Development of the ethical decision-making competence scale.

BACKGROUND: Developing confident capacity for ethical decision-making is vital in nursing education. However, no tool examines nursing students' competence in ethical decision-making. AIM: This study aimed to develop an Ethical Decision-Making Competence Scale (EDM-CS) to assess ethical care decision-making competencies in nursing students. PARTICIPANTS AND RESEARCH CONTEXT: Original items were obtained by employing a focus group and the Delphi method. A cross-sectional design was used to confirm the items remained on the scale. Additionally, the scale's reliability and validity were assessed. The EDM-CS was completed by 498 nursing students. An exploratory factor analysis (EFA) was used to examine the factor structure based on data from group 1 (n = 250). A second-order confirmatory factor analysis (CFA) was used to examine the model's fitness based on data from group 2 (n = 248). This study was conducted between August 2022 and July 2023. ETHICAL CONSIDERATIONS: The Institutional Review Board of OO Medical University Hospital approved this study's design and procedure. RESULTS: From the original 34 items, nine were deleted in the EFA. Thus, the EDM-CS had 25 items and a four-factor structure (ethical judgement, ethical sensitivity, ethical motivation, and ethical action), which explained 60.97% of the total variance. A second-order CFA identified a second-order factor termed 'ethical decision-making competence' with 18 items (root mean square residual = 0.052). The EDM-CS scores correlated significantly and positively with the scores on the Scale of Protective Factor-24 (r = 0.47, p < .001), which indicated good convergent validity. Cronbach's alpha coefficient of the final EDM-CS was 0.90 and ranged from 0.73 to 0.80 for the four subscales. DISCUSSION AND CONCLUSION: The EDM-CS was validated to fit the data adequately. It can be used to evaluate clinical nursing students' ethical decision-making abilities and to develop education strategies to improve their ethical care competence.

Effects of massage intervention on discharged premature infants' weight, parental stress, and parent-child attachment: A randomized controlled trial.

Infant massage enhances the growth and development of premature infants and promotes parent-child bonding. However, its effects on parental stress and parent-child attachment in premature infants, as well as gender differences thereof, remain unclear. In this randomized controlled trial, we used a repeated-measures design and included 61 premature infants (mean gestational age: 35.1 ± 1.5 weeks). Weight, parental stress, and parent-child attachment were measured at multiple time points: before massage and 1, 4, 8, and 12 weeks after commencing infant massage. The results revealed that the massage group infants had significantly higher weight gain than the control (no massage) group infants at all four time points. Moreover, parents in the massage group reported notably lower levels of stress than those in the control group, particularly in the parental distress and difficult children subscales. No significant between-group differences were observed in parent-child attachment. Furthermore, no significant differences were observed between fathers and mothers in parental stress and parent-child attachment. However, fathers reported higher levels of distress than mothers at 4 and 12 weeks. In conclusion, infant massage led to increased infant weight and reduced parental stress over time, and differences between fathers and mothers were not significant, except fathers exhibiting higher levels of distress than mothers over time. Healthcare professionals should educate and support parents on infant massage before discharge of premature infants.

Educational Videos to Reduce Parental Rejection of Pediatric Cardiac Catheterization during the COVID-19 Pandemic.

During the COVID-19 pandemic, people voluntarily reduced their necessary healthcare. We examined whether supplying educational digital versatile discs (DVDs) before admission can reduce parental rejection of pediatric cardiac catheterization for congenital heart disease (CHD). Parents of 70 children with CHD selected for cardiac catheterization were randomly allocated to the DVD (received pre-admission DVDs in the outpatient department; 70 parents of 35 children) or non-DVD groups (did not receive the DVDs; 70 parents of 35 children). The parents could reject the admission of their children within 7 days. Cardiac catheterization was rejected by 14 (20.0%) and 26 (37.1%) parents in the DVD and non-DVD groups, respectively (p = 0.025). Parent Perceptions of Uncertainty Scale scores were lower in the DVD (128.3 ± 8.9 points) than in the non-DVD group (134.1 ± 7.3 points; p < 0.001). Decreased uncertainty due to pre-admission DVD watching could have contributed to the increased parental willingness for cardiac catheterization. The effects of pre-admission educational DVDs were more significant among parents with a lower education, rural residence, with only one child, female child, or younger child. Offering educational DVDs to parents of children selected for cardiac catheterization for CHD may decrease the parental rejection rate of the treatment.

Effects of an ethical decision-making reasoning scheme in nursing students: A randomized, open-label, controlled trial.

