Psychometric evaluation of the traditional chinese version of PedsQL™ 3.0 cardiac module scale in adolescents with congenital heart disease: reliability, validity, measurement invariance, and adolescent-parent agreement.

BACKGROUND: In recent decades, 95% of children with congenital heart disease (CHD) can survive to adolescence and adulthood. However, adolescents with CHD are prone to poorer health-related quality of life (HRQoL). It is imperative to develop a reliable and valid instrument for health professionals to monitor the HRQoL. This study aims to: (1) evaluate the psychometric properties of the traditional Chinese version of Pediatric Quality of Life™ 3.0 Cardiac Module (PedsQL-CM) and measurement invariance across adolescents with CHD and their parents; and (2) investigate the adolescent-parent agreement in HRQoL. METHODS: A total of 162 adolescents and 162 parents were recruited. Internal consistency was examined using Cronbach's alpha and McDonald's Omega. The criterion-related validity was evaluated with intercorrelations between the PedsQL-CM and PedsQL™ 4.0 Generic Core (PedsQL-GC) Scale. The construct validity was examined by second-order confirmatory factor analysis (CFA). Measurement invariance was evaluated using the multi-group CFA. The adolescent-parent agreement was analyzed with the intraclass correlation (ICC), paired t-tests, and Bland-Altman plots. RESULTS: PedsQL-CM showed acceptable internal consistency (self-reports 0.88, proxy-reports 0.91). The intercorrelations were medium to large effect size (self-reports 0.34-0.77, proxy-reports 0.46-0.68). The CFA supported the construct validity (CFI = 0.967, TLI = 0.963, RMSEA = 0.036, 90% CI = 0.026-0.046, SRMR = 0.065). The multi-group CFA proved scalar invariance between self and parent proxy-reports. Parents significantly underestimated their adolescents' HRQoL in cognitive problems (Cohen's d = 0.21) and communication (Cohen's d = 0.23) subscales, while there was a negligible difference in total HRQoL (Cohen's d = 0.16). ICCs were poor to moderate effect size with the highest and lowest agreement in heart problems and treatment subscale (ICC = 0.70) and communication subscale (ICC = 0.27), respectively. The Bland-Altman plots showed lesser variability in the heart problem and treatment subscale and the total scale. CONCLUSION: The traditional Chinese version of PedsQL-CM has acceptable psychometric properties to measure disease-specific HRQoL in adolescents with CHD. Parents may be proxies for adolescents with CHD to rate total HRQoL. When the patient-reported score is the primary outcome, the proxy-reported score could serve as a secondary outcome for research and clinical evaluation.

Development and Validation of Nurses' Well-Being and Caring Nurse-Patient Interaction Model: A Psychometric Study.

Nurses' care nurse-patient interaction (CNPI) competence is critical for improving nursing care quality. The focus is the psychological quality of nurses, which may be derived from their sense of well-being. The purpose of this study was to develop a conceptual model of nurses' well-being and their CNPI competence. A cross-sectional survey was conducted with a total of 212 valid questionnaires obtained from a medical center. Structural equation modeling analysis was performed to validate the conceptual model. The results demonstrated the positive correlation between two constructs of nurses' well-being ("contentment" and "joyfulness") and CNPI competence. A positive correlation between nurses' CNPI competence and their health-promoting lifestyle and work environment satisfaction was supported. Among the constructs of CNPI competence, "respect patients' life experience" was the most correlated with their well-being, health-promoting lifestyle, and work environment satisfaction. The constructs of these three scales, which showed a middle correlation with CNPI competence, are psychological constructs rather than material constructs. When nurses have a greater sense of well-being, a positive attitude towards life, and feel supported and respected in their work environment, their CNPI competence increases. The findings of this study provide important insights and can serve as empirical evidence for nursing managers to enhance nurses' CNPI competence.

[Nurse and Patient Dispute Litigation in Independent Nursing Practice].

