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To explore nurse managers' perceived importance of competencies for their current job at different levels and the associated factors.Little work to date has explored the perceived importance of competencies in nursing leadership and management or considered the related factors in the Taiwan healthcare context.Data collected from a previous large study comprising a cross-sectional web-based survey were analysed. Kruskal-Wallis test, two-sided Fisher exact test and multiple linear regression models were used for statistics analysis.The mix of three skills in Katz's model indicated that human skills were equally important in all three managerial levels. Of the 23 competencies, effective communication and political astuteness were rated by nurse managers at all levels as the highest-scored (M = 4.88, SD = 0.34) and lowest-scored competency (M = 3.92, SD = 0.78), respectively. Managerial level was a significant predictor of the perceived importance of competency.Relationship-based competencies were prominent in the perceived importance of competencies among nurse managers at different levels. Managerial hierarchy influences the relative importance of the different managerial competencies.This study's results provide the talent strategy framework required for improving the competencies of nurse managers at all levels.

This prospective randomized trial examined the effects of a tripartite intervention (behavioral state modulation + nonnutritive sucking + tucking) on stress from procedural pain during heel pricks. Blood samples for routine screening were collected by heel pricks 48 h after birth (Stage 1) and at ≥37 weeks' gestation (Stage 2); salivary cortisol levels (SCLs) pre-prick (T0) and 20 min post-prick (T1) assessed stress. Preterm infants (n = 64) sampled by convenience at Level III neonatal care units were randomly assigned to the control condition (usual care) or intervention condition (tripartite intervention). Generalized estimating equations examined differences in salivary cortisol between conditions. After adjusting for effects of gestational age, postmenstrual age, and baseline SCLs, (1) at Stage 1, the change in salivary cortisol from T0 to T1 in preterm infants who received the tripartite intervention was, on average, significantly lower by 0.431 units (log scale) than the change in preterm infants who received the control condition (p 0.001); (2) in the tripartite intervention condition, the difference between the change in mean SCLs from T0 to T1 at Stages 1 and 2 was significantly lower by 0.287 units (log scale), on average than between the change at Stages 1 and 2 in the control condition (p = 0.026). The provision of a tripartite intervention during heel prick significantly decreased the raise of SCLs compared with infants receiving usual care, suggesting lower stress. Clinicians could easily implement the tripartite intervention for heel-stick support; however, replication is needed before recommending its incorporation into routine heel stick and other stressful procedures.

DESIGN This study applied a cross-sectional, descriptive correlational design. AIMS AND OBJECTIVES The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. BACKGROUND Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. METHODS This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. RESULTS More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. CONCLUSIONS Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. RELEVANCE TO CLINICAL PRACTICE Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.

Background: Healthcare professionals follow codes of ethics, making them responsible for providing holistic care to all disaster victims. However, this often results in ethical dilemmas due to the need to provide rapid critical care while simultaneously attending to a complex spectrum of patient needs. These dilemmas can cause negative emotions to accumulate over time and impact physiological and psychological health, which can also threaten nurse–patient relationships. Aim: This study aimed to understand the experience of nurses who cared for burn victims of the color-dust explosion and the meaning of ethical relationships between nurse and patient. Research design: A qualitative descriptive study using a phenomenological approach. Participants and research context: Clinical nurses who provided care to the patients of the Formosa color-dust explosion of 2015 were selected by purposive sampling (N = 12) from a medical center in Taiwan. Data were collected using individual in-depth semi-structured interviews. Audiotaped interviews were transcribed and analyzed using Colaizzi’s method. Ethical considerations: This study was approved by the institutional review board of the study hospital. All participants provided written informed consent. Findings Three main themes described the essence of the ethical dilemmas experienced by nurses who cared for the burn-injured patients: (1) the calling must be answered, (2) the calling provoked my feelings, and (3) the calling called out my strengths. Conclusions: Healthcare providers should recognize that nurses believed they had an ethical responsibility to care for color-dust explosion burn victims. Understanding the feelings of nurses during the care of patients and encouraging them to differentiate between the self and the other by fostering patient–nurse relationships based on intersubjectivity could help nurses increase self-care and improve patient caregiving.

Background: After transition to home, most preterm infants exhibit higher readmission rates due to lack of readiness for hospital discharge and inadequate discharge preparation. Continuity of care during transitional care is an essential intervention for achieving parental readiness and performance in this group. Objective: The study aims to analyze the effects of continuity of care program for parents with preterm infants (CCPI) on parental performances, parental readiness, and service utilization rates post-discharge. Methods: A randomized controlled trial evaluated 92 dyads of preterm infants and parents. They were randomly assigned to two groups. The experimental group received the CCPI with routine nursing care, and the control group received only routine nursing care. The parental readiness and parental performance questionnaires were completed by the parents and analyzed using analysis of covariance (ANCOVA). The effectiveness of the CCPI in reducing the service utilization rates post-discharge was demonstrated using RM-ANOVA. Results: The parents’ performance who participated in the CCPI was significantly higher, as was their readiness for hospital discharge than the parents of the control group (p< 0.01). In addition, the service utilization rates for the samples significantly decreased (p< 0.01) at the fourth week after discharge. However, there was no significant difference between the first- and second-week post-discharge. Conclusion: The study findings may help policymakers deploy the CCPI for parents with preterm infants while suggesting that the CCPI should be used to promote growing preterm infants to reduce post-discharge service utilization rates significantly.

Sense of control during childbirth is a critical issue concerning the association between high-quality maternity care and infant health. This study explored the facilitators of or barriers to a sense of control and the need for interventions to raise women's experience in childbirth.The data came from 17 participants. Data collection was conducted in the childbirth room and within three days following childbirth, respectively. For tackling the research problems, participant observation and interviewing were applied. Thematic analysis was applied to the data analyzed.Two themes were identified: (1) facilitators of or barriers to practice a sense of control and (2) Care needed for a sense of control. The effectiveness of a sense of control is related to energy refill, mental loading subsided, control over decisions, non-pharmacological usage, and support from the meaningful person. Care needed includes showing empathy, providing information, using complementary pain-relief strategies, and adjusting care by parturient conditions.This study highlights the influencing factors and interventions relating to women's sense of control during childbirth with epidural analgesia. The findings suggest that many approaches, such as white noise, benefit women's sense of control after an epidural. Using non-pharmacological methods, such as a birth ball, should be appropriately regulated by situations to enhance women's sense of control. Through the assessment, education, attention to maternal needs, and recognizing the barriers to a sense of control, women will benefit from the interventions designed to improve their sense of control during childbirth.

This study aimed to evaluate the efficacy of breast milk odor either alone or in combination with breast milk taste (via syringe-feeding) to alleviate neonates’ biobehavioral responses to pain during heel-prick procedures. This prospective randomized controlled trial recruited 114 neonates by convenience sampling from a newborn unit of a medical center in Taiwan. Neonates were randomly assigned to three groups: control (gentle touch + human voice), control + breast milk odor, and control + breast milk odor + breast milk taste. Heart rate, oxygen saturation, and voice recordings of crying were measured across heel-prick procedures: baseline, no stimuli (stage 0); during heel prick (Stages 1–4); and recovery (Stages 5–10). Generalized estimating equations and Kaplan–Meier survival analysis compared differences in changes between groups for heart rate, oxygen saturation, and time to crying cessation. Changes in mean heart rate and oxygen saturation in neonates receiving breast milk odor or breast milk odor + breast milk taste were significantly less than those at the corresponding stage for the control group. Among neonates receiving breast milk odor or breast milk odor + breast milk taste, hazard rate ratios for crying cessation were 3.016 and 6.466, respectively. Mother’s breast milk olfactory and gustatory interventions could stabilize the biobehavioral responses to pain during heel prick procedures in neonates.

