Caring behaviours directly and indirectly affect nursing students' critical thinking.

OBJECTIVES: The purpose of this study was to determine the effect of caring behaviours on critical thinking and to examine whether self-reflection mediates the effect of caring on critical thinking. We also tested whether caring behaviours moderated the relationship between self-reflection and critical thinking. METHODS: For this descriptive, correlational, cross-sectional study, we recruited 293 fifth-year nursing students from a junior college in southern Taiwan. Data were collected in 2014 on critical thinking, caring behaviours and self-reflection with insight using the Taiwan Critical Thinking Disposition Inventory, a Chinese version of the Caring Assessment Report Evaluation Q-sort, and a Chinese version of the Self-Reflection and Insight Scale, respectively. Relationships among variables were analysed by structural equation modelling, with the partial least squares method and Sobel test. RESULTS: The results showed that caring behaviours significantly positively affected critical thinking (ß = 0.56, t = 12.37, p < 0.001) and self-reflection with insight (ß = 0.54, t = 11.99, p < 0.001). Self-reflection and insight significantly positively affected critical thinking (ß = 0.34, t = 6.48, p < 0.001). Further, self-reflection and insight mediated the relationship between caring behaviours and critical thinking. Caring behaviours did not, however, moderate the relationship between self-reflection (ß = 0.001, t = 0.021, p > 0.05) and critical thinking. CONCLUSION: Caring behaviours directly affect self-reflection with insight and critical thinking. In addition, caring behaviours also indirectly affect critical thinking through self-reflection and insight.

[The Influence of Breastfeeding Self-Efficacy and Breastfeeding Intention on Breastfeeding Behavior in Postpartum Women].

BACKGROUND: World Health Organization (WHO) guidelines recommend that infants should be breastfed for six month after childbirth. The average duration of breastfeeding in Taiwan still falls short of this sixth-month timeline. In order to improve the duration of breastfeeding, it is crucial to understand the factors that affect related behavior. PURPOSE: To explore the effects of breastfeeding self-efficacy and breastfeeding intention among exclusive-breastfeeding women during the initial six months after childbirth and to verify the reliability and validity of the infant feeding intentions scale (Chinese version). METHODS: Purposive sampling was used to select and enroll a total of 167 breastfeeding women from a southern metropolitan medical-teaching hospital. Data were collected using a structured questionnaire and phone interviews. Data were analyzed using SPSS 18.0, LISREL8.7, and S-Plus package software to obtain scores for the independent-sample t test, Pearson's product-moment correlation coefficient, one-way analysis of variance, survival analysis, and reliability and validity. RESULTS: Breastfeeding self-efficacy scores ranged from 14 to 70, with a mean score of 44.80 (±11.56). Infant feeding intention scores ranged from 14 to 70, with a mean score of 12.20 (±3.14). Additionally, 29.9% of the participants breastfed exclusively for the entire six months after childbirth. Breastfeeding self-efficacy and breastfeeding intention were positively correlated (r = .45, p < .001). Education level, occupation, and breastfeeding intention were each identified as factors that significantly influenced the success of exclusive breastfeeding during the initial six months after childbirth. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Breastfeeding self-efficacy and breastfeeding intention are correlated with breastfeeding behavior. Based on findings, medical staff should target promotion and education regarding the importance of breastfeeding particularly toward women who have lower levels of education, who are employed, and who express low initial intention to breastfeed.

Scoping review of adherence promotion theories in pelvic floor muscle training - 2011 ICS state-of-the-science seminar research paper i of iv.

AIMS: This paper, the first of four emanating from the International Continence Society's 2011 State-of-the-Science Seminar on pelvic-floor-muscle training (PFMT) adherence, aimed to summarize the literature on theoretical models to promote PFMT adherence, as identified in the research, or suggested by the seminar's expert panel, and recommends future directions for clinical practice and research. METHODS: Existing literature on theories of health behavior were identified through a conventional subject search of electronic databases, reference-list checking, and input from the expert panel. A core eligibility criterion was that the study included a theoretical model to underpin adherence strategies used in an intervention to promote PFM training/exercise. RESULTS: A brief critique of 12 theoretical models/theories is provided and, were appropriate, their use in PFMT adherence strategies identified or examples of possible uses in future studies outlined. CONCLUSION: A better theoretical-based understanding of interventions to promote PFMT adherence through changes in health behaviors is required. The results of this scoping review and expert opinions identified several promising models. Future research should explicitly map the theories behind interventions that are thought to improve adherence in various populations (e.g., perinatal women to prevent or lessen urinary incontinence). In addition, identified behavioral theories applied to PFMT require a process whereby their impact can be evaluated.

