The public's perception of the nursing profession: Validity and reliability of the Chinese version of the nursing image scale in Taiwan.

The public's perception of the nursing image deeply influences nurses' work and professional development. However, the Taiwanese public's perception of nursing remains unclear. This study aimed to determine the validity and reliability of a Chinese version of the Nursing Image Scale (NIS) in Taiwan. This was a psychometric study using a cross-sectional survey. Participants were recruited via the snowball sampling method through the online community software LINE from August 1 to 13, 2019. After data collection, the construction and validation of the NIS to measure public opinion were assessed, including content validity, corrected item-total correlation, exploratory factor analysis (EFA), and reliability. A total of 1331 valid responses were included in the analysis. After EFA analysis, the 20 scale items were divided across the four domains of prudence and care, innovation and cooperation, efficiency and division, and professionalism and respect. The NIS (Chinese version) was valid and reliable for measuring public opinion and may be used to examine changes in public perceptions of nursing.

Peer Victimization Trajectory and Psychosocial Maladjustment in Early Taiwanese Adolescents: A Longitudinal Study.

This study examined the peer victimization trajectory and maladjustment outcomes among early Taiwanese adolescents. Data were extracted from a large-scale longitudinal study with a national representative sample. A total of 1691 school students in 4th, 6th, and 8th grade were analyzed. Using latent profile analysis, students were classified into four trajectories, chronic victims, late onset victims, desisters, and non-victims, based on their self-reported physical and verbal victimization at three time points. Maladjustment, including psychological distress, reduced school attachment, internet addiction, and suicidal ideation in 8th grade, were assessed. The results showed significant differences in adjustment among students in the four trajectories. Chronic victims had the poorest outcomes on most variables, followed by late onset victims and desisters, while non-victims had the least maladjustment. The findings highlight the need for future interventions that would consider students' victim status over time and pay particular attention to those who suffer constant bullying and abuse.

Appraisal and evaluation of the instruments measuring the nursing work environment: A systematic review.

AIMS: To appraise the current instruments available for measuring the nursing work environment and re-examine the definition and construct of the nursing work environment. BACKGROUND: A psychometrically sound instrument is fundamental to understanding and improving the nursing work environment. The nursing work environment is a complex construct, and its definition remains inconclusive. None of the instruments available is considered as the gold standard. EVALUATION: A comprehensive searching was undertaken in August 2021 in six databases according to PRISMA. The COSMIN and modified GRADE were applied to assess the methodological quality and measurement properties of the instruments. Instruments were categorized into three levels. The definition and construct of nursing work environment were revisited. KEY ISSUES: Forty-one studies (19 instruments) were included. One, fourteen, and four instruments are respectively appraised as A-, B- and C-level recommendation. Definition and eight labels of nursing work environment are identified. CONCLUSION: This paper provides recommendations for selecting a proper instrument for the nursing work environment. IMPLICATIONS FOR NURSING MANAGEMENT: This study helps nurse managers to select instruments and understand the construct of the nursing work environment. The eight labels can be used as a reference for tailoring policy aimed at creating a favourable nursing work environment.

The impacts of maternal childhood adversity, stress, and mental health on child development at 6 months in Taiwan: A follow-up study.

Exposure to adverse childhood experiences (ACEs) is not only associated with one's adverse health outcomes in adulthood but also increases the risk of child developmental problems in offspring. However, the mechanisms involved in the transmission of the effects of maternal ACEs to the offspring largely remain unexplored. This study sought to identify possible psychosocial pathways of intergenerational effects of maternal ACEs on child development at 6 months. Data from a longitudinal study on maternal childhood adversity and maternal psychosocial risk during pregnancy as well as maternal mental health problems and child development at 6 months postnatal were used. Structural equation modeling with bootstrapping was used to estimate the indirect effects of maternal ACEs on child development at 6 months. The model showed that maternal ACEs indirectly influenced offspring's development via maternal stressful events during pregnancy and pre- and postnatal mental health problems. This finding highlights the possible interventions at the prenatal and postnatal periods. Early identification of women who have ACEs or who are at psychosocial risk during pre- and postnatal periods is critical to provide interventions to buffer those negative effects on offspring's development. Future studies are needed to longitudinally assess the effects of maternal ACEs on child development over time.

