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Aim. The aim of this paper was to explore nurses’ stress experiences of working under the current health care system in Tawain (the context) using a qualitative approach. Background. Although most global health care institutions have been changing in response to the economic contraction, there is a deficit of information in understanding the changes of the ecology of the health care system in Taiwan from nurses’ perspectives. Design. Grounded theory. Methods. A grounded theory approach was used to collect the data from a sample of 28 critical care nurses from seven hospitals in Taiwan. Data were analysed using a multi-step analytic procedure, based on the approaches of Glaser, Chesler and Strauss and Corbin. Findings. The health care system changes were found to increase critical care nurses’ occupational stress and work dilemmas. For the purpose of this study, the two categories that emerged in the ‘context’ component of the paradigm model are investigated. They were: hospital reorganisation and cultural burden of the nurse’s role. Conclusions. The findings indicated that hospital organisational changes and people’s own belief of the nurse’s role were recognised as the environmental pressures which increase critical care nurses’ occupational stress. Cultural background may play an important role in influencing nurses’ work atmosphere and their ways of being seen. Relevance to clinical practice. Critical care nurses perceived that their hospitals were under huge demands due to the changes in health care policies; these had subsequently caused them a high level of occupational stress. Beliefs in the embedded culture were also identified as significant factors in causing nurses’ role stress. These findings could enhance the knowledge of critical care nurses’ occupational stress and identify the most appropriate stress management skills available to them. Findings will add to the understanding of Chinese nurses who may work globally. [ABSTRACT FROM AUTHOR]

Aims. This paper reports a study which explored family carers' experiences of taking care of a relative who has a spinal cord injury. Background. Spinal cord injury is one of the most disastrous injuries a person may experience. Although one family member experiences the injury, the entire family is affected. In Taiwan, family carers carry the primary responsibility of providing care on a 24-hour basis during the rehabilitation hospitalisation. However, very limited research exists regarding their experiences. Design. This qualitative study has a cross-sectional and descriptive-explorative design. Method. Grounded theory was used to explore the psychosocial implications for family carer who has a relative with spinal cord injury. Data collection and analysis. Data were collected through in-depth, tape-recorded, semi-structured interviews and observation of a group discussion and two religious activities in a rehabilitation hospital in Taiwan. Fifteen family carers participated in this study comprising eight individual interviews and seven participating in the group discussion. Data collection and analysis occurred concurrently. Results. The findings resulted in the core category 'living with a relative who has a spinal cord injury' and identified the experience of taking care of a relative who has a spinal cord injury. Three stages, including four categories: stage 1 'A catastrophic life event'; stage 2 'Confronting challenges'; and stage 3 'Family resilience' or 'Family breakdown'. Conclusions. This study shows that family carers experience a catastrophic life event, they have to confront challenges and the positive consequence is family resilience, the negative consequence is family breakdown. Relevance to clinical practice. Knowing how prospective family carers view their own situation and what they need is essential to provide effective nursing care for the family that has been changed dramatically by a spinal cord injury. [ABSTRACT FROM AUTHOR]

Aim and objective. The purpose of this study was to explore nurses’ experiences during the first year of the installation of a nursing information system (NIS). The objective was to identify the major issues that emerged regarding the users’ concerns of this technology in their daily practice. Background. The success of the implementation of an information system depends mostly on the users’ acceptance of this technology; however, nurses’ experience of a system installation for a particular length of time, as in this study, has seldom been explored. This is a report on a qualitative study that explored nurses’ experiences of a NIS use during the first year of its installation. Design. Descriptive qualitative interviews with nurse participants were used to collect data at a medical centre in Taiwan. Method. Four focus groups were conducted with the 23 nurse participants in November 2005. The interview guide included questions about the impact of computer use on the nurses’ workflow and the electronic documentation process. Results. Six major themes emerged regarding the nurses’ NIS use, including their dissatisfaction with insufficient personal computers and printers, the slow system response time, workflow change, poor content design, decreased charting quality and the impact on their interpersonal relationships. Conclusions. Organizations may need to redesign the computer interface, to provide better hardware and to maintain a more reliable network function to meet the nurses’ needs during the adoption process, as well as to modify or devise appropriate documentation regulations. Relevance to clinical practice. As they continue to use electronic documentation, nurses may become accustomed to the technology and use it more easily as it becomes the required documentation method. However, understanding the barriers and difficulties they encountered could maximize their technology use and improve both the nursing efficiency and the documentation quality. [ABSTRACT FROM AUTHOR]