2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State-of-the-Science Seminar.

AIMS: To summarize the findings and "expert-panel" consensus of the State-of-the-Science Seminar on pelvic floor muscle training (PFMT) adherence held prior to the 41st International Continence Society scientific meeting, Glasgow, 2011. METHODS: Summaries of research and theory about PFMT adherence (based on a comprehensive literature search) were presented by subject experts at the 2011 Seminar to generate discussion and guidance for clinical practice and future research. Supplemental research, post-seminar, resulted in, three review papers summarizing: (1) relevant behavioral theories, (2) adherence measurement, determinants and effectiveness of PFMT adherence interventions, and (3) patients' PFMT experiences. A fourth, reported findings from an online survey of health professionals and the public. RESULTS: Few high-quality studies were found. Paper I summarizes 12 behavioral frameworks relevant to theoretical development of PFMT adherence interventions and strategies. Findings in Paper II suggest both PFMT self-efficacy and intention-to-adhere predict PFMT adherence. Paper III identified six potential adherence modifiers worthy of further investigation. Paper IV found patient-related factors were the biggest adherence barrier to PFMT adherence. CONCLUSION: Given the lack of high-quality studies, the conclusions were informed by expert opinion. Adherence is central to short- and longer-term PFMT effect. More attention and explicit reporting is needed regarding: (1) applying health behavior theory in PFMT program planning; (2) identifying adherence determinants; (3) developing and implementing interventions targeting known adherence determinants; (4) using patient-centred approaches to evaluating adherence barriers and facilitators; (5) measuring adherence, including refining and testing instruments; and (6) testing the association between adherence and PFMT outcome.

Nurses' reflections on good nurse traits: Implications for improving care quality.

BACKGROUND: Good nurses show concern for patients by caring for them effectively and attentively to foster their well-being. However, nurses cannot be taught didactically to be "good" or any trait that characterizes a good nurse. Nurses' self-awareness of their role traits warrants further study. OBJECTIVES: This study aimed (a) to develop a strategy to elicit nurses' self-exploration of the importance of good nurse traits and (b) to explore any discrepancies between such role traits perceived by nurses as ideally and actually important. RESEARCH DESIGN: For this mixed-method study, we used good nurse trait card play to trigger nurses' reflections based on clinical practice. Nurse participants appraised the ideal and actual importance of each trait using a Q-sort grid. The gap between the perceived ideal and actual importance of each trait was examined quantitatively, while trait-related clinical experiences were analyzed qualitatively. PARTICIPANTS AND RESEARCH CONTEXT: Participants were 35 in-service nurses (mean age = 31.6 years (range = 23-49 years); 10.1 years of nursing experience (range = 1.5-20 years)) recruited from a teaching hospital in Taiwan. ETHICAL CONSIDERATIONS: The study was approved by the Institutional Review Board of the study site. FINDINGS: Good nurse trait card play with a Q-sort grid served as an icebreaker to help nurse participants talk about their experiences as embodied in good quality nursing care. Nurses' perceived role-trait discrepancies were divided into three categories: over-performed, least discrepant, and under-performed. The top over-performed trait was "obedience." DISCUSSION: Patients' most valued traits ("patient," "responsible," "cautious," and "considerate") were perceived by participants as ideally important but were under-performed, perhaps due to experienced nurses' loss of idealism. CONCLUSION: Good nurse trait card play with Q-sort grid elicited nurses' self-dialogue and revealed evidence of the incongruity between nurses' perceived ideal and actual importance of traits. The top over-performed trait, "obedience," deserves more study.

Female voiding postures and their effects on micturition.

