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This systematic review aimed to determine whether light-intensity exercise is a viable alternative to moderate-intensity exercise for relieving lumbopelvic pain during pregnancy. Light-intensity exercise produced significant changes in both the visual analog scale and the numeric rating scale, whereas moderate-intensity exercise produced significant changes in the visual analog scale but not the numeric rating scale. Light- and moderate-intensity exercise can reduce lumbopelvic pain during pregnancy. Light-intensity exercises may be an option for pregnant women who are unable to perform moderate-intensity exercise. High-quality randomized controlled trials are needed because there is significant heterogeneity among the included studies, and the strength of the results is questionable.

The purpose of this study was to examine the effectiveness of a professional support (PS) intervention (including individualized health education and supportive phone calls) in reducing the severity of nausea and vomiting (NV) and improving the quality of life (QOL) of women in early pregnancy. An experimental pretest/posttest design with a control group was used. Participants were recruited from a regional teaching hospital in southern Taiwan. The women in the experimental group ( n = 40) received the PS intervention, while those in the control group ( n = 39) only received routine nursing care. Analysis of covariance and mixed models were used to compare the experimental and control groups while adjusting for covariates. The severity of NV and the perceived level of symptom distress were significantly lower in the experimental group than in the control group during weeks 2 and 4, and the women in the experimental group showed a significant improvement in their QOL in week 4 ( p < .05). However, there was no significant difference between the two groups in body weight at week 4 ( p = .501). These findings provide empirical evidence in support of the effectiveness of PS in reducing the severity of NV and improving QOL for women during early pregnancy. This intervention could be routinely applied in prenatal nursing health education. Future studies could apply the concept of PS to different populations and health issues.

Clinical ethic situations in modern multiprofessional healthcare systems may involve different healthcare professions who work together for patient care. The undergraduate interprofessional education of clinical ethics would help to incubate healthcare students' ability of interprofessional collaboration in solving ethical problems. However, the impact from an interprofessional educational model on student's attitudes and confidence of interprofessional collaboration should be carefully evaluated during the process of curricular development. This study aimed to conduct a pilot interprofessional PBL curriculum of clinical ethics and evaluate the curricular impact on interprofessional students' attitude and confidence of collaborative teamwork. Thirty-six medical and nursing students volunteered to participate in this study and were divided into three groups (medical group, nursing group, and mixed group). Tutors were recruited from the Medical School and the College of Nursing. The pilot curriculum included one lecture of clinical ethics, one PBL case study with two tutorial sessions, and one session of group discussion and feedback. A narrative story with multiple story lines and a multiperspective problem analysis tool were used in the PBL tutorials. The students' self-evaluation of learning questionnaire was used to evaluate students' learning of clinical ethics and interprofessional collaborative skills and attitude. The internal consistency of the questionnaire was measured by Cronbach α, and the criterion-related validity of the questionnaire was evaluated through associations between the dimension scores with the student group by one-way analysis of variance test (ANOVA) test and Tukey-Kramer honestly significant difference (HSD) comparison. There was significant difference among different groups in students' ability and attitudes about “interprofessional communication and collaboration” (p = 0.0184). The scores in the mixed group (37.58 ± 3.26) were higher than the medical group (32.10 ± 4.98). In conclusion, our model for the interprofessional PBL curriculum of clinical ethics is practicable and will produce positive impacts on students' attitudes and confidence of interprofessional collaboration.

AIMS AND OBJECTIVES: To design a training program for nurses and evaluate the effectiveness of the training program in improving the nurses' self-efficacy in reporting cases of child abuse and neglect (CAN). BACKGROUND: The problem of CAN cases has become prevalent throughout numerous countries. Previous studies have found that more than 70% of Taiwanese nurses considered that they required CAN training. Moreover, a training program for CAN reporting based on self-efficacy theory in clinical practice has not been developed previously. METHODS: A quasi-experimental research design was implemented. The study participants comprised 80 clinical nurses: 40 in an experimental group and 40 in a control group; the pretest, posttest, and follow-up results were compared between the groups. Moreover, an analysis of covariance (ANCOVA) was applied to test the effectiveness of a nurse CAN training program after controlling for the effects of age, marital status, and working years. The experimental and control groups were compared according to their scores on each self-efficacy subscale. RESULTS: The experimental and control groups differed significantly regarding the outcome measures of all six subscales of CAN-reporting self-efficacy (CANRSE) between the pretest and posttest. Therefore, the results supported the hypothesis that nurse self-efficacy in reporting CAN cases would improve after completing the Child Abuse and Neglect Training Program for Nurses (CANTPN). CONCLUSION: The CANTPN is an appropriate training program for improving nurse competence and confidence in reporting suspected CAN cases. RELEVANCE TO CLINICAL PRACTICE: This paper is relevant to clinical practice because it clarifies a relationship between nurses' self-efficacy and reporting behavior. It also highlights the importance and effectiveness of the training program CANTPN in improving nurses' reporting behavior for CAN cases. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved. Language: en

"Mindfulness" is an emerging concept in the field of healthcare. Ranging from stress relief to psychotherapy, mindfulness has been confirmed to be an effective tool to help individuals manage depression, anxiety, obsessive-compulsive disorder, and other health problems in clinical settings. Scholars currently use various definitions for mindfulness. While some of these definitions overlap, significant differences remain and a general scholarly consensus has yet to be reached. Several domestic and international studies have explored mindfulness-related interventions and their effectiveness. However, the majority of these studies have focused on the fields of clinical medicine, consultation, and education. Mindfulness has rarely been applied in clinical nursing practice and no related systematic concept analysis has been conducted. This paper conducts a concept analysis of mindfulness using the concept analysis method proposed by Walker and Avant (2011). We describe the defining characteristics of mindfulness, clarify the concept, and confirm the predisposing factors and effects of mindfulness using examples of typical cases, borderline cases, related cases, and contrary case. Findings may provide nursing staff with an understanding of the concept of mindfulness for use in clinical practice in order to help patients achieve a comfortable state of body and mind healing.正念之概念分析.「正念」（mindfulness）為近期健康照護領域新興的概念，在臨床上的應用，從舒壓擴展到心理治療，被證實是一種有效的工具，能夠幫助個體處理憂鬱、焦慮和強迫症等健康問題。許多學者對正念有各種釋義，雖然有許多共通之處，但仍具有一些差異，其定義仍然沒有完全一致的共識。目前國內、外已有許多文獻探討正念的介入措施與成效，但多應用於臨床醫療、諮商、教育等領域，反觀於護理臨床實務應用較少，且缺乏有系統之概念分析。故為瞭解正念的概念，本文依據Walker及Avant（2011）提出的概念分析方法，進行正念之概念分析，藉此闡述其定義性特徵，透過列舉典型案例、邊緣案例、相關案例、相反案例，以釐清概念、確認正念發生之前置因子與後果。本文期能提供護理人員對正念概念的瞭解，以應用於臨床實務中，協助個案達到身心療癒的安適狀態。.

The purpose of this study was to investigate the effectiveness of adopting problem-based learning (PBL) and concept mapping (CM) in the educational programs for Taiwanese registered nursing (RN) students. We used a quasi-experimental design with experimental and control groups to evaluate the effectiveness of PBL-CM in three time schedules: before the course began (pre-test), at the end of the course (post-test), and six months after the end of the course (follow-up test). A convenience sample of 120 RN students participated, 51in the experimental group and 69 in the control group. Finding showed that the experimental group had higher scores than the control group for the Critical-Thinking Scale, Self-Directed Learning Scale, and Students' Performance in PBL Tutorial Sessions Questionnaire at the post-test and follow-up test stages. The PBL-CM increased students' critical-thinking skills and personal accountability for self-directed learning, and it would enhance the skills of independent study, reasoning, group interaction and active participation. This study offers guidelines for new nurse-training programs and continuing nursing education in clinical practice.