Aim and objectives. The aim was to develop a practice theory that can be used to guide the direction of community nursing practice to help clients with schizophrenia and those who care for them. Design. Substantive grounded theory was developed through use of grounded theory method of Strauss and Corbin. Methods. Two groups of participants in Taiwan were selected using theoretical sampling: one group consisted of community mental health nurses and the other group was clients with schizophrenia and those who cared for them. The number of participants in each group was determined by theoretical saturation. Semi-structured one-to-one in-depth interviews and unstructured non-participant observation were utilized for data collection. Data analysis involved three stages: open, axial and selective coding. During the process of coding and analysis, both inductive and deductive thinking were utilized and the constant comparative analysis process continued until data saturation occurred. To establish trustworthiness, the four criteria of credibility, transferability, dependability and confirmability were followed along with field trial, audit trial, member check and peer debriefing for reliability and validity. Results. A substantive grounded theory, the role of community mental health nurses caring for people with schizophrenia in Taiwan, was developed through utilization of grounded theory method of Strauss and Corbin. Conclusion. In this paper, results and discussion focus on causal conditions, context, intervening conditions, consequences and phenomenon. Relevance to clinical practice. The theory is the first to contribute knowledge about the field of mental health home visiting services in Taiwan to provide guidance for the delivery of quality care to assist people in the community with schizophrenia and their carers. [ABSTRACT FROM AUTHOR]

The article presents the author's comments on the article "The Health Needs for Single Elderly of Heart Disease in the Hospitalisation and Community Transition," by S.N. Shih and colleagues. It informs that the article discusses health needs of older people in Taiwan with heart disease. It is noted that the article aims to raise awareness regarding chronic disease management in health services industry.

BACKGROUND: This work has been carried out keeping in view that although knowledge related to perimenopause is an important health issue for women worldwide, little information is known about mid-life Taiwanese women's knowledge of perimenopause. OBJECTIVE: The aim of this paper was to explore the level of perimenopausal knowledge of mid-life women in northern Taiwan, to describe the relationship between demographic factors and women's knowledge, and to identify what information health providers need to offer them. DESIGN: A cross-sectional descriptive survey was conducted. METHOD: The Perimenopausal Knowledge Questionnaire was used to collect data. The study was carried out in August 2000 to September 2001. A convenience sample was recruited from traditional Chinese medicine clinics, gynecology clinics and communities in northern Taipei. RESULTS: Our findings indicated that the overall mean correct answer weighted Perimenopausal Knowledge score of these mid-life women was 46.31. The rank of weighted scores from highest to lowest was: (1) self-care during perimenopause, (2) the perception of perimenopause, (3) knowledge related to hormone replacement therapy and (4) body changes associated with the declined oestrogen in perimenopause. Only educational level was significantly associated with Perimenopause Knowledge level (P < 0.01). Less than 20% (n = 353) of the women answered the items that measured self-management of symptoms related to perimenopause correctly. Less than 1.4% of the women knew that taking hormone replacement therapy required a physician's prescription and subsequent regular health check-ups. CONCLUSION: Participants lacked adequate knowledge about perimenopause. RELEVANCE TO CLINICAL PRACTICES: Health providers need to provide factual information about the normal body changes of perimenopause, self-management of perimenopausal disturbances and appropriate use of hormone replacement therapy. [ABSTRACT FROM AUTHOR]

The article comments on a paper which re-validates the postpartum stress scale which was first devised in 1993. The author stresses that the allocation of certain items to the principal dimensions that relate to postnatal stress is at times puzzling. He emphasizes that it would be interesting to determine the stress levels of those who do not satisfy the inclusion criteria. He asserts that the applicability the stress scale outside Taiwan is questionable.