INTRODUCTION AND HYPOTHESIS: This study investigated the effect of sitting and non-sitting postures on uroflowmetric parameters and postvoid residual urine (PVR) and women's preferred voiding posture. METHODS: Female university students (N = 45) voided on a modified sitting-type toilet in three postures: sitting, semi-squatting, and crouching over. Data on uroflowmetric measures were collected using a weight transducer urodynamic device and PVR was estimated by transabdominal ultrasound. RESULTS: Voiding in the three postures did not differ in terms of PVR and five of six uroflowmetric outcomes. However, "delay time to void" was significantly longer while semi-squatting than while sitting and crouching over. Furthermore, 51.1% of women had bell-shaped urinary flow curves while sitting, whereas only 22.2% and 17.8% did while semi-squatting and crouching over, respectively. Most women (88.9%) preferred a non-sitting posture when using a public sitting-type toilet. CONCLUSIONS: Women's preferred non-sitting void posture on public sitting-type toilet should be a concern.

Path analysis for adherence to pelvic floor muscle exercise among women with urinary incontinence.

This study developed and tested the accuracy of a model designed to predict adherence to a pelvic floor muscle exercise regimen by Taiwanese women with urinary incontinence. The sample was composed of 106 women treated for urinary incontinence at urban hospitals in central and northern Taiwan from April 2000 to March 2003. All participants had practiced prescribed pelvic floor muscle exercises for at least 6 weeks at the time they completed study measures, which included adherence to pelvic floor muscle exercise, self-efficacy for the exercise, knowledge of the exercise, attitudes toward the exercise, dyadic cohesion, perceived benefits of the exercise, and severity of urine loss. After stepwise multiple regression analysis, a path analysis was conducted, with significant paths retained as modifiers. Self-efficacy for pelvic floor muscle exercise strongly and directly affected adherence to the exercise regimen. Attitudes toward the exercise, dyadic cohesion, and perceived benefits of the exercise affected adherence when mediated by self-efficacy for pelvic floor muscle exercise. Severity of urine loss also directly affected adherence. Exercise knowledge affected neither self-efficacy nor adherence. The model fit the data and accounted for 40% of adherence variance. Findings affirm the significant role of self-efficacy in predicting adherence to pelvic floor muscle exercise. Thus, self-efficacy for exercise can be an indicator for nurses to tailor exercise-training programs for women with urinary incontinence. Nurses can use the study findings to develop interventions to increase women's adherence to the exercise.

Self-reflection and critical thinking: the influence of professional qualifications on registered nurses.

Background: Ensuring the delivery of quality care and patient safety requires that nurses improve their self-reflection and insight as well as their critical thinking. To understand the factors that influence self-reflection, insight, and critical thinking, more evidence-based research is needed. Purpose: The purpose of this study was to examine whether professional qualifications (i.e. age, years of job experience, and position on the clinical ladder) would affect self-reflection and critical thinking in the experienced registered nurses (RNs) group. Methods: This quantitative and correlational study included 597 RNs (297 novice nurses and 300 experienced nurses), recruited from one medical center hospital in central Taiwan, as participants. Data were collected on self-reflection and critical thinking, using the Chinese-version of the Self-Reflection and Insight Scale and the Taiwan Critical Thinking Disposition Inventory. A structural equation modeling approach was used to examine the relationships among variables. Findings: The results showed a non-significant mean difference in self-reflection with insight scores between the two groups. Experienced RNs had a significantly higher mean score for critical thinking. Further analysis of the data of experienced nurses revealed that self-reflection with insight significantly affected critical thinking (ß = 0.24, t = 4.141, p < .001). Qualifications also affected self-reflection with insight (ß = 0.11, t = 1.808, p > .05) and critical thinking (ß = 0.18, t = 3.143, p < .001). The correlation between qualifications and self-reflection with insight, however, was non-significant. Discussion: Nurses who perceived that they had greater self-reflection and insight reported more critical thinking in clinical care practice. Nurses' qualifications had more of an effect on critical thinking than on self-reflection and insight.

[Good nursing: perspectives of patients and family].

