Effects of Problem-Based Learning Strategies on Undergraduate Nursing Students' Self-Evaluation of Their Core Competencies: A Longitudinal Cohort Study.

To respond to patients' increasing demands and strengthen nursing professionals' capabilities, nursing students are expected to develop problem-solving skills before they enter the workforce. Problem-based learning (PBL) is expected to provide effective simulation scenarios and realistic clinical conditions to help students achieve those learning goals. This article aims to explore the effects of PBL strategies on nursing students' self-evaluation of core competencies. This longitudinal cohort survey study evaluated 322 nursing students attending Chung Shan Medical University, Taiwan, in 2013 and 2014, where PBL teaching strategies are used in all four undergraduate years from freshman to senior. Based on their undergraduate academic levels, students were categorized into three groups- one-year PBL exposure, two-year PBL exposure, and three-year exposure. A core competency questionnaire was administered twice to ask participants to self-assess five professional competencies: learning attitude, problem identification, information analysis, execution, and life-long learning. The results showed that students with the longest exposure to PBL (Group 3) had higher self-evaluated scores for all core competencies than the other groups, except for the execution competency. The mean total competency score increased by 0.12 points between the pre-and-test. In addition, the mean score increased significantly more in Group 3 than in Groups 1 and 2. These trends were consistent for the information analysis, execution, and life-long learning competencies. In conclusion, the changes in the self-evaluated scores between groups indicate PBL strategies effectively improve nursing students' core competencies. The longest exposure group reported higher self-evaluated core competency scores than the other groups, especially for the information analysis, execution, and life-long learning competencies.

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.

Understanding the Associations Among Perceived Stress, Self-Control Skills, and Overeating in Asian Adolescents.

OBJECTIVE: Built on Rosenbaum's self-control theory, this study aimed to examine the mediating role of self-control skills in the relationship between perceived stress and overeating patterns among adolescents from an Asia-Pacific region. METHODS: A cross-sectional study was used with a school-based, nonclinical sample of 195 adolescents. Participants completed self-report measures assessing study variables and demographic information such as body mass index (BMI) status for adolescents and their parents. Mediation analyses were conducted with Hayes' PROCESS macro modeling tool to assess self-control skills as the mediator of the relationships between perceived stress and each overeating pattern based on the regression-based bootstrapping method, adjusting for potential covariates. RESULTS: The prevalence of overweight and obesity was approximately 18% in the current sample of adolescents. While controlling for age, sex, and standardized BMI, self-control skills mediated the effects of stress on emotional and external eating, but not on restrained eating; in addition, self-control skills partially mediated the relationship between perceived stress and an overall overeating tendency. CONCLUSION: Consistent with Rosenbaum's self-control theory, self-control skills were found to mediate the relationship between perceived stress and emotional and external eating. This study highlights the importance of prevention treatments developed to impart adolescents with self-control skills, decrease their perceived stress, and consequently, reduce their overeating patterns during this intense developmental period.

The effect of multimedia health education on pain and anxiety in women undergoing mammography in Taiwan.

OBJECTIVE: Breast cancer is the most common cancer among women in Taiwan. However, the discomfort of receiving mammograms reduces the willingness to screen. MATERIALS AND METHODS: This study using a quasi-experimental design and recruited 150 participants in a medical center, Taiwan. In the control group, only provided traditional health education sheets, the experimental group has joined the intervention of multimedia health education. State-Trait Anxiety Inventory and Visual Analogue Scale, respectively, were used to compare the differences in anxiety and pain between the two groups before and after receiving mammography. RESULTS: After the intervention, the experimental group's state anxiety score was significantly lower than that of the control group (30.63 ± 8.43 vs. 33.77 ± 10.74, p < .05). However, there was no significant difference in pain scores (4.13 ± 2.37 vs. 4.57 ± 2.31; p = .25). CONCLUSIONS: Younger, prior experience with mammography, and high trait anxiety affect pain and state anxiety of women undergoing mammography. The multimedia health education intervention could reduce anxiety effectively, but it does not significantly relieve the pain undergoing mammography.

Electronic Device Use before Bedtime and Sleep Quality among University Students.

