The initial experiences of junior nursing college students when communicating with children during pediatric clinical practicum: A phenomenological study.

PURPOSE: Nursing students feel stressed during pediatric clinical practicum due to limited communication encounters with hospitalized children. The purpose of this study was to describe junior nursing college students' experiences of communicating with children during pediatric clinical practicums. DESIGN AND METHODS: A qualitative phenomenological research design was used. Purposive sampling was used to recruit 18 junior nursing college students who completed their pediatric clinical practicum. Data were collected using semi-structured interviews and were analyzed using Colaizzi's seven-step method for data analysis. RESULTS: Three themes emerged from the data. (1) Difficulties in communicating during initial practicum: fear, rejection, self-doubt of communication abilities, and unfamiliarity with the application of communication techniques posed frustrations among nursing students. (2) Efforts to learn during practicum: self-empowerment, seeking a diverse support system, adjusting communication methods, and striving to establish good relationships allowed nursing students to adapt to the pediatric curriculum. (3) Effective communication at the later stages of practicum: mastering fundamental communication techniques and exercising pediatric therapeutic communication techniques allowed nursing students to feel accomplished. CONCLUSIONS: Junior nursing college students initially encountered difficulties and frustration when communicating with children during their pediatric clinical practicum. This study serves as a guide for educators of pediatric nursing to design courses on communication with hospitalized children. PRACTICE IMPLICATIONS: These findings could be used to develop foundation courses on communicating with children for first-time pediatric nursing practicum students; for example, formulating a course on therapeutic play for children that encompasses communication techniques, pediatric ward simulation, and introduction to therapeutic play.

Efficacy of Scenario Simulation-Based Education in Relieving Parental Anxiety about Fever in Children.

PURPOSE: This study was designed to evaluate the short- and long-term effects of a scenario simulation-based education intervention on parental anxiety about fever in their children. DESIGN AND METHODS: This experimental research was conducted using a two-group pretest-posttest design. One hundred and sixty parents of 3-month to 5-year-old children enrolled in preschools and kindergartens with childcare services were recruited as participants using cluster random sampling. The participants were divided randomly into an experimental group (80) and a control group (80). The former participated in a scenario simulation-based education intervention and received a fever education booklet. The latter received the booklet only. Data were collected using the Children's Fever Anxiety Inventory at three time points: before the intervention (pretest, T1) and at six-month (T2) and 12-month (T3) posttests. RESULTS: Significant intergroup differences in fever anxiety were found at both T2 and T3 (p < .001). For both groups, the scores at T2 and T3 were significantly lower than at T1 (p < .001) and the difference between T2 and T3 did not attain statistical significance (p > .05). Although both groups experienced reduced fever anxiety over time, this reduction was significantly greater in the experimental group than in the control group (p < .001). CONCLUSION: Simulation-based education may be used in conjunction with the traditional fever education booklet to further reduce parent fever anxiety over time. PRACTICE IMPLICATIONS: This simulation-based education approach significantly and positively impacts parental anxiety about fever in their children. Furthermore, the approach may be generalizable to other childhood healthcare settings.

Dual Use of E-Cigarettes and Traditional Cigarettes Among Adolescents in Taiwan, 2014-2016.

