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BACKGROUND Adolescents have autonomous views and participatory rights. There is increasing support for involving adolescents with cancer in the healthcare decision-making process. AIMS The purpose of this study was to synthesize current knowledge to identify major components and outcomes of interventions to enhance shared decision-making (SDM) by adolescents with cancer during and after treatment. METHODS Six electronic databases (PubMed, CINHAL, MEDLINE, Cochrane, EBSCO, and Web of Science) were searched from their inceptions to February 2020. Eligibility criteria were intervention studies, studies of interventions to support adolescents with cancer involved in SDM, and studies of patients diagnosed with cancer between 10 and 18 years of age. Data extraction and quality appraisal were conducted by using a standardized data extraction form. Quality appraisal was based on the Cochrane Risk of Bias Tool. RESULTS Of 331 citations, five studies with a total of 648 participants aged between 13 and 21 years met inclusion criteria. Interventions included structured sessions held one to three times per week. SDM engagement strategies incorporated weekly assignments, live action videos, brochures, Five Wishes© advance directives, and follow-up counseling. Treatment preference congruence in adolescent and parent dyads was higher in intervention groups. Meta-analysis was performed on two studies and demonstrated statistically significant improvements in decision quality at 6 months (z = 3.37, p = .001; 95% CI = .174-.657) and 12 months (z = 3.17, p = .002; 95% CI = .150-.633) after SDM interventions in adolescent cancer survivors. No adverse events among patients were found, although anxiety scores increased in families in an intervention group. LINKING EVIDENCE TO ACTION This review identified essential components of SDM interventions. Our findings may guide the future design of interventions to support high-quality decision-making by adolescents with cancer. Coaching can educate adolescent cancer survivors on quality decision-making methods and can improve the quality of consequent decisions. More research is needed to determine outcomes of SDM interventions.

Background: Cancer survivors are at increased risk of long-term adverse effects related to the disease or treatment. Thus, it is important for cancer survivors to adopt a health-promoting lifestyle (HPL). This study aims to: (1) describe health behavior self-efficacy (HBSE) and HPL of adolescent survivors of childhood cancer, (2) examine the relationships between HBSE, HPL, and various demographic factors, and (3) identify determinants of HPL among adolescent survivors of childhood cancer. Method: A descriptive cross-sectional study was conducted with adolescent survivors of childhood cancer, ranged in age from 11 to 19 years ( n = 82). Participants were recruited from pediatric oncology follow-up clinics at two medical centers in southern Taiwan. Data for each participant were collected from questionnaires assessing HBSE and HPL. Results: Only 61% of the adolescent survivors were considered as normal weight. The exercise was the lowest scoring HBSE subscale. Factors associated with better HPL included: education level, HBSE, well-being, and a healthy diet. Specifically, survivors diagnosed with cancer during adolescence exhibited significantly greater self-efficacy with stress management ( F = 3.20, p = .04) compared with those diagnosed at pre-school ages. HBSE scores for well-being and a healthy diet were significant predictors of HPL, accounting for 43.8% of the total variance observed. Discussion: Our findings suggest that the age of diagnosis of childhood cancer significantly modulates the frequency of health-promoting behaviors of adolescent survivors. Thus, interventions designed to enhance adolescents’ well-being and the management of a healthy diet may enhance HPL in survivors of childhood cancer.

