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This study aimed to explore the factors associated with fatigue in chronic hepatitis C patients before and at 4, 8, 12, 16, 20, and 24 weeks after antiviral therapy. The study employed a prospective and repeated-measures design. The Chinese version of the brief fatigue inventory (BFI-C) and the Pittsburg sleep quality index (PSQI) were employed to collect data. Pegylated Interferon plus Ribavirin dosages and serum values (hemoglobin, alanine aminotransferase [ALT], and aspartate aminotransferase [AST]) were monitored before and during the antiviral therapy at 4, 8, 12, 16, 20, and 24 weeks. The study enlisted 115 patients as participants. Multivariate analysis indicated that gender, educational level, body mass index (BMI), and hemoglobin level were significant determinants of patients’ fatigue. When hemoglobin levels in the patients decreased in week 4 and continued to fall to the nadir at week 12, it prompted the healthcare providers to assess their fatigue levels and initiate proactive interventions as needed.

Aim The study aimed to explore the risk factors for progression to type 2 diabetes in women with gestational diabetes mellitus and the long-term impact of gestational diabetes mellitus on the health of their children. Background The occurrence of gestational diabetes mellitus in women is the strongest predictor of the development of type 2 diabetes in the future. Design A non-concurrent cohort and case-control study design and the guidelines for STROBE checklist were used for the study. Methods We reviewed medical records for the time period from the archives of the hospitals. The short-listed women and their children were invited to participate in a 'Women with gestational diabetes mellitus' research activity from November 2012-February 2016. Blood tests, physiological indicators and demographic questionnaires were applied for data collection. Results A total of 57 women and 57 children participated in the research activity. The risk factors for progression of gestational diabetes mellitus to type 2 diabetes included education level and the 1-h blood glucose level for the antepartum 100-g oral glucose tolerance test and the 2-h blood glucose level for the postpartum 75-g oral glucose tolerance test. However, these risk factors did not have a significant impact on the body mass index and body fat of the women's children. Conclusion Healthcare providers should adopt a breadth of health education strategies to remind women with gestational diabetes mellitus to be aware of certain risk factors, and to urge them and their children to return for regular follow-up visits. Relevance to clinical practice Identification of the risk factors developing type 2 diabetes can make healthcare units incorporate the postpartum follow-up of gestational diabetes mellitus into their standard protocol and case managers continue to follow-up and manage the health of the women and that of their children to reduce adverse health of them.

AIMS AND OBJECTIVES To identify determinants of quality of life among patients who had experienced hypoglycaemia and who were undergoing insulin treatment. BACKGROUND Patients with diabetes receiving insulin treatment are at high risk for hypoglycaemia, which tends to affect their quality of life. DESIGN With a cross-sectional and observational study design (see the STROBE checklist and Appendix S1). METHODS One hundred and fifty patients with type 2 diabetes who had received insulin treatment and had experienced hypoglycaemia (

Postpartum depression is one of the most common psychological disorders of women after childbirth. Despite the importance of social support as an influencing factor, there have been few studies on the trends and characteristics of social support as it relates to postpartum depression.To explore the trends in postpartum depression and social support, to cross-analyze the correlation between the postpartum depression trajectory and the social support trajectory, and to investigate predictors of changes in postpartum depression trajectories.A prospective repeated-measure study and convenience sampling were used to recruit 230 women at 1, 3, and 6 months after childbirth. Structured questionnaires were used for data collection. Trajectory analysis was used to explore the trajectories of postpartum depression and social support during the 6 months after childbirth, and polynomial logistic regression was used to explore predictors of the trajectory of postpartum depression.Postpartum depression was at its most serious in the third month after childbirth, showing patterns of low-risk, moderate-risk, and high-risk trajectories. Social support also showed low, moderate, and high patterns, and the trajectory of postpartum depression was significantly related to the trajectory of social support. The predictors of moderate-risk and high-risk postpartum depression were also found in this study.Postpartum mental health education and online learning systems should be used to increase social support for women after childbirth and reduce the incidence of postpartum depression.

Irritable bowel syndrome (IBS) is a common recurrent functional gastrointestinal disorder that impacts on patients physically and mentally. Studies on IBS have focused on adults, yet few studies have examined IBS among female university students. The aim of this study was to investigate the prevalence of IBS for female university students and its related factors. Using a cross-sectional study design, a total of 2520 female university students were recruited in southern Taiwan. The structured questionnaires, including the Rome III IBS diagnostic questionnaire, IBS symptom severity scale, Perceived Stress Scale, and World Health Organization Quality of Life BREF questionnaire (WHOQOL-BREF) were used for data collection. A total of 1894 female students complete the questionnaires. The response rate was 75.15%. The results indicated 193 female students with IBS and the prevalence of IBS was 10.1%. IBS female students had higher levels of stress and lower QOL than non-IBS female students. The risk factors for female university students developing IBS were dysmenorrhea, food avoidance, class absenteeism, and the lower physical domain of QOL. It is advised to consider these factors when providing students with counselling and relevant services in the expectation of alleviating their IBS symptoms, reducing the incidence rate of IBS, and further improving their QOL.

BACKGROUND eElectronic health (eHealth) chronic kidney disease (CKD) information is readily available over the mobile devices and placed as mobile-health (mHealth) information resources. The field of mHealth on CKD is promising in that it can empower individuals and delay the progress of the disease. OBJECTIVE This study aims to critically review published papers on the eHealth and its implication on mHealth of CKD. METHODS The academic databases EBSCO (CINAHL and PROQUEST), MEDLINE, PubMed, and Cochrane were systematically searched. Eight studies investigated the specific role of mHealth on CKD, including the detailed contents related to the conceptual acceptance and usage of technology in daily life, user, health care professionals, and the system’s bonding, mobile eHealth, content and evaluation of mHealth on CKD. RESULTS The available evidence on mHealth of CKD is limited and the findings indicate a discrepancy of the wording concept of mHealth. Those evidences might be caused by the scarce evidence on the effectiveness of using mHealth on CKD. CONCLUSIONS The limitation on the availability of CKD’s mobile health interventions that focus on patient education, behavior change and prevention contributes to inconsistent usage. Inadequate evidence might interrupt the development of mHealth intervention for individuals with CKD. Our findings illustrate the need on the conceptualizing of mHealth on CKD, acceptance and accessed, content, and evaluation focused on evidence-based will advance the quality of mHealth services, facilitate the continuity of mHealth application, and proposed patient-center-care.

