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As the world’s population is aging and there is a shortage of sufficient caring manpower, the development of intelligent care robots is a feasible solution. At present, plenty of care robots have been developed, but humanized care robots that can suitably respond to the individual behaviors of elderly people, such as pose, expression, gaze, and speech are generally lacking. To achieve the interaction, the main objectives of this study are: (1) conducting a literature review and analyzing the status quo on the following four core tasks of image and speech recognition technology: human pose recognition, human facial expression recognition, eye gazing recognition, and Chinese speech recognition; (2) proposing improvement strategies for these tasks based on the results of the literature review. The results of the study on these improvement strategies will provide the basis for using human facial expression robots in elderly care.

With the recent impact by the COVID‐19 pandemic, nursing research has gone through unexpected changes across the globe. The purpose of this special report is to present the commonalities in the impact of the COVID‐19 pandemic on nursing research across four countries, including the United States, South Korea, Japan, and Taiwan, and one region, that is, Hong Kong, and to make recommendations for future nursing research during the immediate postpandemic period and future pandemic situations. To identify the commonalities, seven researchers/leaders from the five countries/regions had discussions through 3 days of an international workshop. The content for this discussion paper derived from: (a) the exemplars/cases of the COVID‐19 impact on the research process, (b) researchers/leaders' presentations on the COVID‐19 impact, and (c) memos from the workshop. The materials were analyzed using a simple content analysis. The commonalities included: (a) “a heavy emphasis on teaching and fluctuating productivity,” (b) “increased funding opportunities and governmental support,” (c) “gendered experience complicated by professional differences,” (d) “delays and changes/modifications in research process,” (e) “limited research settings and difficulties in getting access,” and (f) “increased online dissemination activities with positive changes in the image of nursing.” With all collective wisdom that nurse researchers have obtained during the COVID‐19 pandemic, nursing research will evolve again for the successful future of the nursing discipline.

The purpose of this article is to discuss the current status of research mentoring in nursing across 4 countries (the United States, Taiwan, South Korea, and Japan) and to make suggestions for future research mentoring. Seven leaders reflected on the current status of research mentoring in nursing, provided exemplars/cases from their own experiences, and their reviews of the literature. Six themes were discussed: (a) "culturally defined"; (b) "professionally contextualized"; (c) "teaching research integrity and research practice"; (d) "with mutual respect and care"; (e) "based on effective communication"; and (f) "supported by institutional and governmental commitment and infrastructure."

The purpose of this article is to identify the commonalities in nursing perspectives among 6 countries/regions (United States, South Korea, Taiwan, Japan, Hong Kong, and Thailand). Nine leaders from the 6 countries/regions reflected on what nursing perspectives were in their own countries/regions and provided exemplars/cases from their own experiences and literature reviews. The data were analyzed using a content analysis. Seven themes were extracted: (a) "embedded in cultural and historical contexts"; (b) "based on philosophical pluralism"; (c) "women-centered perspectives"; (d) "care-oriented holistic views"; (e) "ethical and humane views"; (f) "respecting and advocating"; and (g) "considering diversities."

Purpose Despite the importance of research in the discipline of nursing, current trends in nursing research have rarely been discussed across countries. The purpose of this article was to identify current trends in nursing research across five countries, including the United States, South Korea, Taiwan, Japan, and Hong Kong, in order to provide directions for future global nursing research. Organizing construct A discussion article. Methods To identify the current trends, seven leaders from the five countries had discussions through a series of workshops and conference presentations. After the most recent conference, all the leaders reflected for a month on their presentations and compiled the exemplars and cases from their experience and the existing literature in individual countries into a table. The tables and supporting references were collected at the completion of the reflection period. Then, the PowerPoint (Microsoft Corporation, Redmond, WA, USA) slideshows of the conference presentations by the leaders and the collected tables were analyzed using a content analysis. Findings Six themes reflecting the current trends in nursing research were extracted: (a) demographic alterations; (b) increasing diversities and globalization; (c) technology innovation; (d) individualized or personal care and population health initiatives; (e) health policies and regulations; and (f) nursing workforce changes. Conclusions Future directions for nursing research across the countries were proposed: (a) cost-effectiveness research; (b) implementation science; (c) data science; (d) training of the future generation of nurse researchers; (e) population health; and (f) team science. Clinical relevance This topic could be applied to any clinical settings.

Web-based interventions that promote physical activity have been tested in various populations and proven effective. However, information on recruiting and retaining ethnic minorities in these interventions is limited. This study discusses practical issues in recruitment and retention of Asian Americans using three strategies: (1) only Web-based intervention (Group 1), (2) one with Fitbit Charge HR (Group 2), and (3) one with Fitbit Charge HR and office visits (Group 3). Recruitment and retention rates, minutes of weekly research team meetings, and the researchers' memos were collected. Retention rates were analyzed using descriptive statistics, and the minutes and memos were content analyzed following Weber's methods. Retention rates varied by the end of the first (12% in Group 3, 36.9% in Group 2) and third month (0% in Group 3, 36.9% in Group 2). The practical issues were (1) difficulties in recruitment across strategies, (2) the necessity of using community consultants/leaders across strategies, (3) subethnic differences across strategies, (4) timing issues across strategies, (5) Fitbit as a facilitator with several hindrances, and (6) office visits as an inhibitor. Fitbits with user guidelines and community consultants'/leaders' involvement are proposed for future Web-based interventions to promote physical activity in Asian Americans.

