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The Electrocardiogram (ECG) is one of the important tools for diagnosing myocardial infarction. The ECG training course aims to help nurses establish basic competence in interpreting ECG readings. However, in traditional instruction, learners usually have difficulty memorizing the meanings of different ECG wave forms, which could represent clinical symptoms, or even life-threatening conditions/arrhythmia. Some serious problems could cause death if the nursing staff do not make correct judgments in time. This paper reports an explorative study which investigated a novel pedagogy for nursing school students’ ECG learning performance using a contextual game. A 2 week experiment was conducted to compare the learning performances of the nursing students who played the ECG contextual game and those who learned with traditional instruction. The experimental results show that the students learning with the contextual game showed better learning performance, attitude, motivation, and critical thinking tendency than those who received the traditional instruction.

Background Despite the increasing use of Assisted Reproductive Technology (ART) and the significant physical and emotional commitments that these treatments and procedures involve, only limited evidence exists regarding the psychological health of women who undergo ART. This study investigated the changes over time in the psychological health of women who have conceived using ART during the first, second, and third trimesters of pregnancy and during the postpartum period in Taiwan. Methods A quantitative longitudinal study was conducted at a fertility centre in Taiwan. 158 pregnant women who had conceived using ART completed a web-based questionnaire that included the following instruments: State Anxiety Inventory, Edinburgh Postnatal Depression Scale, Modified Maternal Foetal Attachment Scale, Pregnancy Stress Rating Scale, Maternity Social Support Scale, Intimate Bond Measure, and Parenting Stress Index. The data were collected the first (9–12 weeks), second (19–22 weeks), third (28–31 weeks) trimesters of pregnancy and at 7–10 weeks postpartum. Results Levels of anxiety and depression, which are both key indicators of psychological health, were highest during the first trimester, with scores of 42.30 ± 11.11 and 8.43 ± 4.44, respectively. After the first trimester, anxiety scores decreased and remained stable through the remainder of pregnancy, with scores of 38.03 ± 10.58 in the second and 38.39 ± 10.36 in the third trimester, but increased at two-months postpartum, attaining a score of 41.18 ± 11.68. Further, depression scores showed a similar pattern, declining to a mean of 7.21 ± 4.23 in the second and 6.99 ± 4.11 in the third trimester and then increasing to 8.39 ± 5.25 at two-months postpartum. Pregnancy stress and social support were found to be the most important predictors of change in psychological health during pregnancy and the postpartum period. Conclusion Psychological health was found to be poorest during the first trimester and at two-months postpartum. Moreover, pregnancy stress and social support were identified as key predictors of change in psychological health. The findings indicate a need for increased sensitivity among healthcare professionals to the psychological vulnerability of women who have conceived using ART as well as a need to introduce tailored interventions to provide appropriate psychological support to these women.

Background Assisted reproductive technology (ART) treatment tends to involve significant physical and emotional commitments that can impact maternal, infant, and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers’ experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan. Method Twelve first-time mothers who conceived and gave live birth using ART treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women’s experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy. Results The mothers’ accounts reflected three main themes: ‘being different from mothers who became pregnant naturally’, ‘ensuring health and safety of the foetus’, and ‘welcoming new lives with excitement’. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family’s assistance and support, and worrying about the impact of ART on health. The theme on ‘ensuring health and safety of the foetus’ encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around ‘welcoming new lives with excitement’ reflected four subthemes: overcoming hardship for worthwhile results, realising one’s life and dreams, proving to be fertile enough to give birth, and return to normal life track. Conclusion Findings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes.