This qualitative study aimed to explore patients' perspectives on good nursing for comparison with nurses' perspectives, as identified in a previous study. Purposive sampling was employed to recruit 53 patients and six family members from three medical centers and three regional hospitals, in northern, central, and southern Taiwan. The 59 participants were clustered into nine groups for focus-group interviews for data collection purposes, from March to June, 2003. Most of the participants were male (62.7%), and their mean age was 51.9 years (SD=15.6), with a range from 18 to 81 years old. All of the participants were hospitalized for at least three days and had the physical and mental strength to participate in a 60-90 minute group interview. The interviews were both hand-recorded and audio-taped on site, with permission from the participants, and then transcribed into verbatim narratives for data analysis. Content analysis was used to identify items in relation to good nursing/not-good nursing across narratives. The findings showed that four major categories of good nursing inductively emerged, including: (1) Providing professional nursing as a guardian angel, (2) Demonstrating professional skills with humanity, (3) Being accountable and competent, and (4) Showing self-improvement. The findings indicated that professional nursing competence is the essence of good nursing. Treating patients as relatives is also perceived as good nursing. In comparing the patients definitions of good nursing with those of nurses it was observed that there are similarities in terms of the main categories of the definitions. Patients, however, tend to use negative examples or normative moral terms, such as "should" or "ought to" to connote what is expected of good nursing and how good nursing is expressed in the context of patient-nurse interaction.

[Good nursing from the perspective of nurses].

This qualitative study used an in-depth interview method to explore nurses' perspectives on good nursing practices. A balanced stratified sampling approach was employed to recruit 83 nurses from 18 hospitals that were relatively evenly distributed around Taiwan. Fifteen nurses educated to the masters' level and well trained in the in-depth interview approach collected research data from January through May 2002. Interviews were audiotaped and transcribed in verbatim narratives. Content analysis was used to identify good nursing practices common across narratives. Four good nursing practice categories emerged inductively. These included (1) good decision making and execution, (2) dexterous professional skills, (3) good patient-nurse relationships, and (4) a mature self. Findings present quality nursing care as a relationship that combines professionalism and humanism. In order to provide better care, a nurse must incorporate knowledge from empirical research into his or her practice and internalize his or her value as a nurse. A discussion of the process of self-maturation acquisition and reflective learning offers new insights to guide the construction of nursing education curricula and activities for clinical nursing practice. Further research in good nursing is suggested.

Predictors of Antenatal Psychosocial Stress in Taiwanese Women.

BACKGROUND: Antenatal stress has been associated with adverse outcomes in mothers and their children. However, little research has been conducted to identify the factors associated with psychosocial stress in pregnant women. PURPOSE: This study explored the predictors of psychosocial stress during pregnancy. METHODS: A convenience sample of 136 second-trimester and 164 third-trimester pregnant women were recruited from a medical center in southern Taiwan. Data were collected using a demographic form, Pregnancy Stress Rating Scale (PSRS), Edinburgh Prenatal Depression Scale, Pittsburgh Sleep Quality Index, Maternal-Fetal Attachment Scale, and Interpersonal Support Evaluation List. RESULTS: The results of this study found positive correlations between PSRS and both Edinburgh Prenatal Depression Scale (r = .368, p < .01) and Maternal-Fetal Attachment Scale (r = .168, p < .01) and negative correlations between PSRS and both gravidity (r = -.137, p < .05) and Interpersonal Support Evaluation List (r = -.266, p < .01). Higher pregnancy stress was predicted by depression, lower social support, maternal-fetal attachment, and primigravid status, which together explained 20% of the total variance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Depression, social support, maternal-fetal attachment, and gravidity are discrete predictive factors of psychosocial stress in pregnant women. These findings add to existing knowledge of the factors associated with prenatal stress. Future research should include depression in a support model of antenatal stress management.

Chinese Version of Psychometric Evaluation of Self-Reflection and Insight Scale on Taiwanese Nursing Students.