Incidence and characteristics of paediatric abusive head trauma in Taiwan, 2006-2015: a nationwide population-based study.

OBJECTIVES: To examine the incidence rate and characteristics of paediatric abusive head trauma (PAHT) among children under age 5 years in Taiwan. METHODS: The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was used to identify broad and narrow definitions of children aged under 5 years with PAHT from 2006 to 2015 in Taiwan using a representative national insurance research database. Medical resource utilisation was also analysed. Incidence rates per 100 000 person-years were calculated and presented with 95% CI. Joinpoint regression analysis was used to detect the changes in trends and calculate the annual percentage change in PAHT incidence over time. RESULTS: From 2006 to 2015, 479 (narrow definition) and 538 (broad definition) PAHT cases were identified. Incidence rates of PAHT by narrow and broad definitions among children under 1 year of age (18.7/100 000 and 20.0/100 000) were nearly 10-fold or 20-fold higher than for children aged 1-2 (1.7/100 000 and 2.1/100 000) and 3-5 (0.9/100 000 and 1.2/100 000) years. The PAHT incidence significantly increased since 2012, with trends varying by age and gender. Our results suggest that over 40% of the children with PAHT experienced serious injury and nearly 13% were fatal cases. For 87% (n=57) of fatal cases, this was their first ever hospitalisation. The number of fatal cases among infants was fourfold higher than that of children aged 1-5 years. CONCLUSIONS: This study provides a robust national estimate of PAHT and identifies infants as the most vulnerable group for PAHT in Taiwan. Education to enhance healthcare profession's sensitivity and competence for the early identification and diagnosis of PAHT is critical.

From childhood victimization to internalizing and externalizing behavior problems through self-esteem in adolescence.

In this study, we aimed to determine whether forms of victimization influence internalizing and externalizing behavior problems differently and whether these relationships are mediated by self-esteem. This study included 2321 Taiwanese adolescents aged 11-21 from a previous case-control study. Six forms of victimization, self-esteem, and seven behaviors were measured. Gender, age, group (justice-involved vs. high-school adolescents), and family dysfunction were covariates in generalized linear models and path analysis. Different forms of childhood victimization were associated with different internalizing and externalizing behavior problems. Additionally, psychological abuse and psychological neglect were negatively associated with self-esteem, which itself was associated with all internalizing and externalizing behavior problems. Significant indirect effects of psychological abuse and psychological neglect on all internalizing and externalizing behavior problems (mediated by self-esteem) were also identified. Due to the limitation of measurement, the interpretation about the influence of victimization patterns could not be made. Findings suggest that different forms of childhood victimization may lead to different mechanisms for internalizing and externalizing behavior problems in adolescents. Further research is needed to identify the mechanisms underlying different forms of childhood victimization and to clarify the effects of victimization patterns to develop effective interventions.

[Implementation of Trauma-Informed Healthcare].

Trauma that is rooted in extremely stressful events is an important factor affecting human health. Patients who have experienced trauma may present in a variety of different ways in healthcare settings. One of these ways is the exhibiting of strong emotional or behavioral reactions triggered by traumatic memories. Caring for patients affected by known or unknown trauma is a significant challenge for healthcare providers. The core of trauma-informed care includes understanding trauma; respecting, empathizing and responding to the needs and reactions of patients with trauma; and providing care in a manner that prevents re-traumatization. In this article, the impact of trauma on overall health is introduced followed by a presentation of trauma triggers in the healthcare context, underscoring the importance of prioritizing care for patients with a history of trauma. Lastly, the concept and principles of trauma-informed care are incorporated into healthcare practice, providing specific, practical application strategies for healthcare providers to use in clinical settings. Trauma-informed healthcare practice relies on healthcare providers and organizations working together. The principles include the self-awareness and self-care of healthcare providers, awareness of the patient's trauma reaction, ensuring patient safety, building trust and transparency in care, working collaboratively with the patient and the healthcare team, and providing choices and empowerment during the care process. This article provides a reference to healthcare providers for providing friendly and high-quality care to patients with trauma.