Although some health-care providers, including some research, categorize all Asians into aggregate data as if they were one group, each nationality is very different. Cultural values differ even among Chinese according to their geographic location within Taiwan, Hong Kong, China:—north, south, east, west; rural versus urban; interior versus port city—as well as other variant cultural characteristics. Chinese immigrants to Western countries are even more diverse, with a mixture of traditional and Western values and beliefs. These differences must be acknowledged and appreciated. This chapter follows the dominant values and beliefs according to the 12 domains of the Purnell Model of Cultural Competence: overview/heritage, communication, family roles and organization, workforce issues, biocultural ecology, high-risk behaviors, nutrition, pregnancy, death rituals, spirituality, health-care practices, and health-care practitioners.

Despite an increasing number of online programs to promote physical activity, they have rarely been evaluated for their effects on cardiovascular symptoms of racial/ethnic minority women at midlife. This study aimed to determine the preliminary efficacy of a newly developed online program for physical activity promotion on cardiovascular symptoms of Asian American midlife women. This study was a pilot repeated-measures randomized controlled trial (pretest/posttest) among 26 Asian American midlife women. The variables were measured using multiple instruments on background features, physical activity, and cardiovascular symptoms at three points of time (baseline, after 1 month, and after 3 months). Linear mixed models were used to analyze the data. The prevalence and severity of cardiovascular symptoms did not show a statistically significant group-time interaction. However, the increase in lifestyle physical activity over time was significant only among the intervention group (Δ = 0.49, P = .016). The results supported the program's preliminary efficacy on lifestyle physical activity for Asian American women at midlife, but not on cardiovascular symptoms.

The purpose of the study was to explore the levels of and relationships between disaster nursing competence, anticipatory disaster stress, and the motivation for disaster engagement among undergraduate nursing students in Taiwan. A cross-sectional research design was applied. Using convenience sampling, 90 nursing students participated with an 86.54% response rate. The Disaster Core Competencies Questionnaire, Anticipatory Disaster Stress Questionnaire, and Motivation for Disaster Engagement Questionnaire were used to collect data. The Pearson correlation and ANOVA were used to analyze the data. Results showed that students&rsquo, level of disaster nursing competence was low, anticipatory disaster stress was not high, and motivation for disaster engagement was high. Motivation for disaster engagement was positively correlated with anticipatory disaster stress. Students who were more willing to participate in disaster management had a higher level of anticipatory disaster stress and motivation for disaster engagement. It is suggested that healthcare institutions and schools should work together to design disaster education plans using innovative teaching/learning strategies to increase students&rsquo, willingness and motivation for disaster engagement.

Introduction: Because virtually no theories were available to explain unique characteristics of Asian women’s leadership in nursing, a middle-range theory on women’s leadership in Asian culture was previously published. To reflect recent political and social changes in different countries, there is a necessity to refine the theory. The purpose of this article is to present the refined middle-range theory on Asian women’s leadership in nursing. Methodology: Using an integrative approach, the theory was further developed based on two major sources: literature reviews and exemplars/cases from six different countries. Results: The Refined Middle-Range Theory on Women’s Leadership in Asian Culture has two main domains: (a) leadership frames and (b) leadership contexts. The domain of leadership contexts has been extended with two additional main concepts including demographic contexts and health workforce/system contexts. Discussion: The refined theory is expected to guide Asian women’s leadership in nursing across the globe.

Introduction: Asian cultures reflect patriarchal cultural values and attitudes, which likely have influenced women leaders in their countries differently from women in Western cultures. However, virtually no leadership theories have been developed to reflect the experiences and development of nursing leaders from Asian cultures. The purpose of this article is to present an emerging integrated middle-range theory on Asian women’s leadership in nursing. Methodology: Using an integrative approach, the theory was developed based on three major sources: the leadership frames of Bolman and Deal, literature reviews, and exemplars/cases from five different countries. Results: The theory includes two main domains (leadership frames and leadership contexts). The domain of leadership frames includes human resources/networks, structure/organization, national/international politics, and symbols. The domain of leadership contexts includes cultural contexts, sociopolitical contexts, and gendered contexts. Discussion: This theory will help understand nursing leadership in Asian cultures and provide directions for future nurse leaders in this ever-changing globalized world.

OBJECTIVE Based on previous studies, a Web-based physical activity promotion program with educational modules on menopausal symptoms and physical activity has been developed for Asian American midlife women to reduce their menopausal symptoms through increasing their physical activity. The purpose of this pilot randomized intervention study was to determine the efficacy of the Web-based program in improving menopausal symptom experience of Asian American midlife women. METHODS This was a randomized repeated measures pretest/posttest (pretest, post 1 month, and post 3 months) control group study among 29 Asian American midlife women. Multiple instruments were used, including the Midlife Women's Symptom Index and the Kaiser Physical Activity Survey. The data were analyzed using a mixed-model growth curve analysis. RESULTS Over time, total severity scores decreased for the control group (-0.53, P

BACKGROUND Intravenous injection is the most common medical treatment and the main cause of pain in hospitalized children. If there is no appropriate health care for pain relief, the proportion of moderate and severe pain often exceeds 70%. With nonpharmaceutical-based pain management, Buzzy is recognized as an effective device for rapidly relieving injection pain in hospitalized children. However, Buzzy is not widely used in Asia and very few experimental studies in Asia have addressed the effectiveness of the Buzzy device at treating needle pain in hospitalized children. OBJECTIVE The main purpose of this study was to investigate the effectiveness of the Buzzy device for diminishing pain levels among hospitalized children in Taiwan. METHODS We applied a quasiexperimental design with random assignment. According to the time of admission, child participants were randomly assigned to treatment and nontreatment groups. The Buzzy device was applied as an intervention in this study. The samples size was 30 per group. The study participants were recruited from the pediatric ward of a medical center in northern Taiwan. The research data were collected longitudinally at three time points: before, during, and after intravenous injection. Three instruments were used for assessment: a demographic information sheet, the Wong-Baker Face Scale (WBFS), and the Faces Legs Activity Cry Consolability (FLACC) scale. The data were analyzed by descriptive analysis, the Mann-Whitney U test, the Wilcoxon signed-rank test, and the χ2 test. RESULTS A total of 60 hospitalized children aged 3 to 7 years participated in this study, including 30 participants in the treatment group and 30 participants in the nontreatment group. The average age of children in the treatment and nontreatment groups was 5.04 years and 4.38 years, respectively. Buzzy significantly mitigated pain in children during intravenous injection with a significant difference between the two groups in pain-related response (FLACC) and actual pain (WBFS) (Z=–3.551, PZ=–3.880, PZ=–2.387, P=.02). When Buzzy was employed, the children experienced less pain than they did during previous intravenous injections (Z=–3.643, P CONCLUSIONS The intervention of using the Buzzy device was effective in reducing pain levels of intravenous injection among hospitalized children. The specific focus on children in Asia makes a valuable contribution to the literature. For clinical application, the reliable pain relief measure of Buzzy can be used in other Asian children to help health care providers improve noninvasive care among children. For future applications, researchers could integrate Buzzy into therapy-related games and a technology-based app to increase the efficiency of use and provide more data collection functions.