Aims This study described the development and psychometric testing of the competency inventory for nurse managers across all levels in Taiwan. Background The competency-based approach to develop nursing leadership and management competencies for the healthcare context is still insufficiently explored in terms of professional development in nursing administration. Methods This study used mixed methods, including qualitative study for generating the preliminary inventory and a cross-sectional survey of 573 nurse managers for psychometric properties of the inventory. Results Exploratory factor analysis revealed four domains with 23 items that explained 58.21% of the overall variance. The overall Cronbach's alpha coefficient was 0.93. Confirmatory factor analysis showed a well-fitting goodness-of-fit statistics. The construct validity was adequate, with an average variance extracted of 0.68 and composite reliability of 0.90. Conclusions Across different levels, nurse managers have 23 essential competencies. The competency inventory demonstrates adequate psychometric properties with good construct validity and internal consistency, thereby reliable and valid for guiding the competency development of nurse managers. Implications for nursing management The essential competencies of the inventory can serve as a criterion-referenced measurement for competence proficiency in professional development of nursing administration and contribute to performance improvement of nurse managers in practice.

Background: Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient’s body and self. Aim: To understand the meaning of traumatic injury for body and self for patients receiving intensive care. Research design: A qualitative descriptive study using Giorgi’s phenomenological approach. Participants and research context: Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30–60 min. Audiotaped interviews were transcribed and analyzed. Ethical considerations: This study was approved by the Institutional Review Board of the medical center. Findings: The impact of the experience of traumatic injury on participants’ body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. Discussion and conclusion: The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient’s body and self that facilitates ethical care and recovery from injury.

PURPOSE Even routine procedures can cause pain and stress, and can be harmful to the fast-growing brain of preterm infants. Mitigating pain and stress with sucrose and analgesics has side effects; thus, an alternate choice is the use of natural breast milk and infants' sensory capabilities. Therefore, this study examined the effects of different integrations of sensory experiences-mother's breast milk odor and taste (BM-OT), heartbeat sounds (HBs), and non-nutritive sucking (NNS)-on preterm infant's behavioral stress during venipuncture. DESIGN This study was a prospective, randomized controlled trial. METHODS Infants born preterm (

Sleep is important for preterm infants' brain development, but they are frequently exposed to painful procedures in the neonatal intensive care unit (NICU) that disturb their sleep cycle and affect their growth. The purpose of this study was to examine the prolonged effects of a supportive care bundle (modulation of the infants' states, non-nutritive sucking, facilitated tucking, and oral sucrose feeding) on preterm infants' sleep variables (sleep efficiency, total sleep time, sleep latency, and frequency of wake bouts) during hospitalization. The team recruited 65 preterm infants (gestational age at birth 28-36 weeks, average birth weight 1,652 g) from a Level III NICU at a medical center in Taiwan. Infants were randomly assigned to one of two treatment conditions to be administered while receiving intrusive procedures: (1) control condition (usual care, including routine procedures, positioning, and gentle touch); or (2) intervention condition in which the supportive care bundle was added to usual care. Sleep variables were measured using actigraphy for a baseline of three continuous days on the 6th to 8th days after birth and again for 3 continuous days when infants weighed ≧1,950 g. Two forms of generalized estimating equation analyses with control of significant covariates were used for data analysis. The supportive care bundle not only significantly increased sleep efficiency and total sleep time but also significantly decreased duration of sleep latency and frequency of wake bouts. These results provide evidence to support the incorporation of the supportive care bundle into NICU clinical practice during intrusive procedures.

Preterm infant pain can be relieved by combining non-nutritive sucking (sucking), oral sucrose, and facilitated tucking (tucking), but the pain-relief effects of oral expressed breast milk (breast milk) are ambiguous.We compared the effects of combined sucking+ breast milk, sucking+breast milk+tucking, and routine care on preterm infant pain during and after heel-stick procedures.A prospective, randomized controlled trial.Level III neonatal intensive care unit and a neonatal unit at a medical center in Taipei.Preterm infants (N=109, gestational age 29-37 weeks, stable disease condition) needing procedural heel sticks were recruited by convenience sampling and randomly assigned to three treatment conditions: routine care, sucking+ breast milk, and sucking+breast milk+ tucking.Pain was measured by watching video recordings of infants undergoing heel-stick procedures and scoring pain at 1-min intervals with the Premature Infant Pain Profile. Data were collected over eight phases: baseline (phase 1, 10min without stimuli before heel stick), during heel stick (phases 2 and 3), and a 10-min recovery (phases 4-8).For infants receiving sucking+ breast milk, pain-score changes from baseline across phases 2-8 were 2.634, 4.303, 2.812, 2.271, 1.465, 0.704, and 1.452 units lower than corresponding pain-score changes of infants receiving routine care (all p-values0.05 except for phases 6 and 7). Similarly, for infants receiving sucking +breast milk+ tucking, pain-score changes from baseline were 2.652, 3.644, 1.686, 1.770, 1.409, 1.165, and 2.210 units lower than corresponding pain-score changes in infants receiving routine care across phases 2-8 (all p-values0.05 except for phase 4). After receiving sucking +breast milk +tucking and sucking +breast milk, infants' risk of mild pain (pain score ≥6) significantly decreased 67.0% and 70.1%, respectively, compared to infants receiving routine care. After receiving sucking +breast milk +tucking and sucking +breast milk, infants' risk of moderate-to-severe pain (pain score ≥12) decreased 87.4% and 95.7%, respectively, compared to infants receiving routine care.The combined use of sucking+breast milk +tucking and sucking+breast milk effectively reduced preterm infants' mild pain and moderate-to-severe pain during heel-stick procedures. Adding facilitated tucking helped infants recover from pain across eight phases of heel-stick procedures. Our findings advance knowledge on the effects of combining expressed breast milk, sucking, and tucking on preterm infants' procedural pain.

Background Pregnancy-induced hypertension (PIH) is a leading cause of maternal and fetal morbidity and mortality. Although case management programs have been proposed to improve maternal and fetal outcomes in high-risk pregnancies, limited data are available regarding the effect of case management on women with PIH. Purpose The aim of this study was to evaluate the effect of an antepartum case management program on stress, anxiety, and pregnancy outcomes in women with PIH. Methods A quasi-experimental research design was employed. A convenience sample of women diagnosed with PIH, including preeclampsia, was recruited from outpatient clinics at a medical center in southern Taiwan. Sixty-two women were assigned randomly to either the experimental group (n = 31) or the control group (n = 31). The experimental group received case management for 8 weeks, and the control group received routine clinical care. Descriptive statistics, independent t or Mann-Whitney U tests, chi-square or Fisher's exact tests, paired t test, and generalized estimating equations were used to analyze the data. Results The average age of the participants was 35.1 years (SD = 4.5). No significant demographic or clinical differences were found between the control and experimental groups. The results of the generalized estimating equations showed significantly larger decreases in stress and anxiety in the experimental group than in the control group. No significant differences were identified between the two groups with respect to infant birth weeks, infant birth weight, average number of medical visits, or frequency of hospitalization. Conclusions/implications for practice The nurse-led case management program was shown to have short-term positive effects on the psychosocial outcomes of a population of Taiwanese patients with PIH. These results have important clinical implications for the healthcare administered to pregnant women, particularly in terms of improving the outcomes in those with PIH.

