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Due to their underdeveloped physiological maturity, preterm infants often face challenges related to sucking, breathing, and swallowing coordination during initial feeding. This lack of coordination may lead to episodes of apnea and choking, resulting in unstable vital signs. Preterm infants with this issue must gradually learn oral feeding skills appropriate to their developmental stage. Registered nurses play a critical role in assessing the right time to transition from tube to oral feeding and in providing a safe and positive oral feeding experience. In this article, three validated assessment tools for feeding premature infants are introduced, accompanied by clinical research data demonstrating their use in clinical practice. These three tools include: (1) the Neonatal Oral Motor Assessment Scale, which is applied to evaluate oral motor skills using observations of nonnutritive sucking and the sucking state during the two minutes before feeding; (2) the Premature Oral Feeding Readiness Assessment Scale, which is used to assess readiness for oral feeding in preterm infants; and (3) the Early Feeding Skills assessment, which is used to evaluate the oral feeding skills of preterm infants. These tools aid nurses in helping preterm infants achieve independent oral feeding, facilitating earlier discharge and return to home. The clinical implications and effectiveness of these tools are also discussed to provide to nurses the means and confidence necessary to apply them appropriately in clinical settings.

Background: Multimedia health education may be applied to improve self-care behaviors in patients. However, the long-term effects of multimedia health education on insulin injection performance have been insufficiently studied., Purpose: To evaluate the effect of a multimedia insulin pen-injector health education intervention on patients in terms of their insulin injection skills and glycated hemoglobin level and the time spent by nurses on insulin injection education., Methods: Using a randomized controlled trial and two-group repeated-measures study design, patients with type 2 diabetes who were novice users of a Lantus, Levemir, or Novomix pen injector were recruited. A total of 72 patients, comprising 36 in a control group and 36 in an experimental group, participated in the study. The participants' injection skills were photographed using a smart phone., Results: Patients in the experimental group earned higher scores for attaching a new needle, removing air bubbles, selecting the required dose, selecting a suitable injection site (abdomen, arms, thigh, or buttocks), and injection performance skills than those in the control group. However, no significant differences were found between the two groups in terms of HbA1c levels at 13 weeks after discharge. The time spent by nurses on delivering health education to the experimental group was 0.38 times that of the time spent on the control group., Conclusions: Multimedia health education may not only enhance patients' self-injection skills but also save on human resources and nursing hours. The findings of this study may provide references for healthcare providers in educating patients with diabetes regarding self-administering insulin pen injections.

This case report describes a nursing experience providing end-of-life care to a child with Niemann-Pick disease type C. The period of nursing care was from April to June 2018. After comprehensive nursing and family assessment, dyspnea and caregiver's role strain were identified as the primary nursing-care problems. Niemann-Pick is a rare disease caused by genomic abnormalities. Patients with this disease are unable to metabolize lipids, which accumulate in organs, causing hepatosplenomegaly, dyspnea, and central nervous system degeneration. There is a lack of relevant experience in medical and nursing care due to the small number of cases worldwide. It is difficult to predict the progress of this disease and the life expectancy of the patient. The complex indications of this disease complicate the caregiver burden and process of end-of-life care. Thus, the multi-disciplinary team integrated the discharge preparations, symptom control skills, and related resources to build consensus with the family. We provided nursing care continuously from hospital to home as well as improved quality of care and family cohesion and reduced caregiver load. We hope that sharing this experience provides a reference for discharge planning and end-of-life care for children with rare diseases.