Background Foetal reduction—removal of one or more foetuses to reduce the number of foetuses in multiple conceptions—is a procedure used for improving pregnancy outcomes following assisted reproductive technology (ART) treatment. While there is a recognition of the importance of understanding the experiences of women who undergo foetal reduction to offer appropriate help and support, studies that provide relevant insights are sparse. Our aim was to gain an in-depth understanding about first-time mothers’ experiences of foetal reduction following ART treatment in Taiwan. Methods We adopted a qualitative design based on a phenomenological approach for this study. In-depth semi-structured interviews were conducted with seven first-time mothers who underwent foetal reduction following ART treatment at a fertility centre in Taipei, Taiwan. All interviews were recorded, transcribed and analysed using the Colaizzi strategy. Results The views and experiences relating to foetal reduction reflected five key themes: hesitation, ambivalence and distress; the guilt of knowingly terminating a life; rituals and ceremonies to ease the sense of guilt; persuading oneself to consider the ‘big picture’; and wishing for a reunion in next pregnancy. Mothers often regretted that they took clinical advice to implant multiple embryos and then having had to resort to foetal reduction. There was a sense of hesitation, ambivalence and distress reflected in the views from all participants. They believed that they ended the fetuses’ lives knowingly and expressed strong feelings of guilt. Mothers often tried to persuade themselves to look at foetal reduction within the ‘big picture’ of the overall pregnancy outcome. Losing their unborn babies was as an unforgettable incident for most mothers, and they wished for a reunion with the lost baby in the next pregnancy. Conclusion Findings indicate the need for ART providers to undertake a more sensitive approach that involves detailed discussions with women and their families to tailor the embryo transfer processes to suit individual needs. Women who undergo foetal reduction should be provided with tailored interventions towards enhancing their coping strategies before and after foetal reduction taking into account the cultural and religious context.

Background: This study explored the factors influencing antenatal care booking among pregnant women attending antenatal clinics in Lower River region of The Gambia. Aims: To identify barriers to antenatal care booking and suggest measures to address them. Methods: This was a cross sectional descriptive study using convenient sampling technique to recruit 238 pregnant women attending antenatal care services into the study. The statistical methods used were descriptive, ANOVA, t-test, Pearson's correlation, χ2 square and logistic regression. Findings: The mean gestational age (weeks) at booking was 22.58±6.96. Respondents' wellbeing score revealed a mean score of 68.25±17.48. Husband's level of education, type of clinic, difficulty in getting national identification card, and wellbeing were significantly associated with antenatal care booking. Logistic regression showed that among all the predictors, wellbeing was the variable that significantly contributed to the model (OR=0.64, PConclusions: There is a need to incorporate mental health attention in routine antenatal care services to assess women's wellbeing and to give support and care to women with low wellbeing scores for desirable pregnancy outcome.

Table S4. Showing predictors of womenâ s perception of support and control during childbirth. (DOCX 13Â kb)

Table S3. Showing the difference in demographic-obstetric characteristics and womenâ s perception support and control during childbirth. (DOCX 15Â kb)

Demographic-obstetric information questionnaire. (DOCX 28 kb)

The Support and Control in Birth (SCIB) scale - English version. (PDF 43Â kb)

Epigenetics is a field of biomedicine that expanded tremendously during the 1980s. Epigenetics is the study of heritable changes in gene expression independent of underlying DNA (DeoxyriboNucleic Acid) sequence, which not only affect this generation but will be passed to subsequent generations. Although conception is the critical moment for making decisions regarding gene mapping and fetal health, studies have shown that perinatal nursing care practices also affect the genetic remodeling processes and the subsequent health of the mother and her offspring. To optimize maternal-infant and the offspring health, it is important to ensure that the new mother get adequate nutrition, reduce stress levels, adopt gentle birth practices, facilitate exclusive breastfeeding, and avoid contacting toxic substances.表觀遺傳學於周產期照護的應用.表觀遺傳學是20世紀80年代從生物醫學逐漸擴展的新領域，指的是在不改變DNA（DeoxyriboNucleic Acid）序列的前提下，通過某些機制引起可遺傳的基因表態的變化，且這種遺傳表徵的變化不僅影響這一代，也會傳遞給下一代。人的基因圖譜及健康不僅在受孕時決定，從表觀遺傳學的角度，周產期的照護措施也攸關此胎嬰兒與其子代基因的表現與母嬰之健康。因此，確保母嬰得到適切的營養、減少母嬰壓力、推動溫柔生產照護、推廣完全母奶哺育，以及環境中避免母嬰接觸毒性物質，將可優化母嬰與後代的身心健康。.

