Factors affecting health adaptation of Chinese adolescents with type 1 diabetes: A path model testing.

Glycemic control and quality of life (QoL) are both considered indicators of health adaptation among adolescents with type 1 diabetes (T1D). The purpose of this study was to construct a path model addressing the influences of individual characteristics, school support, resilience, and self-care behaviors on glycated hemoglobin (HbA1c) and QoL among adolescents with T1D in Taiwan. This was a cross-sectional design study. A structured questionnaire was used to collect information on individual characteristics, school support, resilience, self-care behaviors, and QoL. The latest HbA1c was collected from medical records. Data from 238 adolescents with T1D were analyzed using structural equation modeling to test the hypothesized path model. The findings indicated that self-care behaviors and resilience both directly influenced HbA1c and QoL. School support directly influenced QoL but indirectly influenced HbA1c. We suggest that improving self-care behaviors and resilience could be considered an appropriate intervention for enhancing the health adaptation of adolescents with T1D. Increasing school support might be a strategy to improve QoL among adolescents with T1D.

Efficacy of an empowerment program for Taiwanese patients with type 2 diabetes: A randomized controlled trial.

AIM: To examine the efficacy of an empowerment program on glycosylated hemoglobin, self-care behaviors, self-efficacy, and quality of life in Taiwanese patients with type 2 diabetes. BACKGROUND: Although empowerment interventions have proven beneficial in western populations, they are rarely applied in Taiwanese populations. METHODS: A randomized controlled trial was conducted. The experimental group (n=33) participated in a 3-month empowerment program for motivating patient self-awareness, assessing the causes of problems, goal setting, individual self-care plan development, and checking whether the goal is reached (MAGIC). The control group (n=32) received routine clinical care. RESULTS: The experimental group had significantly decreased glycosylated hemoglobin at 3 months after the end of the intervention and significantly improved self-care behaviors, self-efficacy, and quality of life at the end of the intervention and at 3 months after the end of the intervention. CONCLUSIONS: An empowerment program effectively improves diabetes control in Taiwanese patients with type 2 diabetes.

[Disorder in life and the world: the illness experiences of women with diabetes in Taiwan].

BACKGROUND: The role of women is strongly associated with health behavior. Understanding the illness experiences of women with diabetes helps health professionals to provide appropriate health care to women with diabetes. PURPOSE: The purpose of this study was to explore the illness experiences of women with diabetes. METHODS: This study used interpretive ethnographic methods with in-depth interviews and field observations to obtain emic points of view from women who were diagnosed with diabetes. Agar's hermeneutic cycle was used to analyze the collected data. The participants were recruited under the principle of maximum variation. The inclusion criteria targeted women who: (1) had been diagnosed with diabetes for at least one year, (2) were able to speak Mandarin or Taiwanese, and (3) were willing to participate and have their sessions tape-recorded in a diabetes clinic in southern Taiwan. A total of 18 women with diabetes between 24 and 79 years of age were enrolled as participants. RESULTS: "Disorder in life and the world" was the main storyline elicited from participants. The four themes con-structed from this disorder were: (1) disorder of the body: reliance on medical care to understand the body, (2) disorder of life: shift from being in control of food to being controlled by food, (3) disorder of the family: sick person is perceived as incompetent, and (4) disorder of the self: controlling the body for the family. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Healthcare providers should recognize and make positive use of the potential of the cultural role of women to improve the ability of women to self-manage their diabetes. Additionally, perceiving the entire family as the client may improve the illness experience for Asian women with diabetes.

The Efficacy of a Family-Based Intervention Program on Childhood Obesity: A Quasi-Experimental Design.