BACKGROUND: Although medical dispute and other contentious cases involving patients and nurses have risen significantly in recent years, few studies have examined the litigation issues involved in nurse-patient disputes. PURPOSE: This study was designed to explore the background, categories, and degrees of harm to patients and the judgments made by the courts. METHODS: Qualitative research was used. Cases of criminal, written judgments related to nurse practice negligence and recorded in district courts in Taiwan from 2008 to 2017 were selected. Data were analyzed using content analysis. RESULTS: A total of 41 hospitals and 55 nurses were identified. The largest number of cases involved regional hospitals (36.6%), internal medicine departments (31.7%), general wards (46.3%), night shifts (40.0%), and staff nurses (85.5%). Four categories of independent nurse practice negligence were identified, including observation-evaluation, environmental security, physician notification, and nursing records. Negligent homicide (58.2%) was the most common court judgment and ten nurses (18.2%) were found guilty of the charges brought against them. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study highlight for nurses the content of nurse practice negligence and the related judgments by the courts, which hopefully may guide nurses to avoid practice negligence in the future.

Nurses' Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction Correlation: A Psychometric Study for Development of Nursing Health and Job Satisfaction Model and Scale.

Although promoting healthy work environments to enhance staff members' health and well-being is a growing trend, no empirical studies on such a model have been conducted in the nursing management field. The purpose of this study was to develop and validate measurement scales and a conceptual model of nurses' well-being, health-promoting lifestyle, and work environment satisfaction (WHS). A cross-sectional survey was conducted to develop a WHS model and Nursing Health and Job Satisfaction (NHJS) scale. A total of 672 questionnaires were obtained from registered nurses by stratified random sampling for validation analysis. The percentage of total variance explained greater than 92.6%, suggesting a good ability of the scales to explain the variability in participants' responses. The hypotheses of positive correlations among nurses' health-promoting lifestyle, well-being, and work environment satisfaction were supported. The WHS model demonstrates the positive correlation with correlation coefficients of 0.57-0.86 among nurses' health-promoting lifestyle, well-being, and work environment satisfaction. Nurses' attitudes play a key role in promoting a healthy lifestyle. The most important work environment satisfaction variable for improved sense of well-being is respect from other medical staff. The findings can serve as an instrument for hospital nursing administrators to accurately assess and enhance nurses' retention rate and health.

Maternal Caregiving for Children Newly Diagnosed with Acute Lymphoblastic Leukemia: Traditional Chinese Mothering as the Double-Edged Sword.

AIMS AND OBJECTIVES: To explore the meaning of maternal caregiving in the Chinese culture for children newly diagnosed with acute lymphocytic leukemia (ALL). BACKGROUND: Recurrence of and death associated with ALL remain the main concerns for mothers. Mothers experience guilt and anxiety towards their child's cancer. DESIGN: Descriptive phenomenological study. METHODS: Twelve mothers were recruited from a medical centre in Central Taiwan. The mothers were primary caregivers for their child diagnosed as having ALL in the past 3 months to 1 year. Data were collected through semi-structured interviews and analysed using Colaizzi's method. RESULTS: Four main themes emerged: feeling this world crashing by knowing the diagnosis, feeling the double-edged sword of mothering, worrying about potential risks for their vulnerable child, and passing through difficulties with power of support. CONCLUSIONS: Most mothers felt this world crashing due to potential loss of their child and seeing their child's suffering. The mother was blamed for her child's cancer but was also required to shoulder all caregiving for their child. The mothers needed to compromise their lives to protect their child from potential infection. Perceived power of support helped the mothers overcome difficulties. RELEVANCE TO CLINICAL PRACTICE: Findings support that nurses encouraging mothers to tell their stories, regardless of culture, will facilitate healing. Establishing trust and providing support from nurses, physicians, psychologists and social workers will lead mothers' readiness to deal with care of their sick child. Increasing visiting time for parental support for children hospitalized in the PICU is suggested as well.

Cross-cultural adaptation and validation of the Chinese Comfort, Afford, Respect, and Expect scale of caring nurse-patient interaction competence.

