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.

Nurses' Views on the Potential Use of Robots in the Pediatric Unit.

PURPOSE: To describe nurses' views on the potential use of robots in the pediatric unit. DESIGN AND METHODS: A qualitative descriptive design was employed. Semi-structured interviews were conducted with 23 nursing staff who worked in the pediatric unit. The interviews were audiotaped, transcribed, and analyzed using qualitative content analysis. RESULTS: Three themes emerged related to the nurses' views on the potential use of robots in the pediatric unit (1) care impact - advantages, which included: (a) reducing healthcare providers' workload and (b) adequately meeting the needs of pediatric patients and their families; (2) care impact - shortcomings, which included: (a) deficiency of individualized care and (b) reduced employment opportunities for skilled nursing staff; and (3) attitude impact, including (a) lifelong learning and (b) integrating culture and technology to meet pediatric care needs. CONCLUSIONS: Robots' application may ameliorate the overall quality of pediatric care, allowing for better apportioning of nurses' time and energies to focus on direct patient care and reducing nurses' workloads. However, some possible disadvantages need attention, including robots' inability to provide genuine human touch, demonstrate human emotions associated with pediatric care, and exhibit cultural sensitivity. It is desirable to embed nursing practice needs in the advanced functions of robots and thereby ensure safe, reliable robotics suitable for pediatric care usage. PRACTICE IMPLICATIONS: The findings can be used as a reference for nurses encountering challenges in working with robots, and for lifelong learning needs for pediatric nurses.

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.

Prescription patterns of traditional Chinese medicine amongst Taiwanese children: a population-based cohort study.

BACKGROUND: Traditional Chinese medicine (TCM) has been used by Chinese patients and in many other countries worldwide. However, epidemiological reports and prescription patterns on children are few. METHODS: A cohort of 178,617 children aged 18 and under from one million randomly sampled cases of the National Health Insurance Research Database was analyzed for TCM prescription patterns. SAS 9.1 was applied and descriptive medicine utilization patterns were presented. RESULTS: The cohort included 112,889 children treated by TCM, with adolescents (12- to 18-year-olds) as the largest group. In the children's TCM outpatient visits, Chinese herbal remedies were the main treatment. The top three categories of diseases treated with Chinese herbal remedies were respiratory system; symptoms, signs, and ill-defined conditions; and digestive system. The top three categories using acupuncture were: injury and poisoning, diseases of the musculoskeletal system and connective tissue, and diseases of the respiratory system. Of the top ten herbal medicines prescribed by TCM physicians, the top nine herbal formulae and the top ten single herbs were associated with diseases of the respiratory system. CONCLUSION: This study identified patterns of TCM prescriptions for children and common disease categories treated with TCM. The results provide a useful reference for health policy makers and for those who consider the usage of TCM for children.

Psychosocial and emotional adjustment for children with pediatric cancer and their primary caregivers and the impact on their health-related quality of life during the first 6 months.

PURPOSE: To evaluate caregiver-reported psychosocial adjustment and health-related quality of life (HrQoL) of Taiwanese children with newly diagnosed cancer and their caregivers during the first 6 months of treatment. METHODS: Caregivers of 89 newly diagnosed children completed the child behavior checklist, the pediatric quality of life inventory (PedsQL(™) 4.0), the Parenting Stress Index, and the SF-36 questionnaire at diagnosis, and again 3 and 6 months into treatment. They were compared with a group of age- and sex-matched controls from general community. RESULTS: Significantly worse HrQoL in both children and their caregivers and greater parenting stress were noted in the cancer group than the controls during the first 6 months. Children with cancer were found to have significantly more internalizing behavioral problems and somatic complaints, especially those younger than 12 years old. After starting chemotherapy, significant decrease in parenting stress and improvements of both caregivers and children's HrQoL were noted within the first 6 months, although not to the level comparable with normal controls. CONCLUSIONS: Although children and their caregivers can adjust themselves gradually during the first 6 months after diagnosis of cancer, intervention and efforts aimed at reducing their distress and promoting adjustments are still required during this period.

Proteomic analysis of the effects of baicalein on colorectal cancer cells.

