On the difficulty of finding one's place: A qualitative study of new nurses' processes of growth in the workplace.

AIMS AND OBJECTIVE: To explore new nurses' processes of growth in the workplace in order to understand the challenges they face. BACKGROUND: Quantitative and qualitative research to date has not adequately explored the complex ways in which initial work experiences may shape new nurses' very high quit rate and, consequently, impact the long-term nursing shortage in Taiwan. DESIGN/METHODS: We conducted in-depth interviews with new nurses to explore their professional development, including the challenges they faced, and their feelings about staying or quitting. Twenty newly registered nurses who had worked in a hospital setting full-time for a year or less in two southern Taiwan medical centres were interviewed. Data were collected from March-November 2016. EQUATOR guidelines were followed, using the COREQ checklist. RESULTS: Interview transcripts were analysed and coded; three stages of growth were discovered: Feeling disillusioned and shocked, Gaining experiential knowledge and Making a place for oneself. Most nurses (n = 18/20) went through these three stages within 9 months and continued to work in nursing at follow-up 2 years later. CONCLUSIONS: Job continuity was contingent upon new nurses' enduring a painful process of adjustment in the first two stages when new nurses were unsure of themselves and their interactions with preceptors were wrought with social tensions. New nurse development and retention efforts should make explicit the possibility of these tensions and how to deal with them. RELEVANCE TO CLINICAL PRACTICE: A better understanding of new nurses' growth processes and adjustment pains can help refocus professional development and retention efforts towards how new nurses can succeed in finding a place for themselves.

Uses and Perspectives of Aging Well Terminology in Taiwanese and International Literature: A Systematic Review.

The aim of this study is to examine aging well (AW) terminology in Taiwan in its local and global contexts, and to suggest ways of communication by Taiwanese professionals that is sensitive to the lay public's preferences. Researchers conducted a systematic review using Khan et al.'s strategy, and Harden and Thomas' method, to sift through seven databases and synthesize diverse studies on AW. Primary aging well terms used in English and Chinese, their usage frequency in Taiwanese academia, and one term uniquely used by lay people in Taiwan were identified. The synthesized literature illustrated commonality as well as diversity in use and interpretation of aging well terms within Taiwanese society and compared with the Western-based research. More qualitative research is needed to explore how AW is experienced, interpreted, and expected from lay perspectives in Taiwan and other countries have primarily relied on translation and adaptation of Western terms in their scientific research.

Anti-allergic potential of Typhonium blumei: Inhibition of degranulation via suppression of PI3K/PLCγ2 phosphorylation and calcium influx.

BACKGROUND: Typhonium blumei Nicolson & Sivadasan (Araceae) is a traditional Chinese medicinal herb possessing detumescent, detoxifying, and anti-inflammatory activities. It is used in Taiwan as a folk medicine to treat cancer and inflammatory diseases. Typhonium blumei is usually not distinguished from Typhonium roxburghii Schott and they are commonly used interchangeably. PURPOSE: To evaluate and compare the anti-allergic and anti-inflammatory properties of T. blumei and T. roxburghii, their composition profiles and molecular basis of the anti-allergic effect. METHODS: The methanolic plant extracts were partitioned with different solvents to obtain the nonpolar fractions. The anti-allergic activity of the nonpolar fractions was assessed by A23187- and antigen-induced degranulation assays using RBL-2H3 mast cells. Several molecular targets were investigated: FcεRI receptor expression by flow cytometry, calcium influx by live cells imaging fluorescent microscopy, cytokines mRNA expression by RT-PCR, and protein expression by Western blotting. The anti-inflammatory activity was evaluated using superoxide anion and elastase release assays in human neutrophils. TLC, NMR and GC-MS analyses were conducted to evaluate the chemical composition of the fractions. RESULTS: The nonpolar fractions of both Typhonium species showed potent inhibitory activity in A23187-induced degranulation assay in RBL-2H3 cells. They also inhibited superoxide production and elastase release in human neutrophils. T. blumei nonpolar fractions inhibited antigen-induced ß-hexosaminidase and histamine release. The nonpolar fractions of T. blumei significantly inhibited calcium influx upon activation with either A23187 or an antigen. The fractions did not affect FcεRI receptor expression, mRNA level of IL-4 and MCP-1 cytokine production or MAPK proteins expression, but did suppress the calcium signaling pathway via PI3K/PLCγ2. The active fractions were rich in fatty acids with palmitic, linoleic and α-linolenic acids identified as the major fatty acids in both plants. The content of omega-3 unsaturated fatty acids was higher in T. roxburghii nonpolar fractions compared to T. blumei. CONCLUSION: Both species possess potent anti-allergic and anti-inflammatory activities. The inhibition of degranulation in mast cells was attributed to calcium influx modulation. The obtained results support the traditional use of T. blumei in the treatment of inflammatory diseases as well as its substitution with T. roxburghii.