Background Many nursing programs include a capstone project as part of the nursing curriculum. In Taiwan, these courses involve development of healthcare products. A student's success can depend on faculty's ability to employ creative teaching behaviors. Purpose To examine the relationship between demographic and teaching characteristics, personality traits, and self-perceived levels of creative teaching behaviors for capstone nursing faculty. Methods This study used a cross-sectional, descriptive, correlational study design. Faculty (N = 53) were recruited from healthcare schools in Taiwan. Data from self-report questionnaires included variables for demographic and teaching characteristics, perceived levels of creative personality traits (imagination, curiosity, adventure, challenge) and creative teaching behaviors (autonomous learning, creative thinking, characteristics/motivations, environment/opportunity). Hierarchical multiple regression identified predictors of creative teaching behaviors. Results Mean total scores for creative teaching behaviors were high for nursing faculty; characteristics/motivations were the lowest subscale score. The creative personality trait of curiosity significantly and positively influenced the perception of high levels creative teaching behaviors. Conclusions High scores for curiosity significantly predicted high scores for creative teaching behaviors for nursing faculty. These findings suggest faculty who perceive themselves as having low levels of creative teaching behaviors might benefit from training to increase levels of curiosity.

The benefits of physical activities on depressive symptoms have increasingly been reported in the literature, but the effect through which a Web-based physical activity promotion program alleviates depressive symptoms is not clearly known, especially among ethnic minority midlife women. The purpose of this pilot randomized control study is to examine the preliminary efficacy of the Web-based physical activity promotion program in enhancing the depressive symptoms of Asian American midlife women through increasing physical activity. This study adopted a randomized repeated measures pretest/posttest control group design. This study consisted of two groups of research participants: 18 in an intervention group and 15 in a control group. By using multiple instruments, the participants’ background and health status, depressive symptom experience, and physical activity experience were measured at three time points (pre-, post 1-month, and post 3-months). The data were analyzed using a modified intent-to-treat linear mixed-model growth curve analysis. After controlling for covariates, random intercept, and random slope, only discrimination stress showed statistical significances in the group effect (0.18, p = .08 for control) and time effect (-0.04, p = .04), but not in the group × time effect (p = .51). The active living habits scores showed statistical significances in the group effect (0.82, p < 0.01 for control), time effect (0.29, p < 0.01), and group × time effect (-0.31, p = 0.03 for control). Findings support the significant effect of the Web-based physical activity promotion program on the women’s discrimination stress and active living habits.

Summary Purpose This study aimed to explore the factors associated with the intention to receive a Pap test among married immigrant women of Vietnamese origin living in Taiwan. Methods This was a cross-sectional community-based study. We enrolled 281 women aged 30 years and over in the study, from July 2013 to January 2014. The participants' characteristics, cervical cancer knowledge, Pap test knowledge, attitudes toward cervical cancer, barriers to receiving a Pap test, fatalism, and intention to receive a Pap test, were measured using self-report questionnaires. Hierarchical multiple regression analyses were performed to examine the variables associated with participants' intentions to receive a Pap test. Results Vietnamese women with low scores on the measures of cervical cancer knowledge and perceived barriers to receiving a Pap test were more willing to receive the test, as were those with high scores on the measures of Pap test knowledge and fatalism. Women who received a Pap test in the previous year were more willing to receive a Pap test within the next 3 years. Conclusions Preventive healthcare for immigrant women should be a focus of nurses. The development of culturally appropriate health education and strategies should enhance their knowledge of Pap tests and reduce perceived barriers to Pap test participation. This study's results can be a reference for nurses who work with immigrant women.

Introduction The necessity of culturally competent Internet Cancer Support Groups (ICSGs) for ethnic minorities has recently been highlighted in order to increase its attractiveness and usage. The purpose of this study was to determine the preliminary efficacy of a culturally tailored registered-nurse-moderated ICSG for Asian American breast cancer survivors in enhancing the women’s breast cancer survivorship experience. Methods The study included two phases: (a) a usability test and an expert review; and (b) a randomized controlled pilot intervention study. The usability test was conducted among five Asian American breast cancer survivors using a one-month online forum, and the expert review was conducted among five experts using the Cognitive Walkthrough method. The randomized controlled pilot intervention study (a pre-test and post-test design) was conducted among 65 Asian American breast cancer survivors. The data were analysed using content analysis and descriptive and inferential statistics including the repeated ANOVA. Results All users and experts positively evaluated the program and provided their suggestions for the display, educational contents, and user-friendly structure. There were significant positive changes in the support care needs and physical and psychological symptoms ( p Discussion The findings supported the positive effects of ICSGs on support care needs, psychological and physical symptoms, and quality of life.