lee t-t (2005) Journal of Clinical Nursing14, 344–353Nurses’ concerns about using information systems: analysis of comments on a computerized nursing care plan system in TaiwanThe purpose of this study was to pursue a deeper understanding of nurses’ perceptions of a computerized nursing care plan as written in comments on a survey.Studies have examined nurses’ perceptions of computer use, but comments written on surveys of computerized nursing care planning have never been reported and the pattern and meaning of such feedback have not been systematically analysed.Of 738 nurses in Taiwan who completed a two-part survey to evaluate a computerized nursing care plan, 202 responded on part II to an open-ended question about overall perceptions of a nursing information system.A sample of 10 questionnaires with comments was subjected to qualitative content analysis. Key words and phrases were identified, then grouped into categories, which were used to code the remaining respondents’ comments. Another 20 were used to pilot test these coding categories. The final coding categories were applied to all 202 questionnaires with comments for data analysis.Nurses were concerned about inconvenient access to computers; reduced work efficiency; inability to individualize patient care and nursing specialty deficiencies; poor content design, system function, and system integration; using the system as a policy requirement; and privacy and legal issues.Hardware availability, content design and user training/education programmes are critical issues that affect nurses’ use of computers in their daily practice.These comments can be applied in strategic planning and staff development programmes to further use of information systems in patient care. [ABSTRACT FROM AUTHOR]

lee t.t. & chang p.-c. (2004) Journal of Clinical Nursing 13, 33–40 Standardized care plans: experiences of nurses in Taiwan Nursing care plans have been viewed as structured plans of action for patient care. Studies have investigated the outcomes or effectiveness of using different types of care plans, but have seldom reported nurses’ perceptions of using care plans in daily practice. The purpose of this study was to explore nurses’ experiences using a standardized care plan. Nineteen clinical nurses at a teaching hospital in Taiwan were interviewed one-on-one and in depth from April to June 2000. Data analysis was based on Miles and Huberman's data reduction, data display, and a conclusion verification process to identify themes and concepts that represented nurses’ experiences using a care plan. The following themes emerged from the interview data: being reminded of care procedures, time-saving in making care plans, time-consuming in making shift reports, undesirable content design, and paperwork-oriented/not patient-centered. With the considerable amounts of money spent on education and training to meet nurses’ needs, a careful examination of nurses’ experiences in using care plans, should assist in care plan development and lead to observable effects on patient care. Nursing documentation reflects nurses’ observations, assessments, and interventions. It is expected that better use of standardized care plans will enhance nurses’ access to appropriate and accurate information in decision-making, thus improving the charting process and care quality. [ABSTRACT FROM AUTHOR]

The article discusses the subject of sexual knowledge, attitudes, and activity among older persons in Taipei, Taiwan. According to the article, this is a subject not often addressed by health professionals in many cultures because of the belief that old age and sex are mutually exclusive. The article states that many older persons would welcome the opportunity to discuss sexual concerns with a health professional and urges health professionals to address this issue.

The author reflects on qualitative research trends in nursing practice and expresses opinion on the papers and posters presented at the International Council of Nurses (ICN) Conference held in 2005, Taiwan. An overview on the popularity of Phenomenology, descriptive and/or exploratory research and grounded Theory among nurse researchers is offered. The author also advises qualitative methodologists to master broad criteria, which in turn would enhance quality study in nursing practice.

AIMS: To (1) develop and implement a Nursing Process Support System in Chinese (NPSSC) enabling computerised documentation for nursing home residents, (2) evaluate the efficiency of NPSSC, (3) assess obstacles to the use of the NPSSC and (4) assess nurse users' satisfaction with the NPSSC. BACKGROUND: Long-term care facilities in Taiwan have been slow to computerise resident's medical records. The development and implementation of a computerised documentation system provides a way to enhance nursing documentation in long-term care settings and can prevent hazards that result from documentation errors. DESIGN: Quasi-experimental. METHODS: This study used one group pre/post-test. Five nursing homes in Taiwan were included in the study. Twenty-seven nurses used the NPSSC to computerise 396 residents' medical records. Using the NPSSC allowed nurses to enter health assessment data into the computer system, which automatically triggered appropriate nursing diagnoses. The NPSSC included geriatric nursing interventions and the use of alternative Chinese therapies. RESULTS: Obstacles that hindered nurses' use of the NPSSC were identified and possible solutions to overcome these hindering factors were discussed. The use of the NPSSC significantly improved nursing documentation in that resident's records were organised and consistent and nurses were able to complete a comprehensive care plan within 48 hours. Nurses reported a higher satisfaction in nursing documentation after the implementation of the NPSSC than previously. CONCLUSIONS: This study suggested a pathway to develop and implement a computer-based, user-friendly nursing documentation system for nursing homes. This study may be used as a template for implementing computerised documentation worldwide. RELEVANCE TO CLINICAL PRACTICE: Nursing home providers may consider implementing the NPSSC to replace the traditional hand-written documentation system. An effective use of in-service programs within the workplace helped ease the transition from hand-written documentation to the computer-based NPSSC. [ABSTRACT FROM AUTHOR]

