[Interpersonal Communication Competence and Conflict Handling Styles of Nurses in Intensive Care Units].

BACKGROUND: Nurses in intensive care units (ICUs) must be capable of employing appropriate conflict handling styles in order to communicate with medical teams, patients, and patient family members effectively. There is a current lack of research on the interpersonal communication competence and conflict handling styles of ICU nursing staffs in Taiwan. PURPOSE: This study aimed to: (1) explore the interpersonal communication competence and conflict handling styles of ICU nurses and related factors and (2) examine the relationship between the interpersonal communication competence and conflict handling styles of ICU nurses. METHODS: A cross-sectional correlational research approach was adopted and convenience sampling was used to recruit 351 ICU nurses from three hospitals in southern Taiwan. Data were collected using a demographic questionnaire, interpersonal communication competence scale, and conflict handling styles scale. RESULTS: (1) ICU nurses demonstrated a moderate or higher level of overall interpersonal communication competence, with "integrating" identified as the most commonly used conflict handling style. (2) Higher educational attainment and job position were both associated with better interpersonal communication competence. (3) The adoption of "compromising" and "avoiding" styles was significantly affected by age; the adoption of "obliging", "compromising", "avoiding", and "integrating" styles was significantly affected by education level; the adoption of "obliging", "compromising", and "integrating" styles was significantly affected by job position; and the adoption of "dominating", "compromising", and "integrating" styles was significantly affected by seniority. (4) Interpersonal communication competence correlated significantly and positively with the adoption of "dominating", "obliging", "compromising", and "integrating" styles. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Future study of the views of ICU nurses toward their own styles in handling interpersonal conflicts is needed. Furthermore, holding training courses annually to orient ICU nurses with the advantages and disadvantages of interpersonal conflict handling styles is recommended.

Development and Psychometric Testing of the Suicidal Recovery Ability Scale (SRAS) for Assessing Individuals Who Have Attempted Suicide.

Assessing the recovery ability of individuals who have attempted suicide is crucial for psychiatric health nurses. The purpose of this study was to develop and test a psychometric Suicidal Recovery Ability Scale (SRAS). Confirmatory factor analysis (CFA) indicated that three subscales with 15 items best fit the data. The global SRAS score showed significant negative correlation with the Beck Hopelessness Scale (BHS) score. The Cronbach's α and test-retest reliability scores for the global SRAS and the subscales all exceeded 0.70. Nurses can use the SRAS to assess the recovery ability of individuals who have attempted suicide and provide proper care to help them.

[Application of Flipped Classroom Teaching Strategy in Nursing Education].

The ultimate purpose of education is to provide students with the skills and motivation necessary for lifelong learning. Students with lifelong learning abilities are better able to continue improving their professional core competencies, especially in terms of problem solving and clinical reasoning. Prior to enhancing lifelong learning abilities, students must learn self-directed learning. Studies have shown that flipped classroom learning has the potential to improve self-directed learning. Flipped classroom teaching requires prerecorded lectures, strengthened teacher-student interaction, and assisting students to learn in-depth. The authors developed a four-phase dynamic case-based learning (4D CBL) innovative teaching strategy and then assimilated this strategy into flipped classroom teaching. This innovative teaching strategy may be used in various academic nursing programs to reinforce self-directed learning and clinical reasoning abilities. After introducing the concepts of flipped classroom teaching and 4-D CBL, how to merge 4D CBL with the flipped classroom model and the effectiveness of this innovative teaching strategy are demonstrated. Nurse educators may use the flipped classroom teaching strategy with 4D CBL in their future practice.

[The Relationship Between Fatigue and Uncertainty in Patients With Liver Cirrhosis].