Introduction: We investigated the use of electronic cigarettes (e-cigarettes) with traditional cigarettes among adolescents during 2014 to 2016 to identify risk factors for using e-cigarettes only, traditional cigarettes only, or both products. Methods: We used cross-sectional data from the Taiwan Global Youth Tobacco Survey, (conducted over a 3-year period by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan), which is representative of tobacco use among adolescents aged 12-18 years. The outcome variable was smoking behavior. Dependent variables included gender, grade, monthly income/allowance, parents' educational level, parents' smoking status, close friends' smoking status, use of other tobacco products, contact with cigarette/e-cigarette advertisements, and access to free cigarettes/e-cigarettes. Multinomial regression identify factors influencing the smoking behaviors of adolescents, as manifested in the use of traditional cigarettes only, e-cigarettes only, e-cigarettes with traditional cigarettes, and nonsmoking. Results: When weighted to the population, the sample included 1723150 adolescents in 2014, 1691568 adolescents in 2015, and 1627216 adolescents in 2016. The rates averaged over three years were as follows: nonsmoking (91.6%), traditional cigarettes only (5.4%), e-cigarettes only (1.5%), and dual usage (1.6%). Among adolescents in Taiwan, the following were risk factors for dual use: male, older, high monthly allowance, smoking parents, smoking friends, use of other tobacco products, contact with cigarette advertisements, and access to free cigarettes. Conclusions: Our results revealed an increase in the number of adolescents using e-cigarettes with traditional cigarettes. We recommend that the government continue smoking cessation programs while maintaining control over advertisements and promotions for tobacco products. Implications: This is the first study to examine the dual use of e-cigarettes and traditional cigarettes among adolescents in Taiwan. This study identified the risk factors of using traditional cigarettes only, using e-cigarettes only, and the dual use of e-cigarettes and traditional cigarettes, with nonsmokers used as a reference group. This study examined the relationship between exposure to cigarette promotions and the use of various tobacco products including the dual use of e-cigarettes and traditional cigarettes, both of which have been disregarded in previous studies.

The impact of smoke-free legislation on reducing exposure to secondhand smoke: differences across gender and socioeconomic groups.

BACKGROUND: On 11 January 2009, Taiwan expanded its smoke-free legislation to all indoor public places and workplaces. This study examined the impact of this policy on secondhand smoke (SHS) exposure in adult non-smokers, across gender and socioeconomic status groups (SES). METHODS: An annual sample of about 13,000-14,000 non-smokers was drawn from cross-sectional nationwide data of Taiwan Adult Tobacco Behavior Surveys during 2005-2011. Logistic regressions were used to analyse the aggregate data to estimate the association between the 2009 smoke-free legislation and SHS exposures in homes and workplaces. Interaction terms were used to examine the impact of the 2009 smoke-free policy on reducing differences in SHS exposure across gender, education and income groups. RESULTS: The 2009 policy reduced the odds of SHS exposure in homes in 2009 (OR=0.76, 95% CI 0.68 to 0.84) and in workplaces (year 2009: OR=0.49, 95% CI 0.39 to 0.62; year 2010: OR=0.79, 95% CI 0.66 to 0.95). The model with interaction terms showed that men were more likely than women to be exposed to workplace SHS (OR=2.02, 95% CI 1.80 to 2.27) but were less likely to be exposed to home SHS (OR=0.79, 95% CI 0.73 to 0.86). SHS exposure in homes was significantly related to lower socioeconomic status, but the 2009 smoke-free policy reduced the difference in SHS exposure across education levels. CONCLUSIONS: The 2009 smoke-free policy reduced the SHS exposure for non-smokers. However, this impact on home SHS did not persist after 2009, and the effect of protection was unequal across gender and SES groups. Thus, further enforcement of smoking restrictions would be needed to reduce the risk of SHS exposure and improve protection against SHS risk among parts of the population with lower socioeconomic status.

Copayment policy reforms and effective care utilization by patients with persistent asthma in Taiwan.

OBJECTIVES: Reforms to the Taiwan National Health Insurance copayment scheme in 2005 imposed a notable increase in the cost of outpatient visits. This provided an ideal situation to determine whether such reforms lead to a reduction in the utilization of effective care by patients with persistent asthma. METHODS: This study applied the pretest-posttest non-randomized control group design in our analysis of nationwide claims data (2002 to 2010). Based on propensity score matching, the patients were divided into two groups, subject and not subject to copayment reform. Medication Management for People with Asthma measure was used to identify patients with persistent asthma and instances of effective care. RESULTS: Matching yielded a final panel of 7,890 individuals with persistent asthma (3,945 individuals in each cohort) eligible for the study. GEE analysis revealed that policy reforms had significant effects over the short-term (OR = 0.745, p < 0.05), medium-term (OR = 0.752, p < 0.01), and long-term (OR = 0.721, p < 0.01). CONCLUSIONS: Reforms to copayment policy were significantly correlated with a reduction in the utilization of effective care by patients with persistent asthma over the short-, medium- and long-term. Government should develop implementation strategies aimed at protecting the economically disadvantaged patients.