[The Ethical Issues in Research on Child Abuse].

Child abuse is a sensitive research topic. Improving the health of the victims of abuse through research, rights protection, and preemption of harm are important and debatable ethical issues. The ethical considerations related to research into child abuse cover two dimensions: 1) using children as subjects and 2) concerns regarding the physical and mental health of children who are targeted by related research. This paper focuses on several common ethical issues in the field of child abuse research, starting from the formulation of the research problem, sampling, data collection, and results reporting. Ethical issues include obtaining informed consent, assuring the autonomy of maltreated children and adults with childhood abuse histories, ensuring a sense of control and safety during data collection, and establishing the role of researchers as mandated reporters. As a researcher, rigorous research design and methodology and self-preparation on the issue of childhood trauma and abuse are essential in order to reduce the risk of harm to victims. This paper is intended to provide suggestions for researchers and institutional review board committees to assess the ethics of conducting research on sensitive issues.

[Facing Children Suffering From Physical Abuse: The Decision-Making Process of Non-Abusing Caregivers].

BACKGROUND: Physical abuse is the most common type of child maltreatment reported in Taiwan. The action of non-abusing caregivers is key to ending this maltreatment and to preventing future victimization in the home. PURPOSE: The purpose of this study was to explore the decision-making process used by non-abusing caregivers to take action after finding that children under their care were being physically abused at home. METHODS: A qualitative descriptive approach was adopted and purposive, snowball sampling was used to recruit 11 non-abusing caregivers of children less than 18 years of age who were experiencing physical abuse at home. Data were collected using semi-structured, in-depth interviews. Data analysis was performed using a constant comparison method that was based on grounded theory principles and techniques. RESULTS: The participants adopted a process that shifted over time from passive observation to active participation in dealing with children under their care being physically abused at home. The three main categories and five subcategories in this process are (1) inaction (shirking parental responsibility and rationalizing spouse's use of corporal punishment); (2) obscure action (family harmony first; strategic solutions); and (3) action (bottom line for asking for help). In this study, the decision-making process was influenced by personal, family, and sociocultural factors. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The decision of the non-abusing caregivers in this study whether or not to take action was influenced by situational factors, which led to various consequences for their children. Non-abusing caregivers should be provided with coping strategies and resources to help them make decisions that protect the best interests of the physically abused child.

[The Process of Healing Child Physical Abuse: Sprouting and Twining].

BACKGROUND: Child physical abuse impacts the physical and psychological health of survivors. Healing child abuse is an essential process that helps survivors reorganize the meaning of the trauma and pursue a normal life. Considering the trauma of child physical abuse within the social context allows the experiences of individual survivors to be reflected in their process of healing. PURPOSE: To explore the social interaction and construction process of healing experienced by survivors of child physical abuse. METHODS: A qualitative research design using grounded theory was applied. Purposive and theoretical sampling was used to recruit survivors of childhood physical abuse who had experienced healing. Semi-structured, in-depth interviews were used and data were analyzed using open, axial, and selective coding. RESULTS: The process of healing child physical abuse in this study was a process of sprouting and twining. Three core categories emerged: thriving, relationships, and ethics. The healing process was analogous to a seed growing in poor soil, sprouting out from the ground, and striving to live by seeking support. The survivors constantly established interactive relationships with their selves and with others and struggled to keep family bonds grounded and growing within the frame of ethics. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The healing process of sprouting and twining for child physical abuse survivors in Taiwan integrates thriving, relationships, and ethics. Professionals working with child-physical-abuse survivors must recognize conflicts in ethics. Strategies should be developed to assist survivors to cope with the impact of childhood trauma in order to facilitate the healing process.

Physical Conditions and Special Needs as Risk Factors of Peer Victimization Among School Children in Taiwan.