Aim To explore the factors that affect the health status of health care providers. Background There is a lack of studies that address the stress, resilience, social support and health status of health care providers. Methods Using a cross-sectional study design, 500 participants were recruited from three hospitals which were operated by one entity in southern Taiwan. Data were collected with structured questionnaires. A logistic regression analysis was performed to explore the factors that might affect the health status of health care providers. Results Among the 500 health care providers, 345 were healthy and 155 were unhealthy. Health status was not significantly correlated with any demographic characteristics, but was significantly correlated with work stress, resilience and social support, with work stress being an important factor influencing the health status of health care providers. Conclusions Health care providers with health issues had higher work stress, less resilience and less social support than did healthy medical personnel. Moreover, work stress was the main factor affecting the health of health care providers. Implications for nursing management Hospital administrators should conduct a series of health management programmes to identify high-risk employees who might need assistance. Such programmes promoting healthy workplaces are necessary, as well as studies that examine the effectiveness of such strategies.

Taiwan is expected to become a "super-aged" nation in 2065. Modern medical advancements, while extending the average human lifespan, has led to higher incidence of patient suffering and greater medical expenses due to chronic disease and terminal illnesses. As the concept and services of hospice and palliative care have become increasingly accepted by the public, the issue of final care for a good death has become a priority concern for both patients and their families. Experiencing a good death at home is a common last wish for terminal patients. However, guidelines for good death at home are still unavailable in Taiwan. The promotion of this concept thus remains a challenge with many limitations. This article aims to explore: (1) the importance of hospice care; (2) the selection of a proper location for good death; (3) the requirements for nursing education in the care of dying patients; and (4) the challenges and strategies of a good death at home, including "the family dimension-connections with the family members" and "the education dimension-promotion of home-based dying in nursing education". The goal is to help terminal patients experience a good death at home, to assist family members embrace the good death of their loved ones, and, eventually, to facilitate peaceful and successful home-based dying for both the patient and their family members.居家安寧療護的挑戰—在宅善終.台灣人口結構快速老化，推估2065年將正式邁入超高齡社會。雖然進步的醫療科技可以讓重症病人延續生命，但是無法醫治其疾病，因此增加病人承受治療的痛苦與浪費醫療成本。安寧療護的理念與服務已經普及化，但是家屬與病人最擔憂的則是後續銜接的照顧問題。善終，是人生的最後一哩路，在宅善終是生命末期病人的最大心願，但是針對在宅善終，國內尚未有完善的指引與支持，在推廣與執行上，面臨限制與困境。本文藉由四個層面的探討：（一）臨終關懷的重要性；（二）臨終地點的選擇；（三）瀕死護理的教育需求；（四）在宅善終之挑戰與策略，包括「家庭面—與家屬的連結」和「教育面—護理教育的推行」，協助生命末期的病人可以在家安逝，家屬對於臨終末期病人不再擔憂與徬徨無助，達到在家往生的目標，讓人們安居其處，逝者適得其所。.

Background Gestational diabetes mellitus (GDM), an obstetric disease that affects the health of pregnant women, is one of the key factors associated with perinatal mortality or disease. Aims To explore the impact of prepregnancy body mass index (BMI) and gestational weight gain (GWG) on perinatal outcomes for women with GDM. Methods With a retrospective study design, women were recruited who received prenatal checkups, gave birth at two teaching hospitals in southern Taiwan from 1995 to 2011, and received a diagnosis of GDM by an obstetrician. A trained research assistant collected the participants' data in each hospital's archives room. The researcher used a retrospective case study method to identify women who received a GDM diagnosis between 1995 and 2011. Results Women with GDM and with an overweight prepregnancy BMI were more likely to have cesarean deliveries and to use glucose-lowering medicines after delivery. Their newborns also had a higher birth weight. In addition, gestational hypertension and cesarean delivery were more common in women with GDM and with excessive GWG than in women with GDM and with normal GWG. The newborns of women with GDM and with excessive GWG had higher birth weights and more nuchal cord than those of women with GDM and with normal GWG. More women with GDM and with excessive GWG underwent blood glucose monitoring than did women with GDM and with normal GWG. Linking evidence to action The prepregnancy weight and GWG significantly affected perinatal outcomes in both the women with GDM themselves and their newborns. Healthcare professionals must provide childbearing women with additional health education in the areas of health promotion, nutrition, weight control, exercise, and maintaining regular everyday lives.

The commitment of nursing preceptors to their role is an important driving force that supports their clinical teaching and affects teaching quality. Role commitment undergoes dynamic development and thus changes over time. Existing studies have utilized only cross-sectional study designs and have not analyzed the changes in commitment trajectories with related factors.This study aimed to investigate the development trajectories of the commitment of preceptors and to examine the predictors between the trajectories of role commitment among nursing preceptors.A single-group, repeated-measures design was adopted, and 59 participants completed the Commitment to the Preceptor Role Scale and the Preceptor's Perception of Support Scale. The latent class growth analysis method was used to estimate the trajectory class patterns. The Wilcoxon rank-sum test, a nonparametric method, was used to compare the differences in demographic characteristics between the trajectories of commitment among nursing preceptors. Predictors were examined using binary logistic regression analysis.The two-class model was the best-fitting model to describe the trajectories of nursing preceptor commitment. The two classes in this model were "low commitment," which accounted for 90.3% of all the participants, and "high commitment," which accounted for 9.7%. A significant difference was found between the two classes in terms of motivation for being a preceptor (p = .048). Neither demographic characteristics nor organizational support had a predictive effect on the trajectories of commitment development.This study found a low level of role commitment among new preceptors. Moreover, internal motivation was found to be a significant factor affecting the trajectories of this commitment. Therefore, institutions should foster an appropriate environment to enhance the role identity of preceptors as well as cultivate and stimulate their commitment to this role.

