A preliminary study of the effectiveness of video visitation on depression and stress in mothers with preterm infants during the pandemic.

BACKGROUND AND PURPOSE: Parents of preterm infants experience anxiety and stress in the neonatal intensive care unit (NICU). Visitation restrictions due to COVID-19 have increased maternal pressure and limited bonding opportunities. Little research exists in Taiwan on using video conferencing as a solution. This study investigates depression and stress levels in mothers of preterm infants and evaluates the effectiveness of video visitation during NICU restrictions. METHODS: This study adopts a cross-sectional design and a qualitative survey. Mothers of premature infants were recruited and they participated in the study. Interventions for video visits were scheduled on the third day of admission to the NICU (T1) and during the second week of the study (T2). After each video visit, participants completed an online survey. The study's online survey used structured questionnaires including demographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Parental Stress Scale (PSS): Infant Hospitalization (IH). RESULTS: A total of 51 mothers of preterm infants participated in the study. During the T1 and T2 periods, single mothers with lower educational levels and those aged below 30 experienced depression and high levels of stress. Lower birth weight and gestational age were associated with maternal depression. Video visitation intervention led to a significant decrease in depression scores (EPDS, T1: 11.3 ± 5.5 vs. T2: 10.1 ± 5.2, p = 0.039). Positive correlations were observed between EPDS and PSS: IH scores (p < 0 .005). CONCLUSION: Video visitation intervention can reduce maternal depression in mothers with preterm infants. Since it is practical, video visitation may be applied even after the pandemic.

The Current Status of Research Mentoring in Nursing Across 4 Countries: A Discussion Paper.

The purpose of this article is to discuss the current status of research mentoring in nursing across 4 countries (the United States, Taiwan, South Korea, and Japan) and to make suggestions for future research mentoring. Seven leaders reflected on the current status of research mentoring in nursing, provided exemplars/cases from their own experiences, and their reviews of the literature. Six themes were discussed: ( a ) "culturally defined"; ( b ) "professionally contextualized"; ( c ) "teaching research integrity and research practice"; ( d ) "with mutual respect and care"; ( e ) "based on effective communication"; and ( f ) "supported by institutional and governmental commitment and infrastructure."

Image and Speech Recognition Technology in the Development of an Elderly Care Robot: Practical Issues Review and Improvement Strategies.

As the world's population is aging and there is a shortage of sufficient caring manpower, the development of intelligent care robots is a feasible solution. At present, plenty of care robots have been developed, but humanized care robots that can suitably respond to the individual behaviors of elderly people, such as pose, expression, gaze, and speech are generally lacking. To achieve the interaction, the main objectives of this study are: (1) conducting a literature review and analyzing the status quo on the following four core tasks of image and speech recognition technology: human pose recognition, human facial expression recognition, eye gazing recognition, and Chinese speech recognition; (2) proposing improvement strategies for these tasks based on the results of the literature review. The results of the study on these improvement strategies will provide the basis for using human facial expression robots in elderly care.

The Effectiveness of the Buzzy Device for Pain Relief in Children During Intravenous Injection: Quasirandomized Study.