The purpose of this paper is to identify practical issues in Internet recruitment of racial/ethnic minorities by analyzing an Internet intervention study conducted with Asian American breast cancer survivors, and to propose directions for recruitment of racial/ethnic minorities for future Internet research. Six practical issues were identified: (a) a relatively fewer number of Internet communities/groups; (b) hindrances in establishing authenticity; (c) difficulties in gaining entrée from the webmasters or website owners of Internet communities/groups; (d) the necessity of racially/ethnically matched research team members; (e) flexibility required in recruitment strategies; and (f) strategies to overcome the low response rate.

This paper aims to conduct and evaluate an educational intervention on preventing cervical cancer among married immigrant women of Vietnamese origin. The study design was a quasi-experimental method with two groups. In total, 260 married immigrant women of Vietnamese origin with national health insurance at least 30 years of age were recruited from November 2013 to January 2015 in southern Taiwan. The effects of the educational intervention, including cervical cancer and Papanicolaou test knowledge, attitudes towards cervical cancer, fatalism, barriers to receiving Papanicolaou tests, intention for receiving Papanicolaou tests within the next year, and intention for receiving Papanicolaou tests within the next 3 years, were evaluated. Repeated measures analyses of variance showed significant interactions between the intervention group and time for cervical cancer knowledge, knowledge of Papanicolaou test, attitudes towards cervical cancer, and intention for receiving a Papanicolaou test within the next 3 years; in addition, 71.4 % reported being satisfied or very satisfied with the intervention. The results of this study can provide information for governments to make appropriate health policies for screening behavior of cervical cancer, increase healthcare professionals' competencies towards Vietnamese women, and increase Papanicolaou test screening rates to decrease cervical cancer mortality. Effective interventions may require particular consideration of married immigrant women.

Nurses are the largest group of healthcare providers and are often the first line responders to a disaster event. Nurses' disaster competence, motivation for disaster engagement, and factors that impact their motivation to respond to disaster events need to be understood. The purposes of the study were to determine the predictive relationships between Taiwanese nurses' disaster competence, anticipatory disaster stress, and motivation for disaster engagement. A cross-sectional design was used to analyze data collected between August 2017 and December 2017 from eight hospitals in southern Taiwan. Ninety participants who met the recruitment criteria completed and returned questionnaires with an 88.24% response rate. Data collection involved administering the Disaster Nursing Competence Questionnaire, Anticipatory Disaster Stress Questionnaire, and the Motivation of Disaster Engagement Questionnaire. The results indicated that anticipatory disaster stress was positively correlated with disaster competence and motivation for disaster engagement. Disaster competence and willingness to join a hospital disaster rescue predicts an individuals' motivation for disaster engagement. The results of the study add to the understanding of factors that correlate with nurses' motivation to participate in disaster events. By understanding these factors, the government and healthcare administrators can design disaster education plans and other strategies to improve Taiwanese nurses' motivation to engage in disaster events.

Objective The beneficial effects of physical activities on sleep-related symptoms have been reported in the literature, and physical activity has been suggested as an efficient strategy to reduce sleep-related symptoms among midlife women. The effect of Web-based physical activity promotion programs on sleep-related symptoms have, however, rarely been explored, especially among midlife racial/ethnic minority women. The purpose of this pilot study was to test the preliminary efficacy of a WPAPP on self-reported sleep-related symptoms and physical activity of Asian American midlife women. Methods This pilot study was a randomized repeated measures pretest/posttest control group study (14 in an intervention group and 12 in a control group). Multiple instruments were used to measure background characteristics (eg, sociodemographic and health status), sleep-related symptoms and physical activity experiences at pretest, post 1 month, and post 3 months. The data were analyzed using an intent-to-treat linear mixed-model growth curve analysis. Results After adjusting for covariates and random intercept, the intervention group showed a significant decrease in the total numbers of psychological (P = 0.0956) and total sleep-related symptoms (P = 0.0733) at post 1 month. Also, both groups showed a significant increase in physical activity (active living habits) at post 3 months (P = 0.0353). Conclusions The WPAPP is potentially beneficial in decreasing Asian American midlife women's sleep-related symptoms and promoting their lifestyle physical activity.

The development of the occupational health nursing profession has promoted stable and healthy human resources in Taiwan. In order to improve the occupational safety, health, and healthcare of workers, the professional core competencies and role functions of occupational health nursing is of utmost importance. This article investigated the current status of occupational health nursing education, role functions, practice scope, and the development and responsibilities of professional associations and proposed the challenges to and the future prospects of the development of occupational health nursing in Taiwan. The key findings include: (1) the role functions and practice scope of occupational health nursing; (2) occupational health nursing courses should be included in the required credits of Department of Nursing and master and doctor programs in occupational health nursing should be established; (3) a certification system of occupational health nursing should be established as soon as possible; (4) the professional associations for occupational health nursing should take responsibility for continuing education and training; and (5) interdisciplinary collaborations among relevant occupational health professionals should be strengthened.台灣職業衛生護理省思—挑戰與展望.職業衛生護理專業的發展是台灣穩定健康勞動人力資源重要的條件之一。為能提升工作者的職業安全衛生與健康照護，職業衛生護理人員的核心能力與角色功能更顯舉足輕重。本文就台灣的職業衛生護理教育現況、角色功能與執業範疇及專業團體的發展與責任等進行檢視，並提出我國職業衛生護理發展上的挑戰與展望，包括：(1)職業衛生護理應具備的角色功能與執業範疇；(2)職業衛生護理課程應列為護理學系的必修學分，並設置職業衛生護理碩、博士學位學程；(3)盡速建立職業衛生護理認證制度；(4)相關專業學術團體應負起在職教育、訓練之責；(5)強化職業衛生相關領域間之跨界合作。.