Retinopathy of prematurity (ROP) is a disorder affecting the development of retinal blood vessels in preterm infants. Eye screening examinations are important to the early detection and treatment of ROP. However, several studies have associated eye examinations with pain, stress, and negative physiological effects. Developmental care has been provided as part of neonatal care in recent decades, and some studies indicate that this care positively affects pain scores, stress response, and recovery time during ROP eye screenings. In this article, five elements of developmental care that are applicable for preterm infants undergoing eye examinations for ROP are highlighted and described. These five elements include environmental modifications (e.g., provide a quite environment and dim room lighting), positioning (e.g., offer a nest or positing support and promote the infant to achieve neuromotor development), oxygen delivery (provide adequate oxygen support according to clinical conditions), approach and interaction (e.g., talk softly to infants and gently touch them before the eye examination), and cue-based individual care (e.g., soothe infants, give them a short break or soother based on observations of needs and cue-based behavior). Effectively addressing these five elements may minimize the pain, stress, and energy consumption during ROP eye screenings and provide individualized care that is comfortable, supportive, and promotes the healthy development of preterm infants.

Child abuse is a sensitive research topic. Improving the health of the victims of abuse through research, rights protection, and preemption of harm are important and debatable ethical issues. The ethical considerations related to research into child abuse cover two dimensions: 1) using children as subjects and 2) concerns regarding the physical and mental health of children who are targeted by related research. This paper focuses on several common ethical issues in the field of child abuse research, starting from the formulation of the research problem, sampling, data collection, and results reporting. Ethical issues include obtaining informed consent, assuring the autonomy of maltreated children and adults with childhood abuse histories, ensuring a sense of control and safety during data collection, and establishing the role of researchers as mandated reporters. As a researcher, rigorous research design and methodology and self-preparation on the issue of childhood trauma and abuse are essential in order to reduce the risk of harm to victims. This paper is intended to provide suggestions for researchers and institutional review board committees to assess the ethics of conducting research on sensitive issues.

The aim of this case report was to identify the optimal point to start oral feeding in order to help a preterm infant successfully pass through the transitional feeding period. Because all preterm infants must go through a transitional feeding period, going through this period successfully is very important. This case report described a nursing experience related to caring for a low-birth-weight preterm infant who showed hunger cues before feeding at around 31gestational weeks during the tube-feeding period. An assessment revealed that the preterm infant did not exhibit good sucking, breathing, and swallowing coordination. Therefore, we decided to design a nursing care plan to help the preterm infant transition smoothly from tube feeding to oral feeding. The nursing care period was from September 21st to November 2th, 2017. The care processes included: 1) the oral stimulation phase: provision of oral stimulation to increase oral motor function, 2) the oral feeding training phase: use of the Preterm Oral Feeding Readiness Scale (POFRAS) assessment tool to assess feeding readiness before oral feeding, 3) use of a cue-based approach to decide the starting and stopping points, and, finally, 4) the transition to the demand feeding phase. As the preterm infant grew, the body weight and feeding amount both increased positively and without complications. This experience may serve as a model for developing clinical guidelines for a cue-based feeding approach for preterm infants during the transitional feeding period.

The biomedical technology related to prenatal screen/diagnosis has developed rapidly in recent decades. Many prenatal genetic examinations are now available to assist pregnant women to better understand the status and development of their fetus. Moreover, many commercial advertisements for innovative prenatal examinations are now shown in the media. Cell-free DNA Screening (cfDNA screening), a non-invasive prenatal testing (NIPT) procedure, is a safe and high accuracy test that may be done at an earlier gestational age to screen for fetal aneuploidy. The following questions should be considered when applying cfDNA screening in clinical practice: 1. what is cfDNA screening, 2. who are its potential users, and 3. what ethical and policy considerations are associated with this examination? This article provides relevant information, clinical practice guidelines, and ethical / policy considerations related to cfDNA screening. Discussing cases involving different clinical situations helps promote understanding of cfDNA screening and maternal-care quality.