Students with physical symptoms and diseases may be at an increased risk of peer victimization. This study examined the associations of several medical conditions (obesity, asthma, allergy, epilepsy, and diabetes) with experience of physical, verbal, and relational victimization among children. A sample of 6,233 fourth-grade students from 314 elementary schools in Taiwan was recruited for the analysis. The mean age of the sample was 10.5, with an even distribution of gender (50.3% male and 49.7% female). Children with asthma, allergy, and epilepsy reported higher frequencies of peer victimization. Those who took daily medications or received treatment were also at a higher risk of being victimized. Diabetes and obesity were not found to be associated with peer victimization. The findings highlighted that children with physical conditions suffer maltreatment from peers. Sensitivity training should be provided to school health professionals, so they can evaluate the risk of victimization among students with special needs during assessment.

The Chinese family-centered care survey for adult intensive care unit: A psychometric study.

AIMS: This study aimed to develop a family-centered care survey for Chinese adult intensive care units and to establish the survey's psychometric properties. BACKGROUND: Family-centered care (FCC) is widely recognized as an ideal model of care. Few studies have explored FCC perceptions among family members of adult critical care patients in Asian countries, and no Chinese FCC measurement has been developed. METHODS: An English version of the 3-factor family-centered care survey for adult intensive care units (FCCS-AICU) was translated into Chinese using a modified back translation procedure. Based on the literature review, two additional concepts, information and empowerment, were added to the Chinese FCCS-AICU. The psychometric properties of the Chinese FCCS-AICU were determined with 249 family members from a medical center in Taiwan and were tested for construct and convergent validity, and internal consistency. RESULTS: Both the monolingual and bilingual equivalence tests of the English and Chinese versions of the 3-factor FCCS-AICU were supported. Exploratory factor analysis supported the 5-factor structure of the Chinese FCCS-AICU with a total explained variance of 58.34%. The Chinese FCCS-AICU was correlated with the Chinese Critical Care Family Needs Inventory. Internal consistency, determined by Cronbach's α, for the overall scale was .94. CONCLUSIONS: The Chinese FCCS-AICU is a valid and reliable tool for measuring perceptions of FCC by family members of adult intensive care patients within Chinese-speaking communities.

Clinical competency in child maltreatment for community nurses in Taiwan.

The purpose of this cross-sectional study was to examine aspects of competency in child abuse among community nurses in Taiwan. A sample of 650 community nurses were recruited from public health centres (PHC) and outpatient clinics in Southern Taiwan. A structured questionnaire with five subscales, knowledge, skills, empowerment, team collaboration and self-reflection was developed and used for data collection. A total of 588 questionnaires were returned and used for analysis. Nearly 20% of community nurses reported having an acquaintance with a maltreatment history. Only 4.6% had experience of reporting a case of child abuse. Most nurses reported strong skills and abilities (empowerment, team collaboration and self-reflection). Outpatient clinic nurses scored higher in four subscales than the PHC nurses. Nurses who had a history as a victim or had reporting experience claimed better clinical competency. Unfortunately, community nurses had limited knowledge in child abuse. The findings support the development of continuing education programmes on child abuse for community nurses.

[The use of therapeutic play in the intensive care of a preschool child with virus-associated hemophagocytic syndrome].

Hospitalization is a stressful experience for children that increases their anxiety and fears, generates resistance and noncompliance, and, as a result, delays necessary treatments. Developing an age-appropriate intervention to reduce the hospitalization-related stress perceived by children is an important component of pediatric nursing. This case study used therapeutic play and drawing to care for a virus-associated hemophagocytic syndrome preschooler who stayed in our pediatric intensive care unit (PICU) between 11/13/2012 and 11/19/2012. Stressors faced by the patient included separation from primary caregiver, unfamiliarity with the medical environment and equipment, non-comprehension of the treatment and medication regimens, and loss of control. The patient displayed incorporative behaviors such as crying, screaming, refusing to be touched, and requesting parental accompaniment. Painting and picture books were used as developmentally appropriate interventions to understand the patient's feelings and to provide a means for him to project and release emotions. This strategy successfully assisted the child to overcome the perceived stress of hospitalization and to cooperate with healthcare providers on his treatment.

Associations of childhood poly-adversity with alcohol problems among undergraduates: adolescent alcohol use trajectories and drinker self-schema.