This study was to compare biopsychosocial consequences among three groups of women with gestational hyperglycemia. We conducted a repeated-measures study at five time points among 132 women with gestational hyperglycemia. Women’s physiological indicators and their psychosocial indicators were measured. There were 22.7% of participants had gestational diabetes mellitus (GDM), 11.4% had gestational impaired glucose tolerance (G-IGT), and 65.9% had mild gestational hyperglycemia (MGH). Women with GDM had higher fasting blood glucose and systolic/diastolic blood pressure than women with MGH. Women with GDM had higher diastolic blood pressure compared to women with G-IGT. Significant differences were found between the five time points regarding women’s fasting blood glucose, diastolic blood pressure, depression, and health status. Health care providers should conduct early screening for predictors of metabolic syndrome in women with any degree of gestational hyperglycemia. Nursing interventions could be offered as early as the perinatal period to promote women’s health.

Aims The aim of this study was to explore the effectiveness of two types of health education on improving knowledge concerning diabetes and insulin injection, insulin injection skills and self-efficacy, satisfaction with health education and glycated haemoglobin (HbA1c) and creatinine levels among patients with type 2 diabetes who began insulin therapy using a pen injector. Background Insulin therapy is recommended to facilitate the regulation of plasma glucose; however, patient's acceptance of insulin therapy is generally low. Healthcare providers should help them improve their knowledge of diabetes and insulin injection, as well as their insulin injection skills. Design A randomized repeated measures experimental study design. Methods The experimental (n = 21) and control (n = 21) groups received multimedia and regular health education programmes, respectively from October 2013–August 2014. Four structured questionnaires were used and videotapes were applied to demonstrate injection skills. Results Generalized estimating equations showed that the experimental group's scores were significantly higher than those of the control group for diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. On the other hand, an analysis of covariance revealed glycated hemoglobin (HbA1c) and creatinine levels did not differ significantly between the two groups. Conclusions Implementation of a multimedia diabetes education programme could improve patients’ diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. Healthcare providers should improve quality of patient care by providing multimedia diabetes health education.

This study aimed to identify the predictors of self-efficacy in administering insulin injection among patients with type 2 diabetes. Using a cross-sectional survey, data were collected via purposive sampling from a metabolic ward of a medical center in Southern Taiwan. Participants were 72 patients with type 2 diabetes, who had started using Lantus, Levemir, or Novomix pen injectors. Data were collected from October 2013 to August 2014, using the Diabetes and Insulin Injection Knowledge Scale, Self-Efficacy in Administering Insulin Injection Scale, and photographs illustrating insulin injection skills. The findings indicated that “knowledge of diabetes and insulin injection,” “insulin injection skills,” “senior high school or above education,” and “diabetes duration” were predictors of self-efficacy in administering insulin injection, which explained 41% of the total variance in self-efficacy. Health care professionals can design relevant strategies for improving patient self-efficacy in administering insulin injection, thereby increasing patients’ insulin self-injection abilities.

To investigate the effects of a virtual community on pregnant women's well-being.The virtual social network has been growing rapidly but its effects remain unclear.A repeated-measure and quasi-experimental study.We designed a closed Facebook community for peer-to-peer interaction with no mediator. A total of 121 pregnant women were assigned to either experimental or control group. Data were collected from May 2012-January 2015 using five instruments related to pregnant women's well-being.Significant differences on pregnant women's well-being were not found between groups. However, higher adherence to the virtual community was significantly related to first-time pregnant women and women whose pregnancy was assisted by a technology treatment.Nurses and midwifes are recommended to pay more attentions on first-time pregnant women and women whose pregnancy was assisted by a technology treatment regarding their pregnancy-related concerns.ClinicalTrials.gov NCT03692923.目的: 研究虚拟社区对孕妇健康的影响。 背景: 虚拟社交网络发展迅速,但其影响仍不明朗。 设计: 重复测量和准实验研究。 方法: 我们设计了一个封闭的Facebook社区,供同行之间进行互动,不需要任何中间人。共有121名孕妇被分为实验组和对照组。数据收集于2012年5月至2015年1月,使用了五种与孕妇健康相关的仪器。 结果: 两组孕妇的健康状况没有显著差异。然而,第一次怀孕的女性和通过技术治疗辅助怀孕的女性对虚拟社区的依附性更高。 结论: 建议护士和助产士更多地关注初次怀孕的孕妇和通过技术治疗辅助怀孕的妇女,以解决她们与怀孕有关的问题。 试验注册号码: ClinicalTrials.gov NCT03692923.

Background Hyperglycemic women face dramatic physiological and psychosocial changes during the perinatal period; however, studies examining hyperglycemic women's health are few, and limited to cross-sectional designs. Purpose This study aimed to examine changes in hyperglycemic women's stress, social support, depression, and health status from pregnancy to 1 year postpartum, and to identify factors predicting hyperglycemic women's perinatal health. Methods Ninety-nine participants with positive results in a 50-g glucose challenge test were recruited in a medical center in southern Taiwan. A repeated measures study was conducted; measurements were made at 28 weeks of pregnancy, and 1 week, 6 weeks, 6 months, and 1 year after childbirth. The Social Support Scale, the Perceived Stress Scale, the Taiwanese Depression Questionnaire, and the Chinese Health Questionnaire were used. Results Compared with hyperglycemic women's depression at 28 weeks of pregnancy, significant decreases in mean depression scores were found at 1 week and 1 year postpartum. Hyperglycemic women's health status improved at 6 months and 1 year postpartum. Depression significantly predicted hyperglycemic women's perinatal health status. Linking Evidence to Action Stress and depression are associated with perinatal health status in hyperglycemic women. Healthcare providers should more closely assess stress and depression levels in hyperglycemic women from pregnancy to 1 year postpartum. Interventions promoting the psychological well-being of hyperglycemic women are required.