This study's aims are to examine the effects of aromatherapy massage on women's stress and immune function during pregnancy.This longitudinal, prospective, randomized controlled trial recruited 52 healthy pregnant women from a prenatal clinic in Taipei using convenience sampling. The participants were randomly assigned to the intervention (n = 24) or control (n = 28) group using Clinstat block randomization. The intervention group received 70 min of aromatherapy massage with 2% lavender essential oil every other week (10 times in total) for 20 weeks; the control group received only routine prenatal care. In both groups, participants' salivary cortisol and immunoglobulin A (IgA) levels were collected before and after the intervention group received aromatherapy massage (every month from 16 to 36 weeks gestation) and were analyzed using enzyme-linked immunosorbent assay.The pregnant women in the intervention group had lower salivary cortisol (p 0.001) and higher IgA (p 0.001) levels immediately after aromatherapy massage than those in the control group, which did not receive massage treatment. Comparing the long-term effects of aromatherapy massage on salivary IgA levels between groups at different times, the study found that the pretest salivary IgA levels at 32 (p = 0.002) and 36 (p 0.001) weeks gestational age (GA) were significantly higher than the pretest IgA at 16 weeks GA (baseline).This study presented evidence that aromatherapy massage could significantly decrease stress and enhance immune function in pregnant women. The findings can guide clinicians or midwives in providing aromatherapy massage to women throughout the pregnancy.

The effects of prenatal yoga on biological indicators have not been widely studied. Thus, we compared changes in stress and immunity salivary biomarkers from 16 to 36 weeks' gestation between women receiving prenatal yoga and those receiving routine prenatal care.For this longitudinal, prospective, randomized controlled trial, we recruited 94 healthy pregnant women at 16 weeks' gestation through convenience sampling from a prenatal clinic in Taipei. Participants were randomly assigned to intervention (n=48) or control (n=46) groups using Clinstat block randomization.The 20-week intervention comprised two weekly 70-min yoga sessions led by a midwife certified as a yoga instructor; the control group received only routine prenatal care.In both groups, participants' salivary cortisol and immunoglobulin A levels were collected before and after yoga every 4 weeks from 16 to 36 weeks' gestation.The intervention group had lower salivary cortisol (p0.001) and higher immunoglobulin A (p0.001) levels immediately after yoga than the control group. Specifically, the intervention group had significantly higher long-term salivary immunoglobulin A levels than the control group (p=0.018), and infants born to women in the intervention group weighed more than those born to the control group (p0.001).Prenatal yoga significantly reduced pregnant women's stress and enhanced their immune function. Clinicians should learn the mechanisms of yoga and its effects on pregnant women. Our findings can guide clinicians to help pregnant women alleviate their stress and enhance their immune function.

Purpose To compare the effects of integrating mother's breast milk (BM) with three different combinations of sensory stimuli on preterm infant pain during peripheral venipuncture procedures. Design A prospective, repeated-measures randomized controlled trial. Methods Preterm infants (gestational age between 28 and 37 weeks, and in stable condition) needing venipuncture were recruited by convenience sampling (N = 140) and randomly assigned to four treatment conditions: (a) routine care (condition 1); (b) BM odor or taste (condition 2); (c) BM odor or taste + heartbeat sounds (HBs; condition 3), and (d) BM odor or taste + HBs + non-nutritive sucking (NNS; condition 4). Pain scores were assessed based on the Premature Infant Pain Profile-Revised (PIPP-R) over nine phases: baseline (phase 0, 5 min without stimuli before venipuncture), disinfecting (phase 1), during venipuncture (phase 2), and a 10-min recovery (phases 3-8). Findings Infants who received BM odor or taste + HBs + NNS had significantly lower increases in pain scores from baseline compared with controls across phases 1 through 8. Infants treated with either condition 2 or 3 demonstrated significant reductions in mild pain during disinfecting and recovery phases, as compared with the controls. When condition 2 was used as the reference, there were no significant differences in pain scores between the infants receiving condition 3 across the nine phases, suggesting mothers' HBs have only mild analgesic effects on venipuncture pain. Conclusions Integration of mother's BM odor or taste, HBs, and tactile NNS should be considered as an intervention for alleviation of procedural pain for preterm infants. Clinical relevance Clinicians should incorporate the integrated sensory intervention into caregiving support for preterm infants undergoing short painful procedures.

In the recent past, the extreme climatic events and disasters driven by natural hazards underlined the importance of building resilience against such events. However, the research of resilience in the context of natural hazards and extreme climatic events is dominated by the physical and natural sciences. Limited tools and strategies are available when it comes to assessing the level of resilience against disaster at the family level in the developing countries like Pakistani. Although families are the basic unit of any society and community, resilience assessment at the family level in the context of disasters, and consideration of the vital constructs and themes for family resilience assessment against disaster are not well-established. In this regard, this study attempts to identify the constructs and themes that should be considered, while designing a tool for family resilience assessment. A qualitative study based on ten in-depth interviews was conducted in the Nowshehra district of Pakistan. The data collected was analysed using NVivo 12. The data analysis at first instance resulted in 63 Codes. This number does not include the overlapping. Followed by further analysis, the resulted codes were checked for overlapping, and the similar codes were integrated into a similar class. The process continued until all similar codes were combined. The study finally concluded four themes, five categories and fifteen subcategories, which need to be taken into account to design a family resilience assessment scale for flood-prone areas.

Aims: The major purpose of this study was to evaluate the feasibility and efficacy of an art therapy support group program for Chinese Canadian breast cancer survivors. The sub-purpose was to understand the experiences of Chinese breast cancer survivors during and after the arts-based intervention. Study Design: A qualitative design was used in this study. Place and Duration of Study: The study was conducted at an urban community health centre in Toronto, Canada between February 2014 and June 2014. Original Research Article

Adolescents with cancer and their parents have to deal with the challenge of returning to their pre-diagnosis social life. The purpose of this study was to describe the subjective lived experiences of Taiwanese mothers and their adolescents who had completed cancer treatment and were returning to school. Eight Taiwanese mother-adolescent dyads were recruited by purposive sampling. Core themes were extracted using phenomenological method and dyadic analysis. Findings were metaphorically captured by the theme “meshing gears.” The mothers and their adolescents were initially like 2 gears spinning alone, side by side due to experiencing different distress related to their social roles. To move toward a normal and healthy life journey, the mothers and their adolescents worked together as a well-tuned machine. This phenomenon is similar to gears meshing without friction to keep moving forward together. Our results suggest that health care professionals should provide follow-up care and interdisciplinary school reentry services to adolescent cancer survivors to improve their quality of life.