BACKGROUND: Self-reflection (also known as reflection) is an internal process that is difficult to perceive or assess. An instrument that is able to measure self-reflection may serve as a resource for educators to assess the learning process of students and to tailor education approaches to student needs. PURPOSE: The aim of this study was to translate the Self-Reflection and Insight Scale (SRIS) into Chinese and evaluate its psychometric properties for use with Taiwanese nursing students. METHODS: For this cross-sectional study, nursing students were recruited from two nursing schools in southern Taiwan in two phases: Phase 1, which included 361 fourth-year students, and Phase 2, which included 703 fifth-year students. Data were collected in December 2012 and May 2013 using the Chinese version of the SRIS (SRIS-C), Taiwan Critical Thinking Disposition Inventory, and the Perceived Identity as a Nurse Questionnaire, which was developed by the author. In Phase 1, exploratory factor analysis was used to explore the factor structure of the SRIS-C in the fourth-year student participants. In Phase 2, confirmatory factor analysis was used to determine the fitness of the model for the fifth-year student participants. RESULTS: Eight items were deleted from the original SRIS to create the SRIS-C. Thus, the Chinese-version measure had 12 items and two factors (self-reflection and insight) that fit the data well. The Cronbach's alpha coefficients for the total scale and its two subscales were .79, .87, and .83, respectively. The 3-week test-retest reliability was .74. SRIS-C scores correlated significantly with scores on the Taiwan Critical Thinking Disposition Inventory and the Perceived Identity as a Nurse Questionnaire, indicating good convergent validity for the SRIS-C. CONCLUSIONS: The current study showed that the SRIS-C has sound psychometric properties. This instrument provides nurse educators with information that may be used to evaluate the self-reflection and insight of students and to develop interventions to effectively improve these skills in Chinese-language-based nursing education.

Prevalence of lower urinary tract symptoms during pregnancy in Taiwan.

BACKGROUND AND PURPOSE: Women often complain of symptoms related to urination during their pregnancy, but data are limited on the clinical profile and lower urinary tract symptoms (LUTS) of pregnant women in Taiwan. This study assessed the prevalence and predisposing factors of LUTS in Taiwanese women during pregnancy. METHODS: A cross-sectional survey was designed to collect data on the prevalence of LUTS during pregnancy. Women attending the antenatal clinic of a medical center in central Taiwan were recruited and asked to complete a LUTS questionnaire including 12 questions on symptoms related to urination. RESULTS: 799 normal pregnant women were included in this study. The most common LUTS were nocturia (60.2%) and stress urinary incontinence (SUI; 46.1%), followed by urgency (34.1%), frequency (27.8%), incomplete emptying (26.2%), a bearing-down sensation (23.8%), and voiding difficulty (12.6%). The prevalence of nocturia, SUI, urgency, and frequency generally increased as gestational age advanced. There was a significantly higher prevalence of SUI in multiparous women than in nulliparous women; however, the prevalence of urgency, frequency, incomplete emptying, bearing-down sensation, and straining was significantly higher in nulliparous women than in multiparous women. High parity, high body weight before pregnancy and advanced gestational age were the predisposing factors of SUI during pregnancy. Only 6.5% of the pregnant women studied complained that SUI caused a social or hygienic problem based on the International Continence Society (ICS) criteria. CONCLUSIONS: This study provides a profile of LUTS in Taiwanese women during pregnancy. Nocturia was the most common lower urinary tract symptom. Nocturia, SUI, urgency, and frequency increased as gestational age advanced. Parity was a predisposing factor for LUTS during pregnancy, with multiparous women experiencing significantly more SUI while nulliparous women had higher prevalence of other LUTS.

[Non-invasive therapeutics in female urinary incontinence by extracorporeal magnetic innervation (ExMI)].

The prevalence of female urinary incontinence (UI) in Taiwan is 19~35% and the condition has a psychosocial impact. It is important to prevent UI and to treat it when it does occur. It is an intractable symptom which is not very responsive to medicine or surgery, although in the past, these were the most common options for treating it. The alternatives include pelvic floor muscle exercises, vaginal cone weight training, functional electrical stimulation and biofeedback. The effectiveness of these methods depends on the patient's motivation and compliance, as well as on health care providers' encouragement. However, the Extracorporeal Magnetic Innervation (ExMI) is simple and easy to use and therefore enhances participants' motivation and compliance. The authors review the relevant literature and describe the development of the revolutionary new treatment and discuss its effectiveness concluding that its clinical effectiveness needs further evaluation.