Disasters are unpredictable and often result in mass casualties. Limited medical resources often affect the response to mass casualty incidents, undermining the ability of responders to adequately protect all of the casualties. Thus, the injuries of casualties are classified in hopes of fully utilizing medical resources efficiently in order to save the maximum possible number of people. However, as opinions on casualty prioritization are subjective, disagreements and disputes often arise regarding allocating medical resources. The present article focused on the 2015 explosion at Formosa Fun Coast, a recreational water park in Bali, New Taipei City, Taiwan as a way to explore the dilemma over the triage and resource allocation for casualties with burns over 90% and 50-60% of their bodies. The principles of utilitarianism and deontology in Western medicine were used to discuss the reasons and rationale behind the allocation of medical resources during this incident. Confucianism, a philosophical mindset that significantly influences Taiwanese society today, was then discussed to describe the "miracles" that happened during the incident, including the acquisition of assistance from the public and medical professionals. External supplies and professional help (social resources) were provided voluntarily after this incident, which had a profound impact on both the immediate response and the longer-term recovery efforts.

Every adult has the right to self-determination and to have his or her autonomy respected. While schizophrenia patients have the right to be discharged from the hospital, their needs subject their caregivers to high care loadings. This situation presents a dilemma for the medical team. The authors justify the patient's autonomy to request and to be granted a discharge. Then, present the decision-making process related to discharge for the reference of medical teams. Capacity is necessary to autonomy. There is currently no standard for assessing the capacity of patients that clearly defines their competence. A sliding scale approach to decision making distinguishes between decisions involving significant potential risk and, therefore, involving higher level of capacity requirements and decisions on minimal potential risk. In order to protect the interests of patients, the sliding scale approach takes into account different decisions. Cases in which schizophrenia patients choose to self-discharge involve a high-level of risk. Poor preparations for follow-up care lead to poor-quality patient care and may cause harm to the patients. In a share decision model, the medical team plays the role of negotiator between the patient and the family and respects the autonomy of the patient while supporting the family through the hospital discharge process. Medical team must have a discharge planning for the patient and family, follow-up care system, and support network. During hospitalization, the discharge plan aims to facilitate the life adaptation and disease recovery for patients with the goal of restoring their normal home life.

Bone marrow transplantation (BMT) is a frequently considered treatment option for terminal childhood cancer. However, the side effects of BMT frequently cause short- and long-term physical discomfort and spiritual suffering, which significantly impact patient quality of life. In Taiwan, parental consent is typically given priority over the assent of children in medical decisions. This article uses a case of an adolescent patient with neuroblastoma undergoing BMT to discuss the best interest standard and contradictions between the consent of parents and the assent of their children. This article argues that medical staffs are responsible to protect the right of children to fully consider and influence the decisions related to their treatment options. Medical staffs should communicate to parents the importance of their children's assent and promote better communication between parents and their children in order to achieve the best outcome for the family as a whole. When mutual communication is unable to resolve conflicts between parents and their children, we recommend seeking assistance from the ethics committee in the hospital.

Background: Developmental care has been broadly applied to identify the behavioral cues and care needs of preterm infants. Past studies indicate a significantly higher level of physical distress in bottle-fed preterm infants than in preterm infants who are breastfed. However, no evidence has yet been reported that supports the influence of feeding methods on behavioral cues., Purpose: This study compares differences in the type and frequency of behavioral cues between breast- and bottle-fed preterm infants., Methods: A comparison study design and secondary data analysis method were used to assess data from two previous research projects. Infant feeding behavioral cues were observed and compared between two groups: 7 preterm infants who were breastfed and 7 preterm infants who were bottle-fed. After cases were matched by infant gestational age, behavioral responses were coded according to the preterm feeding cues coding system (PFCCS) from 7 paired maternal-infant feeding videos that featured preterm infants of 25 to 32 weeks gestational age at birth., Results: The PFCCS classifies 24 feeding behavioral cues into hunger cues, self-regulatory cues, stress cues, and satiety cues. Infants in the breastfeeding group had a higher hunger cue frequency than their bottle-fed peers (p = .013), while bottle-fed infants had a higher stress cue frequency than their breastfed peers (p = .041). Other significant differences in behavioral cues between the two feeding methods included "fluid spillage" (bottle- >breast-, p = .008), "central cyanosis" (bottle- >breast-, p = .024) and "hand pushing" (breast- >bottle-, p = .034)., Conclusions/implications for Practice: Preterm infants in this study who breastfed showed significantly fewer stress cues than those who bottle fed. These findings support the importance of enhancing care provider sensitivity with regard to behavioral-cue observation. Findings further support breastfeeding rather than bottle-feeding for preterm infants.

