Child-rearing experiences and home environment concerns among Southeast Asian immigrant mothers in transnational marriage families in Taiwan.

AIMS: To explore the child-rearing experiences of immigrant mothers and their concerns about children's home environments in the contexts of transnational marriage families and non-native culture. BACKGROUND: Immigrant mothers are often disadvantaged by a relative lack of information on and access to children's healthcare, but little research exists on the experiences of mothers in transnational marriage families as they attempt to provide a secure home environment while navigate an unfamiliar culture. DESIGN: A descriptive phenomenological research design based on intuition was employed to explore immigrant mothers' unique lived reality through their subjective experiences and perceptions. METHODS: Semi-structured interviews with 15 immigrant mothers from 15 transnational marriage families were conducted between May 2016-February 2017. Narratives were analyzed using the descriptive phenomenological method because it permits systematic discovery of the lived experiences from the perspective of the study's participants. RESULTS: Three major themes were identified: (a) striving to maintain a secure home for children; (b) suffering and struggling with difficulties; and (c) trying to overcome difficulties and build an adequate family environment. The essential, prevailing concept of immigrant mothers' experience in child-rearing was identified as 'Where my child is, is home.' CONCLUSION: Immigrant mothers bond emotionally and physically to their new land via their children. Their child-raising experiences are interwoven with their roles in their new familial and cultural homes. IMPACT: Immigrant brides often become mothers soon after marrying to continue their husbands' family line. Understanding their unique child-rearing experiences and challenges in providing a secure home in a non-native culture will help nurses provide effective care. Study results will benefit paediatric/family nurses in any setting where care for transnational marriage families is provided, those families themselves, public policymakers and future researchers.

Experiences of parents providing kangaroo care to a premature infant: A qualitative systematic review.

Parents who give birth to an unexpected preterm infant not only suffer a psychological impact, but, in addition, their roles as parent are full of uncertainty. As part of family-centered care, kangaroo care is an important way to support premature infants and their family. This review synthesizes qualitative studies on the experiences of parents who have used kangaroo care for preterm infants in neonatal intensive care units. English and Chinese databases were searched for relevant studies from 1970 to July 2018. The findings of qualitative studies were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 731 studies were screened, and 9 were included. Five synthesized findings were identified: sense of emptiness of the parent's role, barriers in the translation of parental roles in kangaroo care, preparation enhances parental role expectations, kangaroo care enhances parental competency, and encouragement and support from family and friends. Through the implementation of kangaroo care, nurses are able to help prepare and guide parents, fit parents' needs, and help improve their ability and self-confidence in their parental roles.

Revision and validation of a short scale to assess home environment for elementary school children in transnational families in Taiwan.

PURPOSE: To develop and test a brief scale of the home environment of elementary school children in transnational families or vulnerable families. DESIGN AND METHODS: The scale development process took place in three phases. In the first phase, a 61-item scale was generated by an expert panel based upon related literature and Chinese Home Observation for Measurement of the Environment (C-HOME). In the second phase 15 individual transnational families with elementary school children were interviewed, and items were reduced from 61 to 55 due to understandability or other practical considerations. Phase three's item analysis with 200 such families, reduced items to 41. Factor analysis followed, further reducing items to 27. Finally, the resulting 27-item scale underwent a test-retest with 57 subsample participants. RESULTS: An iterative process of item and factor analyses identified a seven-dimensional, 27-item Home Environment Assessment Scale (HEAS), which accounted for 52.28% of the total variance. K-R 20 was 0.76. The test-retest reliability for the full sample total score was 0.97. CONCLUSIONS: The results provide evidence supporting the scale consistency, content validity, and construct validity, and offer a useful instrument for health care professionals, especially pediatric nurses, to identify home environment interventions for young children in vulnerable families. PRACTICE IMPLICATIONS: The findings of HEAS-27 can serve to guide pediatric health care professionals in promptly screening, evaluating, and teaching families so that children in a vulnerable population have adequate quality and quantity of support in the home environment.

Evaluation of nursing students' perceptions of their cultural care competency: A mixed method study in Taiwan.

Growing cultural diversity among immigrants has challenged health care practice in Taiwan. This study used mixed methods to evaluate how the implementation of a course on cultural competence embedded in a nursing course affected nursing students' perceptions of their cultural care competency. An evaluation survey with a quantitative questionnaire comprising pre- and post-test measures of self-perceived cultural care competency was implemented for 48 participants at the commencement and completion of the course. A focus group interview (n = 10) was conducted and a thematic approach applied to analyze qualitative data. The results found a significant improvement in self-perceived cultural care competency (t = 7.15, p < 0.001). Two themes emerged from the qualitative analysis: (1) the thought-provoking nature of the course and (2) appreciation for the multiple learning strategies of the course. The findings suggest that embedding cultural competence education in nursing courses is essential to improving nursing students' perceptions of their cultural care competency.

Pharmacokinetic and pharmacodynamic study of LFA3Ig fusion protein in healthy volunteers and patients with psoriasis.