Aims. To describe the attitudes toward and the use of folk remedies among caregivers of children who were hospitalised in Taiwan. Background. Parents incorporate folk remedies into the care of sick children in many cultures, including Taiwan. Twelve common folk remedies are commonly used in the Taiwanese culture for the care of sick children. Design. The study employed a descriptive, exploratory design using survey methods. Participants were 92 caregivers (parents) whose children were hospitalised for at least three days in a hospital in the middle district of Taiwan. Results. Sixty per cent of the participants used some form of folk remedies in the care of their hospitalised children. The most frequently used remedies were: spirit-calling (63%); carrying a cross or incense bag (47%), praying a Buddhist mantra (36%). There was a positive relationship between a positive attitude towards folk remedies and current use with children ( p < 0·05). Logistic regression analysis revealed that parents’ previous experience of using folk remedies (odds ratio = 0·272, p = 0·037), and parents’ knowledge of the care of disease (odds ratio = 18·044, p = 0·015) were the strongest predictors of use of folk remedies. Almost three-fourths (73%) of all participants expected that health care providers would respect and not interfere with their use of folk remedies; 72% of parents stated that they would not tell healthcare providers about the use of folk remedies. Conclusions. The majority of the parents of hospitalised children in Taiwan can be expected to use folk remedies for the purpose of psychological and spiritual support during child hospitalised. Relevance to clinical practice. Healthcare providers need to be aware of the folk remedies used within various cultural groups so that culturally appropriate and safe care can be provided for the child and family. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study aimed to explore the menarche and menstruation experiences of young females aged 10-12 years in elementary education in Taiwan. Background. Menarche is a significant milestone in a woman's life and for female adolescents it is a sharply defined biological event that can be a traumatic and uncomfortable time. If used, school nurses can make a significant contribution in educating young people and help to ameliorate these problems. Understanding how young women feel about menstruation is a central element to sexual health education practice. Design. A qualitative research design was employed using focus groups. Methods. Data were collected from 20 female students, aged between 10-12 years. Focus groups were recorded, transcribed and subject to a thematic analysis. Results. Three themes emerged from the data analysis reflecting the menstrual experience of participants. These were: 'Changing bodies: the physical effects of menarche and menstruation', 'Emotional issues: the psychological impact of menarche and menstruation' and 'Social dimensions of the menarche and menstruation'. Conclusion. Our findings show that young females can experience significant physical and emotional difficulties around menstruation - many of which stem from poor information and the reactions of their peer group to menstrual activity. The potential for school nurses to contribute to this education is significant and schools should explore the manner in which nurses can contribute to this area of health education. Relevance to clinical practice. Nurses involved in health education work with young people and ensure that menstruation education addresses the social and psychological impact of the menarche as well as the physical elements of menstruation. Boys should not be absent from this education and the impact of their attitudes towards menstruation upon their female peers should be addressed in health education work. [ABSTRACT FROM AUTHOR]

Aim. To generate a substantive theory for understanding the phenomenon of nursing home care for older people in Taiwan. Background. Taiwanese culture shows great respect for older people and older people are traditionally cared for at home by their families. However, the older population in Taiwan is rapidly increasing and this demographic shift, together with various socio-economic changes, has resulted in nursing homes becoming a new and significant care option. Design. A grounded theory approach was used to study the residents and relatives from three nursing homes in Taiwan. Methods. Formal and informal interviews and participant observation data were collected over two months in each nursing home. Forty nursing home residents and 20 of their relatives were recruited. The data were analysed using the constant comparative method and involved the use of theoretical memos and theoretical sampling procedures. Results. The study found that nursing home care for older people in Taiwan is understood to be a process of forced choice, involving three stages; namely, 'becoming a problem', 'making a forced choice' and 'coping with the forced choice'. Conclusion. Taiwan is in a state of conflict with regard to providing care for older people, a situation in which the influence of traditional cultural and that of industrialisation exist side by side. The consequence of having to relocate older people into nursing homes means that both parties are the victims of this choice. Relevance to clinical practice. This conceptual explanation helps us to understand how the Taiwanese respond to the issue of care for older people and how they resolve their main concerns related to it. Subsequently, it is hoped that this will help health care practitioners to provide care more effectively to meet the needs of the Taiwanese with the aim of enhancing the standards of care for older people. [ABSTRACT FROM AUTHOR]