AIMS AND OBJECTIVES: To investigate the construct validity and reliability of the Chinese Comfort, Afford, Respect, and Expect scale, which can be used to determine clinical nurses' competence. The results can also serve to promote nursing competence and improve patient satisfaction. BACKGROUND: Nurse-patient interaction is critical for improving nursing care quality. However, to date, no relevant validated instrument has been proposed for assessing caring nurse-patient interaction competence in clinical practice. This study adapted and validated the Chinese version of the caring nurse-patient interaction scale. DESIGN: A cross-cultural adaptation and validation study. METHODS: A psychometric analysis of the four major constructs of the Chinese Comfort, Afford, Respect, and Expect scale was conducted on a sample of 356 nurses from a medical centre in China. Item analysis and exploratory factor analysis were adopted to extract the main components, both the internal consistency and correlation coefficients were used to examine reliability and a confirmatory factor analysis was adopted to verify the construct validity. RESULTS: The goodness-of-fit results of the model were strong. The standardised factor loadings of the Chinese Comfort, Afford, Respect, and Expect scale ranged from 0.73-0.95, indicating that the validity and reliability of this instrument were favourable. Moreover, the 12 extracted items explained 95.9% of the measured content of the Chinese Comfort, Afford, Respect, and Expect scale. CONCLUSIONS: The results serve as empirical evidence regarding the validity and reliability of the Chinese Comfort, Afford, Respect, and Expect scale. RELEVANCE TO CLINICAL PRACTICE: Hospital nurses increasingly demand help from patients and their family members in identifying health problems and assisting with medical decision-making. Therefore, enhancing nurses' competence in nurse-patient interactions is crucial for nursing and hospital managers to improve nursing care quality. The Chinese caring nurse-patient interaction scale can serve as an effective tool for nursing and hospital managers to evaluate the caring nurse-patient interaction confidence of nurses and improve inpatient satisfaction and quality of care.

Receipt of Life-Sustaining Treatments for Taiwanese Pediatric Patients Who Died of Cancer in 2001 to 2010: A Retrospective Cohort Study.

Aggressive life-sustaining treatments have the potential to be continued beyond benefit, but have seldom been systematically/nationally explored in pediatric cancer patients. Furthermore, factors predisposing children dying of cancer to receive life-sustaining treatments at end of life (EOL) have never been investigated in a population-based study. This population-based study explored determinants of receiving life-sustaining treatments in pediatric cancer patients' last month of life. For this retrospective cohort study, we used administrative data on 1603 Taiwanese pediatric cancer patients who died in 2001 to 2010. Individual patient-level data were linked with encrypted identification numbers from the National Register of Deaths Database, Cancer Registration System database, National Health Insurance claims datasets, and Database of Medical Care Institutions Status. Life-sustaining treatments included intensive care unit (ICU) care, cardiopulmonary resuscitation (CPR), and mechanical ventilation. Associations of patient, physician, hospital, and regional factors with receiving ICU care, CPR, and mechanical ventilation in the last month of life were evaluated by multilevel generalized linear mixed models. In their last month of life, 22.89%, 46.48%, and 61.45% of pediatric cancer patients received CPR, mechanical ventilation, and ICU care, respectively, with no significant decreasing trends from 2001 to 2010. Patients were more likely to receive all three identified life-sustaining treatments at EOL if they were diagnosed with a hematologic malignancy or a localized disease, died within 1 year of diagnosis, and received care from a pediatrician. Receipt of ICU care or mechanical ventilation increased with increasing EOL-care intensity of patients' primary hospital, whereas use of mechanical ventilation decreased with increasing quartile of hospice beds in the patients' primary hospital region. Taiwanese pediatric cancer patients received aggressive life-sustaining treatments in the month before death. Healthcare policies and interventions should aim to help pediatricians treating at-risk pediatric cancer patients and hospitals with a tendency to provide aggressive EOL treatments to avoid the expense of life-sustaining treatments when chance of recovery is remote and to devote resources to care that produces the greatest benefits for children, parents, and society.

Quality of Life After Hematopoietic Stem Cell Transplantation in Pediatric Survivors: Comparison With Healthy Controls and Risk Factors.

BACKGROUND: Hematopoietic stem cell transplantation has prolonged life for children with life-threatening diseases. Quality of life is an essential outcome for evaluating the long-term effects of transplantation. OBJECTIVE: The aims of this study were to compare the quality of life of children posttransplantation to that of healthy peers and explore the variables associated with the quality of life of posttransplant children. METHODS: A cross-sectional study was conducted with 43 pediatric transplantation survivors and 43 age- and sex-matched healthy peers. RESULTS: The mean age of the transplant group was 12.06 years. The mean time since transplant was 3.73 years. After covariate adjustment, there was no difference between posttransplant and healthy children in each domain and overall quality of life, except for physical functioning where the posttransplant children had lower scores than did the healthy group. Chronic graft-versus-host disease was found to be the primary factor associated with poor posttransplant overall quality of life and emotional and social functioning. Sociodemographic variables, symptom distress, and caregiver depression were not correlated with posttransplant quality of life. CONCLUSIONS: The quality of life of pediatric transplantation survivors was comparable to that of healthy peers. IMPLICATIONS FOR PRACTICE: The finding that children after transplant may achieve quality of life similar to their healthy peers is important information for parents to consider as they consider treatment options. For those sick children who cannot regularly attend school, their emotional and social functioning should be closely monitored.