Baicalein is the flavonoids with multiple pharmacological activities. The aim of our study was to investigate the effects of baicalein on colorectal cancer (CRC) and to recognize the targets of baicalein treatment. To better understand baicalein's target, proteomic approaches were used to purify and identify the protein substrates using 2D difference gel electrophoresis (2D SDS-PAGE) to elucidate proteins differential display. Results from this study investigate that baicalein treatment of CRC cells results in reduced cell proliferation. As a result, differential protein displays between baicalein-treated and untreated CRC were determined and validated. There were 11 differentially expressed proteins between baicalein-treated and untreated CRC. Furthermore, we demonstrate that baicalein inhibits cancer cell proliferation and reduced reactive oxygen species (ROS) by up-regulating the levels of peroxiredoxin-6 (PRDX6). Knockdown of PRDX6 in baicalein-treated CRC cells by specific small interfering RNA resulted in ROS production and proliferation, opposite of the baicalein treatment scenario as indicated by cell cycle distribution. These results illustrate that baicalein up-regulates the expression of PRDX6, which attenuates the generation of ROS and inhibits the growth of CRC cells, whereas baicalein treatment have no effect on normal epithelial cells.

Nurses' experiences of providing care during the COVID-19 pandemic in Taiwan: A qualitative study.

In the event of a contagious disease outbreak that reaches the level of a pandemic, the responsibility of providing care for patients increases for front-line nurses. However, being in a nursing role exposes professionals to a range of risks, including but not limited to contagion and mental health impacts. This qualitative study aimed to explore in-depth nurses' experiences of providing care in the time of the COVID-19 global pandemic. The study followed the COREQ guidelines. Purposive sampling was applied to recruit participants. Semi-structured face-to-face interviews were used to collect the data from 16 nurses across five hospitals in Taiwan in 2020. Contents were analysed using Colaizzi's seven-step method. The essential structure that was identified was 'Providing care cautiously and being alert to the changing environment', which reflects the progress of Taiwanese nurses in providing care during the global COVID-19 pandemic. The essence of the phenomenon is presented through three themes: (i) facing the emerging challenge, (ii) struggling with uncertainty, fear, stigma, and workload, and (iii) adapting to changes in the environment: learning and innovation. The findings identified multi-dimensional impacts of nursing experiences during the COVID-19 pandemic, and the study yielded evidence and practices that can be used to guide and support adequate interventions to support nursing professionals. By understanding the various aspects of nurses' experiences, policymakers and administrators can better address nursing care providers' professional and mental health needs during a pandemic.

Effects of simulation-based learning on nursing students' perceived competence, self-efficacy, and learning satisfaction: A repeat measurement method.

BACKGROUND: Simulation-Based Learning is beneficial to nursing education. Nevertheless, recent studies have shown a side effect of being overwhelmed by repeated exposures to simulation. Thus, how many times simulation scenarios should be provided to students remains a question for nursing faculty. OBJECTIVES: The objectives of this study were to (1) explore the changes in nursing students' perceived competence, self-efficacy, and learning satisfaction after repeated exposures to simulations, and (2) determine the acceptable frequency of SBL in the 'Integrated Care in Emergency and Critical Care' course. DESIGN: A one-group repeated measurement experimental design with self-administered questionnaires in a convenient sample of senior nursing undergraduate students was used. SETTINGS: Department of Nursing at a nonprofit university in southern Taiwan. PARTICIPANTS: Seventy-nine out of 84 senior nursing students who enrolled in the course in 2019 volunteered to complete all measurements. METHODS: After taking the baseline measurements (T0), students were exposed to 75-min simulation scenarios from Time 1 (T1) to Time 3 (T3) three weeks apart throughout the semester. Students' nursing competence, self-efficacy, and learning satisfaction were measured immediately after each exposure. Descriptive statistics, t-test and repeated measurement analysis of variance were used for data analysis. RESULTS: There were statistically significant improvements from T0 to T3 (p < .001) in nursing competence, self-efficacy, and learning satisfaction scores after repeated exposures to simulation. When comparing scores from T1 to T2 and from T2 to T3, there was no significant difference. CONCLUSION: Simulation based learning is effective in improving nursing students' perceived competence, self-efficacy, and learning satisfaction. While the primary changes occur at the first simulation effort, it is the accumulated multiple exposure experiences collectively improve students' learning outcomes. Multiple instructional strategies besides simulation are recommended to maintain nursing students' learning interests to achieve optimal learning outcomes of the course across a semester.

Nursing students' first-time experiences in pediatric clinical practice in Taiwan: A qualitative study.