Esophageal cancer is the 9th leading cause of cancer death in Taiwan. Lack of obvious symptoms or signs during its early stages means that patients are often already in the terminal stage or metastasis at their first diagnosis. A diagnosis of cancer greatly impacts both patients and their families. The purpose of this paper is to explore the current diagnostic methods and treatments used for esophageal cancer. We discuss the effects of physical, psychological and social problems such as dysphagia, fatigue, pain, uncertainty, and social isolation. We also explore the nursing interventions related to these problems. Understanding the health issues related to esophageal cancer will not only help nurses who take care of patients with esophageal cancer provide holistic care, it will also reduce patients' suffering through the treatment and recovery process. By applying interventions that effectively address the physical, psychological, and social realms, healthcare professionals can help patients feel more secure when dealing with related problems. This will improve patients' dignity, value and quality of life through their cancer journey.

Background: Fever is the most common symptom in pediatric healthcare. Providing parents with better information on childhood fever management can improve their cognition and home-care abilities. Vietnamese female spouse comprise the largest segment of women who have emigrated from Southeast Asia to Taiwan over the past two decades. After arrival to Taiwan, they have to encounter the events of pregnancy and being a mother. In health care services, language barriers and cultural issues are key healthcare-related barriers to the adaptation of these women to Taiwan society., Purpose: This study assessed the efficacy of using Vietnamese-language fever management education materials in changing the fever management behaviors of Vietnamese mothers living in Taiwan., Methods: This experimental study used a randomly assigned, pre- and post-test approach. A snowball method was used to recruit Vietnamese women living in southern Taiwan with children under 6 years of age. Participants were randomly assigned to experimental (n = 31, Vietnamese-language fever management brochure + VCD) and comparison (n = 30, Chinese-language brochure + VCD) groups., Results: Both groups achieved significantly improvement scores in (fever) information, attitudes, self-efficacy and skills, with improvements significantly higher in the experimental group than the comparison group., Conclusions / Implications for Practice: This study supports that fever management education presented in the recipient's primary language effectively improves recipient fever management knowledge, attitudes, skills, and self-efficacy.

Developmental care is the core concept of the preterm infant caring model. It is characterized by interaction, individualization, and evolving process. In order to enhance family competency with regard to preterm infant care, health professionals should include parents as team members when preterm infants are hospitalized so that parents can provide care helpful to facilitate preterm infant adaptation to external environmental stimulation. The preterm infant's 6-8 feedings per day represent the most frequent daily activity and an activity in which safety is essential. Potential adverse feeding responses in preterm infants such as tachypnea, cyanosis, and fatigue may stress the mother. This is a particular risk when the mother tries to increase her infant's intake volume by over-stimulating oral-motor activity. Theories and guidelines for feeding preterm infants in western societies have been evolving since the 1980s. However, little has been done in this area in Taiwan. This article addresses preterm infant feeding characteristics and cues, the application of developmental care in feeding infants, and proposes guidelines for feeding preterm infants. Healthcare professionals may reference our suggestions in feeding preterm infants and educating parents.

In bicultural families in Taiwan, women who have immigrated to Taiwan and married a Taiwanese husband are often obligated to be the primary caregiver for their sick children. Thus, in Taiwan's transcultural healthcare environment these mothers are an important communication bridge between healthcare professionals and families. As mothers consider the education and development of their children while the latter recover from illness, they bear primary responsibility for communicating and coordinating amongst the family, hospital and school. Active and comprehensive nursing plans are needed to assist immigrant mothers and their children to complete treatment plans. The author is a primary nurse who helped the mother to understand care methods and how to integrate medical professional, teacher, and family member resources to make her child's reentry school successful. This article described the process of school reentry, follow-ups, specific nursing intervention, and evaluation that contributed to the child achieving his developmental tasks. The author hopes this article can be a reference for clinical care and future research.