BACKGROUND: Cirrhosis is a chronic, progressive, and currently incurable disease. Cirrhotic patients often experience uncertainty due to poor control of symptoms and disease recurrence. Although fatigue is a common symptom in patients with liver cirrhosis, this symptom is often ignored by healthcare professionals due to the lack of efficacious treatment options. Improper management of fatigue may trigger greater uncertainty and affect adaptation success. PURPOSE: To explore the relationship between fatigue and uncertainty and the factors that respectively relate to these two concepts in liver cirrhosis patients. METHODS: A cross-sectional, correlational design and convenience sampling were used to recruit 76 liver cirrhotic inpatients from one hospital. Three structured questionnaires, including the Personal Demographic Questionnaire, Brief Fatigue Inventory-Taiwan Form, and Mishel's Uncertainty in Illness Scale, were used for data collection. RESULTS: (1) The participants suffered from fatigue at a moderate or higher level, with an average score of 5.39 ± 2.34, which affected their daily activities and greatly impacted their recreational activities. Factors that were found to be associated with fatigue included disease severity, albumin level, total bilirubin level, ascites, and the degree to which fatigue affected the performance of daily activities. (2) Uncertainty was found to be at a moderate or higher level, with an average score of 71.81 ± 10.67. Level of fatigue, the degree to which fatigue affected the performance of daily activities, disease severity, and albumin level were found to relate significantly to level of uncertainty. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Fatigue and uncertainty are prevalent and distressing experiences for patients with liver cirrhosis. A comprehensive assessment and broad-based approach to nursing interventions are necessary in order to alleviate fatigue and uncertainty effectively.

Category 3 and 4 Controlled Drugs Users' Perceptions of Participating in Drug-Abuse-Health Prevention Lectures in Taiwan.

This study was designed to explore Category 3 and 4 controlled drug users' perceptions of participating in health-prevention lectures. A phenomenological approach was used. Twelve participants were interviewed after completing the lectures. Findings revealed five themes (1) mixed emotions; (2) self-development; (3) finding the lectures lacked practicality and relevance; (4) highlighting three stages for discontinuing drug-usage; and, (5) suggesting tips for the advancement of lectures. These findings could be used as a map to help health professionals understand drug users' perceptions of attending health prevention lectures and provide insight into how young people might stop using drugs.

Challenges in intergenerational caregiving for frail older people: A multiple case study.

Families in Taiwan are considered central in caring for frail older people. However, rapid social changes are reshaping Taiwanese family values and structures. In this study, we explored the challenges of intergenerational families in caring for frail older people in Taiwan. Using a multiple-case study, 32 participants representing 12 families comprising three or more generations participated in individual, semistructured interviews. A grounded theory technique was used for the data analysis. Four themes emerged in the findings: intergenerational and intragenerational disharmony, restrictions in the physical environment, financial caregiving burdens, and lack of support from the healthcare system. The findings can help raise awareness of filial caregiving obligations of aging family members that have shifted from a parent-child dyad to being shared across multiple generations in Taiwan. Intergenerational caregiving for frail older people has become a challenge for policies aimed at keeping the aging population in the community.

The healing process following a suicide attempt: context and intervening conditions.

The purpose of this study was to explore the context and the intervening conditions that impacted on individuals' healing from a suicide attempt. Patients who had survived a suicide attempt (n=14) and their caregivers (n=6) were interviewed in this study. Findings revealed that the suicidal individuals who lived in a sheltered, friendly environment, and had support systems helped their suicidal healing process. Conversely, suicidal individuals who experienced negative aspects of self, family predicaments, environmental difficulties, and the re-emergence of stressors impeded their suicidal healing process. Consequently, health professionals need to promote healthy internal and external environments for suicidal individuals.

Development and psychometric testing of the Suicide Caring Competence Scale (SCCS) for family caregivers in Taiwan.

Suicide caring competence is important for family caregivers to care their relatives with suicidal tendencies. The purpose of this study was to develop and test the psychometric properties of the Suicide Caring Competence Scale (SCCS) for family caregivers in Taiwan. A 20-item SCCS was tested on 165 family caregivers. Confirmatory factor analysis indicated that five subscales with 19 items best fit the data. The Cronbach's α and test-retest reliability of the SCCS was 0.90 and 0.81, respectively. The SCCS demonstrated acceptable construct validity and reliability. Nurses can use the SCCS to assess the suicide caring competence of family caregivers.

[Liability of pediatric nurses for professional negligence in Taiwan: a case study].