Aim and objective. To examine the relationships between critical thinking ability and nursing competence in clinical nurses. Background. There are few evidance-based data related to the relationship between critical thinking ability and nursing competence of clinical nurses. Design. A cross-sectional and correlation research design was used. Methods. A total of 570 clinical nurses at a medical centre in southern Taiwan were recruited into this study. Two self-report questionnaires, the Watson-Glaser Critical Thinking Appraisal (WGCTA) and the Nursing Competence Scale (NCS), were used to collect data. Results. The critical thinking ability of clinical nurses was at the middle level. The highest score for the subscales of the WGCTA was ‘interpretation ability’ and the lowest was ‘inference ability’. The nursing competence of clinical nurses was at the middle level and above. The highest score for the subscales was ‘caring ability’ and the lowest was ‘research ability’. Critical thinking ability had a significantly positive correlation with nursing competence. Critical thinking, working years, educational levels and position/title were the significant predictors of nursing competence, accounting for 32·9% of the variance. Conclusions. Critical thinking ability had a significantly positive correlation with nursing competence. The critical thinking ability of clinical nurses with a master’s degree was significantly better than those with a bachelor’s degree or a diploma and nurses with over five working years was significantly better than those with under five years. Relevance to clinical practice. The findings of this study can further serve as a reference for nursing education to improve nursing curricula and teaching strategies for nurse preparation. It could also be a guideline for nursing administration personnel in on-the-job training and orientation programs for nursing staff.

The purpose of this study was to explore the relationships among health state, depression, and cognitive functions of institutionalized male veterans. A cross-sectional and correlation research design with a cluster sampling was conducted. A total of 223 veterans who were above 65 years old, with no psychiatric disorders and no organic brain lesions were recruited from two veterans' institutions in Southern Taiwan. The researcher interviewed them one-on-one using structural questionnaires, including demographic data, health status, Taiwan Geriatric Depression Scale (TGDS) and Mini-Mental State Examination (MMSE). The results of this study were as follows: (1) Veterans who were able to read, were married, had good dietary habits, avoided over-oiled and high-fat food to keep healthy, took exercise at least 30 min each time, and had static leisure activities had significant differences in cognitive functions. (2) Cognitive functions were significantly negatively correlated with age and depression, whereas positively correlated with education level, the number of children and perceived health status. (3) Depression, literacy, education level and age were the four predictors of cognitive functions, accounting for 29% of the variance. The findings of this study provide a reference to caregivers and health care professionals for home care, clinical practice and cohort study in the future.

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. Two distinct 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 birth-related 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 birth-related 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.

Nausea and vomiting (NV), fatigue, stress and social support during pregnancy have been well documented using cross-sectional research designs. However, few studies have addressed the patterns and relationships for these variables using a longitudinal research design. The purpose of this study was to examine the patterns of and relationships among NV, fatigue, perceived stress, and social support in pregnant women throughout the three trimesters. A prospective and longitudinal study was conducted from 2003 to 2005. Data were collected on four different measures: the Index of Nausea, Vomiting, and Retching (INVR), the Visual Analog Fatigue Scale (VAFS), the Perceived Stress Scale (PSS), and the Brief Social Support Questionnaire (BSSQ). A total of 91 pregnant women were recruited from prenatal clinics in southern Taiwan. One-way ANOVA indicated that INVR scores and fatigue were significantly different among the three trimesters, but that perceived stress and social support were not. Post hoc analyses, using least significant difference testing, indicated that the first trimester was associated with significantly higher levels of NV than were the second and third trimesters. The first and third trimesters had significantly higher fatigue levels than did the second trimester. Mixed models indicated that the differences among INVR scores among the three trimesters were independent of gravidity, planned pregnancy and age. The difference in fatigue between the first and second trimesters was independent of gravidity, planned pregnancy and age, but fatigue was positively associated with NV. Perceived stress was positively correlated with NV. However, when further examining the relationships among the key variables by adding fatigue, perceived stress was found to positively correlate with fatigue and not NV, and negatively correlated with social support. The findings of this study provide a more comprehensive understanding and evidence-based data of the patterns of and relationships among the above four key variables for pregnant women throughout the three trimesters. This will help health care professionals to provide more effective and appropriate care strategies based on the different stages of pregnancy.

The authors hypothesized that serum retinol-binding protein 4 (RBP4) concentrations will be higher in gestational diabetes mellitus (GDM) subjects. This study tested both women with GDM and healthy pregnant women and correlated their serum RBP4 concentrations with body mass index (BMI) and a variety of other parameters. Also, since there is no information on the relationship between RBP4 concentrations in maternal and fetal serum, this study measured these at delivery and examined whether there were correlations between the cord serum RBP4 levels and maternal serum RBP4 concentrations, neonatal birth weights, and gestational age at delivery. A total of 40 women were evaluated: 20 women with GDM and 20 healthy pregnant women to serve as control subjects. Serum RBP4 concentrations were analyzed with the use of an enzyme-linked immunosorbent assay kit. Serum RBP4 concentrations at glucose challenge test (GCT) were significantly higher in the GDM group (42.4 +/- 13.8 ng/mL) than in the healthy control group (32.0 +/- 8.7 ng/mL; P = .007). BMI at GCT (P = .003) and GDM/no GDM (P = .014) were significantly correlated to serum RBP4 concentrations at GCT by multiple linear regression analysis. In GDM subjects, serum RBP4 concentrations immediately after delivery were significantly lower than those at GCT (30.1 +/- 11.0 ng/mL, 42.4 +/- 13.8 ng/mL; P.001), but there was no such difference in normal subjects (30.9 +/- 10.0 ng/mL, 32.0 +/- 8.7 ng/mL; P = .581). Cord serum RBP4 concentrations were significantly lower than maternal serum RBP4 concentrations at delivery (10.9 +/- 3.8 ng/mL, 30.5 +/- 10.4 ng/mL; P.001). Only fetal birth weight (P = .049) was independently related to cord serum RBP4 concentrations at delivery by multiple linear regression analysis. This study found increased serum RBP4 concentrations at GCT in GDM subjects, and GDM was significantly correlated to serum RBP4 levels after adjustment for the effect of BMI. Lower RBP4 concentrations were found at delivery in GDM subjects. Maternal serum RBP4 concentrations were significantly higher than cord serum RBP4 concentrations, and fetal birth weights were independently correlated to cord serum RBP4 concentrations. These findings may indicate that RBP4 plays a role in the pathogenesis of GDM. However, further experiments are required to clarify this role and find a possible regimen for GDM treatment.

A cross-sectional and comparative research design with convenience sampling was used to recruit pregnant women from prenatal clinics in southern Taiwan between 2002 and 2003 to examine the differences in perceived stress, social support, and maternal psychosocial adaptation among women with different severities (mild or less than mild, moderate, and severe) of nausea and vomiting during pregnancy. A total of 150 pregnant women participated in this study. One-way analysis of variance indicated that perceived stress was significantly different among the 3 groups. The least significant difference post-hoc test revealed that pregnant women with mild nausea and vomiting had significantly lower stress than did pregnant women with severe nausea and vomiting. The severity of nausea and vomiting was significantly associated with the Prenatal Self Evaluation Questionnaire subscales for "acceptance of pregnancy" and "fear of helplessness and loss of control in labor." Social support and maternal psychosocial adaptation were not significantly different among these three groups. The degree of perceived stress and maternal psychosocial adaptation may be related to the severity of nausea and vomiting during pregnancy.

To measure serum resistin levels in infertile women undergoing in vitro fertilisation-embryo transfer (IVF-ET), and to find any correlations between serum resistin levels and body weight, body mass index, the number of oocytes retrieved, and the outcome of IVF-ET. In addition, to assess whether there is any difference in serum resistin levels between infertility caused by polycystic ovary syndrome (PCOS) and infertility caused by other female factors.We designed a case-control study, and a total of 44 infertile women were enrolled. The blood samples for resistin measurement were collected on day 3 of the menstrual cycle prior to the administration of gonadotropin during in vitro fertilisation. These cases were then divided into 2 subgroups (PCOS group versus non-PCOS group) and a number of variables were measured and compared, including serum resistin levels.Serum resistin levels were inversely correlated with the number of oocytes retrieved (r=-0.371, p=0.013). No significant correlation was found between serum resistin levels and body mass index or body weight, either in the whole group or in the 2 subgroups. Serum resistin levels in the non-PCOS group were significantly higher than in the PCOS group (p=0.049). Serum resistin levels in the non-PCOS group were inversely correlated to the number of oocytes retrieved (r=-0.386, p=0.039), but no similar correlation was found in the PCOS group. There was no correlation between serum resistin levels and fertility rate or clinical pregnancy rate in either subgroup.We observed a negative correlation between serum resistin levels and the number of oocytes retrieved during IVF. However, this phenomenon was only present in the non-PCOS group. This result suggests that serum resistin levels might be a good predictor of ovarian response in infertile women without PCOS during IVF. The role of serum resistin in response to inflammation caused by endometriosis or chronic pelvic infection, both of which are major causes of female infertility, should be examined in a further study.