BACKGROUND: Intravenous injection is the most common medical treatment and the main cause of pain in hospitalized children. If there is no appropriate health care for pain relief, the proportion of moderate and severe pain often exceeds 70%. With nonpharmaceutical-based pain management, Buzzy is recognized as an effective device for rapidly relieving injection pain in hospitalized children. However, Buzzy is not widely used in Asia and very few experimental studies in Asia have addressed the effectiveness of the Buzzy device at treating needle pain in hospitalized children. OBJECTIVE: The main purpose of this study was to investigate the effectiveness of the Buzzy device for diminishing pain levels among hospitalized children in Taiwan. METHODS: We applied a quasiexperimental design with random assignment. According to the time of admission, child participants were randomly assigned to treatment and nontreatment groups. The Buzzy device was applied as an intervention in this study. The samples size was 30 per group. The study participants were recruited from the pediatric ward of a medical center in northern Taiwan. The research data were collected longitudinally at three time points: before, during, and after intravenous injection. Three instruments were used for assessment: a demographic information sheet, the Wong-Baker Face Scale (WBFS), and the Faces Legs Activity Cry Consolability (FLACC) scale. The data were analyzed by descriptive analysis, the Mann-Whitney U test, the Wilcoxon signed-rank test, and the χ2 test. RESULTS: A total of 60 hospitalized children aged 3 to 7 years participated in this study, including 30 participants in the treatment group and 30 participants in the nontreatment group. The average age of children in the treatment and nontreatment groups was 5.04 years and 4.38 years, respectively. Buzzy significantly mitigated pain in children during intravenous injection with a significant difference between the two groups in pain-related response (FLACC) and actual pain (WBFS) (Z=-3.551, P<.001 and Z=-3.880, P<.001, respectively). The children in the treatment group had a significantly more pleasant experience than those in the nontreatment group (Z=-2.387, P=.02). When Buzzy was employed, the children experienced less pain than they did during previous intravenous injections (Z=-3.643, P<.001). CONCLUSIONS: The intervention of using the Buzzy device was effective in reducing pain levels of intravenous injection among hospitalized children. The specific focus on children in Asia makes a valuable contribution to the literature. For clinical application, the reliable pain relief measure of Buzzy can be used in other Asian children to help health care providers improve noninvasive care among children. For future applications, researchers could integrate Buzzy into therapy-related games and a technology-based app to increase the efficiency of use and provide more data collection functions.

[Reflections on the Prospective Professional Competency of Taiwan Public Health Nurses].

Societal ageing, the rising prevalence of chronic diseases, and the COVID-19 pandemic have changed the global healthcare environment dramatically. These challenges have significantly burdened community medical and healthcare systems and complicated the work of public health nursing. As an important care provider on the frontlines of primary care, public health nurses (PHNs) must keep up with the current state of the medical environment and statistical data interpretation, scientific data translation, community resource sharing, and telehealth applications. These demands have greatly impacted the traditional routines and existing professional core competencies of PHNs. Discussions among 12 Taiwanese public healthcare experts and the definition of public health nursing capacity from World Health Organization were considered in this review. In addition to reflecting on social changes and the professional development of public health nursing, eight prospective recommendations were provided in this review to enhance the professional competence of PHNs and better prepare them for future changes in the health environment and primary healthcare. The suggestions provide a reference for updating the position statement of PHNs.

COVID-19 and nursing research across five countries/regions: Commonalities and recommendations.

With the recent impact by the COVID-19 pandemic, nursing research has gone through unexpected changes across the globe. The purpose of this special report is to present the commonalities in the impact of the COVID-19 pandemic on nursing research across four countries, including the United States, South Korea, Japan, and Taiwan, and one region, that is, Hong Kong, and to make recommendations for future nursing research during the immediate postpandemic period and future pandemic situations. To identify the commonalities, seven researchers/leaders from the five countries/regions had discussions through 3 days of an international workshop. The content for this discussion paper derived from: (a) the exemplars/cases of the COVID-19 impact on the research process, (b) researchers/leaders' presentations on the COVID-19 impact, and (c) memos from the workshop. The materials were analyzed using a simple content analysis. The commonalities included: (a) "a heavy emphasis on teaching and fluctuating productivity," (b) "increased funding opportunities and governmental support," (c) "gendered experience complicated by professional differences," (d) "delays and changes/modifications in research process," (e) "limited research settings and difficulties in getting access," and (f) "increased online dissemination activities with positive changes in the image of nursing." With all collective wisdom that nurse researchers have obtained during the COVID-19 pandemic, nursing research will evolve again for the successful future of the nursing discipline.

Commonalities in Nursing Perspectives Among 6 Countries/Regions.