Meshing Gears: Mothers and Their Adolescents Returning to Their Social Life After Cancer Treatment in Taiwan.

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

Translation and validation of an instrument for measuring the suitability of health educational materials in Taiwan: suitability assessment of materials.

BACKGROUND: It is essential to provide readily comprehensible health information to the public to increase healthy behaviors and improve outcomes. Researchers in English-speaking countries possess well-developed instruments to evaluate the suitability of health education materials. However, few of these instruments are available for use in Chinese-language environments. PURPOSE: This study aimed to translate the Suitability Assessment of Materials (SAM) into Chinese. Researchers used a rigorous translation and testing process to provide a valid instrument to evaluate the suitability of health education materials written in Chinese. METHODS: The translation process included forward- and back-translations and a test for translation equivalence that evaluated semantic and content equivalence. A panel discussion was held on the discrepancies between the original English and back-translated English versions. The content validity index was calculated to confirm the validity of the SAM Chinese version. Two raters used the Chinese-version SAM to evaluate seven health education handouts. A Cohen's kappa coefficient was calculated to estimate interrater agreement, and Cronbach's alpha assessed the internal consistency of the instrument. RESULTS: Discussions on the differences between the original English and initially translated Chinese versions of the SAM resulted in a final 22-item SAM Chinese version. The content validity index of the final Chinese-language SAM scale was .99, the Cohen's kappa coefficient of agreement was .25, and the Cronbach's alpha value was .91. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The SAM Chinese version is a valid and reliable instrument with potential use in evaluating the suitability of health education materials written in Chinese.

Comparison of resilience in adolescent survivors of brain tumors and healthy adolescents.

BACKGROUND: Resilience is essential for the psychological adjustment of adolescents experiencing difficulty. Comparing differences in resilience between adolescent survivors of brain tumors and healthy adolescents may help identify factors related to resilience in adolescents. OBJECTIVE: The purpose of this study was to clarify how illness impacts the normative development of adolescent survivors of brain tumors by comparing them to healthy adolescents in terms of resilience and how it is affected by various health problems. METHODS: This cross-sectional, case-control study used convenience sampling to recruit 13- to 18-year-old adolescent survivors of brain tumors and healthy adolescents matched by school level, gender, and living area. Data were collected by structured questionnaires. RESULTS: The sample included 60 adolescent survivors and 120 healthy adolescents. Participants in both groups were predominantly male adolescents (63.3%) and junior high school students (55%). The 2 groups did not differ significantly in resilience, but survivors without emotional problems had a higher mean resilience score than did healthy adolescents and survivors with emotional problems (F = 8.65, P < .01). CONCLUSIONS: Our results identify emotional problems as a risk factor for resilience in both adolescent survivors of brain tumors and healthy adolescents. In addition, the impact of emotional problems on resilience was more severe in brain tumor survivors than in healthy adolescents. IMPLICATIONS FOR PRACTICE: Our results suggest that pediatric oncology nurses design interdisciplinary school-based interventions to reduce the impact of emotional problems on resilience in both healthy adolescents and those who survived brain tumors.

Maternal-foetal attachment during early pregnancy in Taiwanese women pregnant by in vitro fertilization.