Demoralization is a relatively new diagnosis that has received increased attention in recent years. This condition is most frequently diagnosed in hospice, cancer, and critical illness patients. Serious demoralization may induce suicide ideation. The current literature on demoralization primarily elaborates on the history of this condition and on the reliability / validation of scales developed to assess demoralization in patients. The present paper conducts a concept analysis of demoralization in accordance with the concept analysis steps outlined by Walker and Avant. We elucidate the definition of relevant terms and identify the characteristic attributes, antecedents, and consequences of demoralization. Additionally, this paper provides examples of model, borderline, contrary, relevant cases and reviews relevant empirical data. We hope this concept analysis enhances the understanding of demoralization among clinical caregivers, increases the general understanding of the methods available to assess demoralization, and, ultimately, helps set patients free of their demoralization haze.失志的概念分析.失志（demoralization）是近年來備受關注的新診斷，最常發生在安寧、癌症及重症病人身上，嚴重者會有自殺之意圖。目前國內外對於失志雖有文獻探討，但大多為歷史的闡述及量表發展之信效度檢測，並無系統性的概念分析。本文依據Walker及Avant之概念分析步驟，進行失志的概念分析，藉此闡述其定義特徵及屬性，並列舉典型案例、邊緣案例、相關案例、相反案例，以釐清其概念，進而確認失志發生之前置因子與後果，並檢視相關實證資料。期望藉此概念分析，增加臨床照護者對失志的了解，提供評估失志的知識與方法，積極幫助病人走出失志的陰霾。.

Background: With the progress of information technology, early adolescents are able to access sex-related information through the Internet easily. This information has been shown to have a significant influence on the sexual health of this population. In addition, parentYchild communications about sex affect the sexual health of adolescents. Few empirical studies have focused on early adolescents and gender differences. Purpose: This study explores gender differences between early adolescents in terms of the use of the Internet to obtain sexrelated information, parentYchild communication, and sex-related knowledge and attitudes. Methods: This cross-sectional and comparative study uses an analysis of covariance and a hierarchical regression for data analysis. The researchers recruited 457 sixth-grade boys (n=204) and girls (n=253) in southern Taiwan as participants and used a structured questionnaire to collect data. Results: Participants exhibited significant differences in terms of Internet usage behavior, parentYchild communications about sex, and sex-related knowledge and sexual attitudes. The male participants spent more time on ＂recreation and entertainment＂ activities on the Internet, whereas their female peers spent significantlymore time searching for information.Regarding parentYchild communications about sex, girls had better motherYchild communications than boys. In addition, no gender-based difference was found for fatherYchild communications about sex. The knowledge of physical changes occurring during puberty and of menstrual healthcare among female participants was superior to their male counterparts. Girls had a more informed sexual attitude, particularly with regard to issues of gender roles, relationships with the opposite gender, and the social aspects of sex. Sex-related knowledge and parentYchild communication about sex were the two major predictors of sexual attitudes for boys and girls, respectively. Conclusions: To develop healthy sexual attitudes among early adolescents, nursing professionals, families, and schools should enhance sex-related knowledge and parentYchild communications, especially with boys. Early adolescence is a key time to provide sex education and Internet-safety education to both boys and girls to improve their sexual health. This study may serve as a reference for families, schools, researchers, and policymakers for promoting the sexual health of early adolescents.

Objective: To determine whether there is a correlation between adiponectin levels and glucose levels in women screened for gestational diabetes mellitus by means of a 50-g oral glucose challenge test, and to examine the difference in adiponectin levels between women who tested negative, and those who tested false positive. We further calculated the correlations between adiponectin levels and glucose levels, body mass index, gestational age and maternal age. Methods: A case control study included 171 mothers with negative or false positive results in the 1-h 50-g glucose challenge test at 24–28 gestational weeks. Serum adiponectin levels were determined by radioimmunoassay at the time of the glucose challenge test. Results: There was a significant difference between women who tested negative at screening, and those who tested false positive with respect to age, prepregnancy body weight and body mass index, and adiponectin levels. Correlation analysis showed adiponectin levels to be negatively correlated to glucose levels (r = 0.193, P = 0.011). To examine the association between glucose levels, adiponectin levels and demographic variables, multiple linear regression analysis was carried out. Prepregnancy body mass index and age accounted for 14.6% of the variance in the glucose challenge test. Adiponectin levels did not contribute independently to the variation in glucose levels. A further multiple linear regression analysis was undertaken to investigate the association between adiponectin levels and age, prepregnancy body mass index and glucose levels in the glucose challenge test. In this regression model, prepregnancy body mass index and age explained 12.1% of the variance in adiponectin levels. Conclusions: In conclusion, our study indicated a negative correlation between adiponectin and glucose levels in women screened for gestational diabetes mellitus by a glucose challenge test. We further found that maternal age and body mass index were independent risk factors for a false positive glucose challenge test. Reduced adiponectin levels in women who tested false positive on the glucose challenge test were dependent on advanced age and higher body mass index. # 2006 Elsevier Ireland Ltd. All rights reserved.

To test the hypothesis that plasma visfatin concentrations will be lower in women with gestational diabetes mellitus, we evaluated women with gestational diabetes mellitus and healthy pregnant women, and then correlated their plasma visfatin concentrations with body mass index (BMI) and various other parameters.A total of 40 women were evaluated: 20 women with gestational diabetes mellitus and 20 healthy pregnant women to serve as control subjects. Plasma visfatin concentrations were analyzed using an enzyme-linked immunosorbent assay.Plasma visfatin concentrations were significantly lower in the gestational diabetes mellitus group (9.4 +/- 3.8 ng/mL) than in the healthy control group (12.6 +/- 4.5 ng/mL) (P = .023). A negative correlation was found between plasma visfatin concentrations and maternal age (r = -0.399, P = .011), first trimester body weight (r = -0.350, P = .027), and first trimester BMI (r = -0.336, P = .034). Multiple linear regression analysis revealed that maternal age (P = .017) and gestational diabetes mellitus/no gestational diabetes mellitus (P = .044) were independently related to plasma visfatin concentrations. However, no relationship was found with either gestational age at the time of sampling or first trimester BMI.Our results show that there are decreased concentrations of plasma visfatin in gestational diabetes mellitus subjects and this may indicate that visfatin plays a role in the pathogenesis of gestational diabetes mellitus. However, further experiments are needed to clarify this role.

Purpose: To test whether nausea and vomiting or fatigue correlated with psychosocial variables. Design: Descriptive, using secondary data from a prenatal database of 113 women in prenatal care in Texas. Mean gestational duration was 59 days at the time of data collection. Methods: Psychosocial factors, frequency of nausea and vomiting and of fatigue were determined by use of questionnaires. Psychosocial measures had reliability and validity and included the Personal Resources Questionnaire and Center for Epidemiologic Studies Depression Scale. A checklist was used for measuring nausea and vomiting and fatigue. Findings: Of 113 participants, 30 (26.5%) reported no, 43 (38.1%) occasional, and 40 (35.4%) frequent nausea and vomiting. Depressive symptoms had the highest correlation with nausea and vomiting. Social support was negatively related to nausea and vomiting. Four (3.5%) women reported no fatigue, 49 (43.4%) reported occasional fatigue, and 60 (53.1%) reported frequent fatigue in the past month. Depressive symptoms had the highest correlation with fatigue. The chi-square statistic showed that fatigue was significantly related to employment. Fatigue was not significantly associated with work hours or stressfulness of jobs. Conclusions: Only a limited number of psychosocial factors were associated with nausea and vomiting and fatigue in early pregnancy. Depression was related to physical symptoms, but unclear was whether depression preceded or resulted from the symptoms. Many women experienced symptoms, and better understanding of causality is needed to ameliorate the effects on women's well-being.