The purpose of this article is to identify the commonalities in nursing perspectives among 6 countries/regions (United States, South Korea, Taiwan, Japan, Hong Kong, and Thailand). Nine leaders from the 6 countries/regions reflected on what nursing perspectives were in their own countries/regions and provided exemplars/cases from their own experiences and literature reviews. The data were analyzed using a content analysis. Seven themes were extracted: (a) "embedded in cultural and historical contexts"; (b) "based on philosophical pluralism"; (c) "women-centered perspectives"; (d) "care-oriented holistic views"; (e) "ethical and humane views"; (f) "respecting and advocating"; and (g) "considering diversities."

Effect of An Online Physical Activity Promotion Program and Cardiovascular Symptoms Among Asian American Women at Midlife.

Despite an increasing number of online programs to promote physical activity, they have rarely been evaluated for their effects on cardiovascular symptoms of racial/ethnic minority women at midlife. This study aimed to determine the preliminary efficacy of a newly developed online program for physical activity promotion on cardiovascular symptoms of Asian American midlife women. This study was a pilot repeated-measures randomized controlled trial (pretest/posttest) among 26 Asian American midlife women. The variables were measured using multiple instruments on background features, physical activity, and cardiovascular symptoms at three points of time (baseline, after 1 month, and after 3 months). Linear mixed models were used to analyze the data. The prevalence and severity of cardiovascular symptoms did not show a statistically significant group-time interaction. However, the increase in lifestyle physical activity over time was significant only among the intervention group (Δ = 0.49, P = .016). The results supported the program's preliminary efficacy on lifestyle physical activity for Asian American women at midlife, but not on cardiovascular symptoms.

Current Trends in Nursing Research Across Five Locations: The United States, South Korea, Taiwan, Japan, and Hong Kong.

PURPOSE: Despite the importance of research in the discipline of nursing, current trends in nursing research have rarely been discussed across countries. The purpose of this article was to identify current trends in nursing research across five countries, including the United States, South Korea, Taiwan, Japan, and Hong Kong, in order to provide directions for future global nursing research. ORGANIZING CONSTRUCT: A discussion article. METHODS: To identify the current trends, seven leaders from the five countries had discussions through a series of workshops and conference presentations. After the most recent conference, all the leaders reflected for a month on their presentations and compiled the exemplars and cases from their experience and the existing literature in individual countries into a table. The tables and supporting references were collected at the completion of the reflection period. Then, the PowerPoint (Microsoft Corporation, Redmond, WA, USA) slideshows of the conference presentations by the leaders and the collected tables were analyzed using a content analysis. FINDINGS: Six themes reflecting the current trends in nursing research were extracted: (a) demographic alterations; (b) increasing diversities and globalization; (c) technology innovation; (d) individualized or personal care and population health initiatives; (e) health policies and regulations; and (f) nursing workforce changes. CONCLUSIONS: Future directions for nursing research across the countries were proposed: (a) cost-effectiveness research; (b) implementation science; (c) data science; (d) training of the future generation of nurse researchers; (e) population health; and (f) team science. CLINICAL RELEVANCE: This topic could be applied to any clinical settings.

Predictors of self-perceived levels of creative teaching behaviors among nursing school faculty in Taiwan: A preliminary study.