Using electronic devices before bedtime impacts sleep quality and has become a major public health issue. This study aims to investigate the associations between electronic devices (EDs) use before bedtime and sleep quality in Vietnamese university students. A total of 369 university students from three departments were recruited. Participants completed self-report surveys, including demographic characteristics, lifestyle, ED-use behaviors, the Pittsburgh Sleep Quality Index, and the Center for Epidemiologic Studies Depression Scale. A total of 48.8% of the students experienced poor sleep quality, and 98.1% reported using at least one type of ED every day within two hours before bedtime. Smartphones are the most used devices (92.3%). ED usage within two hours before bedtime (p = 0.031), lack of exercise (p = 0.006), alcohol consumption (p = 0.025), and coffee intake after 4 pm (p = 0.018) were associated with poor sleep quality. ED use near bedtime for a duration longer than 30 min (p = 0.001) and depression (p < 0.001) were associated with poorer sleep quality among university students. ED use near bedtime more than 30 min was significantly associated with poorer sleep quality after adjusting depression status, exercise, and caffeine/alcohol intake in the latter part of the day. This study emphasizes the importance of adequate sleep and restriction of ED use near bedtime, which are necessary for better sleep in university students.

Exploring the Relationship of Health Beliefs and Self-Care Behaviors Related to Diabetic Foot Ulcers of Type II Diabetes Mellitus Patients: A Cross-Sectional Study.

OBJECTIVE: Diabetic foot ulcers are an invasive complication of diabetes and are increasing. This study investigates the relationship between health beliefs and foot self-care behaviors, among people with type II diabetes. METHODS: A cross-sectional design was adopted, and 98 patients were recruited from outpatient clinics of the endocrine department. The questionnaires of Demographic, Diabetes Foot Ulcer Health Belief Scale (Health Beliefs, DFUHBS), and Diabetes Foot Self-Care Behavior Scale (Self Care, DFSBS) were used to collect data. RESULTS: Among the subjects living alone or who had diabetes less than ten years, the score of DFSBS was significantly lower than among those living with families or who had diabetes for ten years or more. The frequency of performing diabetes foot self-care behavior, among males was lower than among females significantly. Although there was no significant difference in the Health Belief total score, there were differences in the benefit subscale. Those who had junior high school level or less or had diabetes less than ten years, their score was significantly lower than those with senior high school level or more or had diabetes ten years or more. In a multivariable regression model, living with family, diabetes duration, and health beliefs explained 42.9% of the variance of diabetic-foot self-care behaviors. CONCLUSIONS: Living alone, shorter duration of diabetes, male gender, and lower health belief scores predict less adequate diabetic foot self-care behavior. Health care providers should assess these factors when designing individual care plans.

Translation and Psychometric Analysis of the Chinese Version of the Dutch Eating Behavior Questionnaire for Children (DEBQ-C) in Taiwanese Preadolescents.

PURPOSE: This study aimed to translate and evaluate the psychometric properties of a Chinese version of the (DEBQ-C) among Taiwanese preadolescents. DESIGN AND METHODS: The DEBQ-C was translated into Mandarin Chinese (CDEBQ-C) using established translation and back-translation methods and reviewed by an expert panel for cultural equivalence. A convenience sample of 349 preadolescents was randomly split to conduct exploratory factor analysis (EFA) on the first half and confirmatory factor analysis (CFA) on the second. Internal consistency estimates for subscales were evaluated using Cronbach's alpha. Construct validation with academic stress, a theoretically related construct, was also examined. RESULTS: The theoretical dimensions of the original DEBQ-C were supported with an EFA that revealed the presence of three factors with 41.23% variance explained, and model fit was confirmed by CFA. Construct validation was supported by positive correlations with academic stress. Each subscale of the CDEBQ-C demonstrated satisfactory internal consistency (Cronbach's alpha = 0.72-0.86). Overweight/obese preadolescents scored significantly higher on restrained eating compared to other weight groups. CONCLUSIONS: The findings suggest that the CDEBQ-C is a psychometrically valid and reliable instrument for assessing overeating tendencies with Taiwanese preadolescents. Replication studies with greater diversity in age, ethnicity, and weight are needed to provide further evidence of construct validity for the CDEBQ-C. PRACTICE IMPLICATIONS: Clinicians and researchers can use the CDEBQ-C to assess or expand the knowledge of children's overeating. At-risk preadolescents can be identified at an early stage and effective and individualized intervention programs may be designed and facilitated.