BACKGROUND: Liability attribution and professional negligence in pediatric nursing are topics that have been neglected in Taiwan. PURPOSE: (1) Identify the definitions of related criminal activities in accordance with domestic criminal law; (2) Elucidate the facts and the dispute in a current case involving a pediatric nurse; (3) Elucidate the principle of 'no punishment without law'; (4) Explore the reasons why the pediatric nurse in the current case received a verdict of 'not guilty'. METHODS: A literature review and case study approach were used to analyze a sentence reconsideration of the first instance No. 1 (2011) issued by the Taiwan high court, Kaohsiung branch court. RESULTS: The conditions for the scrutiny of criminal activity under Taiwan criminal law are statement of facts, illegality (justifiable cause), and liability (excuse). In this case, the pediatric nurse was accused of failing to prevent an infant from suffocation and of not discharging her obligations as a nurse. The pediatric nurse rebutted the charge of criminal negligence. The intervening behaviors of the pediatric nurse were found to be legal and not culpable. In this case, the High Court and Supreme Court made a final criminal judgment based on the presumption of innocence, and the pediatric nurse was pronounced innocent of the charge. CONCLUSIONS: This article intends to assist pediatric nurses understand their liabilities under Taiwan's criminal law. Pediatric nurses should gain a better understanding of the nature of liability for professional negligence in order to clarify how actions that may be illegal do not necessarily make nurses culpable.

[A comparison of convenience sampling and purposive sampling].

Convenience sampling and purposive sampling are two different sampling methods. This article first explains sampling terms such as target population, accessible population, simple random sampling, intended sample, actual sample, and statistical power analysis. These terms are then used to explain the difference between "convenience sampling" and purposive sampling." Convenience sampling is a non-probabilistic sampling technique applicable to qualitative or quantitative studies, although it is most frequently used in quantitative studies. In convenience samples, subjects more readily accessible to the researcher are more likely to be included. Thus, in quantitative studies, opportunity to participate is not equal for all qualified individuals in the target population and study results are not necessarily generalizable to this population. As in all quantitative studies, increasing the sample size increases the statistical power of the convenience sample. In contrast, purposive sampling is typically used in qualitative studies. Researchers who use this technique carefully select subjects based on study purpose with the expectation that each participant will provide unique and rich information of value to the study. As a result, members of the accessible population are not interchangeable and sample size is determined by data saturation not by statistical power analysis.

[The status of the psychiatric nurse as a guarantor in Taiwan: a case study].

BACKGROUND: Psychiatric nurses have a special obligation and legal duty as guarantor against criminal negligence. The guarantor role and medical negligence in psychiatric nursing are topics that have been neglected in Taiwan. PURPOSE: (1) Identify the status of psychiatric nurses as guarantors; (2) Understand the causal relationship in a legal context between this status and Non-Genuine Omission in the current case; (3) Understand the facts and the dispute in the current case. (4) Explore the reasons why the psychiatric nurse was convicted for criminal negligence in the current case. METHODS: A literature review and case study were used to analyze the high court criminal judgment and sentence reconsideration of the first instance No. 122 (2005). RESULTS: (1) Psychiatric nurses hold two guarantor roles in Taiwan. One role is as legally protected interest guarantor and the other is as supervisors' dangerous source guarantor. (2) The three sources of guarantor status relevant to the current case are: nurses' voluntary commitments; medical contract; duty of care of supervisors. (3) In this case, the psychiatric nurse did not discharge her obligations as guarantor and failed to prevent the patient from committing suicide. Negligence resulted in patient death and the psychiatric nurse was found guilty. CONCLUSIONS: In order to prevent criminal acts, psychiatric nurses should gain a better understanding of their status as guarantor and the obligations entailed in this status. This article is intended to assist psychiatric nurses understand their responsibilities under current laws.

[A case study on duty of care in professional nursing].