Disasters, natural and man made, devastate individuals and society through severe injury, death, property damage, public health problems, and later psychological issues. Emergency nurses are often the first professionals to arrive at the scene of a disaster incident. As such, they must be equipped with knowledge and skills related to disaster management. Training for disaster preparedness has become an important trend for emergency nurses in order to respond immediately to various disasters and to crisis management needs. The purposes of this article were to (1) describe concepts, knowledge and skills related to disaster nursing and (2) describe the disaster nursing experience and training content / protocol of emergency nurses working at the National Cheng Kung University Hospital in Taiwan. Issues related to training, work assignments, practical training, and staff management are also discussed.

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.

Oncology case management models have been encouraged in recent years for cancer treatment in Taiwan as a way to help cancer patients and their families navigate complicated treatment processes. A total of six transdiciplinary oncology teams, led by National Cheng Kung University (NCKU) hospital oncology case managers, operated for four years at NCKUH's Cancer Center. The performance of oncology case managers and level of satisfaction registered by both cancer patients and medical staff were outstanding.

The purpose of gaining the patient's informed consent is ethical, lying in respect for his or her autonomy, and such consent forms the foundation for the performance of clinical medical treatment. In order to respect the patient's autonomy, for example, during decisions about operations, doctors have the obligation to clearly explain that patient's medical condition to him/her. A thorough briefing should be given prior to the obtaining of the patients' consent. In fulfillment of their duties as medical professionals, both doctors and nurses should be involved in clinically informing patients as well as in obtaining their signature for operation and anesthesia. Although informing patients about their physical state is not the responsibility of nurses, it remains absolutely necessary for nurses to understand how people in Asian cultures understand autonomy. This paper begins with a discussion of autonomy in ethics, and then outlines the differences between the Eastern and Western concepts of autonomy, before discussing the obtaining of the signature of consent, a process performed by the nursing staff during clinical treatment, and resulting in the provision of such signatures by patients with the legal capacity to provide them.

Marital violence or intimate partner violence is a serious and recurring public health issue. In the clinical setting, battered women often seek medical advice, because of the health problems that result from marital violence. Thus, nursing staff are the first persons to come into contact with the battered women. Can nurses execute their notify responsibility to prevent continued injury before obtained the woman's agreement? Will this action violate the principle of autonomy or not? Nurses would face an ethical dilemma when they care for battered women. The purpose of this article is to use Aroskar's ethical decision making model to analyze and clarify the ethical dilemmas involved in managing marital violence, including: under the value systems of the person, the profession, and time to illustrate the basic information, decision theory dimensions, and ethical theories or positions. It is hoped that this article provides an ethical decision making model for the ethical dilemmas facing nurses who manage marital violence in the clinical setting.

Fever is the most common problem in medical situations, but controversy still surrounds its benefit/ risk ratio for human beings. Fever is therefore always over-managed, and there is no consistency in management approaches to it. This article discusses fever management through the concept of evidence- based nursing, and provides a reference for clinical nursing. From the starting point of understanding the definition of fever and its physiological reactions, the benefit/risk ratio and management suggestion are discussed. Medical staff are expected to be able to use evidence in deciding approaches to clinical fever management, and to provide correct information with an appropriate attitude to the patient's family members, so that both medical staff and patients can enjoy consistent recognition of and management approaches to fever.