Comparing the Characteristics of Cigarette Smoking and e-Cigarette and IQOS Use among Adolescents in Taiwan.

Objectives: Our objective in this study was to identify the risk factors for cigarette, e-cigarette, and IQOS use among adolescents in Taiwan, with a particular focus on socioeconomic status, smoking status of parents and peers, cigarette promotions, and anti-tobacco campaigns. Methods: Data were obtained from the 2018 version of the annual cross-sectional Taiwan Global Youth Tobacco Survey, which is used to monitor tobacco use among Taiwanese adolescents in junior and senior high schools. The dependent variables in the study were "current cigarette smoking," "current use of e-cigarettes," and "current use of IQOS devices" (i.e., during the 30 days prior to survey completion). Independent variables included gender, school grade, monthly income/allowance, educational level of parents, smoking status of parents, smoking status of close friends, access to free cigarettes, exposure to cigarette advertisements, and attendance at anti-tobacco courses. Logistic regression was used in the identification of factors correlated with the current use of cigarettes, e-cigarettes, or IQOS. Results: We determined that 5.65% of the adolescents in the study were currently using cigarettes, 2.74% were currently using e-cigarettes, and 2.33% were currently using IQOS. Our analysis revealed a number of factors that have a bearing on smoking behavior, including gender, monthly allowance, educational level of parents, smoking status of parents and close friends, access to free cigarettes, and exposure to cigarette advertisements. Conclusions: The tobacco product that was most widely used by adolescents was cigarettes, followed by e-cigarettes and IQOS. The socioeconomic status, smoking status of parents/close friends, and access to cigarettes were all identified as important factors related to the current use of cigarettes, e-cigarettes, and IQOS by adolescents.

Prevalence of heated tobacco product use among adolescents in Taiwan.

OBJECTIVE: To determine the penetration of heated tobacco products (HTPs) into the youth market in Taiwan, with a particular focus on the correlation between IQOS use and the usage of other tobacco products. METHODS: Data from the 2018 Global Youth Tobacco Survey were used to assess previous experience with and current use (within 30 days prior to survey completion) of IQOS products by Taiwanese students aged 12-18 years. Independent variables included the usage patterns of conventional cigarettes and e-cigarettes. The control variables included background information (gender, grade, monthly income/allowance, household educational level, smoking status at home and among close friends), access to free cigarettes, as well as exposure to cigarette advertisements and anti-tobacco courses. Logistic regression was used to identify tobacco usage patterns correlated with IQOS use. RESULTS: In 2018, 2.33% of Taiwan's adolescents were currently using IQOS and 4.17% had tried IQOS. The use of conventional cigarettes and e-cigarettes (individually and together) were associated with an elevated risk of the ever use and current use of IQOS. CONCLUSION: Despite the fact that HTP products are not sold legally in Taiwan, the use of IQOS products by young people is far from negligible. We recommend amending the "Tobacco Hazards Prevention Act" to include regulations pertaining to the sale and marketing of HTPs.

[Ethical decision making for newborns with congenital abnormalities: the 'do not resuscitate' dilemma].

Neonatal intensive care units face increasing ethical dilemmas as advancing medical techniques prolong the dying process of newborns with life-threatening congenital abnormalities. This article explores the ethical dilemma posed with regard to a newborn suffering from Edwards syndrome. The issue whether or not to resuscitate was approached using Jensen's four topics method. Under conditions of medical futility, the presupposition of a poor quality of life for the child and respect for parental autonomy, a decision was made against resuscitation. Medical professionals have a responsibility to help parents deal with the dying process through palliative care that provides a good death for newborns suffering from severe congenital abnormalities.

Electronic Cigarette Use and Attempts to Quit Smoking Cigarettes Among Adolescents in Taiwan.

