Psychometric evaluation of the traditional chinese version of PedsQL™ 3.0 cardiac module scale in adolescents with congenital heart disease: reliability, validity, measurement invariance, and adolescent-parent agreement.

BACKGROUND: In recent decades, 95% of children with congenital heart disease (CHD) can survive to adolescence and adulthood. However, adolescents with CHD are prone to poorer health-related quality of life (HRQoL). It is imperative to develop a reliable and valid instrument for health professionals to monitor the HRQoL. This study aims to: (1) evaluate the psychometric properties of the traditional Chinese version of Pediatric Quality of Life™ 3.0 Cardiac Module (PedsQL-CM) and measurement invariance across adolescents with CHD and their parents; and (2) investigate the adolescent-parent agreement in HRQoL. METHODS: A total of 162 adolescents and 162 parents were recruited. Internal consistency was examined using Cronbach's alpha and McDonald's Omega. The criterion-related validity was evaluated with intercorrelations between the PedsQL-CM and PedsQL™ 4.0 Generic Core (PedsQL-GC) Scale. The construct validity was examined by second-order confirmatory factor analysis (CFA). Measurement invariance was evaluated using the multi-group CFA. The adolescent-parent agreement was analyzed with the intraclass correlation (ICC), paired t-tests, and Bland-Altman plots. RESULTS: PedsQL-CM showed acceptable internal consistency (self-reports 0.88, proxy-reports 0.91). The intercorrelations were medium to large effect size (self-reports 0.34-0.77, proxy-reports 0.46-0.68). The CFA supported the construct validity (CFI = 0.967, TLI = 0.963, RMSEA = 0.036, 90% CI = 0.026-0.046, SRMR = 0.065). The multi-group CFA proved scalar invariance between self and parent proxy-reports. Parents significantly underestimated their adolescents' HRQoL in cognitive problems (Cohen's d = 0.21) and communication (Cohen's d = 0.23) subscales, while there was a negligible difference in total HRQoL (Cohen's d = 0.16). ICCs were poor to moderate effect size with the highest and lowest agreement in heart problems and treatment subscale (ICC = 0.70) and communication subscale (ICC = 0.27), respectively. The Bland-Altman plots showed lesser variability in the heart problem and treatment subscale and the total scale. CONCLUSION: The traditional Chinese version of PedsQL-CM has acceptable psychometric properties to measure disease-specific HRQoL in adolescents with CHD. Parents may be proxies for adolescents with CHD to rate total HRQoL. When the patient-reported score is the primary outcome, the proxy-reported score could serve as a secondary outcome for research and clinical evaluation.

Maternal Caregiving for Children Newly Diagnosed with Acute Lymphoblastic Leukemia: Traditional Chinese Mothering as the Double-Edged Sword.

AIMS AND OBJECTIVES: To explore the meaning of maternal caregiving in the Chinese culture for children newly diagnosed with acute lymphocytic leukemia (ALL). BACKGROUND: Recurrence of and death associated with ALL remain the main concerns for mothers. Mothers experience guilt and anxiety towards their child's cancer. DESIGN: Descriptive phenomenological study. METHODS: Twelve mothers were recruited from a medical centre in Central Taiwan. The mothers were primary caregivers for their child diagnosed as having ALL in the past 3 months to 1 year. Data were collected through semi-structured interviews and analysed using Colaizzi's method. RESULTS: Four main themes emerged: feeling this world crashing by knowing the diagnosis, feeling the double-edged sword of mothering, worrying about potential risks for their vulnerable child, and passing through difficulties with power of support. CONCLUSIONS: Most mothers felt this world crashing due to potential loss of their child and seeing their child's suffering. The mother was blamed for her child's cancer but was also required to shoulder all caregiving for their child. The mothers needed to compromise their lives to protect their child from potential infection. Perceived power of support helped the mothers overcome difficulties. RELEVANCE TO CLINICAL PRACTICE: Findings support that nurses encouraging mothers to tell their stories, regardless of culture, will facilitate healing. Establishing trust and providing support from nurses, physicians, psychologists and social workers will lead mothers' readiness to deal with care of their sick child. Increasing visiting time for parental support for children hospitalized in the PICU is suggested as well.

[Nurse and Patient Dispute Litigation in Independent Nursing Practice].