BACKGROUND: Nurses are expected to discharge their duty of care effectively and professionally to prevent medical negligence. Only three articles have previously focused on medical negligence. Duty of care and medical negligence in nursing are topics that have been neglected in Taiwan. PURPOSE: (1) Classify the duty of care of professional nurses; (2) Investigate the facts and disputes in the current case; (3) Clarify the legal issues involved with regard to duty-of-care violations in the current case; (4) Explore the causal relationships in a legal context between nurses' duty-of-care violations and patient harm / injury. METHODS: Literature analysis and a case study are used to analyze Supreme Court Verdict No.5550 (2010). RESULTS: Duty of care for nursing professionals may be classified into seven broad categories. Each category has its distinct correlatives. In nursing practice, every nursing behavior has a corresponding duty. In this case, the case study nurse did not discharge her obstetric professional duty and failed to inform the doctor in a timely manner. Negligence resulted in prenatal death and the case study nurse was found guilty. CONCLUSIONS: In order to prevent committing a crime, nurses should gain a better understanding of their duty of care and adequately discharge these duties in daily practice.

The effectiveness of designing and evaluating i-STAR applications in pediatric nursing courses.

To apply the App to the curriculum could improve students' motivation and concentration, and also strengthen the effectiveness of professional knowledge of nursing students. OBJECTIVES: To construct and evaluate the effectiveness of smartphone applications (i-STAR) in pediatric nursing courses. METHODS: Quasi-experimental study and two-group repeated-measure design were used to evaluate the effectiveness of smartphone applications (i-STAR) in pediatric nursing courses. The "i" means "interactive", students had to log into App and finish four steps, including "Situation(S), Task(T), Action(A), and Reflection(R). A total of 163 nursing students in the third grade of associate's degree in nursing (ADN) participated in the study. The experimental group consisted of 77 participants, whereas the control group consisted of 86 participants. The instruments included the clinical reasoning readiness scale (CRRS), self-directed learning instrument (SDLI), and learning satisfaction of students. The 1st phase was the development, construction, and testing of the "i-STAR App", including hyperbilirubinemia, pneumonia, and urinary tract infection (UTI). In the 2nd phase, students operated and applied the App in the classroom. The 3rd phase was to evaluate the effectiveness of the "i-STAR App" in the course. RESULTS: The average scores of CRRS and SDLI were not significantly different between the two groups in the T0 andT1 (p > .05). The experimental group of CRRS and SDLI were better than the control group in T0-T1, T1-T2, and T0-T2 (p < .001). The experimental group showed better CRRS and SDLI scores than the control group in T0-T1, and T0-T2 with Repeated measures ANOVA. Also, the experimental group showed prolonged learning effectiveness. The experimental group (41.22 ± 6.08) was more satisfied than the control group (37.29 ± 7.40) (p < .05), although their academic performance was about the same (p > .05). CONCLUSION: "i-STAR App" could enhance students' interest in pediatric nursing courses, strengthen nursing students' clinical reasoning and self-directed learning ability.

Stress and Coping Strategies of Online Nursing Practicum Courses for Taiwanese Nursing Students during the COVID-19 Pandemic: A Qualitative Study.

BACKGROUND: The coronavirus disease (COVID-19) pandemic has resulted in significant changes in nursing education. Maintaining social distance could slow down the spread of COVID-19, and it was necessary, but it significantly reduced students' hands-on clinical practice experience in healthcare settings. Traditional classroom teaching in schools has transitioned to distance or online learning methods, which significantly reduced students' hands-on clinical practice experience in healthcare settings. Although distance education had been implemented for a long time, there are many problems and challenges to be resolved. The experiences and needs of nursing students in remote clinical training urgently require further understanding. PURPOSE: To understand the stress and coping strategies of online nursing practicum courses for Taiwanese nursing students during the COVID-19 pandemic. METHODS: A qualitative research approach with purposive sampling was supplemented by snowball sampling. Semi-structured interviews were conducted, and the data were collected following the eight-step process outlined by Waltz, Strickland, and Lenz (2010). The participants were 12 nursing students on a two-year nursing RN-to-BSN program at a university in Eastern Taiwan, consisting of 11 females and 1 male student. FINDINGS: The stress and coping behaviors of nursing students consist of four main themes, each with three subthemes, including "urgent changes", "the gaps between online courses and practical operations", "mixed feelings of joy and anxiety" and "unexpected gains". CONCLUSIONS: The pandemic has impacted nursing students' learning and living. Engaging in online nursing practicum brought about significant stress; nevertheless, students employed various coping strategies to navigate through this challenging period. The findings of this study would also help nursing educators understand the learning gaps in clinical practicum among students.