Inter-professional practice (IPP), necessary in today's healthcare environment, should be guided and practiced through inter-professional education (IPE). Within the context of an effective IPE program, collaborative medical professionals must be cognizant of the demands of patients' integrated care, organize a collaborative inter-professional team, and achieve the objectives of patient-centered care. However, the many challenges of IPE include insufficient understanding of inter-professional care, occupational culture-related boundary issues, lack of a college education, and insufficient support from academic and medical institutions. This article suggests adopting effective strategies to promote inter-professional recognition, create a harmonious medical culture, eliminate barriers to education, and enhance support for academic and medical institutions. Inter-professional collaboration between academic and clinical institutions must provide resources and substantive professional training. Effectively implementing IPE and IPP is expected to elicit trust, respect, and efficient communication from team members.推動跨領域團隊教育的挑戰和策略.現今的醫療環境需要跨領域團隊照護，跨領域團隊照護必須透過跨領域團隊教育的教導和學習。有效的跨領域團隊教育能使得醫療專業人員具備察覺病人整合照護需求的能力，採用以病人為中心的照護目標，執行跨領域團隊照護。然而目前的跨領域團隊教育面臨許多挑戰，包含缺乏跨領域團隊照護認知、醫療職場文化的藩籬、缺乏學校教育、以及學術或醫療機構支持度不佳。本文建議可行的推動策略有：提升跨領域團隊照護的認知與重視、營造和諧的醫療職場文化、消除學校教育障礙和鼓勵學術或醫療機構支持。由專業認知、職場文化、學校教育及機構支持等層面著手，透過教育與臨床的領導者共同合作，提供所需的資源與持續的專業訓練，使得團隊成員相互信任、尊重及溝通，進而有效推廣跨領域團隊教育與照護。.

Background For first-time fathers, the perinatal period is a critical period of stress and imbalance. Marital intimacy and social support may affect their stress and health status while they change their roles. Aim This study was to explore the changes of and correlations among marital intimacy, social support, and health status and predictors of first-time fathers' health status during the perinatal period. Methods With a repeated measures study design, a total of 217 first-time fathers whose spouses were in the third trimester of pregnancy were recruited for the study. The Chinese Health Questionnaire, Marital Intimacy Scale, and Social Support Scale were employed to collect data at a medical center in the 36th week of pregnancy and the 1st and 4th weeks after childbirth. Results The levels of marital intimacy and social support of first-time fathers during the perinatal period increased significantly with time. Meanwhile, the period of the first week after childbirth was a predictor of first-time father's health status. Conclusions This study only tracked the first-time fathers' health status in the 36th week of pregnancy and the 1st and 4th weeks after childbirth. Future studies could track them until one year after childbirth in order to explore the impact of the perinatal period on the couples and their babies. During the perinatal period, health care providers shall assess and provide needed interventions to first-time fathers as soon as possible to facilitate the first-time fathers to get ready for the role transition and to promote their health status.

Background Postpartum health research has focused primarily on full-term mothers. Aims To explore postpartum stress, depression, social support, health status, and predictors of health status in mothers of premature infants. Methods This study employed a cross-sectional design. With convenience sampling, a total of 203 mothers of premature infants were recruited from two medical centers and four community teaching hospitals in southern Taiwan. The Hung Postpartum Stress Scale, Social Support Scale, Beck Depression Inventory, and Chinese Health Questionnaire were used to assess the mothers’ psychosocial features during the first 6 weeks postpartum. Results Mothers’ health status differed significantly according to levels of postpartum stress and depression. The important health status predictors were age, education, postpartum stress, and depression level. Discussion The concerns and needs of mothers of premature infants differed from those of full-term mothers during the first 6 weeks postpartum; premature infants’ health status was found to be a major perceived stressor for their mothers. Linking Evidence to Action In the process of caring for premature infants’ mothers, healthcare providers should provide individualized care to meet their needs, thus facilitating the reduction of postpartum stress and depression levels. During premature infants’ hospitalizations, healthcare providers should hold regular faculty meetings to provide postpartum women with relevant information about their infants’ health and how to best care for them. Future studies should explore postpartum stress, social support, depression, and health status each postpartum week, which could serve as a guide for nursing interventions.

Aim The post-partum period is a stressful time of change, particularly for immigrant women, but, to the best of the present authors' knowledge, the subject has not been explored. This study aimed to examine immigrant women's post-partum stress, depression, and levels of social support, and to determine the predictors of post-partum stress for Vietnamese immigrant women in Taiwan. Methods A cross-sectional design was used. In this descriptive survey, 208 Vietnamese immigrant women were telephone interviewed by a trained Vietnamese research assistant during one of their 6 weeks post-partum. Data were collected through telephone interviews using three questionnaires, including the Hung Postpartum Stress Scale, Beck Depression Inventory, and Social Support Scale. Results The result shows that Vietnamese women had low level post-partum stress scores. Participants' family support rated higher than friend support. The incidence of depression was 0.5%. Social support, number of post-partum days, and family income were found to be predictors for post-partum stress, accounting for 26.6% of the variance. The Vietnamese immigrant women experienced significant stress regarding their maternal roles and received most of their support from their families rather than from friends. Conclusion Nurses caring for this cohort should therefore consider these factors in order to help them cope with their post-partum stress. Healthcare providers should offer available resources to these immigrant women and their spouses during this critical period in their lives. For instance, antenatal education classes could be provided to help immigrant women manage and overcome post-partum issues.

Aim The aims of this study were to determine the blood glucose screening rate of Taiwanese post-partum women with gestational diabetes (GDM) and to identify the predictors of type 2 diabetes among Taiwanese women with GDM. Methods The medical records of 130 women with GDM, who were delivered at a hospital in southern Taiwan between 1997 and 2010, were retrospectively reviewed. The GDM diagnosis was performed according to the National Diabetes Data Group and Expert Committee Criteria. The 2010 American Diabetes Association diabetes diagnosis criteria were used to determine whether post-partum women subsequently developed type 2 diabetes. Results In total, 71 records (54.6%) included blood glucose testing after childbirth between the first month and the ninth year, and 29 records (22.3%) documented subsequent type 2 diabetes. In a multiple logistic regression analysis, the patients' pre-pregnancy body mass indices and insulin use during pregnancy were independently associated with subsequent type 2 diabetes. Conclusion In this study, documentation during pregnancy, which could have provided beneficial insights, was limited. Healthcare professionals should develop a program to improve the post-partum follow-up of women diagnosed with GDM.

