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Although 5-year colleges account for 41.7% of all nursing graduates in Taiwan, most of these graduates go on to university and earn a bachelor's degree. In 2015, four universities received approval from the Ministry of Education of Taiwan and started to enroll students in the academic-hospital partnership nursing program to guide nursing graduates from 5-year colleges into the nursing workplace. The effects of this program have never been examined, especially from the perspective of the students.The aim of this study was to explore the experiences of students currently participating in the academic-hospital partnership nursing program.A qualitative approach was used in this study. Twelve students were invited to participate in a focus group that met for five sessions over 3 years to understand the motivations for and experiences of participating in the academic-hospital partnership nursing program. Data were analyzed using thematic analysis.Six themes were identified: (a) incentives for participating in the academic-hospital partnership nursing program, (b) worries about making the wrong decision, (c) worries about future adaptation, (d) facing the real workplace, (e) confusion about role perception and benefits, and (f) administrator support.The findings of this study enhance the general understanding of nursing student experiences and the changes over time in the academic-hospital partnership nursing programs. Moreover, the findings may be used to help teachers and nursing administrators at healthcare institutes better support the needs of students at each program stage. In addition, the findings may serve as a reference for the government in refining the design of these programs in the future.

Introduction Today's global nursing shortage is having an adverse impact on health systems around the world and in Taiwan. Many universities in the United States have implemented accelerated BSN (ABSN) programs to create a shortcut for students who have bachelor's degrees in other fields to become nurses. Previous studies have revealed that students feel stress during the programs, especially in their first year. Students' first-year experiences in an ABSN program in the Taiwanese context are worthy of study. Study aim The purpose of the study was to understand nursing students' first-year experiences in an ABSN program in Taiwan. Design A qualitative research design was used in this study. Setting and participations A total of 25 students from a university in central Taiwan participated in this study to share their first-year experiences of studying in an ABSN program. Methods Data were collected from 3 focus group interviews and students' written reflections and were analyzed by qualitative content analysis with the help of ATLAS.ti 7.0. Findings Five themes were identified: (1) pursuing a brighter future, (2) positively facing doubts (3) challenges of surviving, (4) changing their learning attitudes and methods, and (5) seeking support. Conclusions The findings of this study may help nursing schools to provide the support students need and serve school administrators as a reference for refining such programs in the future.

Background Women engage in organizational citizenship behaviour more frequently than men. Little research has investigated organizational citizenship behaviour in men and male nurses, especially from a career development stage perspective. Aim To investigate work-related factors and organizational citizenship behaviour status as well as predictors of organizational citizenship behaviour of male nurses at different career stages. Method A total of 167 male nurses were selected by random sampling to complete a mailed questionnaire. Nurses were divided into the following career stages: exploration (clinical seniority 5 years). Findings Of the 167 male nurses who agreed to participate, 139 returned completed questionnaires, resulting in a response rate of 83.2%. The stage with the highest percentage of male nurses was the establishment stage. Nurses in the maintenance stage had the highest salaries, educational level, hospital position, organizational support, organizational identification, and organizational citizenship behaviour. Organizational identification was the only significant predictor of organizational citizenship behaviour for the three career stages. Conclusions Hospital management should promote organizational citizenship behaviour for male nurses by increasing organizational identification, especially during the establishment stage.

The implementation of National Health Insurance in Taiwan has affected the medical industry by significantly depleting the supply chain&rsquo, s profits. Service providers in the medical industry must meet the dual-service expectation of serving as medical manufacturers with upper reaches and as suppliers in the downstream marketing channel. As a result, service providers must anticipate customer requirements, offer new service items that align with customer demands and improve the quality of existing services. This study aims to examine consumer perspectives about service satisfaction in the domestic medical industry using Kano&rsquo, s two-dimensional model. In addition, it employs the importance-satisfaction model to determine service items that need improvement. The empirical findings show that consumer perceptions about service quality attributes vary and thus, service items may be categorized differently in Kano&rsquo, s model. Further, the reliability of service quality significantly affects customer satisfaction. Thus, service providers can gain a competitive edge and maintain their market position by offering high value added and critical quality attributes. Finally, analyzing customer attitudes toward new service items for indifference quality will help service providers determine effective tactics in a competitive market. In general, service providers should assign higher priority to items that customers consider in need of improvement.