The process and indicators of resilience among nursing students in clinical practicum in Taiwan: A qualitative study.

Background: Resilience is essential for managing stress and maintaining equilibrium. During the clinical practicum, nursing students may experience tremendous physical and mental stress, and these negative experiences are considered a source of resilience for students. However, no universal definition of resilience among nursing students exists in the literature, occasioning the need to define the processes and indicators of resilience. Purpose: This study aims to explore the resilience process and indicators among nursing students in clinical practicum in Taiwan. Participants: Fifteen fifth-year junior college nursing students in Northeastern Taiwan who had completed the clinical practicum were interviewed, including 12 females and three males. All participants were aged 20.3 ± 0.61 years and all participants had clinical practicum experiences over four months. Methods: A qualitative descriptive study, using purposive and snowball sampling methods, was conducted to collect the experience of the nursing students in their internship. Data were collected using a semi-structured guide and deep interviews, and analyzed through the content analysis method by Waltz, Strickland, & Lenz (2010). Results: Based on the participants' practical experiences during their clinical practicum, three main themes and nine indicators were identified. The resilience of nursing students is considered a process. The main themes are (1) uncontrolled clinical practical stress, (2) Maintain learning-life balance, (3) Positive attitude toward nursing. Conclusions: Resilience is a critical factor to stabilize nursing students and enable them to recover from adversity. Both positive and negative experiences significantly impacted the students' attitudes and confidence levels during the clinical practicum. The findings will provide faculty to adapt their teaching method to various situations of nursing students.

Development and Psychometric Testing of the Clinical Reasoning Scale Among Nursing Students Enrolled in Three Types of Programs in Taiwan.

BACKGROUND: There is no instrument currently available to assess the essential nursing competency of clinical reasoning (CR). PURPOSE: The purpose of this study was to develop and test the psychometric properties of CR assessment instrument appropriate for use with nursing students across different types of programs. METHODS: H. M. Huang et al.'s (2018) Framework of Competencies of Clinical Reasoning for Nursing Students was used to guide this study. Two rounds of Delphi study and confirmatory factor analysis (CFA) were conducted to test content and construct validity. Internal consistency was tested for reliability. RESULTS: The four-domain, 16-item Likert-scale Clinical Reasoning Scale (CRS) was developed. One thousand five hundred four nursing students currently enrolled in three different types of nursing programs completed the CRS. The content validity index was .85-1.0, the CFA indicated goodness of fit, and the Cronbach's α score range was .78-.89. CONCLUSION: The CRS is a valid and reliable tool for assessing CR in nursing students in different types of nursing program.

[Traumatic response experiences: one year after Typhoon Morakot].

BACKGROUND: Disaster-related mental health problems have been a focus of recent international scholarly interest. Typhoon Morakot caused exceptional destruction in Southern Taiwan, and victims suffered physically, psychologically and financially in its aftermath. PURPOSE: This study investigates the post-traumatic response and coping behaviors of victims one year after Typhoon Morakot. METHODS: Researchers used a phenomenological method with purposive sampling and interviewed 10 Typhoon Morakot victims. Data were collected using deep, semi-structured interviews. All interview sessions were tape-recorded. Researchers used Colaizzi's seven-step phenomenological method to analyze data. RESULTS: Three common themes emerged in subjects following their disaster experiences. The first was residual traumatic response, including fear of continued flooding, fear of future flood recurrence, indifference in responses, and living on alert; The second was insecurity in daily life due to changed surroundings, including anxiety and a heavy sense of loss; The third was conformity in coping behaviors, including shifting attention away from the disaster, turning to a pluralistic support system, having an optimistic outlook on life, and living in the moment. CONCLUSION: Investigating traumatic response experiences and coping behaviors one year after the Typhoon Morakot disaster can help guide healthcare professionals to promote evidence-based health and nursing services. Findings also provide information to healthcare providers essential to improving nursing quality for victims of disasters.