Background Hypertension is a risk factor for stroke. Increasing patient knowledge and cognition about stroke among hypertensive patients is essential. Aims To explore the effect of a health education intervention on the knowledge and cognition of stroke in hypertensive patients. Methods A quasi-experimental design was used with 103 patients with hypertension. The sample was recruited from a cardiologist's outpatient office at a medical center in Kaohsiung city, southern Taiwan. Half the patients (experimental group, n = 52) received health education, whereas the others received only conventional general outpatient care (control group, n = 51). All patients underwent a pretest followed by posttests at 4 and 8 weeks after the intervention. A stroke knowledge scale and stroke cognition scale were used for data collection. Results The experimental group scored significantly higher than the control group in level of knowledge and cognition of stroke. Discussion This study supports that a health education CD-ROM and printed information provided in the outpatient clinical improves knowledge of and cognition of stroke among hypertensive patients. Implications for Practice In outpatient clinical practice, nurses can help improve patients’ knowledge and cognition of the risks of stroke by playing the health education CD-ROM and providing printed information during the patients’ wait time before appointments. Conclusions Further studies with a longer follow-up (6 months or 1 year) are needed to evaluate the long-term effects of health education on stroke knowledge and cognition among patients with hypertension. Linking Evidence to Action An outpatient health education program using a CD-ROM and printed information for hypertensive patients can improve the patients’ knowledge and cognition of stroke.

ObjectiveTo identify prenatal predictors for paternal childbirth participation in Taiwan.BackgroundIn recent years, certain hospitals in Taiwan have opened the delivery room to expectant fathers, to enable their involvement in the childbirth process. Although studies have revealed that paternal participation during labour yields positive outcomes, the specific characteristics of couples who wish for childbirth participation have not been identified.MethodThis cross-sectional study recruited 199 couples from a medical centre in Southern Taiwan. Structured questionnaires on socio-demographic characteristics, desire for paternal childbirth participation, social support and marital intimacy were administered to expectant mothers and their husbands in the 36th week of pregnancy.ResultsMore than 80% of both expectant mothers and fathers expressed a preference for paternal childbirth participation. Logistic regression analyses showed that women with a bachelor’s degree or higher were most likely to prefer patern...

Many studies have shown that providing health education before surgery may significantly increase health knowledge and decrease anxiety in both patients and their family members. However, few studies have compared the effects on pediatric outpatient surgery outcomes of different health education instruction modes. This study compares the effects of two health education delivery modes on maternal knowledge and anxiety, the number of unexpected early hospital follow-up visits, and the time spent by nurses on health education. A quasi-experimental design with pretest and posttest was used to compare the effect on the outcomes of pediatric circumcision of a multimedia compact disc (CD) and a printed material.Seventy mothers of children who underwent Plastibell circumcision participated in this study. Both the printed material and the multimedia CD significantly increased the knowledge and reduced the anxiety levels of the participants. However, no significant differences in unscheduled early hospital follow-up visits postsurgery were found between the two modes of instruction. Furthermore, we found that significantly fewer hours were spent by nurses on health education for the multimedia CD group in comparison with the printed material group. In the current clinical environment of common staffing shortages, information tools may be used to cost-effectively assist and simplify nursing work. The findings of this study may provide a reference to medical centers that are working to reduce the time spent by nurses on health education for outpatient surgery patients. Furthermore, audiovisual health education tools are recommended to increase nursing effectiveness and save nursing time.

Aims The aim of this study was to determine the effects of nursing preceptorship on the competence, job satisfaction, professional socialization and retention of new nurses. Background Although studies have focused on the effects of nursing preceptorship on new nurses’ competence and retention, a systematic review of the overall effects is lacking. Design A quantitative systematic review. Data sources Five English/Chinese databases were searched for original articles published before June 2015 and only six articles published between 2001–2014 were included in the final analysis. Review methods Joanna Briggs Methodology was used to process one randomization control trial, one quasi-experimental study and four observational studies. Two appraisers independently reviewed each study using the standardized critical appraisal tools from the Joanna Briggs Institute. Results The most adopted preceptorship was a fixed preceptor/preceptee model and one-on-one for 1–3-month duration. It showed that new nurses’ overall competence increased significantly due to preceptorship. Only a few studies explored the effects of preceptorship on the job satisfaction and professional socialization of new nurses. Clear conclusions regarding the effect of preceptorship on nurses’ retention rate could not be made because of inconsistent time points for calculation and a lack of control groups in the study design. Conclusions Preceptorship can improve new nurses’ nursing competence; however, more studies are needed to ascertain its effects on new nurses’ retention rates, job satisfaction and professional socialization to promote nursing care quality and resolve nursing shortages.

Background In Taiwan, a culturally sanctioned ritual of maternal rest and recuperation has been traditionally practiced patrilocally during the first postpartum month. However, in recent years, the places where women may observe the ritual have become more diverse. Aim Our goal was to compare women's psychosocial features based on where they stayed during their postpartum recovery. Methods Using proportional stratified quota sampling of 18 hospitals and clinics in Taiwan by birth rate, we recruited 784 postpartum women. Results Women stayed in their own home (17.1%), with their parents-in-law (33.3%), with their parents (36.0%), or in a postpartum nursing center (13.6%). Women who stayed in their own residence or who stayed in their parents' residence perceived greater social support than women who stayed with their parents-in-law. Conclusions Further research should compare women's adjustment to motherhood and their competence in childcare based on where they stay during postpartum recovery.