Aims and objectives. The objectives of this prospective study were to identify birth-related fatigue trajectories in expectant fathers with the progress of labour and the physiological, psychological and situational factors related to specific trajectory patterns. Background. An increasing number of fathers participate in their partner's labour; however, their fatigue experience remains unclear. Previous studies have focused on overall groups without considering the possibility of between-subject heterogeneity. With an advanced data-analytic strategy, it is feasible to identify subgroup variation within the population over time. Design. A prospective, repeated measures design was used. Method. A convenience sample of 108 Taiwanese expectant fathers was followed throughout the labour process. Data were collected by visual analogue scales and self-administered questionnaires. The repeated measures of fatigue were analysed by using semi-parametric, group-based modelling. Results.Twodistinct groups of individual trajectories among the expectant fathers were identified; the persistent low-fatigue group (49·2%) and the persistent high-fatigue group (50·8%). After birth, a moderate level of fatigue persisted in the high-fatigue group. The fastest period of increasing level in the persistent high-fatigue group was in the latent phase. The persistent high-fatigue group also experienced significantly more sleep difficulties prior to labour and more anxiety than the persistent low-fatigue group. Conclusions. Identifying and characterising meaningful clusters of trajectories could provide a better understanding of the birthrelated fatigue experience of fathers and contributes to recognising the target client and timing for early intervention. Relevance to clinical practice. There are points in time at which professional caregiver actions may have an effect on the birthrelated fatigue of fathers. Caregivers should prevent high levels of fatigue, which could accumulate as fathers accompany the women entering the labour phase. Fathers who present with high fatigue at onset of labour should receive early intervention, especially in the rapid-increasing fatigue period. [ABSTRACT FROM AUTHOR]

Aim. This study reports on nursing students’ current capacity to handle standard and additional infection-control precautions in terms of their knowledge, application skills and confidence. Background. These precautions are recommended as the guidelines for preventing infections and ensuring occupational safety. As nursing students undertake patient care during clinical practice, their knowledge of and ability to apply these precautions with confidence should be examined before they enter the clinical field. Method. A specific tool, the Infection Control Evaluation, was developed and distributed. Design. A cross-sectional survey involving a sample of preservice nursing students was conducted in southern Taiwan. Results. The results were based on an 88% response rate and indicated that the level of knowledge concerning standard and additional precautions was low among Taiwanese nursing students. Their ability in applying these precautions in clinical practice also appeared to be inadequate. Conclusions. Such findings indicate that Taiwanese preservice nursing students require a comprehensive foundation course in infection-control precautions before they enter the clinical environment. This will help to ensure their protection and that of their patients. Relevance to clinical practice. As the findings highlight the importance of providing such education for students before they undertake any clinical work, the information provided here can help nursing educators and academics to develop a specific program. [ABSTRACT FROM AUTHOR]