The mothers of children with attention-deficit hyperactivity disorder tend to experience depression at higher levels because of the poor social interaction and deviant behaviors of their children. These depressed mothers often harm themselves and negatively impact their family and community.This study examines maternal depression and its related factors in the mothers of school-aged children with attention-deficit hyperactivity disorder.A cross-sectional study with a purposive sampling of 100 mothers of school-age children with attention-deficit hyperactivity disorder was developed. Data were collected using a structured questionnaire that included the Parenting Stress Index (PSI), social support scale, and the Beck Depression Inventory (BDI). The Pearson product moment correlation and stepwise multiple regression were used to analyze data.The findings showed that almost half of the mothers with school-aged ADHD children suffered higher pa-renting stress and that 34% required professional psychiatry referral. In addition, 40% of the participants suffered from depression. Higher levels of parenting stress were associated with a higher incidence of depression (r = .647, p.001). Participants with better social support had lower depression levels (r = -.327, p.01). 'Parenting stress' and having a monthly total household income of ≤ NT$40,000 were significant predictors of maternal depression. 'Maternal stress' was the most significant predictor, with a total explained variance of 41.9% (R(2) change = 41.9%).The results of this study are intended to help medical staff better care for the mothers of school-aged children with ADHD. These results will assist in the evaluation of maternal depression, parenting stress, and levels of required social support. It will especially help in the evaluation of maternal depression symptoms of those mothers of low socioeconomic status with high parenting stress. Providing these mothers with parental training, education on effective parenting and discipline strategies, and better social support may effectively reduce maternal depression, which will help minimize the negative impacts of this depression on the family and the community.學齡期注意力缺陷過動症兒童之母親憂鬱及其相關因素之探討注意力缺陷過動症兒童因疾病特性，其母親容易產生精疲力竭、壓力及憂鬱，而母親憂鬱不僅危害本身，同時對家庭和社會亦造成負面影響。探討學齡期注意力缺陷過動症兒童之母親的憂鬱及其相關因素。採橫斷式相關性研究，方便取樣100位學齡期注意力缺陷過動症兒童的母親為研究對象；使用親職壓力量表、社會支持量表及貝克憂鬱量表進行資料收集，並以皮爾森積差相關、逐步複迴歸等進行統計分析。本研究發現學齡期注意力缺陷過動症兒童之母親近四成有憂鬱情形，將近五成親職壓力偏高，其中34%的母親有高度親職壓力需進一步轉介給專業人員。在相關性方面，本研究發現親職壓力越大，母親越容易憂鬱（r = .647, p.001）；社會支持越高，母親的憂鬱會降低（r = -.327, p.01）。「親職壓力」及「家庭每月收入40,000元（含）以下」為學齡期注意力缺陷過動症兒童之母親憂鬱的重要預測因子，而「親職壓力」為最重要之預測因子（R面對高親職壓力之學齡期注意力缺陷過動症兒童的母親，護理人員須注意病童母親憂鬱情形，適時提供親職管教策略，增加其社會支持，以預防或減少母親憂鬱對個人及家庭的傷害。

Pregnancy is an important stage in life for many women. Humans are complex organisms that are prone to exhibiting gradual alterations in their constitutions that fluctuate with age, diet, and living environment. This is particularly true during the pre- and postnatal periods, in which qi and blood are required to ensure foetal growth.To examine women's constitutional transformation of pre-pregnancy, pregnancy, and postpartum.A prospective, longitudinal study was conducted, and structural questionnaires were used to collect data. The participants were healthy pregnant women 21-49 years of age. Data were collected at six times: during the first (weeks 6-13), second (weeks 14-27), and third (weeks 28-40) trimesters and during the postnatal admission (1-week postnatal) and home self-care (6-week and 6-month postnatal) periods, yielding 86 valid questionnaires. A cubic polynomial regression analyses with generalised estimation equations (GEEs) method was used to reveal the trend of constitution score by different constitutions.Significant differences (p.0001) for the scores of Yang-Xu (yang-deficiency), Yin-Xu (yin-deficiency), and Tan-Shi-Yu-Zhi (phlegm-dampness and blood-stasis) constitutions were observed at pre-pregnancy, pregnancy, and 6 months postpartum. A least significant difference test showed that the scores obtained in the pregnancy period and at 6 months postpartum were higher than those of pre-pregnancy, indicating mitigated constitutional imbalance during postpartum. The highest scores of the Yang-Xu and Tan-Shi-Yu-Zhi constitutions occurred in the first trimester (36.02 ± 8.00 vs. 30.00 ± 7.21), and the highest scores of Yin-Xu constitution occurred in the third trimester (32.95 ± 7.48). The lowest scores of the Yang-Xu constitution were obtained at 6 months postpartum (25.24 ± 5.63) and during pre-pregnancy (25.26 ± 4.82), and those of the Yin-Xu and Tan-Shi-Yu-Zhi constitutions were observed in the pre-pregnancy (25.48 ± 4.46 vs. 19.94 ± 3.09). The 6-month postnatal scores of the Yang-Xu constitution nearly recovered to the prenatal level, whereas those of the other two constitutions did not.The results indicate that women's constitutions underwent changes throughout the perinatal stages. These findings provide a valuable reference for healthcare professionals in administering perinatal care and demonstrate empirical evidence for use in future intervention-based research.

The chronic shortage of nursing staffs in hospitals continues to increasingly and negatively impact the ability of medical care systems to deliver effective care and ensure the safety of patients. Bullying is one factor known to exacerbate turnover in the nursing workplace.This study explores workplace bullying and turnover intention among nurses working at a medical center in Southern Taiwan.A cross-sectional and correlation research design was conducted using the Negative Acts Questionnaire-Revised (NAQ-R) and the Turnover Intention Questionnaire. A convenience, purposive sample of 708 nurses was recruited. Inclusion criteria included: holding an RN license, able to communicate in both Mandarin and Hokkienese,6 months of clinical experience, and an NAQ-R score higher than 23. Data were analyzed using SPSS19.0 software.Approximately 85% of participants had experienced some degree of workplace bullying during the previous 6-month period. The trend of the turnover intention tended to the right at a high degree. A moderate, positive, and significant correlation was found between turnover intention and bullying total scores (r=.39, p.05). Multiple regression showed bullying as the most important predicator of turnover intention (15.10%).Based on our findings, we suggest that nurses should enhance their awareness of the negative consequences of workplace bullying. Furthermore, hospitals should implement appropriate mechanisms to decrease the phenomenon of inter-staff bullying, improve the nursing workplace environment, and reduce the rate of turnover intention.護理職場霸凌與離職傾向及其相關因素探討—以南部某醫學中心為例近年護理人力短缺問題已使醫療系統營運及病人安全問題拉高警報，而職場霸凌會讓護理人力短缺問題加劇。探討國內南部某醫學中心護理人員職場霸凌與離職傾向之關係及其相關因素。本研究採橫斷式、相關性研究設計，利用負向行為量表—修正版（Negative Acts Questionnaire-Revises, NAQ-R）、離職傾向量表等結構式問卷收集資料；方便取樣具護理師執照、國台語可溝通且臨床工作年資大於六個月、NAQ-R得分大於23分（排除未受到職場霸凌者）的護理人員708位；資料以SPSS 19.0 for Windows套裝軟體進行統計分析。85%的護理人員在過去六個月中曾遭受過不同程度的職場霸凌，且整體離職傾向偏右、傾向高程度，離職傾向與霸凌總分呈中度正相關（r = .39, p.05）。逐步複迴歸顯示霸凌相較於其他因子，為離職傾向最重要的預測因子（15.10%）。建議應提升護理人員對職場霸凌的知覺，且應全力推展磁性醫院，提供正向的工作環境，改善職場霸凌現象，降低離職傾向，以提升護理人員的留任率。

Objective: The symptoms of depression experienced by women during the postnatal period may have profound effects on the lifelong health of both the mother and the child. In this randomized controlled study, we systematically evaluated the effects of weekly supportive group meetings for women with postnatal distress. Methods: Sixty postnatally distressed women were randomly assigned to support ( n =30) and control ( n =30) groups. Women assigned to the support group participated in four supportive group sessions that comprised discussions concerning transition to motherhood, postnatal stress management, communication skills, and life planning. Results: Subjects who attended the support sessions had significantly decreased scores on the Beck Depression Inventory (BDI) and the Perceived Stress Scale (PSS), and significantly increased scores on the Interpersonal Support Evaluation List (ISEL) as evaluated at the end of the fourth weekly session. In contrast, no significant changes were observed in the control group during this period. Conclusion: This is the first controlled study to provide evidence that participation in support groups for postnatally distressed women provides quantifiable psychosocial benefits.