Purpose A valid and reliable scale to evaluate psychosocial adjustment in adolescents with chronic disease is prudent for improving their health outcome. This study aimed to develop a Chinese version Personal Adjustment and Role Skills Scale III for Adolescents (C-PARSIII-A) with chronic disease and to examine its construct validity and reliability. Design and methods A cross-sectional design was conducted. A total of 145 participants were enrolled from a hospital in Taiwan. Content validity, exploratory factor analysis, and corrected item-total correlations were used to explore a factor structure with appropriate items in a C-PARSIII-A. Confirmatory factor analysis was conducted to confirm its factor structure. Cronbach's α and test-retest reliability were performed to examine the reliability. Results The 18-item C-PARSIII-A with six inter-correlated factors was developed. The standardized factor loadings of each item on its corresponding factor were statistically significant and higher than 0.50; composite reliability and average variance extracted were higher than 0.70 and 0.50 respectively. The correlation coefficients among the six factors in the C-PARSIII-A ranged from 0.10 to 0.84. Cronbach α and test–retest reliability of the C-PARSIII-A were 0.86 and 0.92 respectively. Conclusions The six-factor 18-item C-PARSIII-A is supported by sufficient empirical evidence for construct validity and reliability to assess the psychosocial adjustment of adolescents with chronic disease. Practice implications Nurses can use the C-PARSIII-A to perform assessment and follow-up on the psychosocial adjustment of adolescents with chronic disease, as well as develop interventions.

To translate the 26-item English version Problem Areas in Diabetes-Teen (PAID-T) into a Chinese version and then to examine its psychometrical properties for measuring diabetes distress in adolescents with type 1 diabetes (T1D).The 26-item English version PAID-T was translated into a Chinese version guided by the translation model for cross-cultural research. A cross-sectional design was used and 203 adolescents with T1D were recruited from four hospitals in Taiwan. Content validity, exploratory factor analysis, and item analysis were used to ensure the item quality and build the factor structure of the Chinese version PAID-T. Confirmatory factor analysis, concurrent validity, and reliability testing were also used to examine its psychometric properties.The three second-order factors of the 18-item Chinese version PAID-T were developed. The correlation coefficients of the three-factor Chinese version PAID-T with self-management and glycosylated hemoglobin levels were all significant and ranged from -0.32 to -0.45 and 0.18 to 0.33 respectively. Cronbach's α and the test-retest reliability of the three-factor Chinese version PAID-T ranged from 0.85 to 0.93 and from 0.89 to 0.94 respectively.The Chinese version PAID-T with good translation quality was a reliable and valid scale to screen and assess diabetes distress for adolescents with T1D.Nurses could use the Chinese version PAID-T to track diabetes distress and tailor interventions for adolescents with T1D; also, the Chinese version PAID-T could facilitate the conducting of research on diabetes distress for adolescents with T1D.

Aims and objectives To test the construct and concurrent validity and reliability of the incident-reporting attitude scale used for staff in long-term care facilities (IRA-LTC) by the two-phase cross-validation method. Background Lack of accurate measurement on incident-reporting attitude might hinder improvements of safety practice in long-term care facilities. Design/methods A two-phase cross-sectional questionnaire survey was conducted in Taiwan. A fixed proportion of long-term care facilities were randomly selected that included 20 and 15 long-term care facilities at phases one and two separately. Nursing and administrative staffs in these facilities were recruited at the first phase (N = 207) for testing the validity and reliability of the newly developed scale and for cross-validation of the scale at the second phase (N = 251). The scale of IRA-LTC was a self-developed structured questionnaire consisting of 31 items. The data were analysed using spss for Windows 20.0 and AMOS 24.0. Descriptive statistics, correlation analysis, Cronbach's α, exploratory and confirmatory factory analysis were carried to examine the homogeneity of items, reliability, construct and concurrent validity. The STROBE checklist was adhered (See Appendix S1). Results The IRA-LTC scale comprised two dimensions: "cognition and intention to report" and "barriers to report." The two-factor structure explained 60.20%-61.89% of the total variance at two phases. Validation of the initial factorial model gained at the first phase was satisfactorily supported at the second phase. Concurrent validity of the IRA-LTC scale was satisfied. Cronbach's α for the scale and subscales was 0.94-0.97. Conclusions This IRA-LTC scale is valid and reliable and can be recommended to evaluate the incident-reporting attitude among all kinds of staff in long-term care facilities. Relevance to clinical practice Positive incident-reporting attitude can lead to positive incident-reporting behaviour. Using the IRA-LTC scale for assessing staff's incident-reporting attitude is recommended as the first step to enhance staff's safety performance in long-term care facilities.