BACKGROUND: A pediatric nursing practicum is essential in equipping students with basic knowledge of theory, professional attitudes, and skills for the clinical setting. However, students often face multiple challenges in the practicum due to gaps between theory and practice. PURPOSE: To describe nursing students' first-time experiences in pediatric clinical practice in Taiwan. METHODS: A phenomenological approach with purposive sampling was used. Twenty participants were interviewed individually, in person, within a month of completion of a pediatric nursing practicum. Interviews were semi-structured and digitally recorded. Data analysis followed Colaizzi's methods; epochs (bracketing) focused analysis on students' experiences and maintained objectivity. FINDINGS: Three themes and related subthemes emerged: (a) orienting to the pediatric unit (becoming familiar with common treatments and surroundings in the pediatric unit; recognizing people in the unit); (b) encountering challenges in pediatric and family-centered care (navigating communication between child and families; student nurse-patient relationships: maintaining a good rapport with children and their families; being prepared for quick role changes); (c) translating knowledge into clinical practice thoughtfully (providing desirable and correct responses for children and their families; providing a safe and friendly environment for children and their families). CONCLUSIONS: Student nurses engaged in a variety of care practices necessitated by patients' differing ages, developmental levels, and family needs. Ensuring students' successful completion of the demanding pediatric practicum, including innovative communication, technical skills, and role transitions, is challenging yet achievable. CLINICAL RELEVANCE: Gaining a fuller understanding of nursing students' experiences in the pediatric nursing practicum can assist nursing professionals in preparing students to provide competent care for children and their families.

Effects of simulation-based learning on nursing student competences and clinical performance.

The aims of this study were to explore the effects of simulation-based learning (SBL) on nursing student competences and performance in the clinical setting. A comparison group design was used with data obtained from self-administered questionnaires at the onset and end of the semester. Students' practicum grades were also collected to examine their clinical performance. Four simulated scenarios were added to the course and a Chinese version of the Simulation-Based Learning Evaluation Scale (SBLES) was distributed to the participants. The student practicum evaluation form was used to collect the participants' practicum grades. Data analyses included descriptive statistics, paired t-test, and analysis of covariance (ANCOVA). Positive, significant differences were found in five competences in the test group. In the comparison group, results in the professional knowledge and nursing process subscale showed significant differences, and no significant difference was found in the patient safety, communication, and attitude of reflection subscales. The students in the test group perceived greater competences than those in the comparison group. Finally, no significant findings were found in clinical performance between two groups. The findings showed that SBL is seen as an attractive teaching strategy for students' learning as part of their curriculum and that the effects of SBL on clinical practice need further examination.

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.

Resilience enhancement among student nurses during clinical practices: A participatory action research study.

BACKGROUND: Clinical practice is an essential component of nursing students' preparation for applying theoretical knowledge in a real-life setting. However, students often experience clinical practice as extremely stressful, which may disrupt their clinical performance, impact the quality of patient care they provide as well as their own physical and psychological health, and hinder their continuation into nursing careers. Resilience, understood as the capability to overcome challenges, is critical for these students. PURPOSE: To develop and implement a resilience enhancement (RE)-based project for Taiwanese nursing students during their Last Mile practicum. DESIGN AND METHODS: A participatory action research (PAR) approach was used in which ongoing planning, action, and reflection informed real-time progress. Twenty-eight nursing students in clinical practice participated in the study. A six-workshop RE project was completed over the course of two months. Evaluation methods involved group discussion, individual interviews, and reflective diaries. Content analysis was applied to the data. RESULTS: Through a PAR-based project, participants achieved positive results. Three outcome themes were identified: Increasing self-exploration, Furthering confidence and competency, and Constructing resilience. CONCLUSIONS: The PAR-based RE project helped students to develop resilience by enhancing their nursing knowledge and skills and practicing positive thinking and behavior. CLINICAL RELEVANCE: The findings can be a reference for nursing educators in designing RE programs for students during clinical practice to increase their professional competence and provide psychological supports.

Professional resilience among nurses working in an overcrowded emergency department in Taiwan.

PURPOSE: Professional resilience has become increasingly important for nurses in adverse work environments to reduce the negative results and increase the positive outcomes of stress. This study aimed to explore and understand the experiences of resilience among nurses in an overcrowded emergency department (ED) and increase knowledge about what nurses identified as protective factors, which may be useful for future planning. METHODS: A construction-grounded theory (CGT) approach was adopted. Purposive sampling and snowball technique were employed to recruit 13 participants, which proved sufficient to achieve theoretical saturation. In-depth interviews were conducted and audiotaped. RESULTS: Doubting work value and maintaining optimism were the 2 main themes in the core category of seeing and taking work difficulty and responsibility. Nurses described how their passion for their profession gradually diminished, but they assessed the situation and took responsibility for their jobs. CONCLUSION: This study found that nurses retain their compassion, which sustains them in their work. The issue of ED overcrowding led to pessimism among nurses. However, work rewards encouraged nurses to adopt a more proactive attitude toward work-related adversity.