The Development and Psychometric Properties of the Children's Sleep Assessment Questionnaire in Taiwan.

To develop and examine the validity and reliability of the Children's Sleep Assessment Questionnaire (CSAQ) for school-aged children in Taiwan. DESIGN AND METHODS: We used a cross-sectional study design with stratified random sampling. Pairs of children and parents were recruited from a school-based sample of third- and fourth-grade students, enrolling 362 child and parent pairs. The content validity, construct validity, convergent validity, internal consistency, and inter-rater reliability of the CSAQ were assessed. RESULTS: The CSAQ comprised three parts: sleep hygiene, sleep quality, and sleep disturbance. Sleep hygiene showed a moderate intra-class correlation coefficient (0.37-0.66) between children and parents. Results of exploratory factor analysis suggested a four-factor structure model for sleep quality with 64.9% of variance and a two-factor structure for sleep disturbance with 57.7% of variance. These two models also demonstrated good fit with the confirmatory factor analysis. CONCLUSIONS: The CSAQ is a valid and reliable instrument for assessing sleep problems in school-aged children. PRACTICE IMPLICATIONS: Both clinicians and researchers can use the CSAQ to screen or elucidate the children' sleep problems.

Psychometric Testing of Behavior Assessment for Children.

PURPOSE: The purpose of this study was to test the reliability and validity of the Behavior Assessment for Children (BAC) in a community of school-aged children in Taiwan. METHOD: A school-based sample comprising third grade and fourth grade students was recruited from Taichung City in Taiwan. The parents (n = 248) and teachers (n = 15) of these students completed structured questionnaires, including the Child Behavior Checklist (CBCL) and the proposed BAC. Content validity, concurrent validity, construct validity, internal consistency, and inter-rater reliability of the BAC were assessed. RESULTS: The BAC comprised three subscales (attention, emotion, and self-control) that included 17 items. The content validity index (CVI) score was 0.98. The result of the confirmatory factor analysis (goodness of fit = .90, root mean square of residual = .03, root mean square error of approximation = .06, and comparative fit index = .94) supported the construct validity of the three BAC subscales. The concurrent validity of the BAC subscales significantly correlated with the compatible CBCL subscales (r = .59-.78, p < .001). Cronbach α of the subscales of the BAC ranged from .78 to .92. The intraclass correlation coefficient between the parents and teachers ranged from .31 to .44, and the joint probability of agreement ranged from 31.4% to 92.2%. CONCLUSIONS: The BAC is a valid and reliable instrument for evaluating behavioral problems in school-aged children.

Parenting confidence and needs for parents of newborns in taiwan.

OBJECTIVE: Parenting confidence with regards to caring for their infants is crucial for the healthy adaptation to parenthood and the development of positive parent-infant relationships. The postpartum period is a tremendous transitional time for parents, so their unique needs should be considered. This study explored parenting confidence and needs in parents when their newborns are discharged from hospital, and explored the best predictors of parenting confidence and needs. METHODS: A cross-sectional design with a questionnaire survey was used in this study. The questionnaire included three parts: Demographic, Parenting Needs and Parenting Confidence Questionnaire. We survey a convenience sample of 96 parents from a postnatal ward and a neonatal intermediate care unit of the medical central hospital in Taichung, Taiwan. FINDINGS: The mean age of the subjects was 32 years and 67.7% of the subjects' education level was college or above. Approximately one half of the subjects was multiparous, vaginal delivery and had planned pregnancy. The mean gestational age and birth weight of the newborns was 37.7 weeks and 2902 g, respectively. Parents who had a planned pregnancy (t=2.1, P=0.04) or preterm infants (t=2.0, P=0.046) and those whose infants were delivered by cesarean section (t=2.2, P=0.03) had higher parenting needs. In addition, parents of low birth weight infants had higher parenting needs (r=-0.23, P=0.02). Regarding parenting confidence, multipara parents perceived higher confidence than primipara parents (t=2.9, P=0.005). Needs in psychosocial support were significantly correlated with parenting confidence (r=0.21, P<0.05). The stepwise multiple regression analysis showed that parity and needs in psychosocial support predict parenting confidence of 13.8% variance. CONCLUSION: The findings of this study help care providers to identify parents with low parenting confidence at an early postpartum stage. Health care teams should provide appropriate psychosocial support and health education based on parents needs.