BACKGROUND: Although medical dispute and other contentious cases involving patients and nurses have risen significantly in recent years, few studies have examined the litigation issues involved in nurse-patient disputes. PURPOSE: This study was designed to explore the background, categories, and degrees of harm to patients and the judgments made by the courts. METHODS: Qualitative research was used. Cases of criminal, written judgments related to nurse practice negligence and recorded in district courts in Taiwan from 2008 to 2017 were selected. Data were analyzed using content analysis. RESULTS: A total of 41 hospitals and 55 nurses were identified. The largest number of cases involved regional hospitals (36.6%), internal medicine departments (31.7%), general wards (46.3%), night shifts (40.0%), and staff nurses (85.5%). Four categories of independent nurse practice negligence were identified, including observation-evaluation, environmental security, physician notification, and nursing records. Negligent homicide (58.2%) was the most common court judgment and ten nurses (18.2%) were found guilty of the charges brought against them. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study highlight for nurses the content of nurse practice negligence and the related judgments by the courts, which hopefully may guide nurses to avoid practice negligence in the future.

Cross-cultural adaptation and validation of the Chinese Comfort, Afford, Respect, and Expect scale of caring nurse-patient interaction competence.

AIMS AND OBJECTIVES: To investigate the construct validity and reliability of the Chinese Comfort, Afford, Respect, and Expect scale, which can be used to determine clinical nurses' competence. The results can also serve to promote nursing competence and improve patient satisfaction. BACKGROUND: Nurse-patient interaction is critical for improving nursing care quality. However, to date, no relevant validated instrument has been proposed for assessing caring nurse-patient interaction competence in clinical practice. This study adapted and validated the Chinese version of the caring nurse-patient interaction scale. DESIGN: A cross-cultural adaptation and validation study. METHODS: A psychometric analysis of the four major constructs of the Chinese Comfort, Afford, Respect, and Expect scale was conducted on a sample of 356 nurses from a medical centre in China. Item analysis and exploratory factor analysis were adopted to extract the main components, both the internal consistency and correlation coefficients were used to examine reliability and a confirmatory factor analysis was adopted to verify the construct validity. RESULTS: The goodness-of-fit results of the model were strong. The standardised factor loadings of the Chinese Comfort, Afford, Respect, and Expect scale ranged from 0.73-0.95, indicating that the validity and reliability of this instrument were favourable. Moreover, the 12 extracted items explained 95.9% of the measured content of the Chinese Comfort, Afford, Respect, and Expect scale. CONCLUSIONS: The results serve as empirical evidence regarding the validity and reliability of the Chinese Comfort, Afford, Respect, and Expect scale. RELEVANCE TO CLINICAL PRACTICE: Hospital nurses increasingly demand help from patients and their family members in identifying health problems and assisting with medical decision-making. Therefore, enhancing nurses' competence in nurse-patient interactions is crucial for nursing and hospital managers to improve nursing care quality. The Chinese caring nurse-patient interaction scale can serve as an effective tool for nursing and hospital managers to evaluate the caring nurse-patient interaction confidence of nurses and improve inpatient satisfaction and quality of care.

An evaluation of disease knowledge in dyads of parents and their adolescent children with congenital heart disease.

BACKGROUND: Congenital heart disease (CGHD) can be considered a chronic disease for many patients. To adopt a healthy lifestyle and to avoid complications, patients with CGHD and their parents need to have good knowledge of the heart defect and its consequences. OBJECTIVE: The aims of this study were to evaluate patient and parental knowledge of CGHD and to explore the related factors of their respective disease knowledge. METHODS: This study included 116 dyads of adolescents with CGHD (43.1% male adolescents; aged 12-18 years) and one of their parents (79.3% mothers; median age, 46 years). All participants completed the Leuven Knowledge Questionnaire for Congenital Heart Disease, and then we calculated a correct rate score to determine the overall disease knowledge of the respondents. RESULTS: The correct rate score was 38.8% for adolescents with CGHD and 51.4% for parents (t = 7.69; P < .001). The only determinant of knowledge in parents was their educational level (standardized estimate = 6.160, P < .001). In adolescents, knowledge was determined by age (standardized estimate = 2.242, P = .002) and parental knowledge (standardized estimate = 0.311, P < .001). CONCLUSIONS: Although parents have significantly greater disease knowledge than their children do, the level of knowledge in both parents and adolescents is suboptimal. Because parents' knowledge influenced their adolescents' knowledge, educational interventions should target both adolescent patients and parents. Transition programs can play a pivotal role in this respect.