The purpose of this quasi-experimental study was to assess the efficacy of a family-based (FB) weight-loss and behavior-modification intervention among overweight/obese children (age 9-11 years) and their parents in Taiwan. The intervention group (52 child-parent dyads) participated in an FB program for 7 weeks. The control group (55 child-parent dyads) received an educational pamphlet about obesity prevention. The children's body mass index (BMI) z-scores were the primary outcome variable. The parents' BMI, high-calorie (HC) food-intake behaviors, screen-related behaviors, and restrictions on children's consumption of HC foods and screen-related behaviors and the availability of HC foods at home were the secondary outcome variables. Outcome variables were measured at baseline (T0), at the end of the intervention (T1), and 4 weeks after the end of the intervention (T2). A linear mixed model was used to assess the efficacy of the FB program. Results indicated that the children's BMI z-scores decreased significantly more from T0 to T2 in the experimental group than in the control group. The decreases in parents' HC food-intake behaviors and availability of HC foods at home and the increase in parental restrictions on children's consumption of HC foods were significantly greater in the experimental than in the control group from T0 to T1 and T0 to T2. The FB program was effective in modifying parental behaviors and the weight of overweight/obese children in a Taiwanese population.

Relationships among sexual self-concept and sexual risk cognition toward sexual self-efficacy in adolescents: cause-and-effect model testing.

AIM: Sexual self-efficacy plays an important role in adolescents' sexual health. The aim of this study was to test a cause-and-effect model of sexual self-concept and sexual risk cognition toward sexual self-efficacy in adolescents. METHODS: The study was a cross-sectional survey. Using a random sampling method, a total of 713 junior nursing students were invited to participate in the study, and 465 valid surveys were returned, resulting in a return rate of 65.2%. The data was collected using an anonymous mailed questionnaire. Structural equation modeling was used to test the relationships among sexual self-concept, sexual risk cognition, and sexual self-efficacy, as well as the mediating role of sexual risk cognition. RESULTS: The results revealed that the postulated model fits the data well. Sexual self-concept significantly predicted sexual risk cognition and sexual self-efficacy. Sexual risk cognition significantly predicted sexual self-efficacy and had a mediating effect on the relationship between sexual self-concept and sexual self-efficacy. CONCLUSION: Based on social cognitive theory and a structural equation model technique, this study confirmed the mediating role of sexual risk cognition in the relationship between sexual self-concept and sexual self-efficacy. Also, sexual self-concept's direct and indirect effects explaining adolescents' sexual self-efficacy were found in this study.

Organisational support, organisational identification and organisational citizenship behaviour among male nurses.

AIMS: The purpose of this study was to explore the relationship between organisational support, organisational identification, and organisational citizenship behaviour and the predictors of organisational citizenship behaviour in Taiwanese male nurses. BACKGROUND: The turnover rate among male nurses is twice that of female nurses. Organisational citizenship behaviour is the predictor of turnover intention. Little information is available on the relationship between organisational support, organisational identification and organisational citizenship behaviour, particularly for male nurses. METHODS: Data were collected in 2010 from a questionnaire mailed to 167 male nurses in Taiwan. A cross-sectional survey with simple sampling was used in this study. RESULTS: The results showed that organisational identification and organisational support were correlated with organisational citizenship behaviour. Organisational distinctiveness, organisational support of work conditions and the type of organisation were the main predictors of organisational citizenship behaviour. Together they accounted for 40.7% of the total variation in organisational citizenship behaviour. Organisational distinctiveness was the most critical predictor, accounting for 29.6% of the variation. CONCLUSION: Organisational support and organisational identification have positive relationships with organisational behaviour. Organisational distinctiveness is an important factor in explaining organisational citizenship behaviour in male nurses. IMPLICATIONS FOR NURSING MANAGEMENT: This finding provides concrete directions for managers to follow when providing organisational identification, in particular, the organisational distinctiveness will help male nurses to display increasingly more organisational citizenship behaviour.

Risk and protective factors for suicidal ideation among Taiwanese adolescents.