[The internationalization of the nursing profession in Taiwan].

Globalization, nursing manpower migration, and the multinational nature of the medical industry have increased the level of internationalization in Taiwan's nursing profession. In nursing practice, competencies for the general nursing list (Taiwan version) and ICNP (International Classification for Nursing Practice) have been clinically tested and revised. In academic nursing, significant effort is invested toward achieving the three general objectives of internationalized teaching, internationalized campuses, and international academic exchanges. We should further test and revise Taiwan's competencies for the general nursing list, and the ICNP should be continually tested and revised. Additionally, nursing personnel should strengthen foreign language competencies, appreciate different nursing practice cultures, participate in international exchange activities, and place increasing emphasis on international cooperation in research and nursing education accreditation. Such should further enhance and strengthen international cooperation, which should further encourage internationalization in the domestic nursing profession.

The Chinese version of the Facts on Aging Quiz scale: reliability and validity assessment.

BACKGROUND: The use of health care services by older adults is increasing with the aging of the population. It is therefore essential that health care workers are current in their knowledge about gerontology; thus, educational programs regarding the care of elders are essential. Chinese-language assessments to measure knowledge about gerontology and aging and attitudes toward older adults are lacking. OBJECTIVE: This study was designed to measure the reliability and validity of a Chinese-language version of Palmore's facts on aging quiz (FAQ 1). METHOD: Cronbach's alpha, construct validity, content validity and convergent validity of the Chinese version of the FAQ 1 were assessed. A sample of 220 student nurses was recruited. Part of the sample (n=125; Group A) was comprised of experienced nurses who had returned to school for advanced degrees. The remaining 95 participants were first-year undergraduate students without prior work experience (Group B). The FAQ 1 was administered to all participants. The Chinese-language version of Kogan's Attitudes toward Older People (KAOP) was also administered to assess convergent validity of the FAQ 1. RESULTS: Cronbach's alpha of the FAQ was 0.68, content validity was 0.82, and construct validity and convergent validity were acceptable. Group A had more correct answers on each item than Group B, indicating that students with prior work experience with the elderly were more knowledgeable regarding older people and aging. CONCLUSIONS: Based on the results of the assessment, the Chinese version of FAQ 1 is a valid and reliable instrument for measuring students' or health care providers' knowledge about older people.

Cigarette smoking and cognitive impairment: a 10-year cohort study in Taiwan.

The relationship between cigarette smoking and cognitive impairment is not a simple one. Some studies have demonstrated that cigarette smoking is a risk factor for cognitive impairment in the elderly, whereas other studies have shown cigarette smoking to be protective against dementia. This study aims to explore the relationship between cigarette smoking and cognitive impairment in elderly persons without dementia, during a 10-year period. Data were derived from a population-based cohort study of 1436 elderly Taiwanese. Cognitive function was measured by the SPMSQ both in 1993 and in 2003. A total of 1436 participants free of cognitive impairment at baseline (SPMSQ> or =6 in 1993) were included in these analyses. Subsequently, participants were divided into three groups: never, past, and current smokers. The effect of cigarette smoking on cognitive function was assessed using logistic regression. In the logistic regression model adjusted for age, education, hypertension, diabetes, heart disease, and stroke at baseline, persons who had quit smoking (Odds ratio=OR=0.31; 95% CI=0.18-0.53; p<0.001) and those who continued to smoke (OR=0.37; 95% CI=0.20-0.70; p<0.001) were about one-third as likely to develop cognitive impairment as were those who never smoked. However, no dose-response relationship was observed between pack-years and cognitive impairment. Past and current smokers were less likely to develop cognitive impairment during a 10-year follow-up than were those who had never smoked. The present study suggests that smoking may be protective for cognitive function.