Aim Male nurses are reported to experience role strain. Fear of gender stereotyping can be stressful and frustrating for male nursing students, which could make them feel isolated and excluded. The aim of this qualitative study was to investigate how male nursing students in Taiwan perceive the barriers to their experience as nursing students and how they manage these barriers in their study environment and social life. Methods A qualitative research approach was used in this study. Data were collected during 2014 from 24 male nursing students from three nursing educational institutes in Taiwan who participated in order to share their experiences by using a semistructured interview. All the interviews were recorded, transcribed verbatim, and analyzed by thematic analysis. Results The main theme that described the experiences of the male nursing students in Taiwan was: “There is nothing wrong with being a male nurse.” Contrary to other studies, role strain for the participants was minimal. The students experienced some barriers because of being a male nursing student, both at school and in their social life. Most of these students tended to manage the barriers by developing positive thinking and coping strategies. Conclusion Nursing educators are encouraged to use the findings from this study to provide appropriate support for male nursing students.

Background Hospital nurses are frontline health care workers in controlling the spread of infectious diseases. It is not known if nurses working in negative pressure isolation wards (NPIWs) are better prepared than before to safely care for patients with common infectious diseases. Methods For this qualitative descriptive study, 10 nurses were interviewed in depth about their experiences caring for patients in an NPIW. Tape recordings were transcribed verbatim and analyzed by qualitative content analysis. Results The following 5 themes were identified: (1) complexity of patient care, (2) dissatisfaction with the quantity and quality of protective equipment, (3) shortage of nursing staff, (4) continued worries about being infected, and (5) sensitivity to self-protection. Our participants' anxiety and uncertainty about being infected in the NPIW were increased by the complexity of patients' health problems and organizational factors. To protect themselves against infection before and during patient care, participants also developed sensitivity to, concepts about, and strategies to improve self-protection. Conclusions NPIW administrators should pay more attention to nurses' concerns about improving the NPIW working environment, supply good quality protective equipment, and provide appropriate psychologic support and ongoing education to ensure that nurses feel safe while working. This ongoing education should refresh and update nurses' knowledge about disease transmission, therefore decreasing unnecessary anxiety based on misunderstandings about becoming infected.

Mental health nurse are frequently subjected to patients' violent and aggressive behaviour. These assault experiences have given rise to mental health nurses' physical and psychological trauma, and negatively impact the quality of patient care. The purpose of the present qualitative study was to understand mental health nurses' experiences of being assaulted, the influences on their patient care, and their perspectives of the effectiveness of in-service, violence-prevention education. Ten mental health nurses from two different inpatient mental health facilities were interviewed using a semistructured interview guide. Thematic analysis of interview data found six themes: (i) violence is unpredictable; (ii) violence is normal; (iii) lasting psychological trauma; (iv) limited support from peers and the administrator; (v) violence prevention requires team cooperation; and (vi) doubting the effectiveness of in-service education on violence prevention. Psychiatric ward administrators should assess nurses' learning and skill needs to determine whether these needs are met by existing in-service training programmes. A culture of safety should also be promoted by building a warm and supportive ward climate for both staff and patients, which would include team cooperation and support for colleagues who suffer a violent incident.

This study applies the refined Kano model and importance-satisfaction model to investigate medical institutions' satisfaction with and perceptions of importance of domestic pharmaceutical logistics services. Survey data involving 104 respondents from medical institutions are analyzed with importance-satisfaction and the refined Kano model. The results demonstrate that the refined Kano model will generate different classification of quality attributes for the pharmaceutical logistics industry, and medical institutions with different characteristics really have varying responses to quality attributes of pharmaceutical logistics services. The present research contributes to the literature by demonstrating that provision of high-value-added and crucial quality attributes by service providers can give them an edge in the market. In addition, when service providers understand their customers’ attitudes toward innovative service, it can enable them to strengthen their tactics in a competitive market.