Postpartum fatigue, baby-care activities, and maternal-infant attachment of vaginal and cesarean births following rooming-in.

AIM: This study compares women's postpartum fatigue, baby-care activities, and maternal-infant attachment following vaginal and cesarean births in rooming-in settings. BACKGROUND: Postpartum women admitted to baby-friendly hospitals are asked to stay with their babies 24 hours a day and to breastfeed on demand regardless of the type of childbirth. METHODS: The study used a descriptive cross-sectional study design. A total of 120 postpartum women were recruited from two accredited baby-friendly hospitals in southern Taiwan. Three structured questionnaires were used to collect data, on which an analysis of covariance was conducted. RESULTS: Women who experienced a cesarean birth had higher postpartum fatigue scores than women who had given birth vaginally. Higher postpartum fatigue scores were correlated with greater difficulty in baby-care activities, which in turn resulted in weaker maternal-infant attachment as measured in the first 2 to 3 days postpartum. CONCLUSIONS: Hospitals should implement rooming-in in a more flexible way by taking women's postpartum fatigue and physical functioning into consideration.

Comparing Taiwanese women's biopsychosocial features by location of postpartum recovery.

BACKGROUND: In Taiwan, a culturally sanctioned ritual of maternal rest and recuperation has been traditionally practiced patrilocally during the first postpartum month. However, in recent years, the places where women may observe the ritual have become more diverse. AIM: Our goal was to compare women's psychosocial features based on where they stayed during their postpartum recovery. METHODS: Using proportional stratified quota sampling of 18 hospitals and clinics in Taiwan by birth rate, we recruited 784 postpartum women. RESULTS: Women stayed in their own home (17.1%), with their parents-in-law (33.3%), with their parents (36.0%), or in a postpartum nursing center (13.6%). Women who stayed in their own residence or who stayed in their parents' residence perceived greater social support than women who stayed with their parents-in-law. CONCLUSIONS: Further research should compare women's adjustment to motherhood and their competence in childcare based on where they stay during postpartum recovery.

Reduction of RNA A-to-I editing in Drosophila acclimated to heat shock.

Although an increasing number of RNA adenosine-to-inosine (A-to-I) editing sites are being discovered, how the editing frequencies of these sites are modulated to fine-tune protein function in adaptive responses is not well understood. A previous study screening for heat tolerance in Drosophila mutants discovered a hypnos-2 mutant strain that was later found to be defective in dADAR, the Drosophila gene encoding the A-to-I editing enzyme. This supports the hypothesis that cells and organisms respond to stressful environments by ADAR (adenosine deaminase acting on RNA)-mediated RNA editing. Here, we investigated changes in the RNA A-to-I editing frequencies of 30 Drosophila nervous system targets in response to heat shock, a stress acclimatization that requires the dADAR function. To our surprise, most of these nervous system editing targets showed reduced editing. Our results suggest that a change in RNA editing pattern is a mechanism by which organisms acclimate to drastic environmental change. However, how RNA editing confers heat resistance is more complicated and requires further investigation.