PURPOSE: This study assessed the relationship between electronic cigarette (e-cigarette) use and attempts to quit smoking cigarettes by adolescent smokers in Taiwan. METHODS: Data were obtained from the cross-sectional Taiwan Global Youth Tobacco Survey conducted annually between 2014 and 2016, which included adolescents aged 12-18 years. The independent variable was e-cigarette use in the previous 30 days. The outcome variable was attempts to quit cigarette smoking during the previous 12 months. We controlled for the following variables: year of survey, gender, grade, monthly income/allowance, numbers of cigarettes per day, smoking status of parents and friends, use of other tobacco products, access to free tobacco products, assistance in quitting smoking, and exposure to anti-tobacco campaigns. RESULTS: Among cigarettes smokers, the prevalence of current e-cigarette use (in the previous 30 days) increased from 9.82% (2014) to 27.46% (2016), whereas attempts to quit smoking cigarettes decreased slightly from 71.31% (2014) to 70.59% (2016). Current e-cigarette use (OR = 1.21) was positively associated with attempts to quit cigarette smoking. Smokers who observed anti-tobacco media messages (OR = 1.12), attended antismoking classes (OR = 1.17), were influenced by warnings on cigarette packages (OR = 3.32), or received help to quit (OR = 3.11) were more likely to have attempted to quit cigarettes. CONCLUSIONS: We identified factors correlated with attempts to quit smoking, and recommend that the government continue monitoring electronic cigarette use, combat smoking in the media, provide antismoking classes, and expand health warnings on cigarette packages.

Effectiveness of Simulation-Based Education on Childhood Fever Management by Taiwanese Parents.

BACKGROUND: Childhood fever is a common symptom managed by parents at home. Most parents do not know the definition of fever, its effect, or its management. To establish simulation-based education for parents and evaluate its effectiveness for fever management at home are essential for nursing care. This study assesses the long-term effects of simulation-based education on information, motivation, behavioral skills, and behaviors related to parental fever management in Taiwan. METHODS: Cluster random sampling was used to recruit parents having children aged from 3 months to 5 years who were attending kindergartens in Kaohsiung, Taiwan. A total of 160 parents were randomly assigned into experimental (EP) and control (CP) groups equally. Parents in the EP group received simulation-based education with fever education brochures, while the CP group received only the brochure. Data on parental fever information, motivation, behavioral skills, and management behaviors were collected before the 1st day, on the 1st day (except management behaviors), at the 6-month, and at the 12-month marks post-training with a self-developed instrument based on the information-motivation-behavioral skills model. RESULTS: The results of a generalized estimating equation analysis indicated that the information, motivation, behavioral skills, and management behaviors of all participants had improved at the post-test assessment, with the EP group showing significantly better improvement than the CP group. This study supports that simulation-based education effectively enhances fever management of parents for a long period of time. CONCLUSION: Simulation-based education, compared to using the brochure, was a better strategy for improving parental information, motivation, behavioral skills, and behaviors regarding fever management. We suggest that providing community-based education on fever with scenario simulation is needed to increase parental competence for child care.

The costs of smoking and secondhand smoke exposure in Taiwan: a prevalence-based annual cost approach.

OBJECTIVES: To assess the costs of the health effects of cigarette smoking and secondhand smoke (SHS) exposure to society. DESIGN: Prevalence-based, disease-specific cost-of-illness study. We used an epidemiological population-attributable risk method to determine the costs that can be attributed to smoking and SHS exposure. SETTING: Taiwan. PARTICIPANTS: All adult population aged 35 and older. PRIMARY OUTCOME MEASURES: Direct costs of healthcare expenditures spent for treating tobacco-related diseases, indirect mortality costs measured by the value of lost productivity due to tobacco-related premature deaths and indirect morbidity costs measured by the value of time lost from work due to tobacco-related illness. RESULTS: In 2010, direct costs of smoking and SHS exposure amounted to US$828 million, accounting for 3.4% of Taiwan's total personal healthcare expenditures. Smoking and SHS exposure also contributed to 15 555 premature deaths-corresponding to a loss of 284 765 years of life and US$820 million in productivity-and US$22 million in indirect morbidity costs. These direct and indirect costs totalled US$1670 million, representing 0.4% of Taiwan's gross domestic product and averaging about US$720/adult smoker. The share of the total costs was greater from active smoking (92%) than SHS exposure (8%), and greater for men (92%) than women (8%). CONCLUSIONS: Smoking and SHS exposure impose a huge financial loss in Taiwan. Sustained tobacco control efforts to encourage people to quit smoking, prevent smoking uptake by children and young adults and protect all people from SHS exposure are needed.