Intersubjectivity is a significant element of humanistic care. However, there is a lack of evidence related to the perceptions of nurses in clinical practice settings.To explore the evidence of correspondence in clinical intersubjective caring activities.The van Manen's thematic analysis approach was used to analyze the data, which was obtained from dialogues in small group learning settings. Six scenarios were identified to define the nature of correspondence in nursing care.In terms of reason, ethical relation, and activity, the following three items of correspondence in humanistic care were identified: coexistence through reconciling relationships with the other, cooperation through bringing out (unfolding) and not through putting in (imposition), co-transcendence from actions and reflections.By adopting openness in correspondence, nurses may promote coexistence through being open-minded to their opposite, promote cooperation with their opposite, and promote co-transcendence through pursuing authentic existence. The findings show that correspondence that is grounded in coexistence, cooperation, and co-transcendence promotes creativity and diversity in caring actions.人性化照護的感通.人性化護理重視護病間的互為主體性，但缺乏對主體感知的探究。.找出以感通說明護病間互為主體的意義與其內涵。.採用van Manen主題分析法，根據小組課程對話內容，比較分析完成照護的案例，找出六個臨床護理範例，再繼續比較範例的性質，建構出感通的主題內容。.護病關係中的感通，依其源由、倫理、行動性，形成三項主題：(1)共在：不受制於先入為主的「順勢而為」，(2)共做：不設限於無可奈何的「循循善誘」，(3)共榮：不受限於他人眼光的「勇於實踐」。.當護理人員面對難以照護的人或事時，嘗試著對反面者開朗的「共在」，由成己以成物的「共做」，可達到具體且充實存在的「共榮」，塑造更好的照護行動與自身。顯示具有共在、共做、共榮性的感通，能夠促成照護行動的創造性與豐富性。.

This prospective repeated-measures study explored potential factors (postmenstrual age, body weight, gender, chronological age, illness severity, and circadian rhythm) related to preterm infants’ circadian sleep/wake patterns. Circadian sleep/wake patterns were measured using an Actiwatch for 3 continuous days in preterm infants (gestational age of 28-36.4 weeks) in a neonatal intensive care unit and hospital nursery. Potential factors associated with circadian sleep/wake patterns were analyzed using the generalized estimating equation. For our sample of 30 preterm infants, better sleep/wake patterns were associated with male gender, younger postmenstrual and chronological age, lower body weight, and less illness severity. Preterm infants’ total sleep time ( B = 41.828, p < .01) and percentage of sleep time ( B = 3.711, p < .01) were significantly longer at night than during the day. These findings can help clinicians recognize preterm infants’ sleep problems, signaling the need to provide individualized support to maintain these infants’ sleep quality during their early life.

The study purpose was to examine the validities and reliabilities of the Chinese-versions Frommelt Attitudes Toward Care of the Dying Scale (Attitudes Scale) and Caregiving Behaviors Scale for End-of-Life Patients and Families (Behaviors Scale). The scales were tested in a convenience sample of 318 nurses with ≥6 months work experience at three hospitals. Cronbach’s alphas of the Attitudes and Behaviors Scales were .90 and .96, respectively. Each scale had Kaiser–Meyer–Olkin index >.85 and Bartlett’s test of sphericity >4000 ( p < .001). Attitudes Scale loaded on three factors: respecting and caring for dying patients and families, avoiding care of the dying, and involving patients and families in end-of-life care. The Behaviors Scale loaded on two factors: supporting dying patients and families, and helping families cope with grief. Factor loadings for both scales were ≥.49. Both Attitudes and Behaviors Scales are reliable and valid for evaluating nurses’ attitudes and caregiving behaviors for the dying.

This research was conducted to describe Taiwanese mothers’ lived experience of caring for their child diagnosed with adrenoleukodystrophy. Analysis of eight interviews by Colaizzi’s method revealed six themes: (1) difficulty confirming the diagnosis; (2) powerlessness toward unsatisfactory treatment; (3) struggles with decisions around carrier testing; (4) guilt about being a carrier; (5) support from family, other parents, and religion; and (6) lack of integrated resources and support. The results suggest the need to raise public and physician awareness about adrenoleukodystrophy via the media and medical education. A central organization to provide parents with comprehensive information is needed.

Study Objectives. To examine the stimulation effect of auricular magnetic press pellet therapy on older female adults with sleep disturbance as determined by polysomnography (PSG).Design. Randomized, single-blind, experimental-controlled, parallel-group.Setting. Community.Participants. Twenty-seven older female adults with sleep disturbance according to the Pittsburgh Sleep Quality Index (PSQI) >5 for at least 3 months were recruited. Participants were screened by both the Hospital Anxiety and Depression Scale (HADS) and the Mini-Mental State Examination (MMSE), as well as polysomnography prior to randomization.Interventions. All eligible participants were randomly allocated into the experimental or control group. Both groups were taped with magnetic press pellet on auricular points for 3 weeks. The experimental group was treated by applying pressure on the magnetic press pellets 3 times per day while no stimulation was applied on the control group.Measurements and Results. Both groups were measured by PSG and PSQI at the beginning of the study and 3 weeks after the study. Both groups showed improvements on PSQI scores compared to the baseline. One-way analysis of covariance adjusted for baseline scores showed that significant improvements of PSG-derived sleep parameters, such as sleep efficiency, were found in the experimental group. However, no significant differences between groups were observed in the proportion of sleep stages with the exception of Stage 2.Conclusions. Auricular therapy using magnetic pellets and stimulation by pressing was more effective in improving the sleep quality compared to auricular therapy without any stimulation.

This prospective, descriptive study used a repeated-measures design to explore preterm infants� biobehavioral responses to 24-hour neonatal caregiving and positioning, and the factors associated with changes in their biobehavioral responses. Thirty preterm infants (gestational age 27.6�36.1 weeks) were observed for 3 days to record biobehavioral responses. Infants� disorganized behaviors increased as caregiving intrusiveness and supine positioning increased. Social interactions did not lead to increases in infants� disorganized behaviors, but to increased regulatory behaviors. Non-nutritive sucking (NNS), and prone positioning reduced occurrences of infant disorganized behaviors. Routine caregiving increased instability of oxygen saturation, but lateral and prone positioning improved physiological stability. Clinicians can appropriately provide NNS, positioning, and social interactions to promote biobehavioral stability.

