacy of self-care behaviour. Recipients' beliefs in their ability to successfully perform self-care behaviour can be promoted by a mastery experience, vicarious experience with other patients, social persuasion and re-explanation of somatic and emotional states by discussing coping methods with healthcare professionals.

A theory of meaning of caregiving for parents of mentally ill children in Taiwan, a qualitative study.

AIMS AND OBJECTIVES: The aim of this study is to generate a theory of meaning of care-giving for parents of mentally ill children in Taiwan. BACKGROUND: Studies indicate that the meaning of care-giving plays an important role in the psychological adjustment of care-givers to care-giving. With a positive meaning of care-giving, care-givers can accept their roles and adapt to them more readily. DESIGN: The research employs the qualitative method of grounded theory, the inquiry is based on symbolic interactionism. METHODS: Twenty parental care-givers of children with schizophrenia were recruited at a private hospital in central Taiwan. Semi-structured interviews were conducted. A comparative method was used to analyse the text and field notes. RESULTS: Responsibility (zeren) emerges as the core category or concept. Responsibility expresses broadly the behavioural principles that are culturally prescribed and centred on familial ethics and values. Related concepts and principles that influence caregiver actions and affections include a return of karma, challenges from local gods and fate. By maintaining their culturally prescribed interpretations of care-giving, parents hope to give care indefinitely without complaints. CONCLUSIONS: The findings clearly suggest that the meaning of care-giving is determined through a process of internal debate that is shaped by culturally specific concepts. The paper attempts to explain some of these culturally specific determinants and explanations of care-giving behaviour. RELEVANCE TO CLINICAL PRACTICE: The theory contributes knowledge about the meaning of care-giving for parents of mentally ill children in Taiwan. It should be useful reference for mental health professionals, who provide counselling services to ethnically Taiwanese care-givers.

Impact of Taiwanese culture on beliefs about expressing anxiety and engaging in physical activity: a discursive analysis of the literature.

AIMS AND OBJECTIVES: This paper analysed the scholarly discourse about the influence of Taiwanese culture on beliefs about expressing anxiety and engaging in physical activity from literature review. BACKGROUND: The well-being of individuals with mental illness is promoted by the World Health Organization. Reducing barriers to treatment and care in community health-service systems requires cultural understanding. However, little is known about the influence of Taiwanese culture on physical activity programmes for people with anxiety disorders in Taiwan. DESIGN: A discursive analysis of the literature. METHOD: Literature was used to examine the impact of Taiwanese culture on beliefs about anxiety and physical activity from historical, economic, social, political and geographical perspectives. RESULTS: Taiwanese cultural beliefs about anxiety and physical activity can be summarised into six themes. Beliefs about anxiety are reflected in three themes: anxiety and shame, beliefs against direct communication and beliefs about anxiety and external forces. Beliefs about engaging in physical activity are reflected in three themes: beliefs about human action, the relationship between health and physical activity and priority of academic achievement. CONCLUSION: This paper exposes the hidden power of culture to influence Taiwanese beliefs about anxiety and physical activity. Three negative beliefs about anxiety influence the expression of anxiety symptoms and help-seeking behaviours. Two positive and one negative belief about physical activity significantly affect choice of activity type and level of participation in physical activity. Anxiety and physical activity have a dynamic relationship and both are deeply influenced by Taiwanese culture. RELEVANCE TO CLINICAL PRACTICE: An awareness of cultural influences on beliefs about anxiety and physical activity is important when encouraging Taiwanese people with anxiety disorders to engage in physical activity. This awareness may help nurses understand better how their patients perceive anxiety and physical activity, leading to more appropriate physical activity programmes to improve both physical and psychological well-being.