Maternal-foetal attachment during early pregnancy in Taiwanese women pregnant by in vitro fertilization.

AIM: The aim of this study was to investigate maternal-foetal attachment at 9, 12 and 20 weeks gestation and to identify factors that influenced maternal-foetal attachment in Taiwanese women who conceived by in vitro fertilization. BACKGROUND: Development of maternal-foetal attachment is an important part of taking on the maternal role. However, evidence about maternal-foetal attachment after assisted conception is inconclusive. DESIGN: A longitudinal design with repeated measures. METHODS: A prospective, longitudinal design with repeated measures was used. Over an 18-month period in 2006-2008, a convenience sample of 160 women who conceived after undergoing successful in vitro fertilization were recruited from a major infertility care centre in Taiwan. Data were collected by self-reported measures, including: (1) Maternal-Foetal Attachment Scale; (2) Symptoms Checklist; (3) Pregnancy-related Anxiety Scale; (4) Social Support Apgar; (5) Chinese childbearing attitude Questionnaire; and (6) Awareness of Foetus Scale. The selected instruments to measure each variable were administered to participants at 9, 12 and 20 weeks gestation. RESULTS: Maternal-foetal attachment increased as pregnancy progressed from 9 to 20 weeks gestation. General linear mixed model showed predictors of maternal-foetal attachment included Chinese childbearing attitude, awareness of the foetus, and social support. CONCLUSION: Health provider awareness of cultural influences on the development of early maternal-foetal attachment of women pregnant by in vitro fertilization is needed. Prenatal education in early pregnancy might incorporate more information about foetal development to allow the mother to visualize her unborn child. Providing social support for women who were conceived by in vitro fertilization is beneficial to the development of maternal-foetal attachment.

Exercise behavior in adolescents with mild congenital heart disease.

BACKGROUND AND RESEARCH OBJECTIVES: Most children with congenital heart disease (CHD) are expected to survive to adolescence and adulthood owing to medical advances and care management. These adolescents need to be well informed about their exercise capacity and take greater personal responsibility for their exercise behavior as they mature. The aims of this study were to compare the amount and intensity of exercise engaged in by male and female adolescents with mild CHD while on summer vacation and during the academic semester and to determine the extent to which their exercise behavior met cardiologists' recommendations, based on New York Heart Association functional classification. PARTICIPANTS AND METHODS: A repeated-measure design was used to evaluate exercise behavior in 126 adolescents 12 to 18 years old with mild CHD from the outpatient cardiology departments of 3 medical centers in Taiwan. Exercise, classified as mild, moderate, or vigorous, was evaluated during summer vacation and during the fall semester using a 7-day self-reported exercise log. RESULTS AND CONCLUSIONS: Patients engaged in significantly more mild and total exercise during summer vacation than they did during the fall semester. They also engaged in significantly less vigorous exercise during summer vacation than they did in the fall semester. Female respondents engaged in significantly less moderate (P = .019), vigorous (P < .001), and total (P = .015) exercise than did their male counterparts but showed no difference in mild exercise. During the summer and fall, nearly 50% of the adolescents followed their cardiologist's recommendations for exercise. Adolescents with mild CHD engaged in more exercise during summer vacation but engaged in more vigorous exercise during the fall semester. Approximately one half did not follow the exercise intensity recommended by cardiologists. Inadequate exercise patterns may lead to cardiovascular complications. Planned interventions related to exercise instruction are needed for adolescents with CHD.

Effects of maternal confidence and competence on maternal parenting stress in newborn care.

AIM: This paper is a report of a correlational study of the relations of maternal confidence and maternal competence to maternal parenting stress during newborn care. BACKGROUND: Maternal role development is a cognitive and social process influenced by cultural and family contexts and mother and child characteristics. Most knowledge about maternal role development comes from western society. However, perceptions of the maternal role in contemporary Taiwanese society may be affected by contextual and environmental factors. METHODS: A prospective correlational design was used to recruit 372 postpartum Taiwanese women and their infants from well-child clinics at 16 health centres in central Taiwan. Inclusion criteria for mothers were gestational age >37 weeks, ≥18 years old, and healthy, with infants <4 months old. Data were collected between August 2007 and January 2008 using a self-report questionnaire on mothers' and infants' demographic variables, maternal confidence, maternal competence and self-perceived maternal parenting stress. RESULTS: After controlling for maternal parity and infant temperament, high maternal confidence and competence were associated with low maternal parenting stress. Maternal confidence influenced maternal parenting stress both directly and indirectly via maternal competence. CONCLUSION: To assist postpartum women in infant care programmes achieve positive outcomes, nurses should evaluate and bolster mothers' belief in their own abilities. Likewise, nurses should not only consider mothers' infant care skills, but also mothers' parity and infant temperament. Finally, it is crucial for nurses and researchers to recognize that infant care programmes should be tailored to mothers' specific maternal characteristics.