AIM: The aim of this study was to investigate maternal-foetal attachment at 9, 12 and 20 weeks gestation and to identify factors that influenced maternal-foetal attachment in Taiwanese women who conceived by in vitro fertilization. BACKGROUND: Development of maternal-foetal attachment is an important part of taking on the maternal role. However, evidence about maternal-foetal attachment after assisted conception is inconclusive. DESIGN: A longitudinal design with repeated measures. METHODS: A prospective, longitudinal design with repeated measures was used. Over an 18-month period in 2006-2008, a convenience sample of 160 women who conceived after undergoing successful in vitro fertilization were recruited from a major infertility care centre in Taiwan. Data were collected by self-reported measures, including: (1) Maternal-Foetal Attachment Scale; (2) Symptoms Checklist; (3) Pregnancy-related Anxiety Scale; (4) Social Support Apgar; (5) Chinese childbearing attitude Questionnaire; and (6) Awareness of Foetus Scale. The selected instruments to measure each variable were administered to participants at 9, 12 and 20 weeks gestation. RESULTS: Maternal-foetal attachment increased as pregnancy progressed from 9 to 20 weeks gestation. General linear mixed model showed predictors of maternal-foetal attachment included Chinese childbearing attitude, awareness of the foetus, and social support. CONCLUSION: Health provider awareness of cultural influences on the development of early maternal-foetal attachment of women pregnant by in vitro fertilization is needed. Prenatal education in early pregnancy might incorporate more information about foetal development to allow the mother to visualize her unborn child. Providing social support for women who were conceived by in vitro fertilization is beneficial to the development of maternal-foetal attachment.

Population-based study of birth prevalence and factors associated with cleft lip and/or palate in Taiwan 2002-2009.

BACKGROUND: Facial cleft deformities, including cleft lip with or without cleft palate (CL/P) and cleft palate (CP), are common congenital birth anomalies, especially in Asia. This study aimed to analyze the prevalence of CL/P and CP and to identify associated factors in Taiwan. METHODS: This population-based epidemiological study retrospectively analyzed birth data obtained from the Department of Health in Taiwan for years 2002-2009. Frequency distribution, percentages and related predictors were investigated, and findings were presented by types of cleft deformities. Logistic regression analysis was performed to identify factors associated with cleft deformities. RESULTS: Overall prevalence of cleft deformities among 1,705,192 births was 0.1% for CL/P and 0.04% for CP over the 8-year study period. Higher prevalence of CL/P or CP was observed with multiple pregnancies, being male for CL/P, being female for CP, gestational age ≤37 weeks and lower birth weight (<1.5 kg). Both CL/P and CP were significantly associated with gestational age <37 weeks and birth weight<1.5 kg (all P <0.0001). CL/P was significantly associated with multiple parities (P = 0.0004-0.002). Male newborns and female newborns were significantly associated with CL/P and CP, respectively (both P<0.0001). CONCLUSIONS: Overall prevalence for congenital cleft deformities in study subjects was 0.1%, in keeping with high rates in Asia. Results suggest the need for awareness and early identification of those at high risk for cleft deformities, including newborns with gestational age <37 weeks, weighing <1.5 kg at birth and women with multiple parities, as a potential strategy to counter long-term adverse effects on speech and language in this population.

An evaluation of disease knowledge in dyads of parents and their adolescent children with congenital heart disease.

BACKGROUND: Congenital heart disease (CGHD) can be considered a chronic disease for many patients. To adopt a healthy lifestyle and to avoid complications, patients with CGHD and their parents need to have good knowledge of the heart defect and its consequences. OBJECTIVE: The aims of this study were to evaluate patient and parental knowledge of CGHD and to explore the related factors of their respective disease knowledge. METHODS: This study included 116 dyads of adolescents with CGHD (43.1% male adolescents; aged 12-18 years) and one of their parents (79.3% mothers; median age, 46 years). All participants completed the Leuven Knowledge Questionnaire for Congenital Heart Disease, and then we calculated a correct rate score to determine the overall disease knowledge of the respondents. RESULTS: The correct rate score was 38.8% for adolescents with CGHD and 51.4% for parents (t = 7.69; P < .001). The only determinant of knowledge in parents was their educational level (standardized estimate = 6.160, P < .001). In adolescents, knowledge was determined by age (standardized estimate = 2.242, P = .002) and parental knowledge (standardized estimate = 0.311, P < .001). CONCLUSIONS: Although parents have significantly greater disease knowledge than their children do, the level of knowledge in both parents and adolescents is suboptimal. Because parents' knowledge influenced their adolescents' knowledge, educational interventions should target both adolescent patients and parents. Transition programs can play a pivotal role in this respect.

Using standardized patient with immediate feedback and group discussion to teach interpersonal and communication skills to advanced practice nursing students.