OBJECTIVE: Undergraduate drinking is associated with childhood adversity, early alcohol experience, and drinker self-schema. However, the pathway linking childhood adversity to undergraduate drinking problems remains undefined. This study aimed to identify the effects of childhood poly-adversity on the sequelae of adolescent alcohol-use trajectory, drinker self-schema, and alcohol problems among undergraduates. We also examined whether adolescent alcohol-use trajectory and drinker self-schema mediated the effects of childhood poly-adversity on undergraduate alcohol problems. METHODS: Baseline data from an ongoing prospective study, which included 851 first- and second-year full-time college students in Taiwan, were used. An anonymous online questionnaire was administered. RESULTS: The results showed that low poly-adversity and high poly-adversity were associated with the mean of initial alcohol use frequency during adolescence and further alcohol problems at college than those with no adversity. High poly-adversity was also associated with the increase in alcohol use frequency during adolescence. Both initial and increase in alcohol use frequency were associated with higher drinker self-schema scores and further alcohol problems. The indirect effects of high poly-adversity on undergraduate alcohol problems were mediated through adolescent alcohol-use trajectories and drinker self-schema. CONCLUSION: Findings suggest that early identification of childhood poly-adversity and interventions to decrease adolescent drinking may prevent the formation of drinker self-schema and reduce undergraduate drinking problems.

The Effectiveness of Parenting Programs in Preventing Abusive Head Trauma: A Systematic Review and Meta-Analysis.

Parenting programs are the most common intervention for preventing the lethal form of child maltreatment, abusive head trauma (AHT). However, certain results of the effects of these programs have not yet been compared across studies. A systematic review with meta-analysis is warranted to quantitively synthesize the available evidence to identify effective elements and strategies of the programs for preventing AHT. This review aims to estimate AHT preventive parenting programs' pooled effect on the reduction of AHT incidence, the improvement of parental knowledge, and the increased use of safe strategies in response to infants' inconsolable crying. Studies published in English and Mandarin were searched and retained if they were randomized control trials (RCTs) or with a quasi-experimental design, included an AHT preventive parenting program, and provided data that quantified targeted outcomes. Eighteen studies were included in this review. AHT preventive parenting programs had a pooled effect on improving parents' knowledge and increasing the use of safe coping strategies in response to inconsolable crying but not on the incidence of AHT and parents' emotional self-regulation. Subgroup analyses showed that the intervention effects were mostly present across study designs or measurements and emerged in the reduction of AHT incidence compared with historical controls. The findings suggest that AHT preventive parenting programs enhance parenting knowledge and skills to provide safe care for infants. Further efforts to evaluate AHT parenting programs on the reduction of AHT incidence are necessary for decision-making on allocating and disseminating interventions.

[Understanding a hospitalized, school-aged child's stress in the PICU: the application of picture books in nursing care].

Hospitalization in the pediatric intensive care unit (PICU) can be a very stressful and sometimes traumatic experience for school-aged children due to illness, painful procedures, unfamiliar environment, and separation from family. We incorporated picture books into PICU nursing care to explore the stress response in a school-aged child with compartment syndrome who was hospitalized in the PICU. Observation, interview and communication with the patient were used to assess her psychological reactions and emotional and behavioral responses to stress related to hospitalization and medical treatment. Autonomy and control were provided and strengthened by giving the patient choices and purposive life plans. Picture books were used to establish rapport and help the patient express her feelings, needs, and desires for parental love and company. This case report highlights the importance of nurses' awareness of children's stresses and needs during hospitalization in the PICU as well as the value of picture books or other age-appropriate tools for this patient population.

Systematic review of effectiveness of situated e-learning on medical and nursing education.