Background: Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses’ values, the physician–nurse power hierarchy, and the influence of the culture. Research objective: To analyze the main causes for moral distress with interpretive interactionism. Research design: A qualitative study was adopted. Participants: Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples. Ethical considerations: Approval from the Institutional Review Board of the Kaohsiung Medical University Hospital. Findings: Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician–nurse power hierarchy, and the Oriental culture affect nurses’ goodness-based intention for patients, which deteriorates moral distress. Discussion: The main cause for moral distress is the moral goodness of nurses. If nurses’ goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients’ right to know about their diseases, the choice of treatment, and patients’ autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care. Conclusion: The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses’ confidence and cultural sensitivity, so as to reduce the moral distress of nurses.

To construct a model addressing the pathways from baseline diabetes distress, attribution of peer reactions, parenting style and 3-month self-management to 6-month glycated haemoglobin levels in adolescents with type 1 diabetes.A prospective design was adopted.A total of 177 adolescents aged 10-19 with type 1 diabetes were enrolled from four hospitals in Taiwan. Diabetes distress, attribution of peer reactions and parenting style were collected at baseline, self-management was collected at the third month and glycated haemoglobin levels were collected at the sixth month. Data were collected from May 2015-June 2016.Baseline diabetes distress and 3-month self-management directly affected 6-month glycated haemoglobin levels. Baseline attribution of peer reactions directly affected baseline diabetes distress and 3-month self-management; also, it indirectly affected 6-month glycated haemoglobin levels through 3-month self-management. Baseline parenting style directly affected baseline diabetes distress, baseline attribution of peer reactions, 3-month self-management and 6-month glycated haemoglobin levels; it also indirectly affected 6-month glycated haemoglobin levels through baseline diabetes distress and 3-month self-management.A model simultaneously incorporating individual, parental and peer factors to glycaemic control in adolescents with type 1 diabetes has been constructed. Improving diabetes distress and self-management should be essential strategies to improve glycaemic control in adolescents with type 1 diabetes. Encouraging adolescents with type 1 diabetes to communicate openly with peers about diabetes care and educating their parents to provide more responsive and autonomy-encouraging parenting style might be vital strategies to improve diabetes distress, 3-month self-management and glycaemic control.Individual, parental and peer factors should be simultaneously considered to improve glycaemic control in adolescents with type 1 diabetes. Nurses should evaluate these factors to tailor interventions improving glycaemic control in adolescents with type 1 diabetes.目的: 构建模型,说明患有1型糖尿病青少年从基准时间糖尿病困扰、同龄人反应归因、父母教养方式以及3个月自我管理到6个月糖化血红蛋白水平的转变途径。 设计: 采用前瞻性设计。 方法: 共选取台湾四所医院177名10-19岁患有1型糖尿病的青少年作为研究对象。于基准时间收集糖尿病困扰、同龄人反应归因和父母教养方式情况数据,于第3个月收集自我管理情况数据,于第6个月收集糖化血红蛋白水平数据。数据于2015年5月至2016年6月期间收集。 结果: 基准时间糖尿病困扰和3个月的自我管理对6个月时的糖化血红蛋白水平有直接影响。基准时间同龄人反应归因会直接影响基准时间糖尿病困扰以及3个月的自我管理情况;同时,它还通过3个月的自我管理对6个月时的糖化血红蛋白水平产生间接影响。基准时间父母教养方式对基准时间糖尿病困扰、基准时间同龄人反应归因、3个月的自我管理情况以及6个月时的糖化血红蛋白水平具有直接影响;同时,它还通过基准时间糖尿病困扰和3个月的自我管理情况对6个月时的糖化血红蛋白水平产生间接影响。 结论: 本研究建立了一个针对患有1型糖尿病青少年的血糖控制模型,且该模型同时纳入了个人、父母和同龄人因素。改善糖尿病困扰和自我管理情况应可作为改善患有1型糖尿病的青少年的血糖控制的基本策略。通过鼓励患有1型糖尿病的青少年与同龄人就糖尿病护理进行坦诚沟通,并指导其父母提供更多的响应式和自主鼓励式教养方式,此等方法可成为改善糖尿病困扰、3个月自我管理和血糖控制的重要策略。 影响: 为改善患有1型糖尿病的青少年的血糖控制情况,应同时考虑个人、父母和同龄人因素。护士应对此类因素进行评估,为患有1型糖尿病的青少年量身制定干预措施,以改善其血糖控制情况。.