BACKGROUND: Interpersonal and communication skills (IPCS) are essential for advanced practice nursing (APN) in our increasingly complex healthcare system. The Standardized Patient (SP) is a promising innovative pedagogy in medical and healthcare education; however, its effectiveness for teaching IPCS to graduate nursing students remains unclear. OBJECTIVES: We examined the effectiveness of using SP with SP feedback and group discussion to teach IPCS in graduate nursing education. DESIGN: Randomized-controlled study. PARTICIPANTS: First-year APN students in Taiwan. METHODS: Participants were randomly assigned to the experimental (SP assessments with SP feedback and group discussion) or control (SP assessments only) group. There were two outcome indicators: IPCS and student learning satisfaction (SLS). The IPCS were assessed before and after the study in interviews with the SPs. SLS was measured when the study ended. RESULTS: All participants expressed high SLS (94.44%) and showed significant (p ≤ 0.025) improvements on IPCS total scores, interviewing, and counseling. However, there were no significant differences between groups. Qualitative feedback from encounters with SPs is described. CONCLUSIONS: Using SPs to teach IPCS to APN students produced a high SLS. The students learned and significantly improved their IPCS by interviewing SPs, but future studies are needed to confirm the effectiveness of SP feedback and group discussions.

Social-cognitive determinants of exercise behaviour among adolescents with mild congenital heart disease.

BACKGROUND: Nowadays, most adolescents with mild congenital heart disease (CHD) undergo medical or surgical correction in early childhood for their congenital anomalies. There is a need to examine the determinants of exercise behaviour among adolescents (CHD) who are able to exercise. AIMS: The aims of this study were to examine determinants of exercise among adolescents with mild CHD, including personal beliefs about exercise, interpersonal influences on exercise, and availability of physical environments for exercise, based on social-cognitive theory. METHOD: A repeated-measures study was conducted at three medical centres in Taiwan. All participants, 126 adolescents with CHD aged 12 to 18 years, had a cardiologist's recommendation of exercise with no limits or limits only on vigorous exercise. Self-administered questionnaires were completed during a summer vacation and again in the fall semester of school along with a 7-day exercise log. The data were analysed using structured equation modelling. RESULTS: The effect of interpersonal influences on total exercise and moderate-to-vigorous exercise was mediated by personal exercise beliefs. Peer influences had significant effects on moderate-to-vigorous exercise through the mediator of perceived exercise self-efficacy. There was no significant difference in the determinants of exercise behaviour during two periods. Personal exercise beliefs, particularly perceived exercise self-efficacy, played the most important role in determining the performance of moderate-to-vigorous exercise. CONCLUSIONS: The social-cognitive determinants may serve as a clinical reference for promoting exercise among adolescents with mild CHD.

Measuring knowledge of patients with congenital heart disease and their parents: validity of the 'Leuven Knowledge Questionnaire for Congenital Heart Disease'.

BACKGROUND: Patients with congenital heart disease (CHD) and their parents need to have sufficient knowledge on their condition, treatment, medication, and preventive measures. The Leuven Knowledge Questionnaire for Congenital Heart Disease (LKQCHD) was developed to comprehensively measure the level of knowledge in patients with CHD. AIMS: This study aimed to translate the LKQCHD into Chinese and to test its validity to be used in patients with CHD and their parents. METHOD: Questionnaire translation was guided by a three-step linguistic validation method. Evidence based on test content and on relation with other variables was obtained. For test content, we included five experts in CHD and research methods. Furthermore, the instrument was tested in 89 pairs of adolescents with CHD and their parents. RESULTS: We found a high item-level content validity index (>0.78 in all except two items), high scale-level content validity index (>0.90), high free-marginal multirater Kappa (>0.75), and low average proportion of missing values (0.49% in adolescents; 0.51% in parents), showing an excellent content validity. The hypothesized positive correlations between parental knowledge and parental educational level and between patient's knowledge and patient's age, as well as the hypothesis that parents have more knowledge than their children, were confirmed. This provides validity evidence based on relation with other variables. CONCLUSIONS: The Chinese version of the LKQCHD is valid to assess the level of knowledge in patients with CHD and their parents.

Knowledge of using acetaminophen syrup and comprehension of written medication instruction among caregivers with febrile children.