Knowledge of using acetaminophen syrup and comprehension of written medication instruction among caregivers with febrile children.

AIM: This article aims to explore caregivers' knowledge of acetaminophen and comprehension of written medication instructions about acetaminophen syrup when administered to febrile children. BACKGROUND: Fever is one of the most common problems about which primary caregivers seek medical advice for their children. Administration of acetaminophen is the most common form of treatment for febrile children. Medication safety is of the upmost importance for medication administration in this patient group. DESIGN: A cross-sectional study design was used. METHODS: The study included 102 caregivers with febrile children under six years old. A self-designed questionnaire was used to solicit participants' responses concerning: (1) approaches to fever management prior to hospital admission; and (2) knowledge and comprehension of antipyretic medication administration. Caregivers were asked to answer specific questions about the instructions provided with the medication. Results. Antipyretic by oral (66%) and antipyretic suppository (60%) were the most commonly used forms of fever management in febrile children. After reading the written medication instructions, one-third of the participants had more than one misunderstanding of the instructions for medication with timing, time interval of administration and/or medication dosage. Almost two-thirds of the participants misunderstood the side effects of acetaminophen. Participants with a poorer academic background were associated with poorer comprehension of the provided instructions. CONCLUSION: Administration of antipyretic medication is the most common approach taken to reduce children's temperature. A significant percentage of primary caregivers appear to lack a thorough understanding of the instructions provided with antipyrexial medication. RELEVANCE TO CLINICAL PRACTICE: Written medication instruction is a major source of information for primary caregivers. Clinical nurses have a potentially important role to play to provide caregivers with legible and understandable medication instructions and to ensure that caregivers fully comprehend this information.

R1 version, self-concept in Taiwanese adolescents with congenital heart disease.

BACKGROUND: The objectives of this study were to evaluate and compare differences in self-concept between male and female adolescents with congenital heart disease, and to compare the self-concepts of these adolescents to that of the general adolescent population using normative data. METHODS: A total of 300 adolescents, 143 male and 157 female, from two medical centers in Taiwan completed the Tennessee Self-Concept Scales and the scores of male and female subjects were compared. The scores of adolescents with congenital heart disease were also compared with normative data of healthy Taiwanese adolescents. RESULTS: Girls with congenital heart disease showed significantly lower mean scores in Physical Self, Social Self, Personal Self, Academic Self and Overall Self domains on the Tennessee Self-Concept Scales when compared to boys with congenital heart disease. When compared to the average value of normative data, adolescent boys with congenital heart disease had significantly higher mean T-scores on Physical Self, Family Self, Social Self, Personal Self, Academic Self and Overall Self, and adolescent girls had significantly higher mean T-scores in Moral-ethical Self, Social Self, Personal Self, Academic Self and Overall Self domains. There were weak negative correlations between severity of congenital heart disease and Physical Self T-scores, and between the number of heart operations and Academic T-scores. CONCLUSIONS: Self-concept in adolescents with congenital heart disease is similar to or even higher than that of their normal counterparts. More holistic views of adolescents with congenital heart disease, including their self-concept, appear warranted, especially for adolescent girls with congenital heart disease.

From limitation to mastery: exercise experience for adolescents with mild congenital heart disease.