BACKGROUND: Previous research suggests that, to design a program to help students to develop ethical decision making, competence and courage to confront ethical dilemmas should be critical components. PURPOSE: This study examines the effect of an ethical decision-making reasoning scheme in ethical decision making and communication self-efficacy in nursing students. METHODS: This study was a prospective and randomized, open-label, controlled trial design. Nursing students from a medical university served as participants. Students were randomly assigned to an intervention group (IG), which received the ethical decision-making reasoning scheme intervention, or a control group (CG), which received a standard general course. The effect was measured with the Ethical Decision-Making Scale-Revised and the Self-efficacy for Communication Scale. Analysis of covariance (ANCOVA) was used to measure between-group differences, and paired t-tests were used to measure pre- and post-IG/CG differences. RESULTS: A total of 101 nursing students were included and randomly assigned to the IG (n = 50) and CG (n = 51), and 41 IG and 43 CG students completed all aspects of the study. The findings show that there was significant improvement in self-efficacy in communication (t = 2.341, p = .024) and a decrease in difficulty in communication (t = 2.330, p = .025) in the IG. Ethical decision-making competencies improved more in the IG compared to the CG (F = 4.856, p = .034). Ethical decision-making competencies increased in both males and females, but there were no significant differences between males and females at the end of study (F = 0.264, p = .610). CONCLUSION: These findings suggest that ethical decision-making training can improve students' confidence in communicating with patients and may help to improve students' more complex ethical decision making.

Childbearing Perceptions Among Taiwanese Women Undergoing In Vitro Fertilization Treatment: A Qualitative Study.

INTRODUCTION: Some infertile women are eager to have children. The purpose of this study was to explore the childbearing perceptions of women who undergo in vitro fertilization (IVF) treatment. METHODOLOGY: Qualitative phenomenological data were collected from 20 infertile women who received IVF treatment in Taiwan. We conducted one-on-one in-depth interviews with the women. Audio recordings were transcribed as textual data and analyzed using Giorgi content analysis until saturation was achieved. RESULTS: Three themes were identified: important tasks related to practicing the family life cycle, ensuring a tight circle of marriage, and the hope to change health. DISCUSSION: Perceptions regarding childbearing in women undergoing IVF treatment in the context of the traditional Chinese fertility culture are multifaceted. To improve the overall integrity of health care provided to infertile women, nurses should be encouraged to consider the cultural connotations and needs of infertile women in the clinic.

An intervention program to promote health-related physical fitness in nurses.

AIMS: To assess the effects of exercise intervention on nurses' health-related physical fitness. BACKGROUND: Regular exercise that includes gymnastics or aerobics has a positive effect on fitness. In Taiwan, there are not much data which assess the effects of exercise intervention on nurses' health-related physical fitness. Many studies have reported the high incidence of musculoskeletal disorders (MSDs) in nurses However, there has been limited research on intervention programs that are designed to improve the general physical fitness of nurses. DESIGN: A quasi-experimental study was conducted at a medical centre in central Taiwan. METHODS: Ninety nurses from five different units of a hospital volunteered to participate in this study and participated in an experimental group and a control group. The experimental group engaged in a three-month intervention program consisting of treadmill exercise. Indicators of the health-related physical fitness of both groups were established and assessed before and after the intervention. RESULTS: Before intervention, the control group had significantly better grasp strength, flexibility and durability of abdominal muscles than the experimental group (p < 0.05). After the intervention, logistic regression was used to adjust for marital status, work duration, regular exercise and workload and found that the experimental group performed significantly better (p < 0.05) on body mass index, grasp strength, flexibility, durability of abdominal and back muscles and cardiopulmonary function. CONCLUSIONS: This study demonstrates that the development and implementation of an intervention program can promote and improve the health-related physical fitness of nurses. RELEVANCE TO CLINICAL PRACTICE: It is suggested that nurses engage in an exercise program while in the workplace to lower the risk of MSDs and to promote working efficiency.

Risk of Subsequent Hypertension and Diabetes in Women With Hypertension During Pregnancy and Gestational Diabetes.

OBJECTIVE: To assess risks of postpartum hypertension and diabetes mellitus (DM) for women with hypertension during pregnancy (HDP) with and without gestational DM (GDM). PATIENTS AND METHODS: From insurance data of 15- to 44-year-old women with pregnancy in 2000-2011, we established an HDP/GDM cohort (n=1270), an HDP/non-GDM cohort (n=5077), and a comparison cohort without either disorder (n=12,594), frequency matched by age and year of pregnancy. Postpartum hypertension and DM were assessed before 2012. RESULTS: The postpartum hypertension incidence increased with age in all cohorts, with overall rates of 13.1, 8.82, and 0.79 per 1000 person-years in the HDP/GDM, HDP/non-GDM, and comparison cohorts, respectively. The adjusted hazard ratios (aHRs) of hypertension were 16.8 (95% CI, 11.8-24.1) for the HDP/GDM cohort and 11.2 (95% CI, 8.19-15.2) for the HDP/non-GDM cohort relative to the comparison cohort. The corresponding incident DM rates were 41.9 and 8.06 vs 2.55 per 1000 person-years in the 3 cohorts, respectively, with aHRs of 16.2 (95% CI, 13.2-19.9) for the HDP/GDM cohort and 3.15 (95% CI, 2.55-3.89) for the HDP/non-GDM cohort relative to the comparison cohort. Incident DM in the HDP/GDM cohort was 44% greater in 15- to 29-year-old women vs 40- to 44-year-old women (49.1 vs 34.2 per 1000 person-years), with aHRs of 39.2 (95% CI, 24.5-62.7) and 5.52 (95% CI, 2.92-10.4), respectively, relative to comparisons of respective age groups. CONCLUSION: Subsequent hypertension and DM risks are greater in women with HDP/GDM than in women with HDP only compared with women without these complications. Younger women with HDP/GDM should be particularly cautious.