Hyperglycemic women face dramatic physiological and psychosocial changes during the perinatal period; however, studies examining hyperglycemic women's health are few, and limited to cross-sectional designs.This study aimed to examine changes in hyperglycemic women's stress, social support, depression, and health status from pregnancy to 1 year postpartum, and to identify factors predicting hyperglycemic women's perinatal health.Ninety-nine participants with positive results in a 50-g glucose challenge test were recruited in a medical center in southern Taiwan. A repeated measures study was conducted; measurements were made at 28 weeks of pregnancy, and 1 week, 6 weeks, 6 months, and 1 year after childbirth. The Social Support Scale, the Perceived Stress Scale, the Taiwanese Depression Questionnaire, and the Chinese Health Questionnaire were used.Compared with hyperglycemic women's depression at 28 weeks of pregnancy, significant decreases in mean depression scores were found at 1 week and 1 year postpartum. Hyperglycemic women's health status improved at 6 months and 1 year postpartum. Depression significantly predicted hyperglycemic women's perinatal health status.Stress and depression are associated with perinatal health status in hyperglycemic women. Healthcare providers should more closely assess stress and depression levels in hyperglycemic women from pregnancy to 1 year postpartum. Interventions promoting the psychological well-being of hyperglycemic women are required.

Objective To investigate the risk factors for developing GDM among Taiwanese pregnant women. Design A retrospective cohort and case-control study. Setting At a medical centre in Southern Taiwan. Participants The hospitalised pregnant women who were diagnosed with either GDM or normal glucose tolerance (NGT) between 1997 and 2011. The glucose tolerance test results were interpreted according to criteria established by the National Diabetes Data Group for GDM. Participants were divided into either a GDM group (case group) or a normal glucose tolerance (NGT) group (control group) in order to determine the risk factors for GDM. Measurements With a retrospective chart review, data regarding demographics, a family history of diabetes, history of gestation, and physiological index for pre- and postpregnancy periods were collected. χ 2 tests and independent t tests were used to examine the correlations between demographic characteristics and GDM. Stepwise multivariate logistic regression was used to determine the factors associated with GDM. Findings The results of the comparison between the GDM group ( n =106) and the NGT group ( n =406) showed that the risk factors for GDM were maternal age, education, a family history of diabetes, and prepregnancy body mass index (BMI). Key conclusion and implication for practice Older age, lower levels of education, a family history of diabetes, and higher prepregnancy BMI were significant risk factors for GDM. In addition to performing risk factor assessment, health care providers should proactively promote the importance of GDM screening to pregnant women at their first antenatal visit.

Aims and objectives. This study was conducted in Taiwan on couples for a month in the postpartum period to investigate the correlated factors that affect their health status. Background. Most studies have focused on the postpartum health status of mothers, but few of them mention about the postpartum health status of fathers. Design. A cross-sectional design. Methods. This study was carried out on a cross-section of couples, and the data were collected through telephone interviews conducted by a research assistant using structured questionnaires. A total of 201 couples who had given birth to a healthy single baby at a medical centre in southern Taiwan were recruited between 1 August 2007–31 November 2007. Results. The two most important factors correlated with mothers’ health statuses, during the month-long postpartum period, were mothers’ educational and postpartum stress levels. The result also showed that baby’s Apgar score at the first minute was the main factor related to father’s health status during the month-long postpartum period. Conclusions. Educational programmes should incorporate factors that affect couples’ health status during the one month postpartum period to promote postnatal couples’ health. Relevance to clinical practice. To improve the couples’ health status during the one month postpartum period, we need to strengthen the stress-coping skills of mothers and provide them with coping resources to support their maternal roles, to provide social support to fathers and to incorporate issues of marital intimacy and parental attachment into the couples’ educational programmes. Also, a father’s presence at his infant’s birth is encouraged to enhance parental attachment.

Aims. This study aims to contribute to the current body of literature by examining immigrant women’s postpartum health in the context of Taiwan, in particular, their experience with postpartum stress and depression as well as the levels of social support available to them. This study also aims to identify predictors of their postpartum health status. Background. While there has been considerable research on the risk factors for poor postpartum health in the general population, research on the factors influencing immigrant women’s postpartum health has been limited. Design. A non-experimental research design. Methods. We collected data from a sample of 340 immigrant postpartum women who could speak Mandarin Chinese, recruited from 10 general hospitals and one obstetric clinic in Taiwan from March 2005 – September 2006. The Hung Postpartum Stress Scale, Beck Depression Inventory-II, Social Support Scale and Chinese Health Questionnaire were used in this study. Results. We found that immigrant women’s postpartum health status differed significantly in relation to their key helpers, depression status, levels of postpartum stress and social support. The logistic regression analysis showed that a one-point increase in immigrant women’s postpartum stress increased the probability of suffering from minor psychiatric morbidity by 1·04 times. Conclusions. These findings suggest that health care professionals should pay attention not only to immigrant postpartum women’s basic financial and support needs but also to their postpartum stress and stressors. Relevance to clinical practice. The use of trained community health advocates in partnership with registered nurses can help meet the needs of postpartum women and improve maternal and infant health through their home visits. These nursing interventions should be tailored specifically to decrease immigrant Asian women’s postpartum stress and improve their overall health status and well-being.

Aims and objectives. This study aims to assess expectant fathers’ social support, marital intimacy and health status during the third trimester of their partners’ pregnancies. Further, we investigate the predictors of father–infant attachment after childbirth. Background. Becoming a father is a transition. Research has focused more on mothers than on fathers, even though the philosophy of the maternal care system is about providing family-centred care. The psychological status of first-time fathers and the attachment they have to their infants have received little attention in the research. Design. A repeated measures study design. Methods. A total of 195 first-time fathers were recruited during the third trimester of their partners’ pregnancies. During that time, they completed the Social Support Scale, the Marital Intimacy Scale and the Chinese Health Questionnaire. After childbirth, they completed the Paternal Attachment Inventory during the one-week postpartum period. Results. The fathers who perceived more marital intimacy and support from their partners were more attached to their infants. Moreover, marital intimacy and partner support were important predictors for father–infant attachment. Conclusions. Future research is warranted to determine the prenatal predictors of father–infant attachment for high-risk families. Relevance to clinical practice. The philosophy of maternal care is family oriented; for health professionals, pregnancy is an important time to provide information and counsel couples. Interventions should not only target the health and well-being of expectant mothers but should also actively invite fathers to participate in prenatal care with their partners to facilitate marital intimacy and father–infant attachment.