Predicting all-cause and cause-specific mortality by static and dynamic measurements of allostatic load: a 10-year population-based cohort study in Taiwan.

OBJECTIVE: To evaluate the role of allostatic load (AL), either static or dynamic measurements, in predicting all-cause and cause-specific mortality of older people in Taiwan. DESIGN: A prospective cohort study. SETTING: Population-based community study. PARTICIPANTS: One thousand twenty-three community-dwelling older people. MEASUREMENTS: Allostatic load (calculated by systolic blood pressure, diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, triglyceride, glycosylated hemoglobin, fasting glucose, waist-to-hip ratio, body mass index, dehydroepiandrosterone sulfate, insulin-like growth factor-1, 12-hour urine cortisol, 12-hour urine epinephrine, 12-hour urine norepinephrine, 12-hour urine dopamine, white blood cell count, neutrophils, interleukin-6, albumin, creatinine) and all-cause and cause-specific mortality from national death registry. INTERVENTION: None. RESULTS: Adjusted for age and sex, each 1-point increase in AL score was associated with 20% incremental risk of mortality [hazard ratio 1.20, 95% confidence interval (CI) 1.09-1.31]. This association can be extended to cause-specific mortality in both sexes in general. In addition, the higher AL score quintile was significantly associated with higher risk of 10-year all-cause mortality (P < .0001). This association was consistent across different cause-specific mortality (ie, malignant neoplasm (P = .008), cardiometabolic diseases (P < .0001), infectious diseases (P < .0001), respiratory diseases (P < .0001), and others (P = .0002), respectively. Compared with AL score decliners, adjusted for age, sex, and baseline AL score in 2000, participants with fast increase had significantly higher mortality (HR 2.68, 95% CI 1.23-5.84, P = .01). The effect was stronger in men (HR 2.83, 95% CI 1.1-7.29, P = .03 in slow increase; HR 4.06, 95% CI 1.56-10.6, P = .001 in fast increase group), but it was insignificant in female participants. CONCLUSIONS: Higher AL score or rapid increase of AL score significantly increased subsequent mortality risk in older adults, either measured statically or dynamically. AL is predictive of 10-year mortality regardless of cause of death, and rapid increase in AL score is associated with higher subsequent mortality.

Parental knowledge, concerns, and management of childhood fever in Taiwan.

BACKGROUND: Childhood fever is a commonly treated condition in medical settings. Many studies around the world have reported on the phenomenon of parental fever phobia. Studies of parental knowledge regarding childhood fever are lacking in Taiwan. PURPOSE: This study explores parental knowledge, concerns, and management of childhood fever and their correlates in Taiwan. METHODS: This study used a cross-sectional survey and self-administered questionnaire. Six hundred forty-nine parents were recruited as participants from pediatric clinics and kindergartens in southern Taiwan. RESULTS: Nearly half (47.2%) of participants incompletely understood the healthcare information about childhood fever provided by physicians and nurses. Furthermore, 41.6% of parents were dissatisfied with the information provided. The median score of parental knowledge was 10 (interquartile range [IQR] = [8, 12] out of a maximum of 23). Parent gender, religion, education level, and occupation were independent predictors of knowledge scores. Parents who were never or sometimes concerned about childhood fever had significantly higher knowledge scores than those who were always concerned about childhood fever (median knowledge score: 11, IQR = [9, 13] vs. 10, IQR = [8, 11]). Most parents followed Western medical advice to manage childhood fever; however, 31.1% of parents combined this with traditional folk treatments. Levels of concern among parents included 86.6% of parents who frequently or always worried about their children's fever. Fever-induced anxiety was reported by 68.8% of the parents. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Participants' lack of fever-related knowledge was because, in part, of either their not understanding or their dissatisfaction with provided information. The higher level of concern compared with other countries and studies indicates that parents in Taiwan need appropriate information about fever management to alleviate their concerns and guide them in caring for their febrile children.