BACKGROUND: : Suicide is the ninth leading cause of death in adolescents aged 15-19 years in Taiwan. Suicidal ideation is an important predictor of committing suicide among adolescents. OBJECTIVES: : The aim of this study was to examine the important risk factors, the protective factors, and the role of protective factors on the relationship of risk factors to suicidal ideation among Taiwanese adolescents aged 15-19 years. METHODS: : By adopting a cross-sectional study, senior high school students (n = 577) aged 15-19 years in southern Taiwan were recruited for this study. An anonymous self-reported questionnaire was used to collect demographic characteristics, risk factors, protective factors, and suicidal ideation of the sample. Hierarchical logistic regression was used to identify the important risk and protective factors and the interaction between risk and protective factors on suicidal ideation. RESULTS: : Nearly 18% (n = 101) of the participants reported having suicidal ideation during the past 12 months. Gender (female; odds ratio [OR] = 4.23), life stress (OR = 1.03), depression (OR = 3.44), peer suicidal ideation (OR = 4.15), and bullying victimization (OR = 1.81) were important risk factors of suicidal ideation among the targeted sample. In addition, self-esteem (OR = 0.92) and emotional adaptation (OR = 0.88) were important protective factors of suicidal ideation. Self-esteem and emotional adaptation were not used to moderate the negative effects of life stress, depression, perceived peer suicidal ideation, and bullying victimization on suicidal ideation. The final model explained 40.6% of the total variance in suicidal ideation and correctly predicted 86.1% of participants with suicidal ideation. DISCUSSION: : Suicidal ideation prevention programs should be targeted to female adolescents. School-based efforts that provide adolescents with self-esteem enhancement, emotional regulation skills training, positive peer norms for life, coping skills for managing stress and depression, and antibullying programs might help reduce the suicidal ideation of adolescents.

The Mini Nutritional Assessment (MNA) is useful for assessing the risk of malnutrition in adults with intellectual disabilities.

AIM: The study was aimed to examine the appropriateness of using the Mini Nutritional Assessment to screen for risk of under- and over-nutrition in adults with intellectual disabilities. BACKGROUND: Persons with intellectual disabilities are at increased risk of malnutrition, but routine monitoring of their nutritional conditions are not widely done. DESIGN: The study purposively recruited 104 institutionalised adults (≥19 years old) with intellectual disabilities to serve as participants. METHODS: Participants were interviewed with a structured questionnaire to elicit personal data, health-related information and answers to items in the Activities of Daily Living and the Mini Nutritional Assessment scales and measured for anthropometrics. Biochemical data were taken from their routine medical measurements. Each subject was graded with the Mini Nutritional Assessment that adopted Taiwanese-specific anthropometric cut-off points (T1) and an alternative version that omitted the body mass index item (T2). RESULTS: Both Mini Nutritional Assessment versions were able indentifying individuals at risk of malnutrition among adults with intellectual disabilities and rated comparable proportions of patients malnourished (6·7 and 5·8% for Mini Nutritional Assessment-T1 and Mini Nutritional Assessment-T2, respectively) or at risk of malnutrition (14·4 and 17·3%, respectively). Persons with cerebral palsy were at greater risk of malnourishment than persons with other disabilities. CONCLUSION: The Mini Nutritional Assessment is appropriate for screening for under- and over-nutrition in adults with intellectual disabilities. The Mini Nutritional Assessment (especially the version without body mass index) can make routine monitoring of nutritional status of these patients an easier task. However, further studies are needed to develop subtype-specific versions (tools) as various subtypes of intellectual disability are associated with different nutritional problems. RELEVANCE TO CLINICAL PRACTICE: The Mini Nutritional Assessment can serve as a tool for routine screening for under- and over-nutrition in persons with intellectual disabilities.

Short form of the Chinese version Diabetes Quality of Life for Youth Scale: a psychometric testing in Taiwanese adolescents with type 1 diabetes.