Aim The purpose of the study was to develop and psychometrically test the Nurses Clinical Reasoning Scale. Background Clinical reasoning is an essential skill for providing safe and quality patient care. Identifying pre-graduates’ and nurses’ needs and designing training courses to improve their clinical reasoning competence becomes a critical task. However, there is no instrument focusing on clinical reasoning in the nursing profession. Design Cross-sectional design was used. This study included the development of the scale, a pilot study that preliminary tested the readability and reliability of the developed scale and a main study that implemented and tested the psychometric properties of the developed scale. Method The Nurses Clinical Reasoning Scale was developed based on the Clinical Reasoning Model. The scale includes 15 items using a Likert five-point scale. Data were collected from 2013–2014. Two hundred and fifty-one participants comprising clinical nurses and nursing pre-graduates completed and returned the questionnaires in the main study. The instrument was tested for internal consistency and test–retest reliability. Its validity was tested with content, construct and known-groups validity. Results One factor emerged from the factor analysis. The known-groups validity was confirmed. The Cronbach's alpha for the entire instrument was 0·9. Conclusion The reliability and validity of the Nurses Clinical Reasoning Scale were supported. The scale is a useful tool and can be easily administered for the self-assessment of clinical reasoning competence of clinical nurses and future baccalaureate nursing graduates. Study limitations and further recommendations are discussed.

The purpose of this study was to explore the factors associated with Pap testing among married immigrant women of Vietnamese origin residing in Taiwan, including demographics, knowledge of cervical cancer, knowledge of Pap tests, fatalism, attitudes toward cervical cancer, and barriers to receiving Pap tests. A cross-sectional correlational design was used. Data were collected from July 2012 to January 2013. Participants were recruited through snowball sampling in two communities in Southern Taiwan. A total of 451 married immigrant women of Vietnamese origin aged 30 years and over were invited to participate in the study and 427 participated. Data analysis included descriptive statistics and multivariate logistic regression. Participants with no children were significantly less likely to have received a Pap test (odds ratio = 0.278, 95% confidence interval [CI] = 0.135-0.569); each additional point of knowledge about Pap tests increased the likelihood of having a Pap test by 19% (odds ratio = 1.190, 95% CI = 1.093-1.297), and each additional point in barriers to receiving Pap tests decreased the chances of having received a Pap test (odds ratio = 0.714, 95% CI = 0.637-0.800). The results can provide governments with a reference for developing policies for cervical cancer prevention among married immigrant Vietnamese women.

Information literacy is a crucial skill for nurses to retrieve, judge, and provide appropriate information to patients and their caregivers. This study aimed to develop a blended course to cultivate nursing students’ informatics competency. This was a three-semester study including a development of the course, pilot-test and modification of the course design, and final implementation of the modified course design. Almost all class activities were done online except for periodical meetings for problem discussions. Information literacy definition, tool literacy, resource literacy, social literacy, research literacy, publishing literacy, and critical literacy were included in the course curriculum. Twenty-one and 18 students enrolled in the first and third semester of the study. Those students were invited to complete a survey consisting of 25 Likert-scale questions that asked about perception of blended-learning/teaching strategy, effectiveness of the blended course, and what was learned at the conclusion of the course. The majority of students perceived positively toward the teaching strategies, expressed that they understood more about information literacy, and presented abilities in applying information literacy skills in nursing. Structure of the course can be used to cultivate and improve nursing students’ competency in informatics. The teaching model can be used in future online courses.

Summary Background The Team-Based Learning (TBL) method has been used as a teaching strategy in many disciplines. It is instructor-led, learner-centered learning with functions similar to those of problem-based learning, but it is more cost-effective. However, little is known about the application of TBL to nursing education. Objectives The objectives of the study are to employ the TBL approach in a Maternal-Child Nursing course and to evaluate its effects on learning outcomes. Design We present one-group pretest–posttest research design with the intervention of the TBL teaching strategy. Settings The study was conducted in one of the nursing universities in Taiwan. Participants One-hundred-four students in 2011 and 103 students in 2012 in an RN-to-BSN program who enrolled in the Maternal-Child Nursing course participated in this study. These students had graduated from a five-year nursing diploma program before enrolling in the RN-BSN program. Methods Data were collected before and after the implementation of the TBL, which included active learning, in-class activities, and application exercises. The Class Engagement Survey (CES), Value of Teams (VTs), Self-Directed Learning Instrument (SDLI), and exam scores were used to measure students' learning outcomes. Results TBL significantly influenced the students' learning outcomes. Students who expressed that TBL increased their learning interests had a higher score on VT; and students who had high achievement from the current TBL course had higher scores on the CES, VT, and SDLI. The means of the group test scores and the final examination score were significantly higher than the individual scores from the in-class tests in both 2011, 2012, and the combination of 2011 and 2012. Conclusion The TBL design requires out-of-class preparation before all classes, which requires active and self-directed learning. TBL provides opportunities to foster learner-to-learner interactions, which lead to more active engagement and teamwork among learners. It also promotes the students' class engagement and teamwork values, and it increases academic performance. The TBL is suggested to have a greater effect on academically weaker students.

Developing effective teaching strategies to stimulate students' interest and enthusiasm are urgently needed in current research courses. The purposes of the study were to implement the Cookie Experiments teaching strategy in research course and examine the effects of the strategy on students' attitudes towards nursing research. The study was a pretest-post-test design with 95 students at a Registered Nurses to Bachelor of Science in Nursing (RN-to-BSN) program enrolled in the nursing research course. Results indicated that there was a significant effect of the Cookie Experiments teaching strategy on students' attitudes towards research. Although students perceived a median high score of pressure from the research course, they regarded that the pressure is conducive to their learning of research. Students highly suggested to continuously applying this teaching strategy in the future nursing research courses. Developing and using various teaching strategies with attractive and hands-on methods to motivate nurse students, learning research is strongly recommended.