Health characteristics of older people who rotationally live with families: a nationwide survey.

BACKGROUND: Population aging has been a critical issue around the world and people will have to face living problems when they get old. In Western countries, older people are more used to live alone or in institutions. In Eastern countries, due to filial piety of Chinese culture, the elderly prefer to live with their children or their relatives. There was no empirical study to investigate the relationship between health and living arrangement among older Taiwanese. OBJECTIVE: This study was designed to explore the association between living arrangement and health characteristics among the elderly in Taiwan. METHOD: This study used national representative data from the Taiwan Longitudinal Study on Aging surveyed in 2007. We identified 2621 elders aged older than 65 in 2007 and categorized them into 3 types of living arrangement by the questionnaire. Linear regressions were used to analyze the relationship between living arrangement and health status (activities of daily living [ADLs], instrumental activities of daily living [IADLs], and Center of Epidemiological Studies-depression [CES-D]) among the elderly. RESULTS: Elderly individuals who indicated they rotationally lived with family members had poorer health conditions, including IADLs (Coeff = 0.23; 95% confidence interval [CI]: -0.06-0.52) and CES-D (Coeff = 0.41; 95% CI: -0.59-1.40), than those who steadily lived with family. In contrast, elderly individuals who lived alone had better health conditions in IADLs (Coefficient = -0.38; 95% CI: -0.53 to -0.22) than those who indicated they lived steadily with family. CONCLUSIONS: These findings reveal that this type of rotational living is not a good living arrangement for the elderly.

Clinical outcomes of vertebroplasty or kyphoplasty for patients with vertebral compression fractures: a nationwide cohort study.

OBJECTIVE: To evaluate the outcome of vertebroplasty or kyphoplasty (VK), in comparison with non-VK treatment, among patients hospitalized for first-ever vertebral compression fractures (VCFs). DESIGN: A population-based retrospective cohort study. SETTING: Taiwan' s National Health Insurance claims data. PARTICIPANTS: All individuals aged ≥ 60 years who were newly discharged after hospitalization for a primary VCF diagnosis. INTERVENTION: Percutaneous vertebroplasty or kyphoplasty. MEASUREMENTS: Study outcomes were discharge outcome (re-hospitalization within 1 week, 1 month or 6 months, categorized by diagnosis) and the prescription of anti-osteoporosis medication for secondary fracture prevention. Potential selection bias was adjusted by using propensity score matching to select one conservatively treated patient (e.g. lumbar brace, analgesics, or physical therapy) matched to one patient receiving VK. RESULTS: The study cohort consisted of 9238 patients who had been discharged after hospitalization for a first-ever VCF between 2004 and 2007. During the index hospitalization, 1018 patients received VK, compared with 8,220 patients who did not receive VK. Patients receiving percutaneous procedure group had a consistently lower incidence of 7-day re-hospitalization for any of the three outcomes (OR = 0.48; 95% CI: 0.32-0.72). Considering the cause of re-hospitalization separately, the vertebroplasty/kyphoplasty group had a significantly lower risk of 7-day re-hospitalization for fracture-related diagnosis (OR = 0.28, 95% CI: 0.12-0.68) and musculoskeletal diagnosis (OR = 0.08, 95% CI: 0.01-0.88) as well as a significantly lower risk of 1-month re-hospitalization (OR = 0.74; 95% CI: 0.59-0.93). CONCLUSIONS: VK may protect patients with VCFs from short-term re-hospitalization and a greater need exists for anti-osteoporosis medication as secondary prevention for this at-risk patient group.