OBJECTIVE: To test the psychometric properties of the short form of the Chinese version Diabetes Quality of Life for Youth scale (C-DQOLY-SF). RESEARCH DESIGN AND METHODS: A 30-item C-DQOLY-SF was administered to 371 adolescents with type 1 diabetes. Exploratory and confirmatory factor analysis, correlation with HbA(1c), internal consistency, and test-retest reliability were used to examine the psychometric characteristics of C-DQOLY-SF. RESULTS: A 25-item questionnaire with three correlated second-order factor structures best fitted data. Scores on the 25-item C-DQOLY-SF significantly correlated with HbA(1c) values. Cronbach's α and ICCs of each scale and subscale ranged from 0.77 to 0.90 and from 0.70 to 0.92, respectively. CONCLUSIONS: The C-DQOLY-SF has satisfactory reliability and validity. The C-DQOLY-SF can be conveniently used in clinical settings to assess the quality of life of adolescents with type 1 diabetes.

A path model of health-related quality of life in type 2 diabetic patients: a cross-sectional study in Taiwan.

AIMS: To construct a path model about relationships of perceptions of empowerment, diabetes distress, self-care behaviour and glycemic control to health-related quality of life in Taiwanese Type 2 diabetic patients, suffering from diabetes for 10 years or less. BACKGROUND: Health-related quality of life is the primary end point for people with diabetes. Understanding the path model of health-related quality of life in Type 2 diabetic patients is useful for nurses to design early intervention programmes. METHODS: This was a cross-sectional study. An anonymous questionnaire was used to collect data from 2007 to 2008. Glycosylated haemoglobin (HbA1c) was also collected. Data from 428 Type 2 diabetic patients were analysed with structural equation modelling to test the fit of the hypothesized path model to the data. RESULTS: A model was produced in which self-care behaviour had a statistically significantly direct influence on satisfaction, impact and worry aspects of health-related quality of life. Glycosylated haemoglobin had a statistically significantly negative influence on satisfaction, and impact aspects of health-related quality of life. Perceptions of empowerment had a statistically significantly direct influence on satisfaction aspect of health-related quality of life. Diabetes distress had a statistically significantly direct influence on satisfaction, impact and worry aspects of health-related quality of life. CONCLUSIONS: Nurses should develop new approaches to improve various aspects of health-related quality of life. Nurses could empower patients to improve satisfaction aspect of health-related quality of life. To improve the impact and worry aspects of health-related quality of life, nurses should reduce diabetes distress felt by patients.

Evaluation of a Leadership Orientation Program in Taiwan: preceptorship and leader competencies of the new nurse manager.

The Leadership Orientation Program is designed to provide new nurse managers with the experience and support that assures them of a smooth transition from their current roles to being managers. The main objective of this study was to gain an understanding of the relationship that exists between a nursing preceptorship and a new nurse manager's competencies; it also attempted to establish a predictive model of leader competencies to improve the program. A descriptive cross-sectional research design and rigorous questionnaires were used in this study. Fifteen new nurse managers, 101 staff nurses, and 20 nurse administrators were recruited from those engaged in ongoing preceptorship. Over the course of the study statistically significant improvements in preceptorship were noted in both new manager educational background and support from staff nurses. Eighty-five percent of new nurse managers had good or excellent performance ratings (Mean=84.25%). The significant predictive factors of nurse leader competencies were the educational background of new managers and the teaching resources available with regard to preceptorship (R(2)=88.5%, F=6.86, p<0.001).

Job stress, achievement motivation and occupational burnout among male nurses.

AIM: This paper is a report of an exploration of job stress, achievement motivation and occupational burnout in male nurses and to identify predictors of occupational burnout. BACKGROUND: Since the Nightingale era, the nursing profession has been recognized as 'women's work'. The data indicate that there are more female nurses than male nurses in Taiwan. However, the turnover rate for male nurses is twice that of female nurses. Understanding the factors that affect occupational burnout of male nurses may help researchers find ways to reduce the likelihood that they will quit. METHOD: A survey was conducted in Taiwan in 2008 using a cross-sectional design. A total of 121 male nurses participated in the study. Mailed questionnaires were used to collect data, which were analysed using descriptive statistics and stepwise multiple regression. RESULTS: The job stress of male nurses was strongly correlated with occupational burnout (r = 0.64, P < 0.001). Stepwise multiple regression analyses indicated that job stress was the only factor to have a statistically significant direct influence on occupational burnout, accounting for 45.8% of the variance in this. Job stress was comprised of three dimensions, of which role conflict accounted for 40.8% of the variance in occupational burnout. CONCLUSION: The contribution of job stress to occupational burnout of male nurses was confirmed. As occupational burnout may influence the quality of care by these nurses, nurse managers should strive to decrease male nurses' job stress as this should lead to a reduction of negative outcomes of occupational burnout.