Background Infection preventionists (IPs) play an important role in preventing health care–associated infections in a health care system. However, the limitations of the clinical setting and the unique characteristics of psychiatric patients could be barriers to effective infection prevention. The purpose of this study was to understand how IPs perceived their challenges and how these challenges negatively affect their infection prevention work in psychiatric clinical settings. Methods A descriptive, qualitative research approach was used in this study. Thirteen Taiwanese psychiatric IPs were interviewed in semistructured interviews. Data were transcribed and then analyzed by thematic analysis. Results This analysis identified 6 themes: (1) lack of preservice training in psychiatric infection control, (2) insufficient staffing in practice, (3) working within environmental limits, (4) patient noncompliance, (5) undervaluation of the importance of infection control by professionals, and (6) involvement of hospital administrators. Conclusions The implementation of effective infection prevention in psychiatric clinical settings may be strongly related to the factors of sufficient training and IP staffing while relying on collaboration among patients and clinical professionals and on the full support of administrators.

Previous studies have shown that patients with breast cancer may suffer from symptoms of psychological distress, such as: depression, anxiety, insomnia, and chronic fatigue. Nurses are expected to offer physical and mental support to these patients. Cognitive behavior therapy (CBT) is commonly used in psychiatry as well as in the treatment of patients with breast cancer. CBT is believed to reduce mental distress in patients by changing their negative cognitive schema. The present article discusses the mental problems of patients with breast cancer and introduces the effects of using CBT on patients with breast cancer. Successful examples of training clinical nurses to apply CBT to the patients are introduced in order to facilitate the design of effective CBT training programs for nurses that improve professional knowledge and skills in dealing with the mental health problems of these patients and further enhance the quality of nursing care.運用認知行為治療促進乳癌病人心理健康.過去研究顯示，乳癌病人承受多重的心理壓力，例如憂鬱、焦慮、失眠以及慢性疲憊等，因而護理人員在照顧乳癌病人過程，除了協助減少病人身體上的病痛外，亦應提供身、心理照護。文獻顯示，過去常被用於輔助改善精神症狀的認知行為治療，運用在乳癌病人也有其療效，在治療過程當中，藉由改變病人的認知模式，可有效減緩病人的心理壓力與困擾。本文探討乳癌所衍生的心理健康問題、引入認知行為治療、陳述認知行為治療運用在乳癌病人的成效，以及國外護理人員接受認知行為治療相關教育訓練的模式。透過國外成功的經驗，建議透過跨團隊合作機制，發展有關認知行為治療教育訓練課程等，以加強護理人員心理層面的照護技能，有效的緩解乳癌婦女的心理問題，提升整體照護品質。.

Adult clients with schizophrenia are primarily cared for by their ageing parents. When the parents become ill or die, siblings are considered to be responsible for taking over the caregiving role. However, little is known about caregiving for a sibling with schizophrenia, and no studies have explored this phenomenon in an Asian context. The aim of the present descriptive, qualitative study was to understand the experiences of being the primary caregiver of a sibling with schizophrenia. Data were collected from 10 siblings of currently-hospitalized patients diagnosed with schizophrenia using semistructured, in-depth interviews. Recorded interviews were transcribed and analysed by qualitative content analysis. This analysis identified four themes: (i) stepping forward to become caregiver; (ii) challenges of caregiving; (iii) need for support; and (iv) worries about future care. Our findings suggest that mental health-care professionals should involve all family members, including siblings, in the care plan for the person with schizophrenia, and provide appropriate psychoeducation for all family members to reduce not only the tension and stress of current caregiving, but also anxieties about future care.