BACKGROUND: Many nursing programs include a capstone project as part of the nursing curriculum. In Taiwan, these courses involve development of healthcare products. A student's success can depend on faculty's ability to employ creative teaching behaviors. PURPOSE: To examine the relationship between demographic and teaching characteristics, personality traits, and self-perceived levels of creative teaching behaviors for capstone nursing faculty. METHODS: This study used a cross-sectional, descriptive, correlational study design. Faculty (N = 53) were recruited from healthcare schools in Taiwan. Data from self-report questionnaires included variables for demographic and teaching characteristics, perceived levels of creative personality traits (imagination, curiosity, adventure, challenge) and creative teaching behaviors (autonomous learning, creative thinking, characteristics/motivations, environment/opportunity). Hierarchical multiple regression identified predictors of creative teaching behaviors. RESULTS: Mean total scores for creative teaching behaviors were high for nursing faculty; characteristics/motivations were the lowest subscale score. The creative personality trait of curiosity significantly and positively influenced the perception of high levels creative teaching behaviors. CONCLUSIONS: High scores for curiosity significantly predicted high scores for creative teaching behaviors for nursing faculty. These findings suggest faculty who perceive themselves as having low levels of creative teaching behaviors might benefit from training to increase levels of curiosity.

Relationships between disaster nursing competence, anticipatory disaster stress and motivation for disaster engagement.

Nurses are the largest group of healthcare providers and are often the first line responders to a disaster event. Nurses' disaster competence, motivation for disaster engagement, and factors that impact their motivation to respond to disaster events need to be understood. The purposes of the study were to determine the predictive relationships between Taiwanese nurses' disaster competence, anticipatory disaster stress, and motivation for disaster engagement. A cross-sectional design was used to analyze data collected between August 2017 and December 2017 from eight hospitals in southern Taiwan. Ninety participants who met the recruitment criteria completed and returned questionnaires with an 88.24% response rate. Data collection involved administering the Disaster Nursing Competence Questionnaire, Anticipatory Disaster Stress Questionnaire, and the Motivation of Disaster Engagement Questionnaire. The results indicated that anticipatory disaster stress was positively correlated with disaster competence and motivation for disaster engagement. Disaster competence and willingness to join a hospital disaster rescue predicts an individuals' motivation for disaster engagement. The results of the study add to the understanding of factors that correlate with nurses' motivation to participate in disaster events. By understanding these factors, the government and healthcare administrators can design disaster education plans and other strategies to improve Taiwanese nurses' motivation to engage in disaster events.

The Refined Middle-Range Theory on Women's Leadership in Asian Culture.

Introduction: Because virtually no theories were available to explain unique characteristics of Asian women's leadership in nursing, a middle-range theory on women's leadership in Asian culture was previously published. To reflect recent political and social changes in different countries, there is a necessity to refine the theory. The purpose of this article is to present the refined middle-range theory on Asian women's leadership in nursing. Methodology: Using an integrative approach, the theory was further developed based on two major sources: literature reviews and exemplars/cases from six different countries. Results: The Refined Middle-Range Theory on Women's Leadership in Asian Culture has two main domains: (a) leadership frames and (b) leadership contexts. The domain of leadership contexts has been extended with two additional main concepts including demographic contexts and health workforce/system contexts. Discussion: The refined theory is expected to guide Asian women's leadership in nursing across the globe.

An Exploration of Motivation for Disaster Engagement and Its Related Factors among Undergraduate Nursing Students in Taiwan.

The purpose of the study was to explore the levels of and relationships between disaster nursing competence, anticipatory disaster stress, and the motivation for disaster engagement among undergraduate nursing students in Taiwan. A cross-sectional research design was applied. Using convenience sampling, 90 nursing students participated with an 86.54% response rate. The Disaster Core Competencies Questionnaire, Anticipatory Disaster Stress Questionnaire, and Motivation for Disaster Engagement Questionnaire were used to collect data. The Pearson correlation and ANOVA were used to analyze the data. Results showed that students' level of disaster nursing competence was low, anticipatory disaster stress was not high, and motivation for disaster engagement was high. Motivation for disaster engagement was positively correlated with anticipatory disaster stress. Students who were more willing to participate in disaster management had a higher level of anticipatory disaster stress and motivation for disaster engagement. It is suggested that healthcare institutions and schools should work together to design disaster education plans using innovative teaching/learning strategies to increase students' willingness and motivation for disaster engagement.