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.

Exploring the effect of sexual empowerment on sexual decision making in female adolescents.

BACKGROUND: Traditional health education may not provide adequate sexual information to female adolescents. Sexual health education for female adolescents broadens opportunities for nurses to help female adolescents adopt appropriate sexual attitudes and make appropriate decisions. PURPOSE: The purpose of this study was to understand the effect of sexual empowerment on sexual decision making in female adolescents. METHODS: Twenty-nine female students with steady boyfriends were invited to participate in a sexual empowerment course. Course activities specifically related to sexual empowerment were audio-tape-recorded. Dialogue content was analyzed, and content provided by each study participant was reconfirmed in face-to-face interviews to understand the entire empowerment process in terms of how such may affect responses and to assess the possibility of correctly reinterpreting findings during the member check process. This study also took into consideration degrees of reliability and rigorousness. RESULTS: The four themes found to underlie participant perceptions of their sexual empowerment to make sex-related decisions were as follows: (a) proactively seeking sexual knowledge, (b) reexamining relationships with boyfriends, (c) the right to say "no" and to engage in self-protection, and (d) the need to change sexual attitudes and behaviors. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Using the peer group intervention in sexual empowerment may positively impact sexual health decision making in adolescent girls. Nursing professionals may consider peer group intervention as a sexual empowering method in healthcare.

Testing a model of contraception use behavior among sexually active female adolescents in Taiwan.

The purpose of this cross-sectional study was to test a model of contraception use among sexually active Taiwanese female adolescents, using structural equation modeling. Anonymous questionnaires were distributed to 404 female adolescents who had had sexual intercourse in the previous 3 months. A model was produced in which past contraception use, self-efficacy for contraception use, and decisional balance for using contraception had significant direct effects on current contraception use. Social influences had not only significant direct effects on self-efficacy and on decisional balance, but also a significant indirect effect on current contraception use. These findings provide a reference for the development of contraceptive intervention programs for sexually active female adolescents in Taiwan.

A study of role stress, organizational commitment and intention to quit among male nurses in southern Taiwan.

Gender and sex role stereotyping are recognized as having the potential to limit the professional development of males within the nursing profession. The purpose of this study was to understand the relationships between demographic data and the dimensions of role stress, organizational commitment, and intentions to quit among male nurses in southern Taiwan. Research also investigated the correlations with three dependent variables and identified best predictors of male nurse intentions to quit the nursing profession. A total of 91 male nurses volunteered to participate in this cross-sectional research. Research results were based on data collected from questionnaires sent by mail to participants. A total of 76 valid questionnaires were returned and used in analysis (response rate = 83.5%). Findings pointed to patients, colleagues and society as the major sources of role stress for male nurses. These sources of stress, and the resultant intention to quit on the part of male nurses, are due in significant part to the widespread stereotyping of the profession of nursing as a "woman's occupation". Such stress pressures male nurses to consider quitting to take jobs in other professional fields. Role stress is correlated to intention to quit among male nurses. Role stress and years of service are highly relevant predictors of male nurse intention to quit and leave the nursing profession, explaining 33.8% of variability. We suggest that at various levels of education and society, promotion of male and female equality should be increased. There is also a need for psychological consultation as well as the promotion of male nurse role models to prevent male nurses turning away from nursing careers.