OBJECTIVES: Because of the complexity of clinical situations, traditional didactic education is limited in providing opportunity for student-patient interaction. Situated e-learning can enhance learners' knowledge and associated abilities through a variety of activities. Healthcare providers who interact with virtual patients in designed situations may avoid unnecessary risks and encounters with real patients. However, the effectiveness of situated e-learning is inconsistent. The purpose of this study is to determine the effectiveness of situated e-learning in prelicensure and postlicensure medical and nursing education. METHODS: Literature databases of PubMed, Medline, CINAHL, ERIC, and Cochrane Library were searched. The study eligibility criteria included articles published in English, which examined the effectiveness of situated e-learning on the outcomes of knowledge and performance for clinicians or students in medicine and nursing. Effect sizes were calculated with 95% confidence intervals. RESULTS: Fourteen articles were included for meta-analysis. Situated e-learning could effectively enhance learners' knowledge and performance when the control group received no training. Compared to traditional learning, the effectiveness of situated e-learning on performance diminished but still remained significant whereas the effect become insignificant on knowledge. The subgroup analyses indicate the situated e-learning program significantly improved students' clinical performance but not for clinicians. CONCLUSIONS: Situated e-learning is an effective method to improve novice learners' performance. The effect of situated e-learning on the improvement of cognitive ability is limited when compared to traditional learning. Situated e-learning is a useful adjunct to traditional learning for medical and nursing students.

The structure, function, task, and effectiveness of hospital-based child protection teams in Taiwan.

BACKGROUND: Child protection teams (CPTs) are established in many countries with an intent to safeguard children at risk for maltreatment. However, the tasks and effectiveness of CPTs in Taiwan and many countries remain unclear. OBJECTIVE: A two-step, descriptive correlational study aimed to explore the implementation status and needs concerning the structure, functions, tasks, and effectiveness of hospital-based CPTs using a self-developed evaluation tool in Taiwan. PARTICIPANTS AND SETTING: Five experts and 10 CPT members were evaluated the psychometric properties of the evaluation tool. The main study participants comprised 153 CPT members in Taiwan in 2020. METHODS: Content validity, factor analysis, test-retest reliability, and internal consistency were used to evaluate the psychometric properties of the instrument. Descriptive and correlational statistics were to describe the implementation status and needs of the structure, functions, tasks, and effectiveness of hospital-based CPTs and their relationships. RESULTS: The psychometric properties of the tool were acceptable and satisfactory. The mean scores for each dimension of CPT implementation status were 2.77-2.93 (potential range 0-4) with the lowest for collaboration (mean = 1.97) and incentive (mean = 1.93). The average need scores for each dimension ranged 7.96-8.12 (potential range 0-10), indicating high needs for each dimension, particularly in support, cohesion, and incentive. The implementation status was significantly, weakly correlated with the needs. CONCLUSIONS: There is a need to further strengthen the structure and function of the CPTs and to improve its implementation in Taiwan. It is important to improve inter-agency collaboration and to establish an incentive mechanism for hospital CPTs. Working closely with community agencies is also needed to provide a good quality of care to the maltreated child and the family.

Patterns and trajectories of children's maltreatment experiences in Taiwan: Latent transition analysis of a nationally representative longitudinal study.

BACKGROUND: Little is known about the patterns of child maltreatment change over time and vary according to gender and child protective services (CPS) experience in Taiwan. OBJECTIVE: To examine the latent status and the trajectories of child maltreatment and to identify effects that gender and CPS have on these statuses and trajectories in Taiwan. PARTICIPANTS AND SETTING: A national proportionately stratified sample of 6233 4th-grade students were recruited from 314 elementary schools in Taiwan, and followed up at 6th and 8th graders. A total of 1908 students completed valid data at all three time points was analyzed. METHODS: Latent class analysis and latent transition analysis were used to identify the number of latent variables and the patterns of child maltreatment. Multiple-group model was used to test with gender difference. RESULTS: Four latent maltreatment statuses were identified: high all maltreatment, high psychological maltreatment, high neglect, and no/low maltreatment. A reduction in maltreatment severity occurred over time was found. The percentage of students in the "high all maltreatment" and "high neglect" groups decreased whereas those in the "high psychological maltreatment" and "no/low maltreatment" groups increased. Differences in the transition probabilities of latent maltreatment status by gender was revealed. The percentage of CPS recipients in the "high all maltreatment" decreased over time. CONCLUSIONS: This study highlighted the dynamic nature of child maltreatment and described the timing, continuity, and change that characterizes children's exposure to maltreatment in Taiwan. Policies and interventions geared toward early detection, mitigation, and prevention of child maltreatment are needed.