The purpose of this study was to determine factors related to utilisation of the partograph in three health regions of the Gambia. The study consisted of 120 participants who completed a self-administered semi-structured questionnaire, which demonstrated a statistically significant difference in knowledge levels among registered, state-enrolled and community health midwives. The results also showed significant differences within the workplace of midwives regarding knowledge and utilisation of the partograph. Overall, the knowledge level of the midwives about the utilisation of the partograph was good (80%), and on average 78% of the midwives were utilising the tool to monitor women in labour. These findings may help the Ministry of Health and Social Welfare address the gaps identified in midwives’ knowledge and use of the partograph.

Aim This article is a report of a study to evaluate the effectiveness of an intervention on fathering ability, perceived nurse's support and paternal stress after a preterm infant's admission to a neonatal intensive care unit. Background The birth of a premature infant who is admitted to a neonatal intensive care unit is a stressful experience. Due to the maternal postpartum practice in Taiwan, the father is the main visitor of the infant during the first few weeks, but interventions have rarely focused on the father. Design A historical comparison study. Methods Between August 2009–July 2010, 35 fathers in the comparison group received routine care; 34 fathers in the intervention group received a booklet designed for the fathers during their visits to the neonatal intensive care unit and nurses’ guidance based on the contents of the booklet. Fathering ability, perceived nurse's support and paternal stress were measured. Findings The intervention group had a significantly higher fathering ability and perceived nurse support than the comparison group. In the intervention group, the increased fathering ability reduced paternal stress. After adjusting for severity of illness, an significant moderating effect of perceived nurse support on the relationship between fathering ability and paternal stress was found, accounting for 59·5% of variance. Conclusion Designing a supportive intervention which provides informational, emotional, instrumental, and esteem support for the father can effectively empower his fathering ability and reduce his stress. The intervention should be initiated from the early admission of the premature infant to the neonatal intensive care unit.

This study was conducted to investigate women's perceptions of the support given by midwives during labour and delivery in Gambia, and to compare the results with the perceptions reported in similar studies undertaken in other countries and ethnic groups. In 2009, a total of 120 women were recruited with a purposive sampling method from five public health facilities in the western region of the Gambia. The Bryanton Adaptation of Nursing Support in Labour Questionnaire (BANSILQ) was applied to measure various nursing-support behaviours. Results reveal that study participants valued all the categories of nursing support during labour and delivery. Overall, emotional support was valued as the most helpful during childbirth and informational support was reported as being less helpful. The results of this study were contrasted with those of previous studies into different ethnic populations which also applied the BANSILQ to survey the women's perceptions. Further consideration of the pathways in this web of causation would provide key information which could have significant implications for the future of midwifery education and practice.

Background: A father who does not know how to assist the mother in relieving labor pains may experience a sense of powerlessness and anxiety. The objective of this study was to evaluate how an education program for expectant fathers who attended their partners' labor and birth affected their anxiety.Methods: In a randomized controlled trial, 87 expectant fathers who attended their pregnant partners through labor and birth at a hospital in central Taiwan were allocated by block randomization to an experimental (n = 45) and a control (n = 42) group. The men completed their basic personal information, a childbirth expectations questionnaire, and a Trait Anxiety Inventory when they were recruited. Two hours after birth of their child, all the expectant fathers completed a State of Anxiety Inventory.Results: Our results showed no statistically significant differences between the experimental and control groups of fathers in trait anxiety and their prenatal childbirth expectations. After analysis of covariance (ANCOVA) was applied to correct for education level, sources of childbirth information, attendance at Lamaze childbirth classes, and childbirth expectations at baseline, the effect of the childbirth program was significant for the postnatal level of anxiety (F = 3.38, p = 0.001).Conclusions: The study findings justify the clinical implementation of a birth education program based on the self-efficacy theory as an effective means of reducing anxiety among expectant fathers.

The purpose of this study is to explore the experiences of first-time expectant fathers whose spouses undergo tocolysis in the hospital. The study was conducted by the descriptive phenomenological method. On the basis of the qualitative method, the data were subjected to Colaizzi's content analysis by means of the constant comparison method. Data were collected through one-on-one interviews with six expectant fathers. The findings revealed that the experiences of the fathers could be summarized under the following five themes: being confused and absent-minded in an awkward situation, facing difficulty and attempting to identify solutions, breaking through the dilemma, looking forward to being a father, and looking back with complicated feelings. The findings of this study should provide nursing staff in charge of family- centered maternity care with information about how tocolysis influences the families of first-born babies. They should also contribute to improvements in nursing quality.