AIM: To describe the subjective experience of engaging in exercise for adolescents with mild congenital heart disease (CHD). BACKGROUND: Most children with mild CHD are now expected to survive to adolescence and even into adulthood. With early intervention, cardiopulmonary function and exercise capacity in most are comparable to those of normal peers. However, the exercise behaviours of these adolescent patients and their determinants remain largely undefined. DESIGN: A descriptive phenomenological design was used. METHODS: Eight adolescents with CHD who perceived no or only mild symptoms after engaging in exercise were individually interviewed using a semi-structured interview. Interviews were transcribed and non-verbal communication recorded within 24 hours of the interview. Transcriptions were analysed and perceptions and attitudes grouped according to theme expressed. FINDINGS: The essence of the adolescents with mild CHD engaging in exercise was from limitation to mastery. Four themes emerged: (1) self-awareness: understanding the limitations of their disease and its impact on exercise; (2) perception: focusing on strengths and admitting limitations; (3) transcendence: developing coping strategies and maintaining balance; and (4) living with the disease: mastering oneself and living a normal life. CONCLUSIONS: The findings indicated that, when adolescents faced and accepted their exercise limitation, they would assess their condition, develop coping strategies from their accumulated experience and participate in exercise to maintain a healthy body and mind. RELEVANCE TO CLINICAL PRACTICE: The findings provide a scientific knowledge base for nursing professionals to instruct adolescents with mild CHD in exercise and help families build the confidence of these adolescents.

Development and Validation of Nurses' Well-Being and Caring Nurse-Patient Interaction Model: A Psychometric Study.

Nurses' care nurse-patient interaction (CNPI) competence is critical for improving nursing care quality. The focus is the psychological quality of nurses, which may be derived from their sense of well-being. The purpose of this study was to develop a conceptual model of nurses' well-being and their CNPI competence. A cross-sectional survey was conducted with a total of 212 valid questionnaires obtained from a medical center. Structural equation modeling analysis was performed to validate the conceptual model. The results demonstrated the positive correlation between two constructs of nurses' well-being ("contentment" and "joyfulness") and CNPI competence. A positive correlation between nurses' CNPI competence and their health-promoting lifestyle and work environment satisfaction was supported. Among the constructs of CNPI competence, "respect patients' life experience" was the most correlated with their well-being, health-promoting lifestyle, and work environment satisfaction. The constructs of these three scales, which showed a middle correlation with CNPI competence, are psychological constructs rather than material constructs. When nurses have a greater sense of well-being, a positive attitude towards life, and feel supported and respected in their work environment, their CNPI competence increases. The findings of this study provide important insights and can serve as empirical evidence for nursing managers to enhance nurses' CNPI competence.

Lived experience of epilepsy from the perspective of children in Taiwan.

AIMS: The purpose of this study was to explore the lived experiences of school-aged children with epilepsy in Taiwan. BACKGROUND: Epilepsy affects many people worldwide, especially school-aged children, but few studies have examined children's viewpoints of their experiences with epilepsy. DESIGN: An exploratory, phenomenological interview design was used. METHODS: Children (ages 7-12 years) with well-controlled epilepsy and no developmental delay were recruited from a hospital in central Taiwan. Data were collected from 15 children using a semi-structured interview guide. Interviews were tape-recorded with permission from parents and children. Verbatim transcripts were analysed using Colazzi's phenomenological method. RESULTS: Two themes emerged from the analysis. The first theme, 'living with epilepsy', had two subthemes: disease-related experiences and school-related issues. The second theme, 'coping with epilepsy', had two subthemes: developing strategies to manage or reduce seizures and seeking support from family members. CONCLUSIONS: Taiwanese children with epilepsy had similar lived experiences as their counterparts in Western culture, e.g. unpleasant somatic symptoms, difficulty learning and troubled peer relationships. Taiwanese children also coped similarly with epilepsy by taking medications to control seizures, but they differed from their Western counterparts in trying to self-manage seizures and seeking support from family members. RELEVANCE TO CLINICAL PRACTICE: Public health and school nurses can apply our findings to educate school teachers and parents about epilepsy and encourage activities that allow children with and without epilepsy to interact, thus improving peer relationships and reducing stigmatisation. Children with and without epilepsy would also benefit from an age-appropriate education manual that includes causes of epilepsy, treatment, dealing with seizures and psychological and social adaptation.

Clinical applicability of the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) to mothers of children with asthma in Taiwan.