Inquiring of and gathering family history to establish a pedigree is the basic work to assess the health status of a whole family for clinical services or studies in genetics. Pedigrees, moreover, can show not only the disease circumstances of individuals but also the consanguinity/social relationships between the family members. They can be used to assist clinical professionals to make diagnoses and identify potential risk cases, to whom genetic counseling services could be provided. In addition, pedigrees can help researchers to discover novel genetic diseases and confirm the inheritance patterns and mechanisms. In education, through learning the skills for gathering the materials required to establish pedigree, students can develop the ability to assess the health status of each family member and identify the lifestyle or risk factors affecting health promotion. In addition, through their composition from simple symbols and lines, pedigrees are becoming an international language. Therefore, in 1995, the National Society of Genetic Counseling (USA) proposed recommendations for standardized human pedigree nomenclature. This article provides a brief introduction to standard pedigrees, as well as an account of a case to illustrate how to apply the nomenclature in practice. With the completion of the Human Genome Project in 2001, standardized pedigrees have undoubtedly become the best language through which medical or genomic professionals can communicate and share the latest discoveries.

As a result of the effects of globalization, cross-racial and cross-cultural marriages have become common phenomena in Taiwan society. The rapid increase in the number of immigrants coming to Taiwan has created a society that will need to confront the impact of the arrival of people from different cultures and the problems associated therewith. These challenges must also be faced by healthcare providers and patients. Since communication is a crucial aspect of healthcare situations, the cost of medical care can be very high and treatment may be of limited effect if communication between patients and healthcare providers is not sufficiently comprehensive. The use of an interpreter is therefore a popular solution to facilitate communication between healthcare providers and patients. The quality of interpretation, however, depends on the training of the interpreter, and will have a great influence on the outcome of health care. Without effective communication, the quality of health care cannot be improved. The question of how to provide continual monitoring of the quality of interpretation and establish a comprehensive training course for interpreters should therefore be further investigated in clinical research.

Diet control has been an important integrant part of diabetic treatment programs. However, studies have reported that diet control is the most difficult component of the diabetic self-management program for diabetic patients to follow. Many researches support the positive effects of behavioral modification on diet control. In this paper, we designed a diet behavioral modification protocol and applied this protocol to a patient with type 1 diabetes based on the transtheoretical model. Initial results indicate that this protocol helps this patient improve her HbA1c value.

Peripheral intra vein (I.V.) therapy is common and important in clinical practice, and the arguments about I.V. therapy are still being put forward. Reviewing the relevant literature, this article identifies the points for attention and evaluation prior to I.V. therapy, methods to prevent and manage peripheral extravasation, and important points about legal aspects of I.V. therapy. These include tips on assessing patient needs, scholars views on preventing disease combinations caused by I.V. therapy, methods for verifying the efficacy of the therapy, important points about record-keeping and I.V therapy and advice on dealing with an I.V. therapy lawsuit. The recommendations should be useful to nurses in clinical practice.

Diabetic patients who don't control their disease well often develop complications. Their quality of life can then be substantially affected. Lacking social support a vagrant who develops such complications will find it particularly hard to maintain a good quality of life. The application of Parse practice methodology with supplementary social-support theory can help a vagrant diabetic patient to meet his needs and improves his quality of life. The purpose of paper is to provide nurses with a point of reference in relation to the care of such patients.

"Fever phobia" has been found to decrease parents' ability to assess and manage febrile children appropriately, increase the utilization of emergency health care services, and add to the burden of family finances. Educational intervention is an important means of changing parents' knowledge, attitudes, and practices in order to counteract their misconceptions and over-anxiety, and improve the children's health. Parent-oriented education programs can be conducted in various ways, both inside and outside the clinic. However, evidence of the efficacy of given interventions from systematic evaluation of the literature is required to convince pediatric experts what content to teach and what methods to employ daily. The relevant literature from 1980 to 2004 were collected and reorganized to present the theories, contents, methods, effects, and influencing factors of various fever educational interventions. Accordingly, this article could provide healthcare professionals more information about the efficacy, accurate and reliable of various fever education programs. Thus, impel healthcare professionals provide more information to parents for improving parents' actions and decision making on fever management.