Self-management among adolescents with type 1 diabetes (T1D) is poorer than in other age groups during childhood. A valid and reliable short-form scale to measure self-management in adolescents with T1D is prudent for enhancing their self-management in clinical settings. We used a cross-sectional design to develop a short-form Chinese version of the Self-Management of Type 1 Diabetes for Adolescents Scale (C-SMOD-A) and test its psychometric characteristics. Two hundred adolescents with T1D were recruited from four hospitals in Taiwan through convenience sampling. Content validity, exploratory factor analysis, and corrected item-total correlations were used to shorten the 52-item C-SMOD-A. Confirmatory factor analysis, criterion-related validity, and reliability testing were used to examine the psychometric characteristics of the short-form C-SMOD-A. Finally, the 23-item C-SMOD-A (C-SMOD-A-23) with five inter-correlated factors was developed. Glycated hemoglobin levels were significantly associated with each subscale of the C-SMOD-A-23 with correlation coefficients ranging from -0.18 to -0.31. The composite reliability and test-retest reliability of the five subscales ranged from 0.70 to 0.88 and from 0.78 to 0.93 respectively. Accordingly, the C-SMOD-A-23 has acceptable validity and reliability to measure five specific domains of self-management for adolescents with T1D. Health-care providers could use the C-SMOD-A-23 as a clinical reference to assess specific domains of self-management and provide interventions to enhance self-management for adolescents with T1D.

Purpose: The objective of this study was to explore the maternal health risk factors and sentinel events among women in the Solomon Islands, from the viewpoints of health care providers in the Solomon Islands. Design and Method: Three focus group interviews were conducted in July and August 2011 at a secondary referral hospital in an urban area. The study consisted of 10 registered nurses and 11 skilled birth assistants. Thematic analysis was used for this qualitative data analysis. Findings: Six major themes were emerged from the data: (a) environmental hazard: malaria, (b) malnutrition: iron deficiency anemia, (c) adolescent pregnancy, (d) betel nut chewing, (e) cultural beliefs influencing women’s health, and (f) difficulty accessing health care services. Conclusions and Implications for Practice: The results of this study provide a useful first step toward identifying specific maternal health risks among women in the Solomon Islands. The findings may assist the health sector and midwives/antenatal educators to better understand the health risks and reduce the disease burden among pregnant women in South Pacific countries. The results may also contribute to the development of policies to improve maternal health and to accelerate progress toward the fifth target goal of UNICEF’s Millennium Development Goals.

Background: Understanding the predictors of glycemic control in adolescents of various age groups with type 1 diabetes (T1D) is crucial for nurses to cultivate developmental-specific interventions to improve glycemic control in this age group. However, research has rarely addressed this issue, particularly in the context of Asian populations. Purpose: We explored the predictive influence of demographic characteristics, self-care behaviors, family conflict, and parental involvement on glycosylated hemoglobin (HbA1C) levels 6months after the baseline measurement in adolescents of various age groups with T1D in Taiwan. Methods: A prospective survey design was applied. At baseline, adolescents with T1D completed a self-care behavior scale. Parents or guardians finished scales of parental involvement and family conflict. The HbA1C levels 6 months after baseline measurement were collected from medical records. Two hundred ten adolescent-parent/guardian pairs were enrolled as participants. Multiple stepwise regressions examined the significant predictors of HbA1C levels 6 months after the baseline measurement in the three adolescent age groups: 10-12, 13-15, and 16-18 years. Results: Family conflict was a significant predictor ofHbA1C level within the 10-12 years of age group 6 months after the baseline measurement. Self-care behaviors were a significant predictor of HbA1C level within the 13-15 years of age group 6 months after the baseline measurement. Being female and self-care behaviors were each significant predictors of HbA1C level in the 16-18 years of age group 6months after the baseline measurement. Conclusions/Implications for Practice: Nurses should design specific interventions to improve glycemic control in adolescents of various age groups with T1D that are tailored to their developmental needs. For adolescents with T1D aged 10-12 years, nurses should actively assess family conflict and provide necessary interventions. For adolescents with T1D aged 13-18 years, nurses should exert special efforts to improve their self-care behaviors. In addition, female adolescents aged 16-18 years should be considered an at-risk group.