Male nurses are reported to experience role strain. Fear of gender stereotyping can be stressful and frustrating for male nursing students, which could make them feel isolated and excluded. The aim of this qualitative study was to investigate how male nursing students in Taiwan perceive the barriers to their experience as nursing students and how they manage these barriers in their study environment and social life.A qualitative research approach was used in this study. Data were collected during 2014 from 24 male nursing students from three nursing educational institutes in Taiwan who participated in order to share their experiences by using a semistructured interview. All the interviews were recorded, transcribed verbatim, and analyzed by thematic analysis.The main theme that described the experiences of the male nursing students in Taiwan was: "There is nothing wrong with being a male nurse." Contrary to other studies, role strain for the participants was minimal. The students experienced some barriers because of being a male nursing student, both at school and in their social life. Most of these students tended to manage the barriers by developing positive thinking and coping strategies.Nursing educators are encouraged to use the findings from this study to provide appropriate support for male nursing students.

Mental health nurse are frequently subjected to patients' violent and aggressive behaviour. These assault experiences have given rise to mental health nurses' physical and psychological trauma, and negatively impact the quality of patient care. The purpose of the present qualitative study was to understand mental health nurses' experiences of being assaulted, the influences on their patient care, and their perspectives of the effectiveness of in-service, violence-prevention education. Ten mental health nurses from two different inpatient mental health facilities were interviewed using a semistructured interview guide. Thematic analysis of interview data found six themes: (i) violence is unpredictable; (ii) violence is normal; (iii) lasting psychological trauma; (iv) limited support from peers and the administrator; (v) violence prevention requires team cooperation; and (vi) doubting the effectiveness of in-service education on violence prevention. Psychiatric ward administrators should assess nurses' learning and skill needs to determine whether these needs are met by existing in-service training programmes. A culture of safety should also be promoted by building a warm and supportive ward climate for both staff and patients, which would include team cooperation and support for colleagues who suffer a violent incident.

The fumes from cooking oil, similar to cigarette smoke, contain numerous carcinogens such as polycyclic aromatic hydrocarbons, aromatic amines, nitro-polycyclic aromatic hydrocarbons, etc. In this study, we examined the association between exposure to cooking oil fumes and the risk of cervical intraepithelial neoplasm. The study population in this nested case-control study consisted of women above the age of 19 years living in Chia-Yi County, located in the southwestern Taiwan, who had received pap smear screening between October, 1999, and December, 2000 (n=32,466). The potential cases were women having lesions greater than cervical intraepithelium neoplasm II (> or =CIN2) reconfirmed by cervical biopsy (n=116). The potential controls (case: control=1:2) were age-matched (+/-2 years) and residence-matched women who had normal pap smears within 6 months of the cases. In total, 100 cases and 197 controls were completely interviewed by public health nurses about cooking methods, ventilation, and other potential risk factors. Women who cooked at home in a kitchen (n=269) without the presence of a fume extractor at least once a week between the ages of 20 and 40 had a 2.29 times higher risk [95% confidence interval (CI)=1.08-4.87] of developing cervical intraepithelial neoplasm than those who did not cook once a week in such a kitchen during the same age span, after adjusting for other potential confounders. This finding was further strengthened by the finding that women who did not use the fume extractors had a 2.47 times higher risk (95% CI=1.15-5.32) of developing cervical intraepithelial neoplasm than women who cooked in kitchens with fume extractors that were always switched on while cooking. We also found a joint protective effect of fume extractor use among women older than 40 years (n=202) if they used the extractors during both age spans of their lives, ages 20-40 and >40 years. Comparing our findings on women more than 40 years old who used fume extractors during both periods, we found a 2.05-fold greater risk (95% CI=0.86-4.86) for those who used exhaust fans during only one of the two age spans and a 3.46-fold greater risk in those who had not used an exhaust fan for either period (95% CI=1.08-11.10) (trend test, P=0.02). While exposure to cooking oil fumes may cause cervical intraepithelial neoplasm, women can be protected from this risk by always cooking in kitchens equipped with fume extractors and by keeping them on while cooking.