Aims. To test the reliability and validity of the Chinese version of the Nursing Practice Environment Scale (C-NPES) translated from the Lake’s Practice Environment Scale of the Nursing Work Index and to explore nurses’ perceptions of the nursing work environments in Taiwan Background. Magnet hospitals are characterised by professional autonomy, control over nursing practice, adequacy of staffing, supportive management and effective interdisciplinary relationships, which are successful in attracting and retaining nurses. In Taiwan, this concept has gained importance since the SARS crisis of 2003. However, there have been limited Chinese instruments based on magnet hospital traits to explore Taiwan’s nursing work environment. Design. This study was designed as a cross-sectional survey. Purposive convenience samples of 842 nurses were recruited from five acute hospitals in Taiwan. Internal consistency reliability, content validity using expert review, construct validity using factor analysis and criterion-related validity were examined. Results. The Cronbach’s alphas were 0·90 for the total scale and 0·87–0·65 for the subscales. The validity was obtained using a content validity index and principal component analysis of five-factor structure (variance explained 47·89%). The criterion-related validity was supportive of the turnover rate ( t = 7·84, p < 0·001). The participants disagreed on staffing and resource adequacy and participation in hospital affairs but agreed on professional development. Conclusion. The preliminary psychometric properties of C-NPES have been established. Considering cultural appropriateness, the subscales of staffing and participation in hospital affairs need advanced modification. Relevance to clinical practice. The C-NPES will provide hospital administrators with an overview of magnet hospital settings for nursing practice. It is beneficial for the stabilisation of the nursing workforce as well as for the optimisation of nursing work environments. Additionally, the use of professional development programs to enhance nurses’ knowledge of SARS prevention is favorable. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study examined the relationships among stressors, social support, depressive symptoms and the general health status of Taiwanese caregivers of individuals with stroke or Alzheimer’s disease. Background. Caring for a disabled or cognitively impaired person can be extremely stressful and often has adverse effects on caregivers’ health. While research on caregiving in Taiwan has examined caregivers’ characteristics, caregivers’ need and caregivers’ burden in caring for older people in general, little is known about Taiwanese caregivers of individuals with stroke or Alzheimer’s disease. Design. Cross-sectional, descriptive correlation design. Methods. Data were obtained from a convenience sample of 103 Taiwanese informal caregivers in the South of Taiwan and analysed using descriptive statistics, Pearson’s correlations, multiple and hierarchical regressions and t-tests. Results. Caregivers who had lower household incomes and were taking care of individuals with more behaviour problems had more depressive symptoms. In addition, caregivers who were older and were taking care of individuals with more behaviour problems had worse general health. Caregivers who had more emotional support had less depressive symptoms. Conclusions. Caregivers of persons with Alzheimer’s disease had more depressive symptoms and worse general health than caregivers of persons with stroke. Only emotional support moderated the relationship between one of the stressors (household income) and depressive symptoms. Relevance to clinical practice. The findings of this study may be helpful for nurses and other health care professionals in designing effective interventions to minimise the negative impacts of stressors on the psychological and general health of caregivers in Taiwan. [ABSTRACT FROM AUTHOR]

Aims and Objectives. The aim of this study was to understand the factors related to intention to leave their job among intensive care unit (ICU) nurses in eastern Taiwan and to make between-group comparisons between an intention to leave and an intention to stay as well as to predict the influencing factors that affect ICU staff nurses' intention to leave. Background. Nurses' intention to leave their job may have an important impact on the actual turnover of nurses. The issue has always been of concern to nursing executives. Only limited empirical studies in the area have been investigated in an Asian culture context and particularly the eastern Taiwan region. Methods. A cross-sectional predictive study was performed during 2005 with 130 nurses recruited from two ICUs at a medical centre. A researcher-designed questionnaire based on the Cooper's model with structured interviews was used to determine each nurse's characteristics and their intention to leave their job. Multiple logistic regression analysis was employed to investigate the various factors associated with this. Results. The overall response rate was 100%; 63 (48·9%) revealed that they intended to leave their jobs. The findings were that their self-rated health status, the number of diseases, the level of happiness, the presence of depression, job satisfaction, sleep quality, type of license and their unit were significantly associated with an intention to leave ( p = 0·05-0·001). Depression and sleep quality proved to be the most significant predictors of ICU staff nurses' intention to leave their job. Conclusions. The findings suggest that there is a need to take steps to improve nurses' health-related quality of life and to develop effective strategies to improve nurse retention. Relevance to clinical practice. A succinct validated instrument would help identify the important factors that predict ICU nurses' intention to leave their job, which may result in job disengagement. Predictors found in this study may be used as outcome variables for developing such an effective method of improving nurse retention in ICUs. [ABSTRACT FROM AUTHOR]

Aims. This study aimed to examine the use of a free hotline service for breastfeeding mothers in Taiwan. Specific attention was given to the accumulated consultation time and to investigate the trends and reasons that prompted people to contact the service. Background. Breastfeeding can be a difficult time for mothers, especially during the first two weeks after birth. It has been suggested that a telephone hotline service may be helpful for breastfeeding mothers. Design. In this quantitative study data, including the demographic data and the problems of consultations, were gathered from callers during August 2003 to August 2005. Results. Of the 2445 callers, 935 made subsequent calls (38.2%). Approximately 25.25 calls were answered each day by two specially-trained staff according to an answering book. The mean consultation time for single first-call was 21.82 minutes and for one subsequent-call was 15.87 minutes. Perceived insufficient milk supply (30%) and returning to work (21%) were the top two reasons for a first-call. If callers' problems were about babies' sickness, perceived insufficient milk supply, babies' body weight gain and supplement issues, the accumulated consultation time would last longer. More than half (53.3%; 1303/2445) of callers made the first-call during the first month after birth, followed by 23.2% (566/2445) during babies' age between one and three months old. Conclusion. The telephone hotline service for breastfeeding mothers in Taiwan was well used during the two year period of this study. Many mothers used the service repeatedly for a variety of reasons. Relevance to clinical practice. Recommendations for breastfeeding support strategies for the professionals include category of common breastfeeding problems by different stages after birth. This study supports the establishment of free hotline services may encourage greater empowerment in breastfeeding mothers. Future studies are required to examine client satisfaction of the telephone service. [ABSTRACT FROM AUTHOR]