AIM: To evaluate the pharmacokinetics (PK) and pharmacodynamics of the LFA3Ig fusion protein (LFA3IgFP) in healthy volunteers and patients with chronic plaque psoriasis. METHODS: The clinical trials included 2 phase I open studies. Study 1 was an open-label dose escalation study in 24 healthy volunteers, and study 2 was a single-group, open-label study in 12 patients with chronic plaque psoriasis. The serum drug concentrations were measured, and the concentration-time data were analyzed by compartmental analysis using the Practical Pharmacokinetic Program. RESULTS: In study 1, after intramuscular (im) administration at a dosage of 5, 15, and 25 mg, the concentration-time curves of LFA3IgFP fitted well to a 1 compartment open model. Areas under the concentration-time curves increased linearly with dose. Clearance rates (Cls/ F) and elimination half-lives (T1/2ke) had no significant difference between different dose groups. A transient, slight decline of CD(4+) and CD(8+) T-cell subsets was observed after administration. In study 2, after im administration at a dosage of 15 mg weekly for 8 weeks, the concentration-time curve was best fitted to a 1 compartment open model, with a T(1/2ke ) of 307.9+/-32.7 h. The steady state was attained after the fifth administration. CONCLUSION: The PK behaviors of LFA3IgFP in healthy volunteers and patients with chronic plaque psoriasis complied with linear kinetics within the examined dose range. A significant accumulation was observed after repeated administration at a dose of 15 mg weekly for 8 weeks.

Reduced nosocomial infection rate in a neonatal intensive care unit during a 4-year surveillance period.

BACKGROUND: Hospital-acquired infections are a leading cause of morbidity and mortality in neonatal intensive care units (NICU). The aim of the study was to investigate the change of nosocomial infection rate in a NICU during a 4-year surveillance period. METHODS: We investigated the changes in nosocomial infection rates, infection sites, and microorganism species in a NICU before and after the unit was moved to a new location, extending from November 2008 to October 2012.The new facility was opened on November 1, 2010 and the old NICU was closed on the same day. In the meantime, three catheter-based bundles were implemented in the new NICU and all intensive care units in our hospital due to the new policy. Data collection was performed by independent, experienced infection control nurses. RESULTS: A total of 512 neonates were admitted to the NICU and enrolled in this study. There were 242 infants who were admitted to the old NICU, and 270 infants in the new facility. During the study period, the rate of infection episodes decreased from 19.0% to 11.1% (P = 0.01). Additionally, the average hospital-acquired infection rate decreased from 6.26 cases per 1000 patient-days to 4.09 cases per 1000 patient-days (P = 0.03). The most common infection site was blood stream infection, which decreased from 8.3% to 3.7% (P = 0.03). The total catheter-related infection rates of the blood stream, lower respiratory tract, and urinary tract decreased from 13.6% to 5.9% (P = 0.003). Klebsiella pneumonia, E. coli, Methicillin-resistant Staphylococcus aureus (MRSA), and Coagulase-negative Staphylococci (CoNS) were the most frequently found pathogens in the old NICU, whereas MRSA, CoNS, E. faecalis, and A. baumannii were the most frequently found pathogens in the new NICU. CONCLUSION: The change in the environment and implementation of device bundles in the NICU might be associated with the nosocomial infection rate.

Comparison of the Educational Needs of Neonatologists and Neonatal Nurses Regarding Palliative Care in Taiwan.

BACKGROUND: Education and training are very critical to development of high-quality neonatal palliative care. However, little investigation has been done into Taiwanese neonatal clinicians' educational needs regarding neonatal palliative care. PURPOSES: The purposes of this study were to characterize and identify neonatal clinicians' educational needs regarding neonatal palliative care. METHODS: A cross-sectional descriptive surveyed method via a self administered questionnaire was used in this research. Thirty neonatologists were recruited by a convenience sampling and 30 nurses were recruited by a randomized sampling. RESULTS: Out of sixty neonatal clinicians' survey, few had received the education in neonatal palliative care. Most reported minimal training in, experience with, and knowledge of neonatal palliative care. For neonatologists, two of twelve most strongly-felt educational needs were "discussing palliative care and ethical decision-making with parents" (70%) and "informing parents the poor progress in neonates" (63.3%). In contrast, neonatal nurses wanted more training regarding pain control (50%). Communication skills, including the discussing poor prognosis, bad news, and code status and talking with neonates about end-of-life care, were the educational need most commonly felt by both neonatologists and nurses. CONCLUSIONS: Survey data from neonatologists and neonatal nurses in Taiwan indicate a need for further training on a range of neonatal palliative care competencies.

[Study of the correlation between drug exposure and blood concentration during cyclosporine microemulsion absorption phase in Chinese adult liver transplant recipients].

OBJECTIVE: To analyze the correlation between drug exposure (AUC0-4) and blood concentration of different sample points during Neoral absorption phase in Chinese adult liver transplant recipients, and to evaluate the possibility of using post-dose 2 hour level (C2) as a surrogate marker of AUC0-4 for the therapeutic drug monitoring (TDM) of Neoral. METHODS: Neoral levels at 0, 1, 2, 3, and 4 hours (C1, C2, C3, C4) after morning dose of 22 de novo Chinese adult liver transplant recipients were monitored during different posttransplant periods. Liner regression was used to analyze the correlation between CsA concentration at different time points and the AUC0-4. RESULTS: The best correlation was found at C2, while the correlation of C0 was the lowest. During following-up, the correlation between C2 and AUC0-4 was very stable. CONCLUSION: C2 had the best correlation with drug exposure. This correlation is very stable. C2 may be used as a good surrogate marker of AUC0-4 for the TDM of Neoral.