This descriptive phenomenological study was designed to explore the life experiences of 14 Taiwanese first-time expectant fathers while their wives were in the third trimester of pregnancy. The authors used unstructured interviews to obtain the data from each participant. Data were analyzed by Colaizzi ' s (1978) method as a qualitative content analysis. In addition, the researcher used the work of Lincoln and Guba (1985) to enhance the rigorousness of this study. The findings demonstrated that during the third trimester of their wives ' pregnancy eight key themes emerged among the first-time expectant fathers, as follows: (1). Jubilation; (2). Feelings of uuncertainty (3). Adjustment; (4). Preparation for fatherhood; (5). Engagement; (6). Gender concerns; (7). The wonder of fetal movement, and (8). Expanded vision. The findings from this study have an important contribution to make to an advancement of practice, education and research concerning first-time fathers ' needs and aspirations. In addition, the findings showed that there is a need to reaffirm the place of caring in nursing and midwifery if our goal is to provide a high quality service which meets the needs of the woman and her family. It is essential for nurses to champion the advancement of family-centred care which involves their partners in pregnancy.

Pain is a common, normal, and healthy physical phenomenon during childbirth. However, widely held public and clinical perspectives treat pain as a pathologic process and consider labor pain in a negative context. These perspectives ignore the positive effects of pain in the domains of protection, new life, expectation, purpose, preparation, and progression. The pain interpretation and pain experience of new mothers deeply impact their mental health, maternal-infant relationship, and transition to motherhood. This paper introduces the common myths related to labor pain, the three stages of pain transmission, and the current approaches to pain management. The authors hope childbirth caregivers may accept labor pain as a meaningful, pleasant, and positive gift, which is the first and most important step toward effective pain management.苦不堪言的生產疼痛？迷思與護理照護疼痛是生產過程中常見且健康的生理現象，然而一般大眾及醫護人員對生產疼痛卻普遍存在病態的觀點，充滿著折磨、酷刑、痛苦等負向感受，而忽略它也包含保護、新生命、期待、目的、準備、進展等正面作用。由於生產疼痛的經驗與感受對於婦女日後情緒的健康、母嬰關係有深遠的影響，並可能影響母職任務的發展。因此，本文除了介紹常見的生產疼痛之迷思、疼痛感受的三階段外，並期許大家以一種感恩正向的思維來省思生產疼痛的意義，進而學習與疼痛為伴的態度來處理生產所造成的疼痛不適。

Midwifery is a practical facet of the health sciences that emphasizes professional competence-oriented teaching and learning. Cognitive and practical processes integrate and build midwifery student professional knowledge, attitudes, and skills. Clinical education is a teaching method and strategy used to prepare midwifery students for professional practice. Midwifery clinical teaching plans are designed using literature review, expert opinions, and student comments and determine total required hours and caseloads. Midwifery clinical teaching activities and methods promote self-reflection, childbirth education fundamentals, learning by role model observation, and learning role function through overseas observership programs. This paper discusses midwifery education dilemmas and coping methods in Taiwan.護理助產臨床教育助產專業是一門實用的健康照護科學，健康照護是一項以專業能力為導向的實務學門，其專業能力必須透過認知之歷程，並經由實務操作以統整並建構護理專業知識、態度與技能。臨床實習是一種教學活動的設計，也是達成實務操作以統整並建構護理專業知識、態度與技能的最合適之教學策略與活動。護理助產研究所參考2006年的「助產學生臨床實習訓練標準化之規劃」結案報告，以及所有課程規劃委員會專家意見與學生背景資料後，明訂自2011學年度入學新生之實習課程規劃為九學分，總時數為696小時。助產實習內容分為專業技能及專業角色的養成，且須完成實習經驗要求。護理助產所之實習課程特色包括反思性學習活動教學、執行生產教育課程、角色模範學習、及海外見習活動。本文將進一步探討目前護理助產臨床教育所面對的困境，並提出因應之道。

