Developing and validating the Nursing Cultural Competence Scale in Taiwan.

BACKGROUND: Culture influences personal health habits and behavior, and healthcare personnel possess different views of cultural perspectives. Currently, an appropriate instrument to assess cultural competence in clinical practice is limited. The present study aimed to develop and examine the psychometric properties of the Nursing Cultural Competence Scale (NCCS) for clinical nurses. METHODS: Developing and assessing the scale was carried out in two phases: Phase I involved a qualitative research to explore the themes of nurses' cultural competence and instrument development; Phase II established construct validity of the scale using a sample of 246 nurses in Taiwan. Data from the questionnaire were analyzed using exploratory factor analysis, confirmatory factor analysis, internal consistency and test-retest reliability. Analysis results were used to determine the reliability and validity of the developed scale. RESULTS: The results showed four factors including cultural awareness ability, cultural action ability, cultural resources application ability, and self-learning cultural ability were generated by exploratory factor analysis, and these factors explained 62.0% of total variance. Cronbach's α of the Nursing Cultural Competence Scale was .88, and test-retest reliability correlation was .70. CONCLUSIONS: The establishment of the tool will facilitate accurate monitoring of the cultural competence among nurses and nursing managers, which can inform the construction of nursing policies aimed at pledge cultural competence expansion.

Higher complication risk of totally implantable venous access port systems in patients with advanced cancer - a single institution retrospective analysis.

BACKGROUND: Totally implantable port systems are generally recommended for prolonged central venous access in diverse settings, but their risk of complications remains unclear for patients with advanced cancer. AIM: The aim of this study was to assess the risk of port system failure in patients with advanced cancer. DESIGN: We conducted a retrospective cohort study in a comprehensive cancer centre. SETTING/PARTICIPANTS: A detailed chart review was conducted among 566 patients with 573 ports inserted during January-June, 2009 (average 345.3 catheter-days). Cox regression analysis was applied to evaluate factors during insertion and early maintenance that could lead to premature removal of the port systems due to infection or occlusion. RESULTS: Port system-related infection was significantly associated with receiving palliative care immediately after implantation (hazard ratio, HR = 7.3, 95% confidence interval, 95% CI = 1.2-46.0), after adjusting for probable confounders. Primary cancer site also impacted the occurrence of device-related infection. Receiving oncologic/palliative care (HR = 3.0, P = 0.064), advanced cancer stage (HR = 6.5, P = 0.077) and body surface area above 1.71 m(2) (HR = 3.4, P = 0.029) increased the risk of port system occlusion. CONCLUSIONS: Our study indicates that totally implantable port systems yield a higher risk of complications in terminally ill patients. Further investigation should be carefully conducted to compare outcomes of various central venous access devices in patients with advanced cancer and to develop preventive strategies against catheter failure.

Sailing against the tide: Taiwanese women's journey from pregnancy loss to motherhood.

PURPOSE: To understand the experiences of Asian women in Taiwan who are adjusting to motherhood following previous pregnancy loss. STUDY DESIGN AND METHODS: Phenomenology was used as the study design, and interviews were used to collect data in a medical center in Northern Taiwan with six women who had given birth to a healthy baby after previous pregnancy loss. Following ethical approval, interviews were audio-recorded, transcribed, and analyzed to develop data themes. RESULTS: The nautical metaphor was chosen because of the fact that Taiwan is an island and surround by sea. The sea has deep cultural meaning of uncertainty in life for the Taiwanese people. A metaphor of "sailing against the tide" emerged from the data to depict three stages of the women's journey: remembering the previous journey of loss; the rising sun brings new life within; and changing tide brings new birth. The essence of their journey through the pregnancy and birth was a permutation of fear, uncertainty, and a deep desire for reassurance of fetal well-being. CLINICAL IMPLICATIONS: This study reinforces the difficulties that women have after a pregnancy loss, but examines it with a unique cultural focus. Nurses and midwives can use these findings to develop caring and understanding practices designed to help women in these circumstances. Pregnancy after a loss is never the same as a previous pregnancy, and is perceived as different from a pregnancy that other "normal" pregnant women have. Women need nurses and midwives who can provide comprehensive practical, physical, culturally specific, psychosocial, and spiritual support to help them successfully chart their journey out of profound loss.