Breaking through the dilemma of whether to continue nursing: Newly graduated nurses' experiences of work challenges.

BACKGROUND: Newly graduated nurses (NGNs) often encounter unique work challenges. PURPOSE: To discover Taiwanese NGNs' experiences of work challenges. METHOD: An interpretive qualitative design was chosen. In-depth interviews were completed with 25 NGNs working in clinical settings in Taiwan. Data were analyzed using content analysis. RESULTS: The essential structure of NGNs' experiences of work challenges was described as struggling and breaking through the dilemma of deciding whether to continue nursing or quit. Four themes with ten subthemes were identified: 1. being tense as if walking on thin ice (fear of making mistakes, uncertainty of decision making for care practice); 2. suffering physical exhaustion and mental stress(work overload and shiftwork, the burden to be expected, unfamiliar work culture); 3. entering and adjusting to the profession (assessing self and deciding whether to stay in nursing, building up competency); and 4. gaining more confidence(problem solving, emotional control, finding an appropriate way for oneself). CONCLUSIONS: Findings indicate the significance of such experiences, and the results are useful for clinical instructors and administration to help NGNs overcome challenges.

Evaluation of Comfort and Confidence of Neonatal Clinicians in Providing Palliative Care.

BACKGROUND: Research found that low levels of professional confidence and personal comfort among neonatal clinicians regarding palliative care may indicate a lack of competence and hesitancy to offer neonatal palliative care services. PURPOSE: This study evaluated the factors associated with the confidence and comfort levels of neonatal clinicians providing neonatal palliative care. METHODS: A cross-sectional survey and questionnaire were used to investigate the confidence and comfort levels of neonatal clinicians regarding neonatal palliative care. RESULTS: Research subjects included 154 neonatal clinicians. Clinicians' confidence in providing neonatal palliative care was significantly impacted by age, marital status, years of professional experience (p < 0.05), and prior palliative care training. Comfort levels were significantly impacted by educational degree, marital status, and years of working experience. Clinicians with a supportive workplace reported increases in both professional confidence (r = 0.286, p < 0.001) and personal comfort (r = 0.521, p < 0.001). CONCLUSION: Research reveals the importance of neonatal palliative education and suggests further development of interdisciplinary neonatal palliative care teams to improve clinicians' professional confidence and personal comfort.

An Interpretative Study on Nurses' Perspectives of Working in an Overcrowded Emergency Department in Taiwan.

PURPOSE: This study aims to gain in-depth understanding of nurses' perspectives of working in an overcrowded emergency. METHODS: Symbolic interactionism and Charmaz's construction of grounded theory were used. Purposive sampling at the start of the study and a further theoretical sampling by snowball technique were used to recruit 40 registered nurses (RN) to participate in in-depth, semi-structured interviews between May and November, 2014. Data analysis included analytic techniques of initial, focused and theoretical coding. RESULTS: Study findings showed searching for work role is derived by the themes of Finding the role of positioning in Emergency Department (ED), Recognizing causes of ED overcrowding, and Confined working environment. Nurses' work experience which represents the RNs not gained control over their work, as care actions influenced by the problematic overcrowded circumstance of the ED environment. CONCLUSION: The findings fill a gap in knowledge about how RNs experience their work role in the context of an overcrowded Emergency Department in Taiwan. Arising from the study result include taking account of nurses' perspectives when planning staff/patient ratios, strategies to reduce waiting time and ensure that clients receive appropriate care.

CO-releasing molecules CORM2 attenuates angiotensin II-induced human aortic smooth muscle cell migration through inhibition of ROS/IL-6 generation and matrix metalloproteinases-9 expression.