Assessment of nursing student abilities with regard to competent nursing practice has played an important role in the clinical nursing education revolution.This study was designed to evaluate the value to Taiwanese BSN graduates of a competence-based clinical performance examination model for medical-surgical nursing.Four semi-structured questions were used to explore the learning experience of 30 nursing students through their performance on a medical-surgical nursing clinical performance examination (CPE). Qualitative content analysis was used to identify categories.Differences found between the CPE and traditional clinical practicum included learning situation, learning process decision making procedures, and result evaluation procedures. Advantages of the CPE included confidence in self-competence, enhanced stimulation in clinical settings, self-directed learning, revised learning, and flexible learning. Disadvantages included poorer control over the overall learning process and less control of outcomes. Benefits to subjects from participating in the CPE included increased awareness, acceptance, and cultivation of self competence. A number of students expressed they perceived no specific benefits attributable to the CPE.Study findings are hoped to contribute to the development of the CPE in medical-surgical nursing in Taiwan.

The aim of this study was to evaluate the effects of auricular acupressure on relieving menstrual symptoms and decreasing nitric oxide (NO) for women with primary dysmenorrhea.This was a randomized clinical trial comparing the effects of auricular acupressure by seed-pressure method and placebo adhesive patch.Settings included colleges in northern and central Taiwan.Serum CA-125 testing was used as a screening test for primary dysmenorrhea (35 mg/dL). The study included 36 college females randomized to acupressure group, 35 to control group.The acupressure group received auricular acupressure by seed-pressure method on liver (CO12), kidney (CO10), and endocrine (CO18) acupoints. The control group had a plain adhesive patch placed on the same acupoints with no seed attached. Acupressure protocol included massaging 15 times on each acupoint, 3 times a day, for a total of 20 days.Primary: Short-form Menstrual Distress Questionnaire (MDQs). Secondary: blood sample of NO. Assessments of MDQs and NO were performed at baseline and within the first 2 days of their next menses (after completion of 20 days of acupressure).In the acupressure group, the overall menstrual symptoms (95% confidence interval [CI] = -49.8 to -6.5, effect size [ES] = 0.43, p = 0.01) and two subscales, menstrual pain (95% CI = -16.4 -to -2.2, ES = 0.45, p = 0.01) and negative affects (95% CI = -11.9-2.0, ES = 0.38, p = 0.04), revealed that menstrual symptoms decreased significantly after auricular acupressure by the seed-pressure method. The ES for the MDQs were in favor of the auricular acupressure by seed-pressure method. NO level increased in the acupressure group, although this difference did not achieve statistical significance (p0.05).This study supports the effects of auricular acupressure by seed-pressure method in improving menstrual symptoms, and offers a noninvasive complementary therapy for women with primary dysmenorrhea.

The purpose of this qualitative research was to explore subjective experiences related to vaginal symptom disturbance and self-management experience of menopausal women. Semi-structured, in-depth interviews were used to collect data. Nineteen participants aged 49 to 68 were recruited. Data obtained from interview transcripts were analyzed using a constant comparative method. Two themes and six related categories emerged from interview data. Vaginal symptom disturbance experience fell into the three categories of sensation of vaginal symptoms; hesitation to share such with others and disturbance of daily life routines. Self-management of vaginal symptoms included unwillingness to visit physicians, self-seeking resources to deal with symptoms, and impacts and coping with sexual life. The impact of vaginal symptoms included distress on physical, mental and sexual life. Health providers should be more sensitive with regard to vaginal symptoms in menopausal women and take a more aggressive approach to provide health education to raise awareness and enhance self-management of vaginal symptoms among menopausal women. Hopefully, participant concerns/insights on vaginal disturbance will provide valuable references for application in teaching materials for health providers to improve menopausal care.

The present article describes how scaffolding is implemented in an intelligent tutorial system call NTUs (number transcoding tutorial system), and what are the results of the system tested empirically on a group of grade students in fostering their number concepts. To use NTUs the system first analyzes a user's errors on a number transcoding task, and the results of analysis are used to infer the user's zone of proximal development (ZPD). A scaffolding process which vas designed with inspiration from how people learn Chinese calligraphy is provided next in the user's ZPD. An empirical test indicates that NTUs can not only foster students' number concepts, but can also attract them to use it.