Aims. To explore the prevalence of breastfeeding in different geographical areas and identify the factors influencing breastfeeding practices during in-hospital stay and at one, four and six months postpartum in Taiwan. Background. The national data on prevalence for breastfeeding patterns are still unknown. Design. Community-based epidemiological survey design. Methods. A total of 12,201 women were sampled from the birth registration and surveyed between June-October 2004. Data were collected through a computer-assisted telephone interview at four different postpartum periods. Logistic regression modelling was applied to determine factors influencing breastfeeding patterns and postpartum time-specific odds ratios. Results. Rates of breastfeeding practices were 29.4, 33.2, 16.9 and 13.1% for in-hospital stay, the first-, fourth- and sixth-month postpartum respectively. Mother's intention to breastfeed was the most important factor to lengthen breastfeeding practices over time. The effect of an advocate programme in the hospital was significantly associated with breastfeeding only at the time of in-hospital stay. Age, family support and singleton were found to be significantly related to the continuation of breastfeeding at the fourth month postpartum. Employment status was significantly associated with the termination of breastfeeding, particularly at the later postpartum period. Geographical variation in breastfeeding practices within the first month postpartum was identified. In contrast, ethnic variation was more apparent at the later postpartum period. Conclusions. This large-scale study revealed a significantly decreasing trend after one month postpartum of breastfeeding rate in each geographical area of Taiwan. Factors associated with women's decision and continuation on breastfeeding patterns tended to be dependent on the time-specific postpartum period and varied between geographical areas. Relevance to clinical practice. If breastfeeding rates are to increase, more attention should be paid to establish early breastfeeding and counter the negative influences of factors within the social environment. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aims of this study were to investigate a sample group of casualty nurses' attitudes towards patients who have attempted suicide in the middle of Taiwan and to identify factors contributing to their attitudes towards attempted suicide. Design. A quantitative study using a questionnaire containing 22 statements with a five-point Likert-type scale was developed from the Domino's Suicide Opinion Questionnaire, and from a comprehensive analysis of research literature on the area of attitudes towards suicide. Methods. The questionnaire was distributed to casualty nurses (n = 155) to investigate their attitudes toward patients who have attempted suicide. Seven large hospitals in the middle of Taiwan were targeted. Results. This sample group of casualty nurses from the middle of Taiwan held positive attitudes toward patients who have attempted suicide. In addition, three statistically significant differences were identified: (i) The higher the level of nursing education the more positive the nurses' attitudes towards patients who had attempted suicide. (ii) The casualty nurses who did not have a religion held more positive attitudes towards suicidal behaviour than those who followed a religion. (3) Casualty nurses who had suicide care experience with 1-10 patients had more positive attitudes towards suicidal patients than nurses who had nursed above 10 patients who had attempted suicide. Conclusions. The results indicated that casualty nurses in Taiwan require further education on and training in all aspects of suicide to foster more positive attitudes towards patients who attempt suicide. Relevance to clinical practice. The role of casualty nurses is pivotal to the front-line care of people who are suicidal and their attitudes play a major part in the provision of effective care. [ABSTRACT FROM AUTHOR]