AIMS: This study examined the clinical applicability of the World Health Organization Quality of Life Scale brief version (WHOQOL-BREF) to mothers of children with asthma in Taiwan. BACKGROUND: The WHOQOL-BREF scale has been culturally adapted for Taiwan and applied to a variety of ill and healthy subjects in hospitals and the community and to the general population in the 2001 National Health Interview Survey in Taiwan. Its application to explore the QOL of mothers of children with asthma in Taiwan allows future cross-population comparisons. DESIGN: A cross-sectional survey. METHODS: Internal consistency, test-retest reliability; content validity, criterion-related validity and discriminant validity were assessed. A total of 229 mothers participated in the study. RESULTS: The WHOQOL-BREF showed acceptable psychometric properties. Internal consistency of 0.63-0.84, content validity r = 0.39-0.65 (p < 0.01) and criterion-related validity r = 0.28-0.65 (p < 0.05) were reported. Discriminant validity was also found, especially in the domain of physical health. Issues of QOL for mothers, especially in the realm of physical health need more support and attention from health professionals. CONCLUSIONS: This study supports the clinical applicability of the WHOQOL-BREF scale as a measure of QOL of mothers of children with asthma. Future studies to compare the QOL measured by WHOQOL-BREF in female caregivers of children with other chronic health conditions are suggested. RELEVANCE TO CLINICAL PRACTICE: Our findings show that mothers are hardly ever free from the strains of the daily-care of an asthmatic and bear the uncertainties for the unending illness. The health care team is responsible for providing collaborative care approaches in hospital, home and school health care settings for children with asthma and their mothers.

Nurses' Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction Correlation: A Psychometric Study for Development of Nursing Health and Job Satisfaction Model and Scale.

Although promoting healthy work environments to enhance staff members' health and well-being is a growing trend, no empirical studies on such a model have been conducted in the nursing management field. The purpose of this study was to develop and validate measurement scales and a conceptual model of nurses' well-being, health-promoting lifestyle, and work environment satisfaction (WHS). A cross-sectional survey was conducted to develop a WHS model and Nursing Health and Job Satisfaction (NHJS) scale. A total of 672 questionnaires were obtained from registered nurses by stratified random sampling for validation analysis. The percentage of total variance explained greater than 92.6%, suggesting a good ability of the scales to explain the variability in participants' responses. The hypotheses of positive correlations among nurses' health-promoting lifestyle, well-being, and work environment satisfaction were supported. The WHS model demonstrates the positive correlation with correlation coefficients of 0.57-0.86 among nurses' health-promoting lifestyle, well-being, and work environment satisfaction. Nurses' attitudes play a key role in promoting a healthy lifestyle. The most important work environment satisfaction variable for improved sense of well-being is respect from other medical staff. The findings can serve as an instrument for hospital nursing administrators to accurately assess and enhance nurses' retention rate and health.

Menstrual and menarche experience among pubescent female students in Taiwan: implications for health education and promotion practice.

AIMS AND OBJECTIVES: This study aimed to explore the menarche and menstruation experiences of young females aged 10-12 years in elementary education in Taiwan. BACKGROUND: Menarche is a significant milestone in a woman's life and for female adolescents it is a sharply defined biological event that can be a traumatic and uncomfortable time. If used, school nurses can make a significant contribution in educating young people and help to ameliorate these problems. Understanding how young women feel about menstruation is a central element to sexual health education practice. DESIGN: A qualitative research design was employed using focus groups. METHODS: Data were collected from 20 female students, aged between 10-12 years. Focus groups were recorded, transcribed and subject to a thematic analysis. RESULTS: Three themes emerged from the data analysis reflecting the menstrual experience of participants. These were: 'Changing bodies: the physical effects of menarche and menstruation', 'Emotional issues: the psychological impact of menarche and menstruation' and 'Social dimensions of the menarche and menstruation'. CONCLUSION: Our findings show that young females can experience significant physical and emotional difficulties around menstruation - many of which stem from poor information and the reactions of their peer group to menstrual activity. The potential for school nurses to contribute to this education is significant and schools should explore the manner in which nurses can contribute to this area of health education. RELEVANCE TO CLINICAL PRACTICE: Nurses involved in health education work with young people and ensure that menstruation education addresses the social and psychological impact of the menarche as well as the physical elements of menstruation. Boys should not be absent from this education and the impact of their attitudes towards menstruation upon their female peers should be addressed in health education work.

Study of menstrual attitudes and distress among postmenarcheal female students in Hualien County.

