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Purpose: To explore the relationship among resilience, stress, and demographic factors in certified nursing assistants (CNAs) who worked in long-term care institutions during the coronavirus disease 2019 pandemic. Method: A cross-sectional correlation-based research design was used. Data were collected using a demographic questionnaire, Connor-Davidson Resilience Scale, and Occupational Stress Scale. CNAs from 21 long-term care institutions in Taiwan were recruited. Results: This study included 118 female and 26 male CNAs (response rate = 80%). Mean age was 46.8 years. A moderately negative correlation was found between workplace resilience and stress. Overall, being a woman and parent were found to be significantly correlated with CNAs' resilience. Furthermore, resilience and shift work were important predictors of stress. Conclusion: We suggest that leadership and management pay more attention to CNAs' basic demographic background information. Furthermore, timely, relevant strategies can be provided to enhance resilience and reduce workplace stress. [Journal of Gerontological Nursing, 50(7), 19–26.] [ABSTRACT FROM AUTHOR]

This study aimed to examine the factors affecting the relationship between stress and anxiety in critically ill patients. A cross-sectional research paradigm was employed to enroll patients admitted to the medical intensive care unit (ICU) of a medical university hospital. Partial least squares structural equation modeling (PLS-SEM) was used to examine the data. A total of 90 ICU patients were included in this study; 56 were men and 34 were women. The patients' mean age was 65.3 years. Only the emotional responses dimension of illness was significantly positively correlated with stress. However, the emotional responses dimension of illness representation, acute physiology and chronic health evaluation system (APACHE) score, age, and education level were significantly positively correlated with anxiety. Nevertheless, treatment control was significantly negatively correlated with anxiety. Overall, illness representations (emotional responses and treatment control), APACHE score, age, and education were important predictors of anxiety, with an explanatory power of 37.9%. We recommend that for clinically relevant practice, besides focusing on ICU patients' illness representation, attention should also be paid to their individual characteristics, such as differences in age and education levels. [ABSTRACT FROM AUTHOR]

The purpose of this study is twofold: to examine the relationship between illness representation and self-efficacy and to test the determinants and the effect of self-efficacy, resilience, and stroke impact on fatigue in middle-aged stroke survivors. This study used a cross-sectional and quantitative approach. The instruments included the Chronic Disease Self-Efficacy Scale, Stroke Impact Scale, Resilience Scale, and Fatigue Impact Scale. Structural equation modeling (SEM) was performed to analyze the data. A total of 63 patients with stroke (39 male and 24 female) were recruited form a medical university hospital. The results showed that patients' illness representation had a significantly effect on self-efficacy for managing disease. In addition, SEM analysis demonstrated that self-efficacy, resilience and stroke impact influenced fatigue, explaining 20.6% of the variance in fatigue. It was concluded that to improve patient fatigue, we believe it is imperative to design interventions that improve patients' self-efficacy, promote patients' resilience, and better function. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the relationships among nursing students' perceived nursing image, caring behaviours and gender‐friendliness barriers to determine whether gender‐friendliness barriers affect nursing image and caring behaviour among male nursing students. Background: Because caring is typically seen as a feminine trait, male nurses face gender‐role strains in the current nursing environment. Gender‐friendliness barriers may have an impact on the vital relationship between professional nursing image and caring behaviour. Design: This study used a quantitative and cross‐sectional research design. Methods: Participants were 141 male students who had obtained at least 1 month of clinical practice experience. We collected data using three instruments: The Caring Assessment Report Evaluation Q‐sort (CARE‐Q), Gender‐Friendliness Barriers in Nursing Programs (GFB‐NP), and Nursing Image—as a Profession Questionnaire (NIPQ). Data were collected from August 2016–July 2017. Partial least squares structural equation modelling (PLS‐SEM) with bootstrapping was used to test the hypothesis model. Results: The full model results indicated a direct positive and significant path from professional nursing image to caring behaviour (β = 0.47, 95% CI = 0.32 to 0.61, t = 6.19, p < 0.001). Gender‐friendliness barriers had a direct and significant negative relationship between professional nursing image (β = −0.31, 95% CI = −0.49 to −0.12, t = 3.17, p < 0.01) and caring behaviour (β = −0.18, 95% CI = −0.35 to −0.02, t = 2.18, p < 0.05). In addition, the variable of student‐perceived barriers to gender‐friendliness was indirectly and significantly negatively related to caring behaviour (β = −0.15, 95% CI = −0.27 to −0.05, t = 2.57, p < 0.05) through professional nursing image. Conclusion: Male nursing students with a higher nursing image engage in greater caring behaviour. Gender‐friendliness barriers, however, decrease students' nursing image and caring behaviour. Relevance to clinical practice: As applied to nursing education, the goal should be to improve male nursing students' caring behaviours and professional nursing image and decrease gender‐friendliness barriers. [ABSTRACT FROM AUTHOR]