Studies have shown that cardiovascular rehabilitation exercise improves quality of life in post-coronary-bypass-surgery patients. However, the rate of participation in this exercise by this patient group in Taiwan has increased only 8.2% during the past 13 years (from 61.9% in 1996 to 70.1% in 2009). Little is known about the factors that influence patient motivation to participate in cardiovascular rehabilitation exercise.This study explores the factors that influence patient participation in rehabilitation exercise following coronary bypass surgery.This cross-sectional, correlational study recruited a convenience sample of 253 patients who had undergone coronary bypass surgery at a medical center in southern Taiwan. Structured questionnaires, including a patient rehabilitation exercise experience questionnaire, Short Form-36 Health Survey-Taiwan Form, and cardiac rehabilitation exercise design factors questionnaire were used for data collection. SPSS19.0 was used to analyze data.The variables "healthcare provider recommendation of rehabilitation exercise", "exercise program accessibility", "physical health status", and "patient post-surgical exercise patterns" each had a significant influence on participant participation in post-surgical rehabilitation exercise. Binary logistic regression analyses identified "receiving information on rehabilitation exercise", "level of patient-perceived importance of rehabilitation exercise", and "having post-surgical exercise patterns" as important predictors of participation in a rehabilitation exercise program, with OR ratios of 112, 7.86, and 3.23 times respectively. These 3 factors accounted for 90.1% of the total variance.Patient education on coronary bypass post-surgical rehabilitation exercise programs should be emphasized during pre-surgical consultation and care in order to facilitate the recovery of normal life functions following coronary bypass surgery.影響冠狀動脈繞道術後病患參與復健運動之因素探討心臟復健運動可改善冠狀動脈繞道術後病人生活品質。台灣復健參與率於13年間（1996年61.9%至2009年70.1%）卻僅上升8.2%；相關的影響因素缺乏本土實證資料，對有效提升參與率形成限制，因此，亟需深入探討。探討影響冠狀動脈繞道術後個案參與復健運動之相關因素。本研究為橫斷性、相關性研究，選取南部某醫學中心接受冠狀動脈繞道手術之253位個案為研究對象，主要研究工具為「個案復健運動經驗問卷」、「台灣版SF-36健康評估量表」與「影響參與復健運動方案因素調查表」，並以SPSS 19.0 for Windows進行統計分析。病患參與術後復健運動與否，和醫護人員提供復健運動相關資訊、就醫方便性、生理健康狀態、術後有無復健運動習慣等呈顯著性差異。再以二元邏輯迴歸分析發現有接受復健運動相關訊息、覺得復健運動是重要的、術後有運動習慣和是否參與復健運動等因素，於參與術後復健運動可能性分別是沒有參與者的112倍、7.86倍及3.23倍，且整體正確預測率為90.1%。應強化醫護人員對術後復健運動訊息提供之重視，於病人術前早期介入，以有效協助個案早日回復術後的生活功能。

Pregnancy-related nausea and vomiting are uncomfortable symptoms. These symptoms are consistent across cultures, may persist for extended periods of time during the early stage of pregnancy, and may adversely affect expectant mothers and their fetuses. Further, these symptoms may negatively impact mother and infant health and increase medical costs in the absence of effective diagnosis and symptom management. Relevant literature and research is integrated to propose subjective and objective approaches to assessing symptoms such as a index of nausea, vomiting and retching (INVR) and to develop a preliminary clinical management model that prioritizes using a non-pharmacological strategy to treat mild and moderate nausea and vomiting. Article recommendations provide a practical clinical care reference to help pregnant women successfully pass through this uncomfortable stage and achieve better quality-of-life and birth outcomes.孕期噁心嘔吐之症狀經驗評估與護理處置孕期噁心嘔吐在懷孕早期有著高盛行率、沒有文化藩籬、整天都有可能發生的不適症狀，對懷孕婦女與胎兒有許多負面的影響；若未適時、合宜的評估及處置，可能威脅母嬰的健康，增加醫療的支出。本文彙整與剖析相關的資料，提出孕期噁心嘔吐之主觀及量化（例如噁心嘔吐及乾嘔量表）的症狀經驗評估與臨床處置雛型（例如輕、中度噁心嘔吐以非藥物處置為優先），提供臨床照護的具體參考，協助這些婦女順利渡過此不適時期，保有良好的生活品質及較好的懷孕生產結果。

The role of "mother" is understood and represented differently by people from different cultures. In traditional Taiwanese society, mothers demonstrate their existence value by giving birth to and raising sons able to continue her husband's familial line. Sons bear the patriarchal name and care for their parents in old age. However, a son stricken, paralyzed and eventually killed by Duchenne muscular dystrophy (DMD) can destroy a mother's perceived value in this traditional social context. Mothers are thus soundless sufferers. Nurses have a critical role to play in giving encouragement and hope to mothers of children with DMD. Through their own difficult situation, these mothers can also highlight the value and importance of Taiwan's nurses, who work in conditions marked by overloading, high stress, and under-appreciation. Caring for women in critical need of empathy and support help nurses realize their own positive capacity to empower sufferers.是母親—台灣裘馨兒母親之存有與護理師的相遇母親角色的存有乃透過各種文化被人們理解並再現。傳統的台灣女性藉由生育、養育健康兒子以「延續宗族生命」、「養兒防老」來彰顯文化賦予母親的存有價值。然而，當母親的基因使其「兒子」罹患漸進癱瘓至死亡的「裘馨氏肌肉萎縮症」時，母親的存有價值即因悖離文化期待而斷裂。此斷裂之苦使母親身為「人」的存有本質被自身遺忘，而此遺忘讓母親成為無聲的受苦者。當存活在社會期盼—「燃燒自己，照亮別人」卻陷入職業環境惡化的護理人員與裘馨兒母親相遇時，期盼從同為竭力關照他人之母親角色的鏡像中，能鼓勵護理人員自身挺身而出，展現和倡議護理的存有讓人看見，而能在如此惡劣職場環境中對自身更加悅納，並從中產生力量，進而能與裘馨兒母親關照交換，使彼此的存有能發聲於社會且不再受苦。

Women in Taiwan are concerned about postpartum personal healthcare, and over 90% consume Shenghua soup as part of their postpartum recovery regimen. However, knowledge regarding Shenghua soup is inadequate among this population. Therefore, the correlation between Shenghua soup knowledge and consumption behavior deserves further clarification.The study explores the relationships among Shenghua soup knowledge, expected effectiveness, and consumption behavior in postpartum women.A descriptive and correlational research design recruited a convenience sample of 51530-days postpartum women from local specialty hospitals and postpartum centers.(1) Participant education level had a significant impact on Shenghua soup consumption behavior. Those with bachelor and master school degrees earned a higher average score than those educated to the senior high school level; (2) Knowledge correlated significantly and positively with expected effectiveness (r = .14, p.001) and consumption behavior (r = .12, p.001). Consumption behavior correlated positively with expected effectiveness (r = .11, p.05); (3) Marital status, knowledge and expected effectiveness were identified as significant predictors of Shenghua soup consumption behavior; (4) Principal sources of participant information on Shenghua soup were family members (30.84%), media (26.65%), and medical staff (16.44%); (5) Knowledge scores for over half of participants were in the "wrong" to "no idea" range; and (6) 66.6% of participants took Chinese and Western medicines to help uterine contraction, while 76% had consumed Shenghua soup.Findings indicate that postpartum women in Taiwan have insufficient and incorrect knowledge regarding Shenghua soup; hold positive expectations regarding Shenghua soup effectiveness; and have a high Shenghua soup consumption rate. This study may serve as a postpartum care reference for healthcare professionals to improve the postpartum health of women.