AIM AND OBJECTIVES: The aim of this study was to identify and assess the teaching behaviours (knowledge, attitudes and skills) observed in nurse educators as they taught in the clinical setting. BACKGROUND: Many quantitative studies have defined and evaluated teaching effectiveness in the clinical area. Some of these studies established instruments to evaluate faculty effectiveness in the clinical setting; however, they tended to be so broad that they were of limited use in understanding clinical teaching behaviours in nursing education. DESIGN: This study explored clinical teaching behaviours in a nursing practicum. Ten nurse educators taught 10 students in the medical-surgical unit at a hospital in Taiwan for about four weeks. Each teacher was observed by the researcher and one other observer for two days during regularly scheduled clinical teaching time. METHODS: Data collection and analysis were done by a qualitative approach. Content analysis is a process of identifying, coding and categorizing the themes in the data. CONCLUSION: The themes of clinical teaching that emerged from data analysis included teaching aims (task-oriented and learner-centred), teacher competence (teacher knowledge, instructional strategies, planning learning experience, teaching priorities, feedback and caring) and teaching commitment (professional identity and giving of self). These findings offer a holistic blueprint of clinical teaching for nursing faculty members, which will enhance the quality of nursing education. RELEVANCE TO CLINICAL PRACTICE: Complexity in nursing education has increased as it is challenged to meet the needs of diverse populations in rapidly evolving and highly technical health-care settings. Clinical teachers must be enabled and empowered to provide students with appropriate knowledge and skills to meet the needs of patients. To develop students' professional nursing identity now and in the future, nurse educators have to commit themselves to both nursing and teaching in clinical settings. More nurses need to be prepared for careers in education at the master's and doctoral levels. [ABSTRACT FROM AUTHOR]

Aims and objectives. This research explores the compliance by older people in Taiwan with wearing hip protectors and whether protectors can prevent fractures or decrease injuries after falls. Background. The ageing process causes degeneration of nerves, joints, muscles and then the incidence of falls in the older people is higher than in the young. Therefore, fractures caused by falls, particularly hip fractures of older people, need to be studied. Hip protectors are designed to reduce hip fractures and hip injuries when falls occur, by distributing the impact load and absorbing the impact force generated during a fall. Design. This research was designed as a longitudinal study using purposive sampling and intervention for six months. Methods. The target population were older people at high risk for falls and the study was carried out during a six-month period. Self-reported data were collected by interview and questionnaires. The expert validity of the questionnaires, including demographics, high-risk group, compliance and correct wearing of hip protectors and fall injuries, as assessed by three experts, was 0.94 and the test-retest correlation coefficient was 0.95. Individuals were excluded from the research sample if they were 24-hour bedridden, non-mobile or had an existing hip injury. Results. Ten female subjects participated in this study. Their mean age was 76.1 years. During a six-month follow-up, there were 12 falls while wearing hip protectors, however, no fractures occurred because of the falls. Conclusions. This is the first research into hip protectors in Taiwan. The reasons for low compliance by older people were (1) unaccustomed to use, (2) discomfort, (3) wearing only during the daytime, (4) lack of assistance from family caregivers. Relevance to clinical practice. Fall prevention, exercise and the use of hip protectors can significantly decrease the incidence of hip fractures. Although hip protectors are effective in reducing fall fracture risk, the compliance rate remains low. In the future, the researchers will develop a hip protector program related to teaching the correct method for wearing protectors. Helping older people learn how to overcome the discomfort of wearing hip protectors and encouraging a willingness to wear them is imperative. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The purpose of this study was to explore factors that may affect nurses' use of nursing diagnoses in charting standardized nursing care plans in their daily practice. BACKGROUND: Care plans have been viewed as providing a structured approach to the assessment, planning and delivery of patient care. Nonetheless, the challenge for many institutions is to help professional nursing staff refine their understanding of nursing diagnoses and charting skills, to identify patient problems and propose appropriate care plans. METHOD: Twelve clinical nurses working at a medical center in Taiwan underwent one-on-one in-depth interviews from May to July 2000. Data analysis was based on Miles and Huberman's data reduction, data display, and a conclusion verification process to investigate the charting process. FINDINGS: Nurses tended to match patient conditions to the designated nursing diagnoses, be unfamiliar with statements of related factors, use objective data to describe patient conditions, ignore descriptions of nursing goals, dutifully check interventions without always executing them, and choose the same evaluation to meet hospital requirements. CONCLUSIONS: These findings suggest that using educational programmes for enhancing nurses' ability to use nursing diagnoses and exploring the process of diagnostic reasoning would improve the quality of patient documentation. RELEVANCE TO CLINICAL PRACTICE: The trend in health care is to focus on chart audit to reveal indicators of quality of care. Therefore, the experience of nurses in this study could be applied to in-service training programmes by institutions that are replacing traditional, manually written care plans with a standardized care planning system, thus helping other nurses through this transition process. [ABSTRACT FROM AUTHOR]