Purpose: To compare differences in psychosocial changes among experienced and first-time mothers over 6 postpartum weeks. Design: A trend research study design. Method: A cohort of 439 first-time mothers and 420 experienced mothers during the 6 postpartum weeks was recruited in southern Taiwan. Each participant was interviewed over the phone to complete the Hung Postpartum Stress Scale, the Social Support Scale, and the Chinese Health Questionnaire. Findings: Concern about lack of social support was significantly higher in first-time mothers in the third week than in the first week. Conclusions: Postpartum stressors are different for inexperienced and experienced mothers, and these stressors vary in their importance over the 6 postpartum weeks, suggesting that the postpartum nursing needs of the two groups in 6 postpartum weeks may be different. Implication for Practice: Knowledge and skills in mothering capability should be emphasized for first-time mothers, and physical exercises are needed for both groups of mothers.

Aim. The aim of this study was to examine whether the application of cryotherapy with ice in a plastic bag is effective in reducing the severity of wound pain after arthroscopy. Background. In most studies, analgesic medication were administered prior to surgery; postoperative pain may be reduced by analgesics, but they are known to confound the effects of cryotherapy. Cryotherapy by Cryocuff system has commonly been used to manage post arthroscopy patients’ pain. Few studies have tested the effects of cryotherapy by simply applying ice in a plastic bag to relieve postarthroscopy pain. Design. This was a prospective, double-blinded, quasi-experimental study with two groups, interrupted time-series design and multiple treatment replications. Method. Fifty-nine patients who received arthroscopy between July–August 2007 were assigned to receive cryotherapy (the experimental group, 33 people) or no cryotherapy (the control group, 26 people). For the experimental group, three 10-minute sessions of ice packing were conducted over a three-hour period, with 50-minute intervals between each session. The first session of ice packing was applied immediately after recovery from anaesthesia. Results. Cryotherapy with ice in a plastic bag was shown to be effective in lessening the degree of pain in postarthroscopy patients. The pain score of the experimental group decreased from 5·12–1·82 after cryotherapy, representing a significant decrease, while the pain score in the control group decreased from 4·04–2·88 (p = 0·047, 0·012 and 0·005). Conclusions. Cryotherapy with ice in a plastic bag can be applied in standard protocols for patients who have just undergone arthroscopic surgery. Relevance to clinical practice. Cryotherapy with ice in a plastic bag is a simple, readily attainable and cost-effective technique for relieving postarthroscopy pain. We recommend that it be included in standard treatment protocols. Techniques for cryotherapy should be incorporated into in-service education.

Aim. To predict important factors in women’s postpartum stress. Background. The transition to motherhood is often accompanied by stress, but research on predictors of postpartum stress is scant. Design. A cross-sectional survey was used in the study. Methods. Proportional stratified quota sampling based on births at 11 registered general hospitals and seven specialty clinics in the Kaohsiung area of southern Taiwan was used to obtain a high degree of representation. Eight hundred and fifty-nine women participated in the study within six weeks postpartum. The Hung postpartum stress scale, the social support scale and the 12-item Chinese Health Questionnaire were used in this study. Results. Women with minor psychiatric morbidity, one or two children, junior college educational level, formula feeding for their infants, preference for an infant boy and a low level of social support were important predictors for women’s postpartum stress. Conclusion. Our findings provide information and data for service planning and community care for the prevention and amelioration of postpartum stress. Relevance to clinical practice. Postpartum women face a constellation of factors that could put them at risk for high levels of postpartum stress. Postpartum stress could significantly negatively impact women’s health status. Nursing interventions should be tailored to decrease women’s postpartum stress as a means of promoting postpartum women’s pursuit of well-being.

We explored predictors of women's satisfaction with postpartum nursing centers, which have become popular in Taiwan in recent years. After completing a consent form and demographic questionnaire, 401 women from different centers identified by proportional stratified quota sampling completed four questionnaires over the telephone after their fourth week postpartum. A high level of social support and low level of postpartum stress significantly predicted their satisfaction with the postpartum nursing centers. Future studies will be needed to determine whether, compared to traditional care at home, the postpartum nursing centers can help ease mothers' transition to parenthood and improve their childcare competence.

Aims and objectives. The purpose of this study was to investigate the effect of internet health education on female university students’ knowledge and cognition regarding hepatitis B. Background. One of the focal points of preventing hepatitis B is to improve students’ knowledge of hepatitis B. The internet is thought to attract learners, ensure privacy and provide channels for help. Design. Cluster sampling was used to select 189 female students from two universities in Kaohsiung City. The participants were divided into 130 participants who agreed to participate in an internet health education program and 59 who did not. Method. The participants were administered questionnaires on ‘hepatitis B knowledge’ and ‘hepatitis B cognition’ before, two weeks after and four weeks after the health education intervention. The experimental group received an additional ‘user satisfaction’ survey at two weeks after the health education intervention. Results. Participants in the internet hepatitis B educational program scored significantly higher in knowledge of hepatitis B at two and four weeks post intervention. No significant score differences were found in hepatitis B cognition in either of the groups two and four weeks. Sixty per cent of the experimental group indicated that the program was easy to understand, 67·69% found it helpful, 66·15% were generally satisfied with the content. Almost 67% (66·92%) thought the university should adopt and promote the web site. Relevance to clinical practice. This study provides health professionals with a reference for hepatitis B health education programs.