A randomized and controlled multicenter prospective study of the Chinese medicinal compound Fufang Xuelian Burn Ointment for the treatment of superficial and deep second-degree burn wounds.

The objective of this study was to evaluate the efficacy and safety of a traditional Chinese medicine, Fufang Xuelian Burn Ointment (FXBO), to treat superficial and deep second-degree burn wounds. A four-center, randomized, controlled, and prospective study was conducted. Overall, 240 patients with either superficial or deep second-degree burn wounds were enrolled consecutively in this study. Patients who were randomly assigned to the control group (superficial: 72, deep: 48) underwent common burn wound therapy, whereas those randomized to the treatment group (superficial: 72, deep: 48) received common burn wound therapy plus topical FXBO. The healing rate, healing time, effective rate, and safety data were compared between the two groups. The baseline characteristics were comparable for the two groups. The healing rate was 94.79(±7.50) in the control group and 98.60(±5.69) in the FXBO group after 14 days for patients with superficial second-degree burn wounds (P = 0.000), and 95.17(±9.68) versus 97.44(±9.81) at 28 for deep second-degree burn wounds (P = 0.025). The median healing time in the FXBO group were 9 and 21 days for superficial and deep second-degree burns, respectively, compared to 10.5 and 22.5 days, respectively, in control group (P(superficial) = 0.000 and P(deep) = 0.009). The results of the effective rate showed that comprehensive efficacy of the FXBO group was improved compared to the control group for either superficial or deep second-degree burns (P(superficial) = 0.035 and P deep = 0.003). There were no reported drug-related adverse events in both groups. Therefore, FXBO was well tolerated and more effective than control group for treating superficial and deep second-degree burn wounds.

Detection of carbapenemase-encoding genes among clinical isolates of Pseudomonas aeruginosa in a Chinese burn unit.

The carbapenemases have recently emerged as molecules implicated in one of the most feared bacterial resistance mechanisms because of their ability to hydrolyze virtually all lactamase agents and their highly mobile genes. This study aimed to investigate the prevalence of carbapenemase and antimicrobial susceptibilities of Pseudomonas aeruginosa isolated from burn patients in Chongqing, China. Antimicrobial susceptibility of 111 isolates was determined by the disc agar diffusion test and the agar dilution method. Random Amplification of Polymorphic DNA polymerase chain reaction analysis revealed 111 P. aeruginosa 42 genotypes. Carbapenemase genes were amplified by polymerase chain reaction and the sequence verified by blast. Ninety-three of 111 (83.8%) isolates were resistant to imipenem; all of them had developed multidrug resistance and exhibited higher resistant rates compared with the imipenem-susceptible Pseudomonas. Ciprofloxacin was the most effective antipseudomonal agent. Thirty-three of the isolates were identified to contain the metallo-ß-lactamase blaIMP-4 gene and belong to different Random Amplification of Polymorphic DNA polymerase chain reactiongenotypes. In conclusion, the high prevalence of multidrug resistance (94.6%) and the production of blaIMP-4 genes in P. aeruginosa isolates in burn patients highlight the necessity of considering these issues in burn hospitals.

Effectiveness of hand-washing teaching programs for families of children in paediatric intensive care units.

AIMS: The authors developed a video-centred teaching program based on social learning principles to demonstrate hand-washing technique. A comparison was made between families who viewed the video and families who were taught the same techniques with the aid of an illustrated poster in terms of compliance and improvement in hand-washing skills. BACKGROUND: Nosocomial infections are a significant cause of morbidity and mortality in paediatric intensive care unit patients. Hand hygiene is considered the most important preventive action against hospital-acquired infections. A number of studies have shown that increased compliance with hand-washing guidelines for health-care workers leads to decreases in nosocomial infection rates. Furthermore, recommendations have been made to ensure that parents who visit their children in intensive care units wash their hands first. STUDY DESIGN: Quasi-experimental time series. Compliance and accuracy measurements were collected during one to five visits following the initial teaching intervention. METHODS: A total of 123 families, who visited paediatric intensive care units, were recruited and assigned to two groups - one experimental (61 families) and the other a comparison group (62). Participants in the comparison group were taught hand-washing skills using simple illustrations. A 20-item hand-washing checklist was used to examine hand-washing compliance and accuracy. RESULTS: No significant differences were noted in terms of demographics between the two groups. Results from a general estimated equation analysis showed that families in the experimental group had higher compliance and accuracy scores at statistically significant levels. CONCLUSION: The video-based teaching program was effective in increasing compliance and accuracy with a hand-washing policy among families with children in intensive care units. RELEVANCE TO CLINICAL PRACTICE: The education program is a simple, low-cost, low technology intervention for substantially reducing the incidence of nosocomial infection.