Outcomes for type 2 diabetes mellitus patients with diverse regimens.

AIMS AND OBJECTIVES: To compare the levels of self-care behaviour, social support and quality of life among type 2 diabetes mellitus patients who underwent three regimens: taking medicine, taking-medicine-while dieting and taking-medicine-while-dieting-with exercise. BACKGROUND: Diabetes treatment is a critical concern worldwide. However, studies on self-care behaviour, social support and quality of life based on diabetes patients' diverse regimens are few. DESIGN: This study was a cross-sectional design. METHODS: We enrolled 127 outpatients aged over 40 years who visited a metabolism clinic at a medical centre in Southern Taiwan. The Self-care Behaviour Scale, Social Support Scale and Quality of Life Scale were used to collect data. RESULTS: The results indicated that patients with a combined regimen of taking-medicine-while-dieting-with-regular exercise had the highest score at the levels of social support, self-care behaviour and quality of life. CONCLUSION: The study results could offer evidence-based knowledge for healthcare professionals to guide and promote social support, self-care behaviour and quality of life for people diagnosed with type 2 diabetes. RELEVANCE TO CLINICAL PRACTICE: These findings will help healthcare professionals to establish appropriate nursing strategies for type 2 diabetes patients who need to exercise regularly as part of their daily care to enhance their self-care behaviour, social support and quality of life.

A method to identify RNA A-to-I editing targets using I-specific cleavage and exon array analysis.

RNA A-to-I editing is the most common single-base editing in the animal kingdom. Dysregulations of RNA A-to-I editing are associated with developmental defects in mouse and human diseases. Mouse knockout models deficient in ADAR activities show lethal phenotypes associated with defects in nervous system, failure of hematopoiesis and reduced tolerance to stress. While several methods of identifying RNA A-to-I editing sites are currently available, most of the critical editing targets responsible for the important biological functions of ADARs remain unknown. Here we report a method to systematically analyze RNA A-to-I editing targets by combining I-specific cleavage and exon array analysis. Our results show that I-specific cleavage on editing sites causes more than twofold signal reductions in edited exons of known targets such as Gria2, Htr2c, Gabra3 and Cyfip2 in mice. This method provides an experimental approach for genome-wide analysis of RNA A-to-I editing targets with exon-level resolution. We believe this method will help expedite inquiry into the roles of RNA A-to-I editing in various biological processes and diseases.

New concepts of science and medicine in science and technology studies and their relevance to science education.

Science education often adopts a narrow view of science that assumes the lay public is ignorant, which seemingly justifies a science education limited to a promotional narrative of progress in the form of scientific knowledge void of meaningful social context. We propose that to prepare students as future concerned citizens of a technoscientific society, science education should be informed by science, technology, and society (STS) perspectives. An STS-informed science education, in our view, will include the following curricular elements: science controversy education, gender issues, historical perspective, and a move away from a Eurocentric view by looking into the distinctive patterns of other regional (in this case of Taiwan, East Asian) approaches to science, technology, and medicine. This article outlines the significance of some major STS studies as a means of illustrating the ways in which STS perspectives can, if incorporated into science education, enhance our understanding of science and technology and their relationships with society.

The effects of cryotherapy in relieving postarthroscopy pain.