Background Acinetobacter baumannii complex (Abc) comprises at least three phenotypically undifferentiated species, including A baumannii , Acinetobacter genomic species 3 (AGS 3) and Acinetobacter genomic species 13TU (AGS 13TU). Abc bacteremia had rarely been described in patients receiving total parenteral nutrition (TPN). In this study, we aimed to determine any differences in the clinical features of patients having TPN and bacteremia due to A baumannii and those due to non baumannii Abc (including AGS 3 and AGS 13TU). Methods The data of patients who had received TPN and had Abc bacteremia in Taipei Veterans General Hospital between August 1998 and December 2007 were retrospectively reviewed. The Acinetobacter isolates were identified to genomic species level. Results A total of 23 patients with A baumannii and 23 patients with non baumannii Abc (15 AGS 13TU and 8 AGS 3) bacteremia were identified. The two groups of the patients were comparable regarding their gender, age and APACHE II score at the onset of bacteremia. However, several clinical features were different between the two groups of the patients in the univariate analysis. Furthermore, A baumannii isolates were resistant to more classes of antibiotics than non baumannii Abc isolates. The multivariate analysis showed that a higher number of patients with A baumannii bacteremia had received TPN for≥15 days before their onset of bacteremia [odds ratio (OR) 7.214, 95% confidence interval (CI) (1.108–46.989), p = 0.039]. Nevertheless, the 14-day (30.4% vs. 21.7%, p = 0.737) and all-cause in-hospital mortality rate (60.9% vs. 39.1%, p = 0.238) did not differ significantly between these two groups. Conclusion The patients with A baumannii bacteremia demonstrated a longer timeframe in the treatment of TPN prior to the onset of bacteremia than those with non baumannii Abc bacteremia, however the clinical outcomes between the two groups of the patients did not differ significantly.

In this prospective, descriptive study, we used a repeated-measures design to explore the 24-hour effects of caregiving and positioning on preterm infants' states and the factors associated with state changes. Thirty preterm infants (gestational age 27.6-36.1 weeks) were observed for 3 days in the neonatal intensive care unit to record six states: quiet sleep (QS), active sleep, transition, active awake, quiet awake, and fussy or crying. The occurrences of QS increased when infants received no caregiving, social interaction, non-nutritive sucking (NNS), and were laterally positioned. However, QS significantly decreased and fussy or crying state increased when infants received routine and intrusive caregiving. These results suggest that caregiving, NNS, and positioning should be appropriately provided to facilitate infants' sleep, and reduce fussiness or crying.

Newborns are subject to pain during routine invasive procedures. Pain caused by immunization injections is preventable, but remains untreated in neonates.The purpose of the study was to compare the effectiveness of three nonpharmacological pain relief strategies on newborns' pain, physiological parameters, and cry duration before, during, and after hepatitis B intramuscular (IM) injection.In this prospective, randomized clinical trial, we enrolled 165 newborns (gestational age, ≥36 weeks). The infants received IM injections and were randomized to three treatment groups: nonnutritive sucking (NNS), 20% oral sucrose, or routine care. Pain was measured by the Neonatal Facial Coding System, physiological signals by electrocardiogram monitors, and cry duration using a stopwatch.Pain was significantly lower among infants in the NNS (B=-11.27, P0.001) and sucrose (B=-11.75, P0.001) groups than that in controls after adjusting for time effects, infant sleep/wake state, number of prior painful experiences, and baseline pain scores. Infants in the NNS and sucrose groups also had significantly lower mean heart and respiratory rates than the controls. Cry duration of infants receiving sucrose was significantly shorter than those in the NNS (Z=-3.36, P0.001) and control groups (Z=-7.80, P0.001).NNS and oral sucrose can provide analgesic effects and need to be given before painful procedures as brief as a one-minute IM injection. Sucrose orally administered two minutes before injection more effectively reduced newborns' pain during injection than NNS. Both nonpharmacological methods more effectively relieved newborns' pain, stabilized physiological parameters, and shortened cry duration during IM hepatitis injection than routine care.

Aim. To determine the inter-rater reliability, internal consistency, construct and concurrent validity and feasibility of the pain assessment scale for preterm infants. Background. Repeated exposure to painful procedures has an adverse impact on preterm infants’ health outcomes. Although many scales are available for assessing these infants’ pain, only a few reliably and validly assess pain and no gold standard has been established in clinical practice. Design. Instrument development and psychometric analysis. Methods. Preterm infants (n = 60) born 27·6–36·3 weeks gestational age were assessed for pain 3 minutes before (phase I), during (phase II), 3 minutes after (phase III) and the tenth minute after (phase IV) heel-stick procedures. Pain scores were independently coded from video recordings and observations by three trained nurses using our pain-assessment scale, premature infant pain profile and visual analogue scale. Results. Scores on the pain assessment scale for preterm infants differed significantly across four phases of heel-stick procedures (F = 56·86, p 27 weeks. Further examination of the scale’s psychometrics is recommended with diverse samples of infants and different painful procedures. Relevance to clinical practice. The pain assessment scale for preterm infants clearly defines item scoring and weighting, consistently discriminates different levels of pain and helps nurses to recognise infants’ pain. Nurses can easily remember the definition of each item, allowing them to use our scale to evaluate preterm infants’ pain at any time and to provide pain-relief interventions when needed.

Aims. This study examined the effectiveness of non-nutritive sucking on preterm infant pain, changes in infant behaviour and frequency of abnormal physiological signals during heel stick procedures in Taiwan. Background. Preterm infants’ repetitive exposure to painful procedures may result in changes to brain organisation. Pain management should be a priority in neonatal care. Design. Randomised control trial. Methods. Preterm infants (gestational age 28·9–37 weeks) were randomised to two groups: those receiving (experimental, n = 52) or not receiving non-nutritive sucking (control, n = 52) during heel stick procedures. Pain was measured before (for three minutes), during and after (during 10-minute recovery) heel stick procedures by the Premature Infant Pain Profile, changes in infant behaviour and abnormal physiological parameters. Results. Infants in both groups had similar odds ratios for pain and moderate-to-severe pain (0·57 and 0·58, respectively), after adjusting for time effects, postconceptional age, heel stick duration, painful experiences and baseline Premature Infant Pain Profile score. The pain scores of infants with non-nutritive sucking were significantly lower than those of non-nutritive sucking infants at all eight phases of the heel stick procedures. Infants undergoing heel stick procedures in the experimental group had lower rates ratios for ‘grimace’ and ‘hand to mouth or face’ behaviours than control infants (0·73 and 0·78, respectively). Conclusion. Non-nutritive sucking effectively reduced pain, particularly mild to moderate pain and behavioural responses to pain in infants receiving heel stick procedures, suggesting that nurses can offer this intervention to relieve pain in preterm infants undergoing invasive procedures. Relevance to clinical practice. Infants should be given an appropriate-sized pacifier for comfort during painful procedures. Nurses need to be informed about the effectiveness of non-nutritive sucking, its analgesic mechanisms and how to use and incorporate it into practice.

Aims. The purpose of this study was to explore the relationships between specific nurse care-giving behaviours and preterm infant behavioural responses during bathing and to identify nurse behaviours associated with infant ‘stress’. Background. Although recent advances in medical technology have improved neonatal intensive care, the high mortality and morbidity rates in preterm infants have not decreased proportionally. As caregivers strive to reduce infant mortality and morbidity, a factor for consideration is which caregiver behaviours are associated with preterm infant well-being. Design. A descriptive correlational design. Method. Convenience samples of 24 preterm infants and 12 nurses were recruited. A total of 120 baths were videotaped. Infant and nurse behaviours were measured using the coding schemes developed by the researchers. Pearson coefficient correlation, non-parametric Kruskal–Wallis test, t-test and generalised linear models were methods for data analysis. Results. As nurses provided more support, stress was reduced in the infants, and their self-regulation during the bath was enhanced especially by the use of ‘containment’ and ‘positional support’. Conversely, non-therapeutic caregiver behaviours including ‘rapid and rough handling’ of the baby, ‘chatting with other people’ and ‘inappropriate handling’ increased infant ‘stress’ during the bath. Conclusion. The findings provide new information about the link between care-giving and infant responses and how caregivers can better interact with preterm infants during a very sensitive period of brain development. Relevance to clinical practice. How nurses take care of the preterm infants influences their responses to care-giving stimuli. To interact better with the infant during care-giving procedures, nurses need to provide more supportive care-giving behaviours especially ‘position support’ and ‘containment’ based on the infant’s needs, and avoid care-giving that may be too rough and occur too quickly without attending the baby’s stressful signals, positioning the baby in hyperextension posture, or chatting with other people during procedures.