Aims and objectives. To examine the relationship between selected developmental assets and health-promoting behaviours of adolescents. Background. Developmental assets can be considered as potential health assets for adolescents. Understanding the relationship between developmental assets and health-promoting behaviours among adolescents could provide nurses with a new approach to design intervention programmes for adolescent health-promoting behaviours. Design. A cross-sectional study design. Methods. Anonymous questionnaires were administered to 453 adolescents aged between 13–16 years. Canonical correlation analysis was used to examine the relationship between selected developmental assets and health-promoting behaviours. Results. Canonical correlation analysis indicated two significantly meaningful variate pairs between selected developmental assets and health-promoting behaviour sets. The first pair variate accounted for 51·3% of the total variance, which showed that adolescents who had better self-esteem, future aspirations, responsible choices, family communication, non-parental adult role models, peer role models and community involvement had better behaviours of life appreciation, health responsibility, social support, stress management, nutrition and exercise. The second pair variate accounted for 9·6% of the total variance, which showed that adolescents who had better responsible choices had better stress management behaviours. Conclusion. Developmental assets are important to adolescents’ health-promoting behaviours. Interventions focusing on strengthening developmental assets can potentially provide an innovative approach for nurses to improve health-promoting behaviours of adolescents. Relevance to clinical practice. Strengthening developmental assets can potentially improve the health-promoting behaviours of adolescents. Individual and sociopolitical domains should be incorporated into programmes for enhancement of developmental assets. School nurses can cooperate with family and community and provide environments improving adolescents’ developmental assets. Nurses should actively engage in developmental asset programmes for adolescents. The tools for measuring developmental assets modified and developed in this study were valid and reliable. They can be used for further examination of the developmental assets for adolescents in various subset populations.

The role of "mother" is understood and represented differently by people from different cultures. In traditional Taiwanese society, mothers demonstrate their existence value by giving birth to and raising sons able to continue her husband's familial line. Sons bear the patriarchal name and care for their parents in old age. However, a son stricken, paralyzed and eventually killed by Duchenne muscular dystrophy (DMD) can destroy a mother's perceived value in this traditional social context. Mothers are thus soundless sufferers. Nurses have a critical role to play in giving encouragement and hope to mothers of children with DMD. Through their own difficult situation, these mothers can also highlight the value and importance of Taiwan's nurses, who work in conditions marked by overloading, high stress, and under-appreciation. Caring for women in critical need of empathy and support help nurses realize their own positive capacity to empower sufferers.是母親—台灣裘馨兒母親之存有與護理師的相遇母親角色的存有乃透過各種文化被人們理解並再現。傳統的台灣女性藉由生育、養育健康兒子以「延續宗族生命」、「養兒防老」來彰顯文化賦予母親的存有價值。然而，當母親的基因使其「兒子」罹患漸進癱瘓至死亡的「裘馨氏肌肉萎縮症」時，母親的存有價值即因悖離文化期待而斷裂。此斷裂之苦使母親身為「人」的存有本質被自身遺忘，而此遺忘讓母親成為無聲的受苦者。當存活在社會期盼—「燃燒自己，照亮別人」卻陷入職業環境惡化的護理人員與裘馨兒母親相遇時，期盼從同為竭力關照他人之母親角色的鏡像中，能鼓勵護理人員自身挺身而出，展現和倡議護理的存有讓人看見，而能在如此惡劣職場環境中對自身更加悅納，並從中產生力量，進而能與裘馨兒母親關照交換，使彼此的存有能發聲於社會且不再受苦。