A relationship power scale for female adolescents: preliminary development and psychometric testing.

OBJECTIVES: To develop and test psychometric characteristics of the Relationship Power Scale (RPS), which can be used to explore the relationship power of female adolescents in heterosexual relationships. METHODS: Cross-sectional design. Female adolescents in Kaohsiung City, Taiwan, who had a steady relationship with a boyfriend at the time of the study were recruited as study subjects (n=414) to test validity and reliability of the RPS. RESULTS: Confirmatory factor analysis revealed that a one-factor model with correlated uniqueness among the positively worded items best fits the data. There were significantly different scores in 3 different response groups on 2 items regarding who (participants, both themselves and their boyfriends equally, or their boyfriends) had more power in the relationship, and who was more emotionally involved in the relationship for all subjects. For subjects having sex with their steady boyfriends, RPS scores significantly differ among the 3 different response groups on 2 items regarding who had more say about having sex, and who had more say about using condoms. Cronbach's alpha for the RPS was .69. Test-retest reliability coefficients for the RPS were .83. CONCLUSIONS: The RPS exhibited acceptable reliability and validity. Further research is recommended to use the RPS in sex-related behavior research among heterosexual female adolescents.

Correlates of sexual abstinence among adolescent virgins dating steady boyfriends in Taiwan.

PURPOSES: (a) To examine the relations among processes of change, decisional balance, self-efficacy, perceptions of personal power, and relationship power to stage of change (SOC) for sexual abstinence behavior, and (b) to identify the important explanatory factors of SOC for sexual abstinence among adolescent virgins who were dating steady boyfriends. DESIGN: A cross-sectional survey. Female adolescents (N=500) who were dating steady boyfriends and had not had sexual experience in the past were selected. METHODS: An anonymous, self-administered questionnaire was used with parts concerning: age, processes of change for sexual abstinence, decisional balance for sexual abstinence, self-efficacy for sexual abstinence, perceptions of personal power, perceptions of relationship power, and SOC for sexual abstinence. FINDINGS: Processes of change, decisional balance, self-efficacy, perceptions of personal power, and relationship power differed across the SOC for sexual abstinence. Stepwise logistic regression showed higher self-efficacy for sexual abstinence, higher decisional balance for sexual abstinence, and lower age increased the probability of being in the definite group (preparation and action stage). In the final regression model 77.3 % of the participants were correctly classified. CONCLUSIONS: This information about SOC for sexual abstinence can be used by health professionals for intervention strategies for adolescent girls who were dating steady boyfriends.

[The self-determination and family empowerment of nursing home residents].

Long-term care for the elderly, disabled and handicapped is changing, with the trend shifting away from the prior emphasis on professional qualifications and cost management and toward allowing individuals increased authority to influence care policies and determine services provided. Within this trend, increased participation by family members, expanded care recipient rights, and family empowerment are driving the development of a new cooperative relationship between professional health care providers, care recipients and their families.

Correlates for consistency of contraceptive use among sexually active female adolescents.

This study explored the correlates for consistency of contraceptive use among sexually active female adolescents in Kaohsiung County, Taiwan. Overall, 164 female adolescents who had engaged in sexual behavior within the last 6 months and were not pregnant at the time of the study were selected from two vocational high schools in Kaohsiung County, Taiwan. An anonymous questionnaire was used to measure demographic data, contraceptive attitudes, contraceptive knowledge, contraceptive self-efficacy, perception of peers' use of contraceptives, sexual history, and contraceptive use. The results showed that 45.7% of subjects had sex once or more per week, and that 39.6% of subjects always used contraceptives while 15.2% never used contraceptives. Condoms were the most popular contraceptives (51.2%) and the withdrawal method was the second most popular (23.8%). Stepwise logistic regression showed that higher contraceptive attitudes (odds ratio, OR, 1.148) and previous contraceptive education in school (OR, 3.394) increased the probability of consistently using contraceptives, correctly classifying 67.2% of the sample.