Background: Ensuring the delivery of quality care and patient safety requires that nurses improve their self-reflection and insight as well as their critical thinking. To understand the factors that influence self-reflection, insight, and critical thinking, more evidence-based research is needed. Purpose: The purpose of this study was to examine whether professional qualifications (i.e. age, years of job experience, and position on the clinical ladder) would affect self-reflection and critical thinking in the experienced registered nurses (RNs) group. Methods: This quantitative and correlational study included 597 RNs (297 novice nurses and 300 experienced nurses), recruited from one medical center hospital in central Taiwan, as participants. Data were collected on self-reflection and critical thinking, using the Chinese-version of the Self-Reflection and Insight Scale and the Taiwan Critical Thinking Disposition Inventory. A structural equation modeling approach was used to examine the relationships among variables. Findings: The results showed a non-significant mean difference in self-reflection with insight scores between the two groups. Experienced RNs had a significantly higher mean score for critical thinking. Further analysis of the data of experienced nurses revealed that self-reflection with insight significantly affected critical thinking (β = 0.24, t = 4.141, p <.001). Qualifications also affected self-reflection with insight (β = 0.11, t = 1.808, p >.05) and critical thinking (β = 0.18, t = 3.143, p <.001). The correlation between qualifications and self-reflection with insight, however, was non-significant. Discussion: Nurses who perceived that they had greater self-reflection and insight reported more critical thinking in clinical care practice. Nurses' qualifications had more of an effect on critical thinking than on self-reflection and insight. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to determine the effect of caring behaviours on critical thinking and to examine whether self‐reflection mediates the effect of caring on critical thinking. We also tested whether caring behaviours moderated the relationship between self‐reflection and critical thinking. Methods: For this descriptive, correlational, cross‐sectional study, we recruited 293 fifth‐year nursing students from a junior college in southern Taiwan. Data were collected in 2014 on critical thinking, caring behaviours and self‐reflection with insight using the Taiwan Critical Thinking Disposition Inventory, a Chinese version of the Caring Assessment Report Evaluation Q‐sort, and a Chinese version of the Self‐Reflection and Insight Scale, respectively. Relationships among variables were analysed by structural equation modelling, with the partial least squares method and Sobel test. Results: The results showed that caring behaviours significantly positively affected critical thinking (β = 0.56, t = 12.37, p < 0.001) and self‐reflection with insight (β = 0.54, t = 11.99, p < 0.001). Self‐reflection and insight significantly positively affected critical thinking (β = 0.34, t = 6.48, p < 0.001). Further, self‐reflection and insight mediated the relationship between caring behaviours and critical thinking. Caring behaviours did not, however, moderate the relationship between self‐reflection (β = 0.001, t = 0.021, p > 0.05) and critical thinking. Conclusion: Caring behaviours directly affect self‐reflection with insight and critical thinking. In addition, caring behaviours also indirectly affect critical thinking through self‐reflection and insight. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop and validate the Simulation Learning Effectiveness Scale, which is based on Bandura's social cognitive theory. Background A simulation programme is a significant teaching strategy for nursing students. Nevertheless, there are few evidence-based instruments that validate the effectiveness of simulation learning in Taiwan. Design This is a quantitative descriptive design. Methods In Study 1, a nonprobability convenience sample of 151 student nurses completed the Simulation Learning Effectiveness Scale. Exploratory factor analysis was used to examine the factor structure of the instrument. In Study 2, which involved 365 student nurses, confirmatory factor analysis and structural equation modelling were used to analyse the construct validity of the Simulation Learning Effectiveness Scale. Results In Study 1, exploratory factor analysis yielded three components: self-regulation, self-efficacy and self-motivation. The three factors explained 29·09, 27·74 and 19·32% of the variance, respectively. The final 12-item instrument with the three factors explained 76·15% of variance. Cronbach's alpha was 0·94. In Study 2, confirmatory factor analysis identified a second-order factor termed Simulation Learning Effectiveness Scale. Goodness-of-fit indices showed an acceptable fit overall with the full model (χ2/ df (51) = 3·54, comparative fit index = 0·96, Tucker-Lewis index = 0·95 and standardised root-mean-square residual = 0·035). In addition, teacher's competence was found to encourage learning, and self-reflection and insight were significantly and positively associated with Simulation Learning Effectiveness Scale. Teacher's competence in encouraging learning also was significantly and positively associated with self-reflection and insight. Overall, theses variable explained 21·9% of the variance in the student's learning effectiveness. Conclusion The Simulation Learning Effectiveness Scale is a reliable and valid means to assess simulation learning effectiveness for nursing students. Relevance to clinical practice The Simulation Learning Effectiveness Scale can be used to examine nursing students' learning effectiveness and serve as a basis to improve student's learning efficiency through simulation programmes. Future implementation research that focuses on the relationship between learning effectiveness and nursing competence in nursing students is recommended. [ABSTRACT FROM AUTHOR]