wang r.-h., hsu h.-y., lin s.-y., cheng c.-p. & lee s.-l. (2010) Risk behaviours among early adolescents: risk and protective factors. Journal of Advanced Nursing66(2), 313–323. Abstract Title. Risk behaviours among early adolescents: risk and protective factors. Aim. This paper is a report of a study conducted to examine the influence of risk/protective factors on risk behaviours of early adolescents and whether protective factors moderate their impact. Background. An understanding of how risk and protective factors operate to influence risk behaviours of early adolescents will better prepare nurses to perform interventions appropriately to reduce risk behaviours of early adolescents. Method. A cross-sectional study was carried out, based on a sample of public junior high schools (from 7th to 9th grades) in one city and one county in Taiwan. An anonymous questionnaire designed to measure five risk factors, six protective factors and risk behaviours was administered from October 2006 to March 2007. Data from 878 students were used for the present analysis. Pearson’s correlations, anova with random effect models, and generalized linear models were used to analyse the statistically significant explanatory variables for risk behaviours. Findings. Gender, perceived father’s risk behaviour, perceived mother’s risk behaviour, health self-efficacy, interaction of health self-efficacy and perceived peers’ risk behaviour, and interaction of emotional regulation and perceived peers’ risk behaviour were statistically significant explanatory variables of risk behaviours. Health self-efficacy and emotional regulation moderated the negative effects of peers’ perceived risk behaviour on risk behaviours. Conclusion. All protective factors were negative statistically correlated with risk behaviours, and all risk factors positively statistically correlated with risk behaviours. Male adolescents should be considered an at-risk group for risk behaviour intervention. Nurses could provide early adolescents with training regarding health self-efficacy improvement, self-esteem enhancement, emotional regulation skills to reduce their risk behaviours.

Understanding the life experiences of mothers of children with Duchenne Muscular Dystrophy (DMD) is very important for nurses focused on providing family care. The present study provides valuable insight into this issue, as few studies on this important topic have been done previously.The objective of this study was to explore thoroughly the life experiences of mothers taking care of DMD children from their own perspectives.This study used a phenomenological approach. A purposive sample of 11 mothers of DMD children was recruited from the Taiwan Muscular Dystrophy Association (Southern Chapter). All agreed to join this study and were able to speak either Taiwanese or Mandarin fluently. Data collected through one-to-one, in-depth interviews were analyzed using the Colaizzi (1978) phenomenological methodology.Results showed that the life experiences of mothers of DMD children were typified by the theme, "racing with illness". Four categories emerged from interview data, including: "loss of time and space", "physical and psychological pain", "damage to relationships", and "financial difficulties".Study findings may help us better understand the life experiences of mothers of children with DMD and may serve as an important reference with regard to how best to coordinate government, medical, education and other support organizations to provide such mothers with greater support and assistance and DMD children with better care.

Few studies have explored the influence of postpartum depression on later life among mothers in Taiwan. The present follow-up study aims to explore the effects of postpartum depression on the psychosocial health of mothers and on the overall development of their infants. Follow-up evaluations were carried out on 29 postnatally depressed and 31 nondepressed mothers and their infants at 1 year after childbirth. Dependent variables were measured by means of five structured questionnaires. Postnatally depressed mothers reported significantly higher perceived stress but lower social support and self-esteem than nondepressed mothers at 1 year after childbirth. The participants’ postpartum depression had no significant effect on their infants’ eight developmental areas nor did depression influence their plans about the number of children to have in the future. Postpartum depression may have a negative influence on the psychosocial health of women but it does not appear to influence the overall development of their infants and their family planning. (authors)