Recruitment and Retention of Asian Americans in Web-Based Physical Activity Promotion Programs: A Discussion Paper.

Web-based interventions that promote physical activity have been tested in various populations and proven effective. However, information on recruiting and retaining ethnic minorities in these interventions is limited. This study discusses practical issues in recruitment and retention of Asian Americans using three strategies: (1) only Web-based intervention (Group 1), (2) one with Fitbit Charge HR (Group 2), and (3) one with Fitbit Charge HR and office visits (Group 3). Recruitment and retention rates, minutes of weekly research team meetings, and the researchers' memos were collected. Retention rates were analyzed using descriptive statistics, and the minutes and memos were content analyzed following Weber's methods. Retention rates varied by the end of the first (12% in Group 3, 36.9% in Group 2) and third month (0% in Group 3, 36.9% in Group 2). The practical issues were (1) difficulties in recruitment across strategies, (2) the necessity of using community consultants/leaders across strategies, (3) subethnic differences across strategies, (4) timing issues across strategies, (5) Fitbit as a facilitator with several hindrances, and (6) office visits as an inhibitor. Fitbits with user guidelines and community consultants'/leaders' involvement are proposed for future Web-based interventions to promote physical activity in Asian Americans.

Decreasing sleep-related symptoms through increasing physical activity among Asian American midlife women.

OBJECTIVE: The beneficial effects of physical activities on sleep-related symptoms have been reported in the literature, and physical activity has been suggested as an efficient strategy to reduce sleep-related symptoms among midlife women. The effect of Web-based physical activity promotion programs on sleep-related symptoms have, however, rarely been explored, especially among midlife racial/ethnic minority women. The purpose of this pilot study was to test the preliminary efficacy of a WPAPP on self-reported sleep-related symptoms and physical activity of Asian American midlife women. METHODS: This pilot study was a randomized repeated measures pretest/posttest control group study (14 in an intervention group and 12 in a control group). Multiple instruments were used to measure background characteristics (eg, sociodemographic and health status), sleep-related symptoms and physical activity experiences at pretest, post 1 month, and post 3 months. The data were analyzed using an intent-to-treat linear mixed-model growth curve analysis. RESULTS: After adjusting for covariates and random intercept, the intervention group showed a significant decrease in the total numbers of psychological (P = 0.0956) and total sleep-related symptoms (P = 0.0733) at post 1 month. Also, both groups showed a significant increase in physical activity (active living habits) at post 3 months (P = 0.0353). CONCLUSIONS: The WPAPP is potentially beneficial in decreasing Asian American midlife women's sleep-related symptoms and promoting their lifestyle physical activity.

Physical activities and influencing factors among public health nurses: a cross-sectional study.

OBJECTIVES: Public health nurses are responsible for promoting and managing the health of community members, and if they do not have enough physical activity or ignore their own health, not only will their own health decline but the quality of life of the public will also be affected. This study investigated the physical activity of public health nurses and analysed the effects of attitudes, subjective norms, perceived behavioural control and behavioural intention to engage in physical activity. METHODS: This study adopted a cross-sectional research design, and convenience sampling was used to select the research subjects. 198 public health nurses were invited to participate, and 172 completed the questionnaire. Multiple linear regression was used to analyse the influencing factors of physical activity intention and physical activity. RESULTS: Attitudes towards physical activity and perceived behavioural control of physical activity affected physical activity intention. When they had higher behavioural intention, their physical activity behaviour also improved. The physical activity intention significantly influenced the number of days that they had engaged in vigorous physical activity (95% CI 0.1786 to 0.3060, p<0.0001), and significantly influenced the number of days that they walked daily for 10 min (95% CI 0.2158 to 0.4144, p<0.0001), and also significantly influenced their daily sedentary time (95% CI -0.3020 to 0.0560, p=0.0046). CONCLUSIONS: Encouraging public health nurses to heed their own health and motivating them to engage in physical activity warrants attention from policy-makers and government health agencies.