Aims and objectives To understand the relationship of individual characteristics, perceived worksite support and perceived personal creativity to clinical nurses' innovative outcome (receiving the Nursing Innovation Award). Background Since the idea of applying creativity and innovation to clinical nursing practice and management was first advocated in the Nursing Administration Quarterly in 1982, the topic of nursing innovation has gained worldwide attention. To increase the prevalence of nursing innovation, it is important to identify and understand the related factors that influence nurses' innovative outcome. Design This study used a cross-sectional descriptive survey design. Methods A self-administered questionnaire was completed by 32 award winners and 506 nonawarded clinical nurses in Taiwan. Results The level of creativity perceived by all participants was moderate-to-high. Individual characteristics (r = 0·61) and worksite support (r = 0·27) were both correlated with perceived creativity. Individual characteristics and worksite support showed some correlation as well (r = 0·21). Individual characteristics and worksite support could predict perceived creativity after controlling for demographic variables, but only individual characteristics had an effect on innovative outcome. Perceived creativity did not have mediation effects either between individual characteristics and innovative outcome or between worksite support and innovative outcome. Conclusions Clinical nurses' individual characteristics had a direct relationship to innovative outcome, whereas neither worksite support nor creativity was correlated with innovative outcome. Although worksite support did not show effects on innovative outcome, it was related to both perceived creativity and individual characteristics. As suggested by other scholars, there might be other related factors between creativity and innovative outcome. Relevance to clinical practice Although worksite support did not have effect on clinical nurses' innovative outcome, it was related to individual characteristics. Hospital administrators or nursing directors can foster a supportive environment where creative nurses would be more likely to work and engage in innovative activities.

Purpose To analyze and compare the psychometric properties and cultural attributes of the Organizational Commitment Questionnaire and the Organizational Commitment Scale to determine their appropriateness for measuring commitment of Asian nurses, the biggest portion of international nurses. Conclusion The Organizational Commitment Questionnaire was cross-culturally cross-validated when compared with the Organizational Commitment Scale. Both instruments were not tested on Asian nurses. More studies are needed to validate the cultural properties of the Organizational Commitment Scale. Practice Implication Healthcare administrators can use culturally validated instruments, which concern cultural context, including languages and cultural values, to understand Asian nurses' organizational commitment and further lower turnover behavior among them.

Summary Background New nursing graduates' readiness for practice often does not meet the requirements needed in the real situation of clinical sites. Therefore, nurse education has placed more emphasis on developing students' technical skills to cultivate proficiencies needed for clinical sites. Objectives To develop a program including deliberate skill practices and technical skill testing, each conducted before students' clinical practicum, and to examine the program's effects on nursing students' clinical competence. Design The study was a repeated measure correlational design. Settings One nursing university. Participants Two-hundred-fifty-six and 266 nursing students in a RN-to-BSN night school program in Taiwan completed pretest and posttest surveys, respectively in 2009 and 2010. Their mean age was 22.61 years and had worked 12.75 months as a nurse. Methods Students were asked to participate in the deliberate nursing practice program, which includes skill practice and tests, before their last clinical practicum. The Clinical Competence Questionnaire was used to measure the outcome of deliberate practice. Results Findings indicated that participants who had nursing work experience, a higher grade point average, practiced their skills by watching videos, and higher pretest competence scores exhibited significantly higher posttest competence scores. Participants who worked in the operating room/outpatient department, scored higher on self-confidence in clinical performance, and had a higher level of future job stress exhibited significantly lower posttest competence scores. Conclusions Although work experience increased clinical competence, working in the operating room/outpatient department where many nursing skills were not performed did not have the effects. In contrast, skill reviews and better performance before practice promoted competence. Attaining motor skill competency is a slow process requiring practices. Thus, providing deliberate skill-practice program is suggested to help students increase their competence.

A novel filter bank using serial-switched structure for the commercial bands of Band40, WIFI, and Band38 application is proposed. The proposed triple-band filter bank adopt the three order Chebyshev short-ended hairpin comb filters which embedded a pair of the PIN diodes as a switch. The simulated and measured results are matched well.

Background: With advances in computer technologies, Web-based interventions are widely accepted and welcomed by health care providers and researchers. Although the benefits of Web-based interventions on physical activity promotion have been documented, the programs have rarely targeted Asian Americans, including Asian American midlife women. Subsequently, culturally competent Web-based physical activity programs for Asian Americans may be necessary. Objective: The purpose of our study was to explore practical issues in developing and implementing a culturally competent Web-based physical activity promotion program for 2 groups of Asian American women—Chinese American and Korean American midlife women—and to provide implications for future research. Methods: While conducting the study, the research team members wrote individual memos on issues and their inferences on plausible reasons for the issues. The team had group discussions each week and kept the minutes of the discussions. Then, the memos and minutes were analyzed using a content analysis method. Results: We identified practical issues in 4 major idea categories: (1) bilingual translators’ language orientations, (2) cultural sensitivity requirement, (3) low response rate, interest, and retention, and (4) issues in implementation logistics. Conclusions: Based on the issues, we make several suggestions for the use of bilingual translators, motivational strategies, and implementation logistics. [J Med Internet Res 2016;18(11):e303]

The purpose of this article is to explore practical issues in developing and implementing a culturally tailored Internet Cancer Support Group for a group of ethnic minority patients with cancer-Asian Americans. Throughout the research process of the original study testing the Internet cancer support group, the research team made written records of practical issues and plausible rationales for the issues. Weekly group discussion among research team members was conducted, and the discussion records were evaluated and analyzed using a content analysis (with individual words as the unit of analysis). The codes from the analysis process were categorized into idea themes, through which the issues were extracted. The issues included those in (1) difficulties in using multiple languages, (2) collaboration with the information technology department and technical challenges, (3) difficulties in recruitment, (4) difficulties in retention, (5) optimal timing, and (6) characteristics of the users. Based on the findings, we suggest that researchers plan a workable translation process, check technical needs in advance, use multiple strategies to recruit and retain research participants, plan the right time for data collection, and consider characteristics of the users in the study design.