Internet use is an important part of the daily life of adolescents. The ease of searching the internet for information makes finding information on sex, a topic of particular interest to adolescents, easy. Although the internet is replete with sexual information, the influence of internet use on adolescents' sexual health is analogous to a double-edged sword. This article identifies the four main sexual dilemmas facing Taiwan adolescents and analyzes the pros and cons of internet use with regard to adolescents' sexual health. Cons include the predominance of internet pornography and the potential risks of making friends online. Pros include the internet's role as an optimal communications platform and tool for sex-related research. We suggest that nurses have a unique role and functions to play in promoting adolescent sexual health. We also offer recommendations for school health nursing and clinical nursing. Further internet-based quantitative and qualitative research is necessary to clarify relevant sexual health issues. Finally, we offer design suggestions for sexual education homepages.

Properly educating myocardial infarction (MI) patients in the extremely busy cardiac care unit (CCU) work environment is difficult for CCU nurses.This study examined the effectiveness of multimedia nursing education in reducing illness-related anxiety and uncertainty in MI patients following percutaneous coronary intervention (PCI).A quasi-experimental study with judgment sampling was designed and performed at a medical center in South Taiwan. The control group (n = 36) received written nursing education material and the experimental group (n = 40) received multimedia nursing education. Participant illness-related anxiety and uncertainty was measured at four specific periods, namely (1) at admission to the CCU, (2) immediately after completing the nursing education interventions, (3) upon transfer to the general ward, and 4) at discharge. Measurement tools included Mishel's uncertainty in illness scale (MUIS), the state-trait anxiety inventory (STAI), and noninvasive physiological monitoring instruments.Results showed that both interventions lowered anxiety ÷ uncertainty in participants with moderate to severe levels (experimental group - anxiety: t₃₉ = -6.615, p.001 and uncertainty: t₃₉ = -8.317, p.001; control group - anxiety: t₃₅ = -4.767, p.001 and uncertainty: t₃₅ = -9.739, p.001). The experimental group achieved significantly greater reductions than the control group in terms of anxiety and uncertainty in each of the four measurement periods.Based on the evidence, both nursing education formats are valid for patient education and may be chosen based on CCU clinical conditions.

The task of defining, maintaining, and mutually adapting the nurse-patient relationship has been ongoing since modern nursing's earliest days. The nurse-patient relationship changes with social changes and paradigm shifts. Most medical centers today strive to incorporate the concept of partnership into the nurse-patient relationship in response to patient-centered medical care. What is the implication of this relationship? Is it suitable for all nurse-patient situations? What are the impacts on nurses and patients? How should nurses adapt to change in nurse-patient relationships? This article analyzes and reflects upon the nurse-patient relationship within a postmodernist framework guided by concepts of "deconstruction", "de-centralization", "multiplicity", and "inter-subjectivity." We derive a "dual-active" and "dual-expert" partnership between nurses and patients that centers on patient disease management. Core values of this partnership are respect and caring, and strategies include emancipation, enlightenment, and empowerment.

The purpose of this study was to explore correlations among constitution, stress, and discomfort symptoms during the first trimester of pregnancy. We adopted a descriptive and correlational research design and collected data from 261 pregnant women during their first trimester in southern Taiwan using structured questionnaires. Results showed that (1) stress was significantly and positively correlated with Yang-Xu, Yin-Xu, and Tan-Shi-Yu-Zhi constitutions, respectively; (2) Yin-Xu and Tan-Shi-Yu-Zhi constitutions had significant correlations with all symptoms of discomfort, while Yang-Xu had significant correlations with all symptoms of discomfort except for “running nose”; (3) Tan-Shi-Yu-Zhi constitution and stress were two indicators for “fatigue”; Tan-Shi-Yu-Zhi was the indicator for “nausea”; Yang-Xu and Yin-Xu were indicators for “frequent urination.” Our findings also indicate that stress level affects constitutional changes and that stress and constitutional change affect the incidence of discomfort. This research can help healthcare professionals observe these discomforts and provide individualized care for pregnant women, to nurture pregnant women into neutral-type constitution, minimize their levels of discomfort, and promote the health of the fetus and the mother.

Due to the phenomenon of Taiwan'saging population has made, long-term care has become an issue of increasingly emphasized importance. According to the statistics, the family takes responsibility for most long-term care duties and more than 70% of primary family caregivers are female. In the past, because of gender-based divisions of labor and gender role expectations made, it was taken for granted that females would be the socially preferred family caregivers. Those men who devoting in themselves to such work were regarded as a rare precious. As such, family care signified entailed different life experiences for males and females. Over the years, amendments to the civil code have recognized family care contributions, and the allowance for caregivers underlines that care responsibilities have shifted away from the family to society. Traditional gender divisions of labor today are significantly more blurred; family structures have become smaller in size; female labor in the workplace has increased; and ten-year long-term care plans and long-term care insurance have been successively implemented. These transformations will make labor outsourcing more and more popular and transform family care from a private problem to a pubic policy issue. In the future, family caregivers require consideration and support on a sustained basis. It is also important to improve and monitor the quality of care services. Nurses, the major professional members of long-term care teams, should be concerned over the issue of family care while providing nursing care. They should include family caregivers in the care plan so that they can make sure that patients receive comprehensive and constant care in order to enhance the overall quality of nursing care.

To examine the relationships between critical thinking ability and nursing competence in clinical nurses.There are few evidance-based data related to the relationship between critical thinking ability and nursing competence of clinical nurses.A cross-sectional and correlation research design was used.A total of 570 clinical nurses at a medical centre in southern Taiwan were recruited into this study. Two self-report questionnaires, the Watson-Glaser Critical Thinking Appraisal (WGCTA) and the Nursing Competence Scale (NCS), were used to collect data.The critical thinking ability of clinical nurses was at the middle level. The highest score for the subscales of the WGCTA was 'interpretation ability' and the lowest was 'inference ability'. The nursing competence of clinical nurses was at the middle level and above. The highest score for the subscales was 'caring ability' and the lowest was 'research ability'. Critical thinking ability had a significantly positive correlation with nursing competence. Critical thinking, working years, educational levels and position/title were the significant predictors of nursing competence, accounting for 32·9% of the variance.Critical thinking ability had a significantly positive correlation with nursing competence. The critical thinking ability of clinical nurses with a master's degree was significantly better than those with a bachelor's degree or a diploma and nurses with over five working years was significantly better than those with under five years.The findings of this study can further serve as a reference for nursing education to improve nursing curricula and teaching strategies for nurse preparation. It could also be a guideline for nursing administration personnel in on-the-job training and orientation programs for nursing staff.

Heart failure is a chronic and exacerbating disease, which often significantly decreases patient quality of life (QOL). Treatments continue to focus on alleviating the physical symptoms of this disease, and data on QOL factors are limited.The purpose of this study was to explore QOL and associated factors in patients with heart failure.A cross-sectional and correlational research design was conducted using the Kansas City Cardiomyopathy Questionnaire, Beck Depression Inventory-II, and the World Health Organization Quality of Life Assessment. A convenience sample of 200 patients aged 20 years old or above and diagnosed with heart failure were recruited from one medical center and one regional teaching hospital in southern Taiwan. Data were analyzed using SPSS 14.0 software.Results found (1) participants had an average QOL index score of 63.0 (moderate); (2) significant differences in QOL scores for the variables of marriage, occupation type, monthly family income, concomitant diabetes/hypertension, number of complications, and treatment type; (3) participants had an average index score for symptoms of 54.1 (moderate) that was significantly correlated with QOL; (4) a majority of participants were classified in NYHA Class II, mean score of depression was 9.13±6.25 (normal), and functional status and depression were significantly related to QOL; and (5) 59.3% of QOL variance was explained by depression, symptoms and family income per month.This study may help health professionals to understand relationships among symptoms, functional status, depression and QOL in heart failure patients. It may also provide healthcare professionals evidence-based data necessary to further improve symptoms, functional status and depression in heart failure patients, and thus significantly improve QOL in patients with heart failure.