Historically, positivism has been the dominant approach in the philosophy of science. In nursing, most quantitative researchers tend to employ positivism as their epistemological underpinning, which could be why positivism has long been identified as the epistemology of quantitative research. It can be argued, however, that some of the procedures of qualitative research reflect the perspectives on which positivists insist. This article takes grounded theory and phenomenology as examples, in order to observe how positivism influences their methodologies, evidence obtained is then used to support the aruthors' arguments. The article, furthermore encourages beginning researchers to familiarize themselves with background knowledge of philosophy of social sciences, especially epistemologies and methodologies, in order to make clear the philosophical context in which their research is conducted.

Cigarette smoke is one of the most important environmental risk factors for the development of cervical intraepithelial neoplasms (CINs). Given that the prevalence of cigarette smoking in Taiwanese women is very low, compared with Caucasian women (3-4% vs. approximately 28%, respectively), direct smoking is likely a minimal risk factor in the Taiwanese group. However, the evaluation of the association between indirect tobacco exposure, or exposure to environmental tobacco smoke (ETS), and CIN risk in Taiwanese women may be enlightening. The authors designed a community-based nested case-control study to examine the association between ETS exposure and CIN risk among Taiwanese women who were nonsmokers. The study was conducted in Chia-Yi, a city in southwestern Taiwan. The test population comprised adult females (n = 32,466) who had undergone Pap smear screening during the 14-mo period that preceded this study. Potential cases were chosen from individuals who demonstrated positive Pap smear results, which were indicative of at least a level II cervical intraepithelial neoplasm (i.e.,or = CIN2), as confirmed by cervical biopsy (n = 116). The authors chose 2 matched controls for each case; criteria used were (a) the 2 controls for each case had to be approximately the same age (+/- 2 yr) as the case; (b) each case and respective control lived in the same residential area; and (c) each control had a negative Pap smear, determined during the same time frame (+/- 6 mo) that the matched study subject was tested. A total of 100 study subjects and 197 control females (3 cases had only 1 control) underwent interviews by public health nurses, who obtained information about the participants' active and passive smoking histories and other potential risk factors. The incidence of cigarette smoking was low (5.0% [n = 5]) in study subjects and lower in controls (3.1% [n = 6]). The authors' final analysis was restricted to 89 nonsmoking pairs (89 subjects and 175 controls). Of the affected subjects, 85.4% reported exposure to passive smoke at home during their adulthood, vs. 61.1% of controls. The authors found that, after adjusting for other covariates, there was a 2.73-fold increased risk of contracting CIN (95% confidence interval [CI] = 1.31, 5.67) among ETS-exposed individuals. The authors assessed cumulative dose in terms of pack-years (i.e., average daily exposure [number of packs smoked] multiplied by the number of years the same exposure continued). Compared with nonsmokers, women exposed to 1-20 pack-yr and more than 20 pack-yr had 1.90-fold (95% CI = 0.72, 5.03) and 2.99-fold (95% CI = 1.10, 8.09) increased risks, respectively, of developing CIN. The authors concluded that lifetime ETS exposure is a major determinant for contracting cervical neoplasms among nonsmoking women in Taiwan.

To investigate the association between genetic polymorphisms ofX-ray repair crosscomplementing group 1 (XRCC1) codons 194, 280, and 399 and cervical neoplasm susceptibility. A community-based nested case-control study was conducted. The study population consisted of women living in Chiayi City, located in southwestern Taiwan, who had received pap smear screening between October, 1999, and December, 2000 (n=32,466). The potential cases were women having lesions greater than cervical intraepithelium neoplasm II (C1N2) reconfirmed by cervical biopsy. The potential controls (case: control=1∶2) were age matched (±2 yrs) and residency matched women who had had normal pap smears. In total, 100 cases (39 C1N2, 12 C1N3, 46 carcinoma in situ (CIS), and 3 invasive cancer) and 196 controls had the information on both questionnaire and data ofXRCC1 polymorphisms. The frequency ofArg/Arg, Arg/Gln, andGln/Gln in codon 399 among cases and controls was 54% (54/100), 38% (38/100), and 8% (8/100) and 58% (114/196), 37% (73/196), and 5% (9/196), respectively, which were not significantly different. No associations were also observed betweenXRCC1 codon 194 and 280 genotypes and cervical neoplasm. While dichotomized by age (