This study was performed to explore the effects of a training program in developmentally supportive care (DSC) on nurse caregiving and preterm infant behavior during bathing in a neonatal unit. The study applied a single-group pretest and posttest design to analyze behaviors. Twenty preterm infants were bathed 120 times by 13 nurses. Indirect observation was adopted to collect all behavioral data. Results showed that infants felt less stress and nurses were more supportive during posttraining baths. Caregivers should receive training in DSC, and its applications could be expanded to other nursing caregiving activities.

Objective To determine the effect of positions (supine, lateral, semiprone) on the physiological parameters (HR, RR, SpO 2 ) of premature infants receiving NCPAP who were non-oxygen-dependent and non-BPD, and to identify significant clinical changes associated with these variables. Methods A crossover study design with three different positions in the assigned sequence (supine–supine, supine–lateral and supine–semiprone) was used, and each position was maintained for 1 h. The subjects’ vital signs were recorded 30 min after initiation of each position and measured for 30 min. Results Forty-seven infants with a median GA of 28.6 weeks (range 26–35) were studied, and their median BW was 1210 g (range 776–2920). Overall, position-related effects showed significant difference in the variability in RR (OR = 0.68; CI 0.51–0.89), with the variability in RR being significantly lower in the semiprone position. The lateral position was associated with increased RR ( B = 2.9; p = 0.02). Previous use of ventilator (PUV) was associated with increased HR, whereas BW and GA were negatively associated with higher HR. Cesarean birth, use of surfactant and PUV were associated with lower SpO 2 , whereas BW and GA were correlated with higher SpO 2 . GA was identified as a protective factor, while PUV was a risk factor for the variability in both HR and SpO 2 . Conclusions Premature infants receiving NCPAP sleeping in the semiprone position may have more stable RR, while the lateral position did not improve RR. Thus, the semiprone and supine positions may be considered preferable when positioning the monitored premature infants with NCPAP.

Postpartum depression (PPD) affects the health of women and is an important issue that impacts negatively on the happiness of affected families. Previous studies have demonstrated that PPD impairs the mother-child attachment, impacts the marital relationship, and may cause family dysfunction. Although PPD is a common phenomenon, the concept of PPD is easily confused with other similar concepts such as postpartum blues and postpartum psychosis, which may delay proper prevention and management. This paper identifies the definitions, characteristics, antecedents, and consequences of PPD as well as provides empirical screen measurements and examples of model, borderline, and contrary cases in order to differentiate between the concepts of PPD and other disorders using Walker and Avant's (2011) concept analysis methodology. Three defining characteristics of postpartum depression were identified. First, depression begins four to six weeks after delivery and continues for at least two weeks. Second, we benchmarked over 5 depressive symptoms. Third, postpartum depression may disrupt puerperal women's lives by making it difficult for them to care for their babies and to concentrate on daily tasks. We hope that this article enhances nurses' professional competences to detect PPD as early as possible and to promote the quality of care received by postpartum women and their family members.產後憂鬱之概念分析.產後憂鬱是影響婦女健康，且攸關家庭幸福安寧的重要議題。研究證實其可能改變親子依附關係、配偶關係及使家庭功能出現障礙。雖然產後憂鬱的現象非常常見，但是產後憂鬱概念易與其他相關概念（如產後沮喪、產後精神病）混淆，繼而影響適切的預防與處置，因此本文依據Walker及Avant（2011）的概念分析法，界定產後憂鬱的定義性特徵及其發生的前因與後果，提供實證性的篩檢工具，且列舉典型、邊緣與相反案例以和其他相關概念作區別。結果發現產後憂鬱的定義性特徵為：(1)起始時間及持續時間為產婦生產後四到六週開始，持續超過兩週以上；(2)產婦出現憂鬱症狀達五種（含）以上；(3)影響產婦的社會功能，如照顧孩子的能力不夠、無法集中精神處理日常事物等。本文旨在增加護理人員辨識產後憂鬱的能力，以提早發現產後憂鬱的現象，提升產婦及其家庭成員的照護品質。.

Although medical advances have increased the survival rate of preterm infants, morbidity in terms of neurodevelopmental impairment has not decreased for this population. This results in caregivers having to reconsider how neonatal intensive care unit (NICU) caregiving impacts on preterm infants. The purpose of this study was to examine the effects of different phases of a routine tub bath on preterm infants' distress and state behavior in the NICU. The study used an exploratory repeated measures design that focused on preterm infants' distress and state behavior, and evaluated the effects of three phases of a routine tub bath, which were performed according to standard unit practice in the NICU. Thirteen nurses repeatedly bathed 12 infants on different days, and 64 baths were videotaped for the purpose of assessing the variety of distress behavior. The procedures of one bath could be categorized into three phases designated to Phases I, II, and III. The variables were measured by a preterm infant behavioral coding scheme developed for this research. The inter-rater reliability of the instrument ranged from .82 to .99. Mixed effects analysis of variance was used to analyze the differences among the bath phases in the occurrences of distress and state behavior. The results showed significant statistical difference among most distress behaviors during the three phases (e.g. "startle, jerk, tremor" F ratio = 25.62, p < .001; "finger splay, grasping, fisting" F ratio = 49.99, p < .001; "grimace" F ratio = 36.55, p < .001; "fussing or crying" F ratio = 25.27, p < .001), with the exception of "extension, arching and squirming". In particular, the occurrence of distress and state behavior increased significantly in phase II. Routine tub bathing not only disrupts preterm infants' sleep but also causes an increase in distress behavior. Preterm infants' stress increases with the intrusiveness of nursing procedures. NICU caregivers should consider the effects of routine nursing activities that influence the infants, and modify handling to promote techniques to promote preterm infants' recovery, growth and development.

The purpose of this study was to examine whether relationships exist among various preterm infant behaviors. The study used an exploratory method design. Twenty infants were bathed and a total of 120 baths were video recorded and observed to measure preterm infant behaviors based on the frequency that behaviors occurred. The frequency was measured by using the preterm infant behavioral coding scheme developed for the study. Pearson Correlation Coefficients were used to analyze the behavioral data and examine whether the relationships among these behaviors were significant. The interrater reliability of the behavioral variables ranged from .82 to .99. There were highly positive correlations between the stress behaviors. There was, however, negative correlation between the stress behaviors and the stable behavior (sucking). The occurrences of the stress behaviors were associated with the state of " eyes open " and "fuss or crying". Knowing the associations may enhance NICU nurses ' abilities to identify preterm infant behaviors. While interacting with preterm infants, nurses can sensitively and actively sense preterm infant signals, prevent or ameliorate the early threats to an infant ' s life, and adjust care to support the infant ' s growth and development.