to explore the effects of a group health education programme on the childbearing knowledge, attitude, and behaviours among Southeast Asian immigrant women in Taiwan.a quasi-experimental design with convenience sampling was used.participants living in Kaohsiung County, Taiwan, were randomly divided by districts into either the experimental group or the control group.one hundred Southeast Asian immigrant women were recruited as research participants. Among the 100 participants, 50 were in the experimental group and 50 were in the control group. A total of 99 participants completed the entire research procedure.a structured interview was used to evaluate the effects of a group health education programme.the interview consisted of four measurements: the Demographic Inventory Scale, the Childbearing Knowledge Scale, the Childbearing Attitude Scale, and the Childbearing Planning Scale.after employing the group health education intervention, statistically significant changes from the pre-test to the post-test were found in the experimental group's scores for the Childbearing Knowledge Scale (P0.0001), the Childbearing Attitude Scale (P0.01), and the Childbearing Planning Scale (P0.0001). The study's results indicated that providing education through group learning with guidance and support in childbearing health significantly improved Southeast Asian immigrant women's childbearing health knowledge, attitudes, and behaviours.an appropriate, community-based group health education programme can create awareness for childbearing health among Southeast Asian immigrant women in Taiwan and improve their childbearing attitudes and behaviours.

liou s.-r., tsai h.-m. & cheng c.-y. (2013) Journal of Nursing Management 21, 614–623 Acculturation, collectivist orientation and organisational commitment among Asian nurses working in the US healthcare system Aim To examine the relationships between acculturation, collectivist orientation and organisational commitment among Asian nurses in US hospitals. Background Few studies have explored these three variables together in the same study and examined their statuses and mutual relationship among Asian nurses in Western hospitals. Method The study was a cross-sectional design using snowball sampling. A total of 195 Asian nurses participated. The collectivist orientation scale, organisational commitment questionnaire and acculturation factors were used to collect data. Pearson correlation, anova and regression were used to analyse the data. Results Most participants were female Filipinos with a mean age of 39.92 and a bachelor’s degree and stayed in the USA for 13.35 years. They used and preferred to use both their mother language and English, identified themselves as Oriental or Asian and culturally, viewed themselves as very or mostly Asian. Participants scored high on collectivism and commitment. Collectivism was significantly correlated with commitment but did not mediate acculturation factors and commitment. Conclusion To increase Asian nurses’ commitment, it is important that administrators understand their cultural values and provide them with a cultural competent and sensitive environment. Implications for nursing management Healthcare administrators can increase Asian nurses’ commitment through understanding their needs and attitudes toward their job and organisation.

The purpose of this paper is to provide future directions for the usage of Internet communities (ICs) for recruitment of research participants based on issues raised in an Internet survey among 132 cancer patients. About 317 general and 233 ethnic-specific Internet Cancer Support Groups and 1588 ethnic-specific ICs were contacted to recruit cancer patients. Research staff recorded issues and wrote memos during the recruitment process. The written memos and records were later analyzed using content analysis. The issues included: (a) difficulty in identifying appropriate ICs and potential participants, (b) meta-tags, (c) dominant white and women groups, (d) dynamics inside ICs, (e) difficulty in trust building, and (f) potential selection bias. The findings suggest that researchers thoroughly review the ICs' information, be recognizant of potential gender and ethnic issues and current trends in Internet interaction, and consider potential selection bias.

Ethnicity is a sociocultural contextual factor influencing persons’ pain expression and experience that has recently been recognized, and a few researchers have begun to report ethnic variations in cancer pain experience (Laliberte, 2003; Miaskowski, 2004). In a national study, Cleeland et al. (1994) reported that, in settings with predominantly ethnic minority patients including Hispanics and African Americans, 62% of those patients were undertreated according to the World Health Organization (WHO) standards, and they were three times more likely to be undermedicated than patients seen in non-minority settings with predominantly White cancer patients. In another study by Cleeland et al. (1997), researchers reported that 74% of Hispanics and 59% of African American patients with pain did not receive the WHO-recommended analgesics for their pain. In a subsequent study, Anderson et al. (2000) reported that 28% of Hispanic and 31% of African American patients received analgesics that were insufficient to manage their pain. Despite these findings, some recent studies indicated no such variation in pain experience by ethnicity: no ethnic differences in cancer pain experience, measures of pain sensation, pain ratings of ethnically diverse groups of men with myocardial infarction, pain ratings during childbirth, and behavior responses and pain ratings of children with cancer (Edrington et al., 2004; Rustoen, Fossa, Skarstein, & Moum, 2003; Rabow & Dibble, 2005). As these inconsistent findings indicate, it would be hasty to conclude that there are or are not ethnic differences in cancer pain experience, so further studies are needed to develop reliable knowledge that can be used to more adequately manage the pain of cancer patients. Furthermore, existing studies tend to include only a limited number of ethnic minorities, and very few national scope studies having an adequate number of ethnic minorities for valid comparisons have been conducted. The purpose of the study reported in this paper was to determine ethnic differences in reported cancer pain experiences among four of the most common ethnic groups in the U.S. (Hispanic, non-Hispanic (N-H) White, N-H African-American, and N-H Asian). Cancer patients have been reported to experience pain with diverse symptoms, impairments in physical and psychological functioning, and other difficulties that can undermine their quality of life across all states and times (Dodd, 2001). Significant positive relationships between cancer pain intensity and psychological and physical symptoms have been reported (Poulos, Gertz, Pankratz, & Post-White, 2001). Thus, in this study, cancer pain was defined as a multidimensional subjective experience, which accompanies symptoms and changes in functional status. To achieve the purpose, it was hypothesized that there are significant differences in self-reported cancer pain, symptoms accompanying pain, and functional status according to self-reported ethnic identity (Hypothesis 1). Then, to determine the effects of ethnicity on cancer pain, symptoms, and functional status while considering the effects of other demographic and health/illness factors, it was hypothesized that ethnicity adds significantly to the prediction of the cancer pain, symptom, and functional status scores after controlling for selected demographic and health/illness factors (Hypothesis 2). The study reported in this paper relies on a theoretical grounding in feminist perspectives. It was assumed that the inadequate assessment of cancer pain reported by patients does not only come from pure biology, but from their continuous interactions with their environment (Hall & Stevens, 1991). For example, an ethnic minority cancer patient who may have particular difficulty feeling in control in a setting dominated by well-educated professionals may fail to clearly express her/his needs and fail to demand that her/his need for pain control be met (Ramer et al., 1999). In this case, inadequate management of cancer pain could be claimed to result from cancer patients’ interactions with their environments. In the study reported in this paper, using a feminist perspective, patients’ own views and experiences were respected, and ethnicity was viewed as a significant characteristic that influences cancer patients’ interactions with their environments and structures the cancer pain assessment and management processes.