Ang II has been involved in the pathogenesis of cardiovascular diseases, and matrix metalloproteinase-9 (MMP-9) induced migration of human aortic smooth muscle cells (HASMCs) is the most common and basic pathological feature. Carbon monoxide (CO), a byproduct of heme breakdown by heme oxygenase, exerts anti-inflammatory effects in various tissues and organ systems. In the present study, we aimed to investigate the effects and underlying mechanisms of carbon monoxide releasing molecule-2 (CORM-2) on Ang II-induced MMP-9 expression and cell migration of HASMCs. Ang II significantly up-regulated MMP-9 expression and cell migration of HASMCs, which was inhibited by transfection with siRNA of p47phox, Nox2, Nox4, p65, angiotensin II type 1 receptor (AT1R) and pretreatment with the inhibitors of NADPH oxidase, ROS, and NF-κB. In addition, Ang II also induced NADPH oxidase/ROS generation and p47phox translocation from the cytosol to the membrane. Moreover, Ang II-induced oxidative stress and MMP-9-dependent cell migration were inhibited by pretreatment with CORM-2. Finally, we observed that Ang II induced IL-6 release in HASMCs via AT1R, but not AT2R, which could further caused MMP-9 secretion and cell migration. Pretreatment with CORM-2 reduced Ang II-induced IL-6 release. In conclusion, CORM-2 inhibits Ang II-induced HASMCs migration through inactivation of suppression of NADPH oxidase/ROS generation, NF-κB inactivation and IL-6/MMP-9 expression. Thus, application of CO, especially CORM-2, is a potential countermeasure to reverse the pathological changes of various cardiovascular diseases. Further effects aimed at identifying novel antioxidant and anti-inflammatory substances protective for heart and blood vessels that targeting CO and establishment of well-designed in vivo models properly evaluating the efficacy of these agents are needed.

[The nursing experience of a primary caregiver providing care to a patient with moderate mental retardation].

This case report shares the researcher's experience and observations with regard to a primary caregiver responsible to provide nursing care to a patient suffering from moderate mental retardation during the time period October 1st, 2003 to July 31st, 2004. The writer collected subjective and objective information using observation, face-to-face interviews, telephone interviews and scales, including the Caregiver Burden Scale and Taiwanese Depression Questionnaire. A holistic nursing assessment established that the primary nursing problem faced was caregiver anxiety. Through continuous caring and empathetic listening, the researcher encouraged the caregiver to describe her perceptions. Nursing intervention included providing information regarding professional patient care and encouraging support of the caregiver from the patient's family. Results demonstrated that, by the end of this study, the primary caregiver was better able to execute her duties and that her anxiety had been significantly relieved.

Factors influencing nurses' attitudes and intentions toward medication administration error reporting.

AIM: The aims of this study were to explore the factors that influence nurses' attitudes and intentions toward medication administration error (MAE) reporting. METHODS: The theory of planned behavior was used as the framework for this study. A cross-sectional design was used, and data were obtained from self-administered questionnaires. A total of 596 staff nurses who worked in a regional hospital for at least 3 months were invited to participate in this study. The researchers used exploratory factor analysis and confirmatory factor analysis to test the psychometric properties of each measurement scale. The 1 week data collection period was between September and November 2013. Descriptive statistics were used to examine the demographic and job characteristics of the participants and multiple linear regression was used to test the hypotheses. RESULTS: Of the 596 nurses invited to participate, 548 (92%) completed and returned a valid questionnaire. The findings indicated that altruism, and nurse managers' and co-workers' attitudes are predictors for nurses' attitudes toward MAE reporting, and nurses' attitudes and co-workers' attitudes affect nurses' intention to report MAE. No connection was found between report control and nurses' intentions toward MAE reporting. CONCLUSION: The findings reflected that altruism, and nurse managers' and co-workers' attitude, and nurses' attitudes toward MAE reporting are predictors of nurses' intentions toward MAE reporting. The authors strongly recommended the healthcare system to institute an open communication and learning culture.

Indonesian caretaker experiences in providing child care to Taiwanese children.

The purpose of this study was to learn about the experiences of Indonesian nannies in caring for Taiwanese children in Taiwan. An ethnography method was adopted, using in-depth interviews with 52 respondents, 20 of whom were Indonesians employed as caretakers for Taiwanese children and 32 of whom were general informants. Twenty-six of the general informants were Indonesian child caretakers, and six were employers. Audio-taping of interview sessions was permitted by all respondents. Transcriptions of the interviews were written up verbatim. Leininger's (1991) Phases of Analysis for qualitative data was adopted to analyze data. Four themes were extracted from the analysis, including "Learning diverse information from the beginning--the employer's family," "Complying with the advice of the child's mother," "Maintaining the child's daily activities and health," and "Awareness of external context influences on child care." The findings indicated that Indonesian child caretakers carry with them the values, beliefs, and lifestyles of their own culture and have their own ingrained ideas regarding how best to provide care for their Taiwanese charges. Health care providers, by better understanding the general experiences of Indonesian caretakers in Taiwan, can apply competent intervention to help caretakers overcome the challenges of working within a different cultural environment. It is hoped that the results of this study can promote cultural competence in childcare within the context of internationalism.