Although advances in medical technology have increased the survival rate of preterm infants, science is no cure-all for these high-risk patients. A growing number of studies report that caregiving interventions cause physiological and behavioral distress in such infants. The results have prompted changes in caregiving practices, attempting to reduce stress and strengthen protection for the infants, in order to promote their stability and development in the neonatal intensive care unit (NICU) . This study uses qualitative research methods to grasp the richness and diversity of nurses' beliefs and experience in the taking care of preterm infants. Ten groups of questions explore how NICU nurses take care of premature infants, nurses' perspectives on cue-based care, and the extent to which NICU nurses practice cue-based care. The results generated three themes: (1) timely and skillful management of the preterm infants; (2) compassionate and holistic care for the infants and their highly stressed families; and (3) the relationship between good nursing care and meeting the needs of preterm infants, families, physicians, units, and the environment. It is apparent that the approach to care delivery in NICU practice is still clinical-based, and that there are some obstacles to the delivery of cue-based care. The reasons for this include lack of knowledge, incomplete collaboration with team members, and insufficient support from the administrative systems. To improve the quality of nursing care and preterm infant outcomes, it will be necessary to educate NICU nurses on cue-based care, to enhance collaboration among all team members, to reduce their non-nursing workload, and to re-design NICUs for optimal cue-based care.

This study tested the use of a developmentally supportive care (DSC) training program in the form of videotaped and personalized instruction to increase nurses' cognitive abilities for assessing preterm infant behavioral signals and offering supportive care. The study used a two-group pre-test post-test quasi-experimental repeated measures design. The participants were 25 NICU nurses, 13 in the intervention group, and 12 in the control group. An instrument developed for the purpose of the study was a video test that measured the effectiveness of the DSC training. The video test questionnaires were administered to the participants twice with an interval of four weeks. ANCOVA controlling the baseline scores was used for data analysis. In general, the results support the hypothesis that nurses' cognitive abilities were enhanced after the DSC training. The increase in nurses' cognitive abilities is the prerequisite for behavioral change, based on the assumptions of Bandura's Social Cognitive Learning Theory (Bandura, 1986). As nurses' cognitive abilities increased, it would be possible that nurse behaviors in taking care of these preterm infants might change. Therefore, the author recommends that in order to improve NICU care quality and the outcomes of preterm infants, the concepts of developmentally supportive care be incorporated into NICU caregiving practice by educating nurses.

Background Preterm infants manifest pain and stress by behavioural agitation and state change. Few studies have explored the effects of combining nonpharmacological interventions, i.e. non-nutritive sucking, oral sucrose, and facilitated tucking, on infants' behaviours across painful procedures. Objectives To explore the effects of combined use of three nonpharmacological interventions (non-nutritive sucking, oral sucrose, and facilitated tucking) on infants' pain- and stress-related behaviours during four assessment phases: baseline, intervention, heel stick, and recovery. Design Prospective, randomised controlled trial. Setting Level III neonatal intensive care unit in Taipei. Method A convenience sample of 110 infants (gestational age 27–37 weeks) needing heel sticks was randomly assigned to five combinations of nonpharmacological treatments: (1) routine care, (2) non-nutritive sucking+facilitated tucking, (3) oral sucrose+facilitated tucking, (4) non-nutritive sucking+oral sucrose, and (5) non-nutritive sucking+oral sucrose+facilitated tucking. Outcomes were infants' withdrawal or stress ( grimace , limb and trunk extension or squirming ) and approach or self-soothing ( sucking, sucking search, or mouthing ; hand holding or grasping ; and hand to mouth, face ) behaviours. Results The frequency of infants' withdrawal behaviours decreased significantly when they received combinations of nonpharmacological interventions before heel stick. Specifically, grimace frequency decreased by 32.2%, 30.6%, 19.7%, and 13.8% in infants receiving oral sucrose+non-nutritive sucking+facilitated tucking, non-nutritive sucking+oral sucrose, oral sucrose+facilitated tucking, and non-nutritive sucking+facilitated tucking, respectively, compared to those receiving routine care across assessment phases. Furthermore, infants' frequency of limb and trunk extension or squirming decreased by 24.0% when they received non-nutritive sucking+oral sucrose+facilitated tucking compared to those receiving routine care. Infants' frequency of approach behaviours did not change significantly across all phases when they received non-nutritive sucking+oral sucrose+facilitated tucking, non-nutritive sucking+oral sucrose, and oral sucrose+facilitated tucking compared to those receiving routine care. Conclusions The combined use of nonpharmacological interventions (non-nutritive sucking+oral sucrose+facilitated tucking) effectively reduced the frequencies of infants' withdrawal behaviours, i.e. grimace and limb and trunk extension or squirming . Our results provide evidence supporting clinicians' incorporation of the combined use of facilitated tucking, oral sucrose, and non-nutritive sucking into clinical practice during painful procedures. Heel-stick procedures can be atraumatic when conducted while infants are stable and quiet, appropriately positioned, and stabilised and by offering facilitated tucking, oral sucrose, and non-nutritive sucking before gently sticking the heel and squeezing blood.

The need to face others is an inescapable part of the professional responsibilities of nurses. The meaning of "facing the other" is poorly addressed in nursing practice.The purpose of this study was to explore the ethical attitudes of nurses related to facing others.A qualitative approach was used to investigate the living experience of psychiatric nurses in the supervision group in terms of improved ability to handle therapeutic groups.The process of facing the other was for the other, by the other, and then for oneself. The presence of for the other, the sensibility from by the other, and the self-examination of for oneself were discussed in detail.The process of for the other, by the other, and then for oneself constructed the significance of learning from the patients. The group with that used the free-floating discussion format was found to promote the ethical attitude of psychiatric nurses and may be applied in clinical practice.面對他者（人）是照顧病人時無法逃避的現實，但其深層意涵需要釐清。本研究目的在探究護理人員面對他者的倫理態度。採用質性研究法，以自由談的團體分析方式，進行團體治療實作指導的團體督導。此督導團體互動（對話）之過程記錄、研究者的工作日誌、及參與者的學習心得，成為本研究分析的文本。結果發現，面對他者的倫理態度，是一個為人、問己、成己的發展歷程。並由為人的在場、問己的感知、成己的自我照顧，探究此發展歷程。由為人服務到成就自己的專業主體，需要具備問己的功夫。自由談的團體對話，能使護理人員開展問己的能力，發展出關懷的倫理態度，值得推廣於護理實務。

Background: Jaundice occurs frequently in neonates and can cause severe neurological complications; hence, hyperbilirubinemia is usually monitored by direct spectrophotometry. However, lipemia, resulting from inborn disorders or parenteral feeding of preterm neonates with lipid emulsion, may interfere with certain laboratory assessments. Here, we evaluated whether artificial lipemia also interferes with bilirubin measurement by direct spectrophotometry. Methods: Total bilirubin levels were assessed by the spectrophotometry when serial concentrations of Lipofundin®, medium-chain triglycerides, or a stabilizer solution, were added to cord blood samples from five full-term and five preterm newborn infants. Results: In blood specimens from ten neonates, spectrophotometry-determined bilirubin levels proportionally and significantly increased in the presence of Lipofundin® at least 1% v/v or 10% medium-chain triglycerides at least 10% v/v in all pre-term and full-term infants. The stabilizer solution caused no interference. Conclusion: Lipofundin® in the cord blood interferes with spectrophotometric measurement of total bilirubin; this effect is mainly related to triglyceride levels and has implications for management of neonates with jaundice.