AIM: This article aims to explore caregivers' knowledge of acetaminophen and comprehension of written medication instructions about acetaminophen syrup when administered to febrile children. BACKGROUND: Fever is one of the most common problems about which primary caregivers seek medical advice for their children. Administration of acetaminophen is the most common form of treatment for febrile children. Medication safety is of the upmost importance for medication administration in this patient group. DESIGN: A cross-sectional study design was used. METHODS: The study included 102 caregivers with febrile children under six years old. A self-designed questionnaire was used to solicit participants' responses concerning: (1) approaches to fever management prior to hospital admission; and (2) knowledge and comprehension of antipyretic medication administration. Caregivers were asked to answer specific questions about the instructions provided with the medication. Results. Antipyretic by oral (66%) and antipyretic suppository (60%) were the most commonly used forms of fever management in febrile children. After reading the written medication instructions, one-third of the participants had more than one misunderstanding of the instructions for medication with timing, time interval of administration and/or medication dosage. Almost two-thirds of the participants misunderstood the side effects of acetaminophen. Participants with a poorer academic background were associated with poorer comprehension of the provided instructions. CONCLUSION: Administration of antipyretic medication is the most common approach taken to reduce children's temperature. A significant percentage of primary caregivers appear to lack a thorough understanding of the instructions provided with antipyrexial medication. RELEVANCE TO CLINICAL PRACTICE: Written medication instruction is a major source of information for primary caregivers. Clinical nurses have a potentially important role to play to provide caregivers with legible and understandable medication instructions and to ensure that caregivers fully comprehend this information.

Exercise behavior in adolescents with mild congenital heart disease.

BACKGROUND AND RESEARCH OBJECTIVES: Most children with congenital heart disease (CHD) are expected to survive to adolescence and adulthood owing to medical advances and care management. These adolescents need to be well informed about their exercise capacity and take greater personal responsibility for their exercise behavior as they mature. The aims of this study were to compare the amount and intensity of exercise engaged in by male and female adolescents with mild CHD while on summer vacation and during the academic semester and to determine the extent to which their exercise behavior met cardiologists' recommendations, based on New York Heart Association functional classification. PARTICIPANTS AND METHODS: A repeated-measure design was used to evaluate exercise behavior in 126 adolescents 12 to 18 years old with mild CHD from the outpatient cardiology departments of 3 medical centers in Taiwan. Exercise, classified as mild, moderate, or vigorous, was evaluated during summer vacation and during the fall semester using a 7-day self-reported exercise log. RESULTS AND CONCLUSIONS: Patients engaged in significantly more mild and total exercise during summer vacation than they did during the fall semester. They also engaged in significantly less vigorous exercise during summer vacation than they did in the fall semester. Female respondents engaged in significantly less moderate (P = .019), vigorous (P < .001), and total (P = .015) exercise than did their male counterparts but showed no difference in mild exercise. During the summer and fall, nearly 50% of the adolescents followed their cardiologist's recommendations for exercise. Adolescents with mild CHD engaged in more exercise during summer vacation but engaged in more vigorous exercise during the fall semester. Approximately one half did not follow the exercise intensity recommended by cardiologists. Inadequate exercise patterns may lead to cardiovascular complications. Planned interventions related to exercise instruction are needed for adolescents with CHD.

Effects of maternal confidence and competence on maternal parenting stress in newborn care.

AIM: This paper is a report of a correlational study of the relations of maternal confidence and maternal competence to maternal parenting stress during newborn care. BACKGROUND: Maternal role development is a cognitive and social process influenced by cultural and family contexts and mother and child characteristics. Most knowledge about maternal role development comes from western society. However, perceptions of the maternal role in contemporary Taiwanese society may be affected by contextual and environmental factors. METHODS: A prospective correlational design was used to recruit 372 postpartum Taiwanese women and their infants from well-child clinics at 16 health centres in central Taiwan. Inclusion criteria for mothers were gestational age >37 weeks, ≥18 years old, and healthy, with infants <4 months old. Data were collected between August 2007 and January 2008 using a self-report questionnaire on mothers' and infants' demographic variables, maternal confidence, maternal competence and self-perceived maternal parenting stress. RESULTS: After controlling for maternal parity and infant temperament, high maternal confidence and competence were associated with low maternal parenting stress. Maternal confidence influenced maternal parenting stress both directly and indirectly via maternal competence. CONCLUSION: To assist postpartum women in infant care programmes achieve positive outcomes, nurses should evaluate and bolster mothers' belief in their own abilities. Likewise, nurses should not only consider mothers' infant care skills, but also mothers' parity and infant temperament. Finally, it is crucial for nurses and researchers to recognize that infant care programmes should be tailored to mothers' specific maternal characteristics.