PURPOSE/OBJECTIVES To provide future directions for Internet research based on issues raised during the recruitment process of an Internet survey of oncology nurses. DATA SOURCES Throughout the research process, the research staff recorded issues as they arose and wrote memos regarding recruitment issues and possible reasons for the issues. Weekly group discussions were conducted, and written records of the discussions were kept. The written memos and records were reviewed, and the content was analyzed. DATA SYNTHESIS The recruitment issues included flexibility required, mutual trust, changing Internet dynamics, and potential selection bias. CONCLUSIONS As the issues indicated, recruiting nurses for the study only through the Internet did not work well. IMPLICATIONS FOR NURSING For future Internet research, the authors suggest using multiple Internet and real settings for recruitment, a variety of strategies, the quota sampling method, and creative motivation strategies.

The purpose of the study was to determine comparability of an Internet format to a Pen-and-Pencil (PP) format of the Midlife Women's Symptom Index (MSI). This study utilized a cross-sectional comparative design with three sections: (a) a PP survey among 77 middle-aged women; (b) an Internet survey among 81 middle-aged women; and (c) an expert review among 20 women's health experts. Both of the PP and the Internet surveys included sociodemographic questions, the MSI, and the Menopausal Symptom Checklist. Data were analyzed using descriptive statistics, K-R20, and correlation coefficients. The findings supported the reliability and validity of both Internet and PP formats of the MSI.

Background With an increasing number of ethnic minority populations, the use of multiple languages in one research study has increased in recent years. The use of multiple languages helps increase comprehensiveness of educational materials and/or survey questionnaires, and promote ethnic minorities' participation in research. However, little has been clearly known about practical issues in using multiple languages in one research study. Objectives The purpose of this paper is to explore practical issues in using multiple languages in a study among diverse sub-ethnic groups of Asian American breast cancer survivors in order to propose future directions for the use of multiple languages in research projects. Methods Throughout the research process, research team made written records of practical issues and possible reasons for the issues as they arose. Weekly group discussions among research team members were administered, and the written records of these discussions were reviewed and analyzed using the content analysis. The unit of analysis was individual words. The words in the data (memos and written records) were classified into idea categories that emerged from the coding process. Results The idea categories included issues in: (a) collaborators from various sub-ethnic groups; (b) IRB protocol submissions; (c) consistencies in translation process, (d) conceptual equivalence; (e) cultural differences; (f) existing translated versions; and (g) authorship issues. Based on the issues, we made the following suggestions for multi-lingual research: (a) networking and setting multiple communication channels with potential collaborators; (b) checking the institution's IRB policies related to the use of multiple languages; (c) setting the rules and procedures for translation process; (d) checking existing different language versions of instruments; and (e) setting the rules for authorship in advance. Conclusions The suggestions made in this study would help the researchers be prepared in advance to deal with the challenges.

Nurse graduates are leaving their first employment at an alarming rate. The purpose of this study was to explore the relationships between job stress, job satisfaction and related factors over time among these nurses. This study applied a longitudinal design with three follow-ups after nurse graduates' first employment began. Using convenience sampling, participants were 206 new graduates from a university. The Work Environment Nursing Satisfaction Survey and the Clinical Stress Scale were used in this study. Results indicated that job stress remained moderate across three time points. Participants working 12 h shifts exhibited less job stress. Job satisfaction significantly increased in the twelfth month. Participants working 12 h shifts had a higher degree of job satisfaction. Job stress was negatively correlated with job satisfaction. The 12 h work shifts were related to job stress and job satisfaction. These results implied that health-care administrators need to provide longer orientation periods and flexible shift schedules for new graduate nurses to adapt to their work environment.

Developing effective teaching strategies to stimulate students' interest and enthusiasm are urgently needed in current research courses. The purposes of the study were to implement the Cookie Experiments teaching strategy in research course and examine the effects of the strategy on students' attitudes towards nursing research. The study was a pretest-post-test design with 95 students at a Registered Nurses to Bachelor of Science in Nursing (RN-to-BSN) program enrolled in the nursing research course. Results indicated that there was a significant effect of the Cookie Experiments teaching strategy on students' attitudes towards research. Although students perceived a median high score of pressure from the research course, they regarded that the pressure is conducive to their learning of research. Students highly suggested to continuously applying this teaching strategy in the future nursing research courses. Developing and using various teaching strategies with attractive and hands-on methods to motivate nurse students, learning research is strongly recommended.