The purpose of this study was to explore the relationships between life adaptation, social support, and depression among migrant Vietnamese women living in Meinong Township, Kaohsiung County. With a cross-sectional study design, 143 participants were recruited by purposive sampling. Structured questionnaires including Demographic Inventory Scale, Life Adaptation Scale, Social Support Scale, and Beck Depression Inventory Scale were used. Data were analyzed with Pearson's correlation and One-way ANOVA. The results showed that Vietnamese women's social support was significantly correlated with the length of time living in Taiwan, the length of marriage, and their husbands' age. Women's social support was significantly different with languages in common, the way of acquaintance with her husband, and family members living together. Depression was significantly different with family income. Life adaptation was also significantly different with family income. Moreover, there was a significantly positive correlation between Vietnamese women's social support and life adaptation, and significantly negative correlations between Vietnamese women's social support and depression, and between their life adaptation and depression. The study findings could be used as references for health professionals and government agencies to institute strategies and policies for promoting migrant Vietnamese women's life adaptation.

The purpose of this study was to explore the quality of life, and its predictors among middle-aged and elderly patients with Type 2 Diabetes Mellitus. 131 participants of age 40 or above were recruited from an outpatients department in one medical center in southern Taiwan. The study had a cross-sectional design; each participant was administered structured questionnaires, including the Diabetes Self-Care Behavior Scale, the Social Support Scale and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). The results show that the predictors of patient's quality of life were diabetic self-care behaviors, economic status, and frequency of hospitalization, with a total variance of 21%. These findings can help health professionals to learn more about these patients. Furthermore, a suitable program and nursing interventions could be implemented to promote these patients' quality of life.

Postpartum health research has focused primarily on full-term mothers.To explore postpartum stress, depression, social support, health status, and predictors of health status in mothers of premature infants.This study employed a cross-sectional design. With convenience sampling, a total of 203 mothers of premature infants were recruited from two medical centers and four community teaching hospitals in southern Taiwan. The Hung Postpartum Stress Scale, Social Support Scale, Beck Depression Inventory, and Chinese Health Questionnaire were used to assess the mothers' psychosocial features during the first 6 weeks postpartum.Mothers' health status differed significantly according to levels of postpartum stress and depression. The important health status predictors were age, education, postpartum stress, and depression level.The concerns and needs of mothers of premature infants differed from those of full-term mothers during the first 6 weeks postpartum; premature infants' health status was found to be a major perceived stressor for their mothers.In the process of caring for premature infants' mothers, healthcare providers should provide individualized care to meet their needs, thus facilitating the reduction of postpartum stress and depression levels. During premature infants' hospitalizations, healthcare providers should hold regular faculty meetings to provide postpartum women with relevant information about their infants' health and how to best care for them. Future studies should explore postpartum stress, social support, depression, and health status each postpartum week, which could serve as a guide for nursing interventions.

Aim To examine the impact of application of different nursing staffing models on patient safety, quality of care and nursing costs. Background One proposed means of addressing the staff shortage while decreasing nursing costs is the application of nursing staffing models. However, the optimal proportion of registered nurses to nurse aides remains unclear. Design A retrospective cohort study. Methods To examine a total of 667 inpatients of a 20-bed respiratory care centre at a medical centre located in southern Taiwan. Three mixed models of nursing staffing, where the portion of nurses compared with nurse aides was 76% (n = 213), 100% (n = 209) and 92% (n = 245), were applied during three different periods between 2006 – 2010. Results The 76% RNs group made fewer medication errors than the 100% RNs group; the 76% and 92% RNs groups had a higher rate of urinary tract infections; the 92% RNs group had a lower rate of bloodstream infections; the 76% RNs group had a lower rate of ventilator weaning; and the 76% and 92% RNs groups incurred higher nursing costs. Conclusions Use of different nursing staffing models that substitute nurse aides for RNs may negatively affect patient safety and quality of care and increase nursing costs. To avoid this risk, hospitals should employ and train their own nurse aides and develop a training system and education materials for RN and nurse aides.

The study was conducted to examine the changes of first-time mothers' psychiatric health status, social support, marital intimacy, postpartum stress, and maternal attachment during the transition to motherhood. A repeated measures study was conducted at the 36th week pregnancy, the first week postpartum, and the fourth week postpartum with 217 primiparous women. The results showed that the proportion of women with minor psychiatric morbidity declined over time from late pregnancy to early postpartum. The levels of marital intimacy and social support was the highest at the fourth week and the first week postpartum, respectively. Maternal attachment increased and postpartum stress decreased from the first week to fourth week postpartum. Women with minor psychiatric morbidity reported significantly higher postpartum stress than women without minor psychiatric morbidity. Identifying women with psychiatric morbidity in advance, and providing social support during late pregnancy would be effective strategies to enhance first-time mothers' adjustment to the transition of motherhood.

The purpose of this study was to predict women's minor psychiatric morbidity after they had childbirth as measured repeatedly at the first, the third, and the fifth weeks of the postpartum period. The Chinese Health Questionnaire, the Postpartum Stress Scale, the Zung's Self-rating Depression Scale and Anxiety Scale, and the Social Support Scale were used at the three points of time. A total of 526 women in Taiwan participated in the study. The results indicated that postpartum stress and anxiety are important predictors for postpartum women's minor psychiatric morbidity at three points in time.

Aims and objectives To investigate Taiwanese women's mental health trajectories from the third trimester of pregnancy to four weeks postpartum and the correlations of these trajectories with perceived social support and demographic characteristics. Background Previous studies have reported differences between prenatal and postpartum mental health status. Design A repeated design study was conducted in a medical hospital in Southern Taiwan. Methods One-hundred and ninety-four Taiwanese women completed the Chinese Health Questionnaire and Social Support Scale at the 36th prenatal week and first and fourth week postpartum. Results Three linear mental health trajectories for perinatal women were identified. Consistently poor perinatal mental health was reported by 16·0% of the participants. Less social support was associated with lower prenatal mental health scores. Younger age was a risk factor for consistently poor perinatal health. Vaginal delivery was associated with improved mental health after childbirth. Conclusions Mental health was worse in the third trimester of pregnancy than postpartum. Less social support was associated with lower prenatal mental health scores, and this association was similarly distributed between women with consistently poor and improved mental health after birth. Relevance to clinical practice Health care providers should assess women's mental health status and provide timely interventions during the perinatal period. Social support should be provided for pregnant women, especially younger women or those with lower perceived social support.