"Caring" has always been considered a natural and integral aspect of nursing. It is the core and essence of nursing. The human caring theory developed by Watson in the late 1970s (1975-1979) is a grand theory embracing ten carative factors. Swanson proposed her caring theory, a middle range theory that embraces five caring processes, in 1991. Although both Watson and Swanson have indicated that integration of their two theories may increase overall reliability, we must better understand their mutual similarities and differences in order to achieve an application suited to global circumstances. The purpose of this article was to compare and analyze the two caring theories. This article describes the basics of the two theories, discusses articles related to both in the literature and then describes current domestic and international applications. This article is intended to help health professionals better understand the underlying purpose of "caring" and to provide guidelines and points of reference for caring behaviors. It is hoped that such may also enhance caring behavior in practice and core nursing competencies as well as enrich the humanistic aspect of nursing, a profession that increasingly regimented by standard procedures and the requirements of technology.

The purposes of this prospective, longitudinal study were to examine the relationships between leptin, human chorionic gonadotropin (hCG), cortisol, and psychosocial stress and nausea and vomiting (NV) in women with mild-to-moderate NV throughout pregnancy. Participants comprised 91 pregnant women recruited from prenatal clinics in southern Taiwan. Data analysis using one-way analysis of variance (ANOVA) indicated that leptin, hCG, cortisol levels, and Index of Nausea, Vomiting, and Retching (INVR) scores, but not stress (measured with the Visual Analog Scale, VAS) scores, were significantly different among the three trimesters. The average INVR score and hCG level decreased from the first to third trimesters (p < .0001 for both). The average leptin and cortisol levels increased from the first to third trimesters (p = .001 and p < .0001, respectively). Analysis using mixed models indicated that the INVR scores decreased significantly in a progressive manner through the stages of pregnancy and were significantly lower in the second and third trimesters. Findings reveal that stress/VAS and hCG may both be significantly and independently associated with INVR scores. Future research should examine psychosocial reactions in addition to exploring other biochemical markers related to NV and stress.

The purpose of this study was to explore health promoting lifestyles and related factors in pregnant women.This was a descriptive study using convenience sampling. Altogether, 172 pregnant women were recruited from a medical center in southern Taiwan. Personal data was collected, and the instruments used included perceived health status, self-efficacy of health behaviors, perception of family or peers' health-promoting behaviors, and Health Promoting Lifestyle Profile (HPLP Pi).The results showed that the standardized total score of health promoting lifestyles was 66.88 (moderate level). The subscales of the HPLP Pi in descending order of standardized scores were as follows: "interpersonal relationships," "health responsibility," "psychological wellness," "nutrition," "stress management" and "physical activity." There were significant differences in the total scores of the HPLP Pi among subjects with different educational level, socioeconomic status, chronic diseases, exercise habits, length of sleep, and perceived health status. Both perception of health-promoting behaviors among family (or peers) and self-efficacy of health behaviors had significantly positive relationships with health-promoting lifestyles. Perception of the family or peers' health-promoting behaviors, self-efficacy of health behaviors, perceived health status and chronic diseases were the four significant predictors of health-promoting lifestyles, accounting for 62.4% of the variance.The findings of this study could be used as a reference for prenatal care, nursing education, and maternal / neonatal health policies.

Aims. To develop a short-form version of the Chinese Prenatal Self-Evaluation Questionnaire and to examine its reliability and validity. Background. Health professionals are short of screening instruments, especially in Chinese, to assess adaptation of pregnant women. Design. A cross-sectional research design was used. Pregnant women who visited prenatal clinics in southern Taiwan were recruited for this study. This study was conducted in two phases. The first phase was to develop a Chinese short form of the Prenatal Self-Evaluation Questionnaire, using a convenience sample that consisted of 600 pregnant women. The second phase was to examine the reliability and validity of the short-form Chinese Prenatal Self-Evaluation Questionnaire, and used a convenience sample consisting of 225 pregnant women. Internal consistency and split-half reliability were used to assess reliability. Construct, convergent and discriminate validities were conducted to assess the validity. Results. Item, correlation, factor and cluster analyses were used to eliminate 35 items from the questionnaire and to retain 44 items in phase one. The correlation coefficient between the short-form Chinese Prenatal Self-Evaluation Questionnaire and the original Chinese Prenatal Self-Evaluation Questionnaire was 0·95, indicating that the short-form Chinese Prenatal Self-Evaluation Questionnaire was acceptable. In phase two, 35 items were eventually retained and divided into six factors: concern for well-being of self and baby (seven items), acceptance of pregnancy (six items), identification of a motherhood role (three items), preparation for labour (six items), relationship with own mother (eight items) and relationship with husband (five items), accounting for 50·42% of the total variance. The convergent and discriminant validities were good, because the correlation coefficients between subscales and the total scale as well as between subscales and subscales were 0·57–0·71 and 0·18–0·41 (p

Aims and objectives. To understand (1) the change of stage of changes, self-efficacy, decisional balance and processes of change for sexual abstinence behaviour across a 15-month interval, (2) relations of baseline stage of changes, self-efficacy, decisional balance and processes of change to follow-up stage of changes for sexual abstinence and (3) the important predictors of follow-up stage of changes and transition of stage of changes for sexual abstinence behaviour. Background. Examining factors of sexual abstinence behaviour among adolescents can provide useful information in designing sexual abstinence intervention programmes. Design. This study applied a transtheoretical model and used a longitudinal design. Method. Anonymous questionnaires were administered to 281 participants at baseline and 15-month follow-up. Results. In summary, 46·3% (n = 130) of the participants were in the same stage, 30·2% (n = 85) regressed and 23·5% (n = 66) progressed their stage from baseline to follow-up. Baseline self-efficacy, decisional balance and processes of change are related to follow-up stage of changes for sexual abstinence. Participants with higher baseline self-efficacy, lower decrease of self-efficacy from baseline to follow-up and lower decrease of decisional balance from baseline to follow-up were more in the definite group (preparation and action stage) at follow-up. Participants with higher baseline decisional balance, lower decrease of decisional balance from baseline to follow-up and lower decrease of self-efficacy from baseline to follow-up were more in the advancement transition group at follow-up. Conclusions. Focus of interventions could differ according to intervention purpose. Reducing the decrease of self-efficacy and decisional balance across time is important to enable adolescents to be in or progress to better stages across time. Relevance to clinical practice. To make adolescents be in later stages at follow-up, increasing baseline self-efficacy is important. If the purpose is to progress the stages, baseline decisional balance should be emphasised. Health care providers should continually boost the self-efficacy and decisional balance of adolescents across time.

The purpose of this study was to examine women's psychosocial adaptation during different trimesters of pregnancy and to compare maternal psychosocial adaptation between primigravida and multigravida. A cross-sectional and comparative research design was conducted. A convenience sample consisting of 717 pregnant women who made a prenatal clinical visit in southern Taiwan were recruited for this study. The sample included 369 primigravida and 348 multigravida. A Demographic Inventory and the Chinese version of the Prenatal Self-Evaluation Questionnaire (PSEQ) were used to collect data. Results found that (1) the subscale "relationship with husband" for multigravida showed statistically significant differences between the three trimesters, with scores for the third trimester higher than those for the first. Also, multigravida had poorer adaptation on "relationship with husband" in the third trimester than in the first; (2) Analysis of covariance was used to adjust for age, marital status and planned pregnancy, as the distribution of such variables was significantly different between primigravida and multigravida. Results showed significant differences between the two sample groups in terms of PSEQ total scores and scores for "concern for well-being of self and baby," "preparation for labor," and "fear of helplessness, and loss of control in labor." This indicates that primigravida had poorer maternal psychosocial adaptation than multigravida and worried more about "concern for well-being of self and baby," "preparation for labor," and "fear of helplessness, and loss of control in labor." The findings of this study provide evidence-based data to help nursing professionals provide more suitable nursing care to pregnant women. Nurses should assess pregnant women's psychosocial adaptation during their prenatal visiting and then assist them to better understand the process of childbirth and enhance their level of control during labor. In addition, nurses should appraise women's relationships with their husbands during the third trimester and supply appropriate nursing care to pregnant women for a more pleasant pregnancy and labor experience.