The effects of music listening on psychosocial stress and maternal-fetal attachment during pregnancy.

OBJECTIVE: While music listening has been studied as an intervention to help reduce anxiety in pregnant women, few studies have explored the effect of music listening on pregnancy-specific stress relief. This study examines the effects of music listening on psychosocial stress and maternal-fetal attachment during pregnancy. DESIGN: A randomized controlled trial was implemented. A valid sample of 296 pregnant women in their second or third trimester was randomly distributed into an experimental group (n=145) and a control group (n=151). INTERVENTIONS: The experimental group received routine prenatal care and music listening. The control group received routine prenatal care only. MAIN OUTCOME MEASURES: Data were collected using a demographic form, Pregnancy Stress Rating Scale (PSRS), Perceived Stress Scale (PSS), and Maternal-Fetal Attachment Scale (MFAS). RESULTS: The post-test results identified a significantly lower level of psychosocial stress in the experimental group than in the control group, particularly in terms of the stresses related to baby care and changing family relationships and to maternal role identification. However, no statistically significant differences in terms of perceived stress and maternal-fetal attachment were found between the post-test results of the two groups. CONCLUSION: This study provides evidence in support of using of music in interventions designed to relieve psychosocial stress in prenatal women. IRB approval number: ER98223.

The development and testing of the pelvic floor muscle exercise self-efficacy scale.

The purpose of this study was to establish a reliable and valid instrument to evaluate women' s confidence in performing pelvic floor muscle exercise (PFME). Based on the researcher' s own experience and with extended literature review, social cognitive theory and a health promotion model were utilized to formulate the 17-item Chen pelvic floor muscle exercise self-efficacy (PFMSE) scale. Data were collected from 106 urinarily incontinent women and the reliability and validity of the scale were tested. The results showed that the scale has a high Cronbach' s alpha of .95 for its internal consistency. Test-retest reliability over 6-30 days was r = .86 (p < .001), showing acceptable stability of the Chen PFMSE scale. Exploratory factor analysis was used to test the initial construct validity, and two factors were extracted, which explained 34.16% and 32.55% of the total variance respectively, with a total of 66.71% . The two factors were named as (1) belief in PFME execution and its benefits, and (2) belief in performing PFME as scheduled and despite barriers. It is also evident that the Chen PFMSE scale satisfies concurrent validity when compared with well-developed and tested instruments such as general self-efficacy ( GSE), perceived PFME benefits, and incontinence impact questionnaire-7 (IIQ-7). The results suggest that the Chen PFMSE scale has solid psychometric properties, and is a useful tool for clinicians to design appropriate interventions and to foster positive PFME self-efficacy during treatment for women with urinary incontinence and undergoing PFME training.

Nurses' beliefs and values about doing cue-based care in an NICU in Taiwan.

Although advances in medical technology have increased the survival rate of preterm infants, science is no cure-all for these high-risk patients. A growing number of studies report that caregiving interventions cause physiological and behavioral distress in such infants. The results have prompted changes in caregiving practices, attempting to reduce stress and strengthen protection for the infants, in order to promote their stability and development in the neonatal intensive care unit (NICU) . This study uses qualitative research methods to grasp the richness and diversity of nurses' beliefs and experience in the taking care of preterm infants. Ten groups of questions explore how NICU nurses take care of premature infants, nurses' perspectives on cue-based care, and the extent to which NICU nurses practice cue-based care. The results generated three themes: (1) timely and skillful management of the preterm infants; (2) compassionate and holistic care for the infants and their highly stressed families; and (3) the relationship between good nursing care and meeting the needs of preterm infants, families, physicians, units, and the environment. It is apparent that the approach to care delivery in NICU practice is still clinical-based, and that there are some obstacles to the delivery of cue-based care. The reasons for this include lack of knowledge, incomplete collaboration with team members, and insufficient support from the administrative systems. To improve the quality of nursing care and preterm infant outcomes, it will be necessary to educate NICU nurses on cue-based care, to enhance collaboration among all team members, to reduce their non-nursing workload, and to re-design NICUs for optimal cue-based care.