Knowledge of sexual health is an important indicator of the development of healthy adolescent sexuality. An evaluation instrument in nursing school practice, whose results can lead to improved sexual health in adolescents, is needed. We conducted this study to undertake rigorous testing of the Sexual Health Knowledge Scale (SHKS) as a means to ensure a reliable and valid quantitative measure of sexual health knowledge among young adolescent females. A panel of experts assessed the content validity of the 40-item measure. Initial testing involved 481 female adolescents (12–14 years old), using principal component factor analysis with varimax rotation and the determination of Cronbach's alpha coefficients. Confirmatory factor analysis (CFA) was conducted using data from an additional sample of 234 female adolescents (12–14 years old). Principal component factor analysis yielded a four-factor solution with eigenvalues greater than 1 that explained 43.40% of the variance. As a result of the analysis of the scale, 22 items were deleted, resulting in an 18-item scale. The CFA identified a second-order factor termed “sexual health knowledge.” Goodness-of-fit indices showed an acceptable fit overall with the full model (χ2/df(131) = 1.69, RMSEA = 0.054, RMR = 0.013, CFI = 0.92, and GFI = 0.99). We determined that the SHKS is a reliable and valid measure, with good composite reliabilities and goodness-of-fit indices. [ABSTRACT FROM PUBLISHER]

Aims and objectives. The purpose of this study was to test a process model that assesses the relationship of sexual health knowledge and normative beliefs to sexual health behavioural intention, with sexual self-concept as a mediating variable. The model is intended to assist in the prediction of which adolescents would exhibit a lower intention to engage in protective sexual health behaviour. Background. Previous research has shown that sexual-related behaviours are associated with sexual self-concept, sexual health knowledge and perceived parental/peer approval of sexual behaviour. Design. This study is a cross-sectional research. Methods. This study was conducted with 545 adolescent girls, aged 12-15 years, from eight junior high schools in Taiwan. Participants were assessed using the Sexual Self-Concept Inventory, the Sexual Health Behavior Intention Scale, the Parental Approval of Sexual Behavior Scale (PASB), the Friends' Approval of Sexual Behavior Scale and the Sexual Health Knowledge Scale. Data were analysed using structural equation modelling, with the maximum likelihood estimate determined by the LISREL 8.52 program. Results. The model exhibited adequate fit (goodness-of-fit index = 0·96, adjusted goodness-of-fit index = 0·94, normed fit index = 0·96, comparative fit index = 0·98, standardised root mean square residual = 0·049 and root mean square error of approximation = 0·048) and the findings indicate that sexual self-concept was a significant influence on the relationship of sexual health knowledge and normative beliefs to sexual health behavioural intention. Conclusions. The results of this study revealed the importance of sexual self-concept for adolescent girls' sexual health behaviour. Relevance to clinical practice. Evidence-based strategies that reinforce and clarify sexual self-concept as a mediating factor may aid in adolescent females' intention to engage in protective sexual health behaviour. [ABSTRACT FROM AUTHOR]