Aims and objectives. To test latent constructs of social influences, contraceptive attitude and self-efficacy for contraception as a causal model of contraceptive intention among adolescents and to search for possible gender differences in the causal model of contraceptive intention. Background. A greater understanding of the causal model of contraceptive intention among sexually inexperienced adolescents will help nurses design contraceptive programmes to improve adolescent contraceptive use when they have sex. Design. This was a cross-sectional study; 770 boys and 685 girls that self-reported not being sexually experienced were selected for this study. Methods. An anonymous questionnaire was used to collect data. By structural equation modelling using the eqs 6.1 software, a hypothesized structural model of contraceptive intention was tested. Findings. For both genders, social influences affected contraceptive intention indirectly through the contraceptive attitude and self-efficacy for contraception. Contraceptive attitude and self-efficacy for contraception affected contraceptive intention directly. Contraceptive attitude also affected contraceptive intention indirectly through the mediation of self-efficacy for contraception. There were gender differences in the variances of contraceptive intention explained by contraceptive attitude, self-efficacy for contraception and social influences. Nevertheless, the data explain only a low proportion of the variability in contraceptive intention. More causal constructs influencing contraceptive intention should be explored in future. Conclusions. Personal factors and social influences operate interdependently to influence contraceptive intention among sexually inexperienced adolescents. Gender is a moderator that can modify the influential level of social influences, contraceptive attitude and self-efficacy for contraception on contraceptive intention. Relevance to clinical practice. Nurses should operate personal factors and social influences interdependently when they are designing intervention programmes for sexually inexperienced adolescents. To make intervention more effective, nurses also need to provide gender-specific intervention programmes for sexually inexperienced adolescents.

The aim of this article is to provide information about preoperative and postoperative nursing care for patients with insulinoma. The content is based on a literature review and the author's clinical experience. It describes insulinoma and provides concrete nursing measures for patients with the disease, who face problems of anxiety, risk of injury, risk of infection, nutrition and fluid volume deficit, information provision and emotional support before and after surgery.

This study was conducted to investigate the basic needs and communication difficulties of intubated patients in surgical intensive care units (ICUs) and to identify predictors of the basic needs from the patient characteristics and communication difficulties.In this descriptive correlational study, 80 surgical ICU patients were recruited and interviewed using 3 structured questionnaires: demographic information, scale of basic needs, and scale of communication difficulties.The intubated patients were found to have moderate communication difficulties. The sense of being loved and belonging was the most common need in the intubated patients studied (56.00 standardized scores). A significantly positive correlation was found between communication difficulties and general level of basic needs (r = .53, P.01), and another positive correlation was found between the length of stay in ICUs and the need for love and belonging (r = .25, P.05). The basic needs of intubated patients could be significantly predicted by communication difficulties (P = .002), use of physical restraints (P = .010), lack of intubation history (P = .005), and lower educational level (P = .005). These 4 predictors accounted for 47% of the total variance in basic needs.The intubated patients in surgical ICUs had moderate basic needs and communication difficulties. The fact that the basic needs could be predicted by communication difficulties, physical restraints, and educational level suggests that nurses in surgical ICUs need to improve skills of communication and limit the use of physical restraints, especially in patients with a lower educational level.

Background Women worldwide experience pregnancy-related nausea and vomiting yet tolerate this significant prenatal stressor. The physical and emotional stress caused by pregnancy-related nausea and vomiting may influence maternal psychosocial adaptation yet few studies have examined these relationships. Objectives The purpose of the study was to examine the relationships between nausea and vomiting, perceived stress, social support and their ability to predict maternal psychosocial adaptation among Taiwanese women during early pregnancy. Design A correlational, cross-sectional research design. Setting Four prenatal clinics in Taiwan. Participants Women ( n =243) who had completed the 6–16 week of gestation consented to participate. Methods Subjects completed four self-report questionnaires in additional to providing demographic data: Index of Nausea, Vomiting, and Retching (INVR), Perceived Stress Scale (PSS), Interpersonal Support Evaluation List (ISEL), and the Prenatal Self-Evaluation Questionnaire (PSEQ). Results Pregnancy-related nausea and vomiting was experienced in varying degrees by 188 (77.4%) women. Stepwise multiple regression analysis revealed that 37.6% of the variance in maternal psychosocial adaptation was explained by the severity of nausea and vomiting, perceived stress, social support, and pregnancy planning. Conclusions Women at higher risk for poor maternal psychosocial adaptation have not planned their pregnancy and experience severe pregnancy-related nausea and vomiting. Severe pregnancy-related nausea and vomiting associated with high-perceived stress levels may be mediated by social support.

Two common symptoms of pregnancy are nausea and vomiting, which, for some women, cause great discomfort and profoundly impact daily life. A descriptive phenomenological method was used to understand how Taiwanese women deal with nausea and vomiting during pregnancy. A purposive sample of 10 expectant mothers participated in the study. A transcription of each informant's verbal description of her nausea and vomiting experience was made and analyzed using Colaizzi's phenomenological methodology. Four themes emerged from the interview data after inductively analyzing the narrative content concerning nausea and vomiting: 1) understanding nausea and vomiting, 2) finding coping strategies, 3) psychosocial adaptation, and 4) needing support. The results also indicated the importance of social support to pregnant women's health, including instrumental and emotional forms of support. Health professionals, however, were not mentioned in the mothers' narratives as a source of support. The issues of social support, language translation, and western and eastern perspectives on nausea and vomiting and cultural differences in perceptions of their severity are discussed.

This paper reports a qualitative study describing the process of recovery from postpartum depression in Taiwanese women. We carried out a study using grounded theory with a purposive sample of 23 postnatally depressed women in 2001-2002. The Beck Depression Inventory was used to screen for severe depression. Women with scores higher than 16 at 6 weeks after childbirth were categorized as having postpartum depression. Only two out of the 23 mothers were being treated for depression at the time. The data were analysed by constant comparative method. Being reborn was the core concept that emerged from the data on the mothers experience of going through postnatal depression which was a process of descent into near-death insanity and eventual rebirth. Such postnatally depressed mothers often underwent four stages of coping with the loss of self or loss of former identity and attachment to their new lives as mothers. The four stages were: (1) shattered role identity (2) feeling trapped and breaking down (3) struggling for selfintegrity and (4) regaining vitality. The experience of postpartum depression should be examined within the social and cultural contexts in which it occurs. These Taiwanese data can be used to develop culturally-sensitive health care. The nursing role is primarily that of reflective listening to help the women adjust to the process of being reborn - an internal process of painful growth represented by motherhood and striving to protect the real self in order to maintain emotional health while negotiating a developmental transition. Preventive interventions might include providing guidance for parenting counselling of individual mothers and facilitating the development of support groups. (authors)

The purpose of this study was to estimate the prevalence of, and to investigate the risk factors for physical abuse against pregnant aborigines in Taiwan. A cross-sectional survey was conducted. Aboriginal women who had just given birth in hospitals were recruited from January to December 2003. The women were interviewed with a structured questionnaire about the physical abuse and substance use experiences. Participants were 1143 aboriginal women who had just given birth in hospitals. About 175/1143 of the women (15.3%) had ever experienced physical abuse from a husband or intimate partner, and 79/1143 of the women (6.9%) had experienced it during their recent pregnancy. Multiple logistic regression analysis revealed that the women who were more likely to have been physically abused during their pregnancy were: had fewer years of education, husbands who were unemployed, with a patriarchal family situation and had alcohol, cigarette and non-prescription drug use. Based on these results, we suggest that health care professionals provide adequate support and health education, develop interventions, and use referrals in concert with routine prenatal care in order to reduce and prevent the physical abuse of aboriginal women in Taiwan.