AIM: The aim of this study was to examine whether the application of cryotherapy with ice in a plastic bag is effective in reducing the severity of wound pain after arthroscopy. BACKGROUND: In most studies, analgesic medication were administered prior to surgery; postoperative pain may be reduced by analgesics, but they are known to confound the effects of cryotherapy. Cryotherapy by Cryocuff system has commonly been used to manage post arthroscopy patients' pain. Few studies have tested the effects of cryotherapy by simply applying ice in a plastic bag to relieve postarthroscopy pain. DESIGN: This was a prospective, double-blinded, quasi-experimental study with two groups, interrupted time-series design and multiple treatment replications. METHOD: Fifty-nine patients who received arthroscopy between July-August 2007 were assigned to receive cryotherapy (the experimental group, 33 people) or no cryotherapy (the control group, 26 people). For the experimental group, three 10-minute sessions of ice packing were conducted over a three-hour period, with 50-minute intervals between each session. The first session of ice packing was applied immediately after recovery from anaesthesia. RESULTS: Cryotherapy with ice in a plastic bag was shown to be effective in lessening the degree of pain in postarthroscopy patients. The pain score of the experimental group decreased from 5·12-1·82 after cryotherapy, representing a significant decrease, while the pain score in the control group decreased from 4·04-2·88 (p = 0·047, 0·012 and 0·005). CONCLUSIONS: Cryotherapy with ice in a plastic bag can be applied in standard protocols for patients who have just undergone arthroscopic surgery. RELEVANCE TO CLINICAL PRACTICE: Cryotherapy with ice in a plastic bag is a simple, readily attainable and cost-effective technique for relieving postarthroscopy pain. We recommend that it be included in standard treatment protocols. Techniques for cryotherapy should be incorporated into in-service education.

Postpartum psychosocial changes among experienced and inexperienced mothers in Taiwan.

PURPOSE: To compare differences in psychosocial changes among experienced and first-time mothers over 6 postpartum weeks. DESIGN: A trend research study design. METHOD: A cohort of 439 first-time mothers and 420 experienced mothers during the 6 postpartum weeks was recruited in southern Taiwan. Each participant was interviewed over the phone to complete the Hung Postpartum Stress Scale, the Social Support Scale, and the Chinese Health Questionnaire. FINDINGS: Concern about lack of social support was significantly higher in first-time mothers in the third week than in the first week. CONCLUSIONS: Postpartum stressors are different for inexperienced and experienced mothers, and these stressors vary in their importance over the 6 postpartum weeks, suggesting that the postpartum nursing needs of the two groups in 6 postpartum weeks may be different. IMPLICATION FOR PRACTICE: Knowledge and skills in mothering capability should be emphasized for first-time mothers, and physical exercises are needed for both groups of mothers.

Predictors of postpartum stress.

AIM: To predict important factors in women's postpartum stress. BACKGROUND: The transition to motherhood is often accompanied by stress, but research on predictors of postpartum stress is scant. DESIGN: A cross-sectional survey was used in the study. METHODS: Proportional stratified quota sampling based on births at 11 registered general hospitals and seven specialty clinics in the Kaohsiung area of southern Taiwan was used to obtain a high degree of representation. Eight hundred and fifty-nine women participated in the study within six weeks postpartum. The Hung postpartum stress scale, the social support scale and the 12-item Chinese Health Questionnaire were used in this study. RESULTS: Women with minor psychiatric morbidity, one or two children, junior college educational level, formula feeding for their infants, preference for an infant boy and a low level of social support were important predictors for women's postpartum stress. CONCLUSION: Our findings provide information and data for service planning and community care for the prevention and amelioration of postpartum stress. RELEVANCE TO CLINICAL PRACTICE: Postpartum women face a constellation of factors that could put them at risk for high levels of postpartum stress. Postpartum stress could significantly negatively impact women's health status. Nursing interventions should be tailored to decrease women's postpartum stress as a means of promoting postpartum women's pursuit of well-being.

Diabetes Empowerment Process Scale: development and psychometric testing of the Chinese version.