The purposes of this study were to assess menstrual attitudes and menstrual distress and investigate factors associated with menstrual distress among postmenarcheal female elementary students. A total of 129 female students from 12 elementary schools in Taiwan's Hualien County participated in this study. A stratified cluster random sampling method was adopted. The questionnaire used consisted of three sections asking questions regarding the individual's menstrual characteristics, menstrual attitudes, and menstrual distress. Study results showed that most respondents experienced menstrual blood seepage during the daytime and awakened at night during their periods due to worries about menstrual blood seepage. This study found that indigenous students had significantly more frequent episodes of menstrual blood seepage during the daytime and awakened at night during period than did nonindigenous students. The mean score on the Menstrual Attitude Questionnaire was 1.88 (SD = 0.36, possible score = 1-4). The three most prevalent symptoms of menstrual distress were dysmenorrhea, acne, and fatigue. The mean score on the Menstrual Distress Questionnaire was 1.00 (SD = 0.76; possible score = 0-4). Moreover, there was a significantly negative correlation between menstrual attitudes and menstrual distress and significantly positive correlations between menstrual distress and (a) time since menarche, (b) menstrual blood seepage during the daytime, and (c) menstrual blood seepage while sleeping. Study results recommend that families and elementary schools help postmenarcheal female elementary students to accept menstruation as a natural process.

Trend analysis of nursing intervention studies published by Taiwan nurses association between 1954 and 2006.

This study reviewed historical nursing intervention studies in Taiwan and analyzed results based on sample characteristics, methodology characteristics, and content characteristics. Historical studies were split into four groups, G1970, G1980, G1990, and G2000, based on the decade in which they were published. A comparison was then made to identify significant differences between G2000 and other groups. A total of 103 nursing intervention studies were analyzed in this study. Results included sample characteristics of studies conducted primarily by single-disciplinary research teams, although multidisciplinary studies showed a growth trend across decades, with the number of multidisciplinary studies significantly greater in G2000 than in other decades. Nursing practice was the main area of research, clients were the major participants studied, and hospitals provided the principal research setting. No statistical difference was noted in the above mentioned variables. In terms of methodology characteristics, questionnaires were used most frequently to collect data. A quasi-experimental design was the primary research design employed. Although the number of experimental designs has increased significantly in recent years, most studies specified their inclusion criteria. Reliability and validity of instruments were more clearly specified in recent decade groups than in earlier decade groups. Methodology rigor has improved in recent years, achieving a statistically significant difference between G2000 and other groups in all categories, with the exception of instrument validity. In terms of content characteristics, health education was the leading intervention type. Most interventions were categorized as tertiary prevention, with perceptual outcome used most often as the outcome indicator. However, no statistical differences in content dimension variables were identified between G2000 and other groups. In summary, the number of nursing intervention research cases has risen, and research methodology rigor has improved in recent decades. However, no statistically significant differences in sample characteristics and content characteristics between the most recent and earlier decade groups were found. Suggestions for future domestic nursing intervention studies based on study findings are made at the conclusion of this article.

[Concept analysis of health literacy].

Health literacy has risen to become one of the dominant issues in Taiwan's healthcare system today. Level of health literacy impacts upon public health outcomes. Nevertheless, healthcare professionals in Taiwan remain largely unfamiliar with the concept and importance of health literacy. This paper employs concept analysis as described by Walker & Avant to introduce and analyze the attributes, antecedents and consequences of health literacy. Defining attributes of health literacy include: 1. enabling an individual to function successfully in a healthcare context; 2. facilitating the obtaining, comprehending, communicating and evaluating of health information to make appropriate health decisions and conduct positive health practices; and 3. achieving a good health status. The antecedent of health literacy is literacy. Consequences of health literacy include differences in health outcomes such as health knowledge, use of healthcare services and health status. Hopefully, through concept analysis, findings can help promote nursing clinical practice and related research quality.

Games of lives in surviving childhood brain tumors.

The purpose of this phenomenological study was to describe the commonality of the lived experience of adolescent and young adult survivors (AYAS) of brain tumors in Taiwan from a sociocultural perspective. Seven AYAS aged 13 to 22 years, who had survived 5 to 10 years from the time of diagnosis, participated in this study. In consideration of their emotional duress, each participant was interviewed only once. The data revealed an essential structure: the game of life. The essential structure included six themes as follows: (a) no longer playing well, (b) wandering on the outer edges of social life, (c) helplessly struggling with role obligations, (d) rationally regulating the meaning of surviving, (e) winning a new social face, and (f) mastering the game of life. The findings suggest how nurses might help AYAS to succeed in psychosocial adjustment.