Effectiveness of e-STORY App in clinical reasoning competency and self-directed learning among students in associate nursing program: A quasi experimental study.

AIM: The purpose of this study was to promote students' clinical reasoning (CR) and self-directed learning (SDL). The specific aims were: (1) to examine effectiveness of the e-STORY App in promoting nursing students' CR and SDL; and (2) to explore the relationships between levels of learning motivation and suitability of the e-STORY App. BACKGROUND: CR and SDL are core competencies for nursing students. However, new graduates tend to be in adequately prepared in these competencies. Humanoid diagram uses diagrams to guide students in gaining a comprehensive view of the patient issues, which may promote attainment of these competencies. The Z generation students favor learning through smart devices for the feature of no time and spatial limitations. The e-STORY App was developed to overcome the setbacks of creating hard-copy drawings to promote learning effectiveness. DESIGN: This quasi-experimental study used two-group repeated measure design with a convenience sample. METHODS: A total of 77 students from two sections of the "Seminar for Clinical Case Studies" course participated in the study (experimental group: 39 students; control group: 38 students). Data were collected before, one week after and four weeks after the teaching intervention. The instruments used were demographic information sheet, Huang et al.'s (in press) Clinical reasoning scale and Cheng et al. (2010) Self-directed learning instrument. RESULTS: There were no significant differences in the CR and SDL scores between the experimental and control groups one week after the intervention (p＞.05). Analyses of the delay effects four weeks after the intervention found significantly higher CR scores in the experimental group than the control group (p < .05). However, there were no significant differences in the SDL scores between groups (p＞.05). Analysis of the findings from the experimental group found that students with moderate and low learning motivation showed significantly higher CR scores on the posttest and follow-up test (p < .05). CONCLUSIONS: Application of the e-STORY App as a supplementary teaching strategy promoted nursing students' CR ability, especially in students with moderate or low learning motivation. It is recommended to use the App in students with moderate or low learning motivation to promote learning effectiveness.

Effectiveness of a Mobile Technology-Supported Self-Reflective Course in Communication Behaviors for Outpatient Nurses.

Background Communication is a core competency for outpatient nurses. This study investigated the effectiveness of a mobile technology-supported self-reflective (MTS) course in communication behaviors among outpatient nurses. Method This quasi-experimental study used a convenience sample of 78 outpatient nurses (experimental group = 39; control group = 39). The experimental group completed the MTS communication course. Communication behaviors were evaluated before, 1 week after, and 1 month after the course. Results There was no significant difference in communication behaviors between the groups before the intervention. One week after the intervention, communication behavior scores significantly increased in both groups without significant between-group differences (p > .05). One month after the intervention, the experimental group showed significantly higher communication behavior scores (p < .05). Both groups demonstrated high learning satisfaction. Conclusion The MTS communication course was successful in promoting effective outpatient nurse-patient communication. Health care facilities may want to incorporate the MTS course into their orientation program. [J Contin Educ Nurs. 2022;53(6):279-288.].

The Lived Experiences of Stigmatization in the Process of HIV Status Disclosure among People Living with HIV in Taiwan.

People living with HIV (PLWH) face social stigma which makes disclosure of HIV status difficult. The purpose of this descriptive qualitative study was to understand the lived experiences of stigmatization in the process of disease disclosure among PLWH in Taiwan. Analysis of the semi-structured interviews from 19 PLWH in Taiwan revealed two phases and six themes. Phase one "experiences before disclosure" involved three themes: "Struggles under the pressure of concealing the HIV Status", "Torn between fear of unemployment/isolation and desire to protect closed ones", and "Being forced to disclose the HIV status." Phase two "experiences after disclosure" included three themes: "Receiving special considerations and requirements from school or work", "Receiving differential treatments in life and when seeking medical care", and "Stress relief and restart." Healthcare professionals need to assess stigmatization in PLWH and develop individualized approaches to assist with the disease disclosure process.