This prospective, descriptive study used a repeated-measures design to explore preterm infants' biobehavioral responses to 24-hour neonatal caregiving and positioning, and the factors associated with changes in their biobehavioral responses. Thirty preterm infants (gestational age 27.6-36.1 weeks) were observed for 3 days to record biobehavioral responses. Infants' disorganized behaviors increased as caregiving intrusiveness and supine positioning increased. Social interactions did not lead to increases in infants' disorganized behaviors, but to increased regulatory behaviors. Non-nutritive sucking (NNS), and prone positioning reduced occurrences of infant disorganized behaviors. Routine caregiving increased instability of oxygen saturation, but lateral and prone positioning improved physiological stability. Clinicians can appropriately provide NNS, positioning, and social interactions to promote biobehavioral stability.

Background Pain and stress agitate preterm infants, interrupting their sleep. Frequent high arousal states may affect infants' brain development and illness recovery. Preserving infants' sleep and relieving their pain during painful procedures are both important for their health. Objectives To compare the effectiveness of different combinations of non-nutritive sucking (sucking), oral sucrose, and facilitated tucking (tucking) with routine care on infants' sleep–wake states before, during, and after heel-stick procedures. Design Prospective, randomised controlled trial. Setting Level III Neonatal Intensive Care Unit in Taipei. Method A convenience sample of 110 infants (gestational age 26.4–37 weeks) needing heel sticks were randomly assigned to five combinations of non-pharmacological treatments: sucking–oral sucrose–tucking; sucking–oral sucrose; oral sucrose–tucking; sucking–tucking; and routine care. Infant states, measured by a state-coding scheme, included quiet sleep, active sleep, transition, quiet awake, active awake, and fussing or crying. All states were recorded at 1-min intervals during four phases: baseline, intervention, heel-stick procedures, and recovery. Results Infants receiving sucking–oral sucrose–tucking or sucking–oral sucrose experienced 52.8% ( p =0.023) and 42.6% ( p =0.063) more quiet-sleep occurrences than those receiving routine care after adjusting for phase, baseline states, non-treatment sucking during baseline and recovery, positioning, and infants' characteristics. Infants receiving oral sucrose–tucking, sucking–oral sucrose, sucking–oral sucrose–tucking, and sucking–tucking experienced 77.3% ( p p =0.008), 51.5% ( p =0.017), and 33.0% ( p =0.105) fewer occurrences of fussing or crying, respectively, than those receiving routine care after adjusting for related factors. Conclusions The four treatment combinations differentially reduced infants' high arousal across heel-stick procedures. The combined use of oral sucrose–tucking, sucking–oral sucrose, and sucking–oral sucrose–tucking more effectively reduced occurrences of infant fussing or crying than routine care. Treatment combinations of sucking–oral sucrose–tucking and sucking–oral sucrose also better facilitated infants' sleep than routine care. To preserve infants' sleep, clinicians should use combinations of non-nutritive sucking, oral sucrose, and facilitated tucking to reduce agitation during painful procedures.

To determine the inter-rater reliability, internal consistency, construct and concurrent validity and feasibility of the pain assessment scale for preterm infants.Repeated exposure to painful procedures has an adverse impact on preterm infants' health outcomes. Although many scales are available for assessing these infants' pain, only a few reliably and validly assess pain and no gold standard has been established in clinical practice.Instrument development and psychometric analysis.Preterm infants (n = 60) born 27·6-36·3 weeks gestational age were assessed for pain 3 minutes before (phase I), during (phase II), 3 minutes after (phase III) and the tenth minute after (phase IV) heel-stick procedures. Pain scores were independently coded from video recordings and observations by three trained nurses using our pain-assessment scale, premature infant pain profile and visual analogue scale.Scores on the pain assessment scale for preterm infants differed significantly across four phases of heel-stick procedures (F = 56·86, p0·0001). Internal consistency was 0·84 and inter-rater reliability was 0·88-0·93. Scores on our pain scale correlated well with scores on the premature infant pain profile (0·74-0·83) and visual analogue scale (0·72-0·81).The pain assessment scale for preterm infants integrates all possible pain indicators, with each item modified for clinicians' simple and easy pain measurement to potentially yield different information. Our scale is valid, reliable and feasible for preterm infants with gestational age27 weeks. Further examination of the scale's psychometrics is recommended with diverse samples of infants and different painful procedures.The pain assessment scale for preterm infants clearly defines item scoring and weighting, consistently discriminates different levels of pain and helps nurses to recognise infants' pain. Nurses can easily remember the definition of each item, allowing them to use our scale to evaluate preterm infants' pain at any time and to provide pain-relief interventions when needed.

Background Preterm infants' repeated exposure to painful procedures may contribute to negative consequences. Thus, improving preterm infants' neurodevelopmental outcomes requires prioritising their pain management. Objectives To compare the effectiveness of two non-pharmacological pain-relief strategies (non-nutritive sucking and facilitated tucking) with routine care on preterm infants' pain, behavioural, and physiological responses before, during, and after heel-stick procedures. Design Prospective, randomised controlled crossover trial. Setting Level III Neonatal Intensive Care Unit in Taipei. Method Thirty-four preterm infants (gestational age 29–37weeks) needing three procedural heel sticks were recruited by convenience sampling and randomly assigned to a sequence of three treatments (two pain-relief interventions and the control condition): (1) routine care, non-nutritive sucking, facilitated tucking, (2) non-nutritive sucking, facilitated tucking, routine care, and (3) facilitated tucking, routine care, non-nutritive sucking. Each treatment condition was performed on a different day to avoid any carry-over effect. Pain was measured by the Premature Infant Pain Profile (PIPP), infant behaviour by a behavioural coding scheme, and physiological signals by electrocardiogram monitors. All data were collected 3min without stimuli (baseline), during heel-stick procedures, and recovery. Results Infants receiving non-nutritive sucking and facilitated tucking had significantly lower mean (standard deviation) pain scores during heel-stick procedures (6.39 [3.35] and 7.15 [3.88], respectively) than those receiving routine care (9.52 [4.95]). Infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios (0.39, p =0.011 and 0.34, p =0.005, respectively) for pain (PIPP score≥6) than infants receiving routine care after adjusting for time, baseline pain scores, and infants' characteristics. Similarly, infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios (0.23, p p =0.03, respectively) for moderate-to-severe pain (PIPP score≥12) than infants receiving routine care. Infants receiving facilitated tucking had lower frequency ratios for stress-related behaviours, abnormal heart rates, and decreased oxygen saturation than infants receiving routine care. Conclusions Both non-nutritive sucking and facilitated tucking effectively reduced pain scores more than routine care during heel-stick procedures. Non-nutritive sucking reduced PIPP pain scores more effectively than facilitated tucking. However, facilitated tucking showed broader effects not only on relieving pain, but also on enhancing infants' physiological and behavioural stability during heel-stick procedures.