pai h.-c., lee s. & yen w.-j. (2012) The effect of sexual self-concept on sexual health behavioural intentions: a test of moderating mechanisms in early adolescent girls. Journal of Advanced Nursing 68(1), 47-55. Abstract Aim. The purpose of this study was to examine whether normative beliefs would act as a moderator of the main relationship between sexual self-concept and sexual heath behavioural intentions. Background. Sexual self-concept has been defined as an individual's evaluation of his or her own sexual feelings and actions. Research has shown that sexually related behaviours are associated with sexual self-concept and perceived parental/peer approval of sexual behaviour. Methods. We conducted cross-sectional research, using face-to-face interviews, to assess sexual self-concept, normative beliefs and sexual health behavioural intention. This study was conducted with 534 adolescent female participants, aged 12-15 years, in Taiwan. Data was collected between September and December 2009. We conducted structural equation modelling to examine the proposed conceptual model. Findings. We found that individuals with a high score on sexual self-concept (i.e. who had stronger erotic feelings) were less likely to believe that they would behave in ways that would protect their sexual health (i.e. low behavioural intention, β = −0·44, t = −8·43, P < 0·001). The hypothesized moderating role of normative beliefs was also supported. Those with a greater tendency to believe that their parents/peers approved of sex (i.e. normative beliefs) were more likely to have a positive sexual self-concept (β = 0·57, P < 0·001), and were less likely to protect their sexual health (β = −0·19, P < 0·01). The findings showed that, together, normative beliefs and sexual self-concept accounted for 24·9% of the variance in girls' sexual health behavioural intentions. Conclusions. We recommend that interventions that target sexual health behavioural intentions for this population would be more effective if such interventions targeted normative beliefs and helped adolescent females to clarify their sexual self-concept. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study which assesses the Clinical Nursing Practice Environmental Scale (CNPE-S) using a confirmatory factor analysis in Taiwan. According to the authors, the CNPE-S has good psychometric properties, with adequate internal consistency estimates for the five subscales. They add that the five subscales have sufficient internal consistency for use as independent scales in future health care research. An explanation of each subscale is provided.

In this study we explored the relationship among obesity, menopausal status, and health behavior among middle-aged women in a rural community of southern Taiwan. This was a cross-sectional study using a face-to-face interview to collect data. Sixty middle-aged women from four community centers participated in this study. The results indicated that approximately 23.3% of the women had body mass index (BMI) ≥27 kg/m2, and 38.3% of the women's waist girths were above 80 cm. Both BMI and waist circumference (WC) of the middle-aged women were significantly different between reproductive and postmenopausal status. The variable of nutrition-related health behavior was significantly and negatively associated with the BMI levels and accounted for 12% of the total variance. An understanding of the factors that contribute to obesity is provided among middle-aged women in Taiwan's rural communities. [ABSTRACT FROM AUTHOR]

Abstract Aim We explored the impact of gender role orientation (masculinity and femininity) on student nurses' caring behaviour and critical thinking. Background Caring and critical thinking are at the core of professional nursing education. Previous studies revealed inconsistent findings regarding the impact of gender roles on caring behaviour and critical thinking. Design and Methods We employed a quantitative correlational study. Nursing students (N = 449; female = 310, male = 139) who had at least had one month of clinical practice experience were recruited from four universities in Taiwan. Students' ages ranged from 19 to 29 years (Mean age = 21.24 years, SD = 1.28). Data were collected from August 2016 to July 2017, using three questionnaires: Taiwan Critical Thinking Disposition Inventory (CTDI), Caring Assessment Report Evaluation Q-sort Scale (CARE-Q), and Bem Sex Role Inventory (BSRI). Partial least squares structural equation modelling and generalized linear models were conducted to test the research model and hypotheses. Results Findings indicated that students who reported higher caring and masculinity presented greater critical thinking (ß =.37 and ß = 0.24, respectively; p s <.001). Students' gender, age, femininity, or clinical practice experience, however, were not significantly associated with critical thinking (ß = -0.01, ß = 0.09, ß =.10, and ß = 0.01, respectively; p s >.05). In addition, students who reported higher masculinity and femininity presented greater caring behaviour (ß =.22 and ß = 0.38, respectively; p s <.001). Students' gender, age or clinical practice experience were not significantly associated with caring behaviour (ß =.04, ß =.03, and ß = -0.05, respectively; ps > 0.05). The findings confirmed a direct influence of caring and masculinity on critical thinking. Masculinity indirectly affected critical thinking via caring behaviour. Caring and masculinity accounted for 34.4% of the variance in critical thinking, and masculinity and femininity accounted for 29.1% of the variance in caring behaviour. Conclusion Our study confirms the effect of age, gender role, and caring behaviour on critical thinking. We recommend that the cultivation of nursing care behaviour focus on students' gender role orientation. In addition, clinical nurse educators, when working with male students on patient caring, should consider their gender role orientation and support male nursing students' ways of presenting caring behaviours. [ABSTRACT FROM AUTHOR]