AIM: This paper is a report of the development and psychometric testing of the Chinese version of the Diabetes Empowerment Process Scale. BACKGROUND: In people living with diabetes, empowerment can improve metabolic and psychosocial outcomes. A scale for measuring empowerment processes can also help healthcare professionals to optimize their empowering actions and would improve their interactions with people living with diabetes. METHOD: Based on literature reviews and interviews with people living with diabetes, a 27-item Chinese Diabetes Empowerment Process Scale was developed. Fifteen items were produced after item analysis and content validity testing. To test construct validity, concurrent validity and internal consistency, 211 outpatients living with diabetes completed the Chinese Diabetes Empowerment Process Scale, a Self-care Behaviour Scale and a Diabetes Empowerment Scale. Test-retest reliability was also analysed with 30 patients. The study was conducted in 2008 and 2009 in Taiwan. RESULTS: Confirmatory factor analysis indicated that a second-order factorial model with four subscales and 15 items best fitted the data. The four subscales were Mutual participation, Raising awareness, Providing necessary information and Open communication. Scores on the Chinese Diabetes Empowerment Process Scale correlated statistically significantly with those on the Self-care Behaviour Scale (r=0.21-0.40; P<0.01) and Diabetes Empowerment Scale (r=0.35-0.65; P<0.01). Reliability was supported by acceptable Cronbach's α (range: 0.73-0.91) and test-retest reliability scores (range: 0.75-0.83). CONCLUSION: The Chinese Diabetes Empowerment Process Scale has satisfactory validity and reliability for measuring the empowerment process of health professionals. Further studies are needed to test the applicability of the scale to other populations.

Voices from the frontline: Perceptions and needs of nurses involved in a nosocomial cluster of tuberculosis infection.

Little is known about the psychological aspects of health care workers who contract tuberculosis (TB). This study explored the perceptions and the needs of nurses who were involved in a nosocomial cluster of TB infection in Taiwan. Using a phenomenological research design, we conducted semistructured interviews with nine participants. The data management was processed by Colaizzi's method. The result reveals that nursing staff members who occupationally contracted TB undergo two phases. From the detection of their infection to recovery, they experienced different perceptions and needs. The hospital should be mandated to accommodate nurses' varying needs accordingly. Clinical-implication-related infection control strategies, grouped into three levels of prevention, are discussed.

Women scientists in Taiwan: an update.

This paper reflects upon issues of gender and science in Taiwan. Its starting point is the first academic paper on the subject published in Taiwan in 1996 by Fu and Wang, and then it draws upon the biographical accounts of 20 women scientists. We emphasize the importance of focusing on the specific contexts of the history of science and women in Taiwan. Partly as a result of Taiwan's colonial past and women's limited access to education, women scientists did not emerge in Taiwan until the second half of the 20(th) century when higher education became available to women. The gender issues with which women scientists in Taiwan have had to cope include the ways in which women have been excluded or included, their marital and career status, the local and global politics of scientific knowledge, and negotiating social networks. These issues have remained largely the same since the Fu and Wang study, but they have certainly gained wider attention and understanding, and greater articulation, both within academia and society.

Maternal satisfaction with postpartum nursing centers.

We explored predictors of women's satisfaction with postpartum nursing centers, which have become popular in Taiwan in recent years. After completing a consent form and demographic questionnaire, 401 women from different centers identified by proportional stratified quota sampling completed four questionnaires over the telephone after their fourth week postpartum. A high level of social support and low level of postpartum stress significantly predicted their satisfaction with the postpartum nursing centers. Future studies will be needed to determine whether, compared to traditional care at home, the postpartum nursing centers can help ease mothers' transition to parenthood and improve their childcare competence.

Evaluation of self-regulatory online learning in a blended course for post-registration nursing students in Taiwan.

Online learning has become a common means of enhancing face-to-face classroom learning and is at the center of most collaborative, multimedia educational environments. There is some evidence that students' self-regulatory (SR) learning can be facilitated in a web-based learning environment, but studies of the effectiveness of self-directed online courses for post-registration nursing students have been few, and the results have been inconclusive. This study qualitatively examined the ways in which adding an online, asynchronous learning component to a nursing course might facilitate post-registration nursing students' self-regulatory learning. Learners' asynchronous communication on an online bulletin board comprised the qualitative dataset. Content related to their e-learning activities and experiences was extracted and generalized in order to examine the possible effects of this online interaction on SR learning. The themes that emerged indicated that students practiced SR learning skills through their online peer interaction. We propose several strategies for facilitating a self-regulatory learning environment based on these results from a course for post-registration nursing students in Taiwan.