[Reflections on Occupational Health Nursing in Taiwan: Challenges and Perspectives].

The development of the occupational health nursing profession has promoted stable and healthy human resources in Taiwan. In order to improve the occupational safety, health, and healthcare of workers, the professional core competencies and role functions of occupational health nursing is of utmost importance. This article investigated the current status of occupational health nursing education, role functions, practice scope, and the development and responsibilities of professional associations and proposed the challenges to and the future prospects of the development of occupational health nursing in Taiwan. The key findings include: (1) the role functions and practice scope of occupational health nursing; (2) occupational health nursing courses should be included in the required credits of Department of Nursing and master and doctor programs in occupational health nursing should be established; (3) a certification system of occupational health nursing should be established as soon as possible; (4) the professional associations for occupational health nursing should take responsibility for continuing education and training; and (5) interdisciplinary collaborations among relevant occupational health professionals should be strengthened.

An Emerging Integrated Middle-Range Theory on Asian Women's Leadership in Nursing.

INTRODUCTION: Asian cultures reflect patriarchal cultural values and attitudes, which likely have influenced women leaders in their countries differently from women in Western cultures. However, virtually no leadership theories have been developed to reflect the experiences and development of nursing leaders from Asian cultures. The purpose of this article is to present an emerging integrated middle-range theory on Asian women's leadership in nursing. METHODOLOGY: Using an integrative approach, the theory was developed based on three major sources: the leadership frames of Bolman and Deal, literature reviews, and exemplars/cases from five different countries. RESULTS: The theory includes two main domains (leadership frames and leadership contexts). The domain of leadership frames includes human resources/networks, structure/organization, national/international politics, and symbols. The domain of leadership contexts includes cultural contexts, sociopolitical contexts, and gendered contexts. DISCUSSION: This theory will help understand nursing leadership in Asian cultures and provide directions for future nurse leaders in this ever-changing globalized world.

Improving menopausal symptoms through promoting physical activity: a pilot Web-based intervention study among Asian Americans.

OBJECTIVE: Based on previous studies, a Web-based physical activity promotion program with educational modules on menopausal symptoms and physical activity has been developed for Asian American midlife women to reduce their menopausal symptoms through increasing their physical activity. The purpose of this pilot randomized intervention study was to determine the efficacy of the Web-based program in improving menopausal symptom experience of Asian American midlife women. METHODS: This was a randomized repeated measures pretest/posttest (pretest, post 1 month, and post 3 months) control group study among 29 Asian American midlife women. Multiple instruments were used, including the Midlife Women's Symptom Index and the Kaiser Physical Activity Survey. The data were analyzed using a mixed-model growth curve analysis. RESULTS: Over time, total severity scores decreased for the control group (-0.53, P < 0.10), whereas they did not exhibit a meaningful change for the intervention group. Both study groups experienced improvement in active living habits over time, but such an improvement was greater for the intervention group (ß = 0.29, P < 0.001) than for the control group (ß = 0.08, P < 0.10). The time × group interactions for total severity scores were not statistically significant anymore after controlling for physical activity (-0.34 for the control group, P = 0.10). CONCLUSIONS: The findings supported the feasibility of a 3-month Web-based intervention for menopausal symptom management among Asian American midlife women and the preliminary efficacy of the program in increasing their physical activity.

The Effects of an Educational Intervention on Preventing Cervical Cancer Among Vietnamese Women in Southern Taiwan.

This paper aims to conduct and evaluate an educational intervention on preventing cervical cancer among married immigrant women of Vietnamese origin. The study design was a quasi-experimental method with two groups. In total, 260 married immigrant women of Vietnamese origin with national health insurance at least 30 years of age were recruited from November 2013 to January 2015 in southern Taiwan. The effects of the educational intervention, including cervical cancer and Papanicolaou test knowledge, attitudes towards cervical cancer, fatalism, barriers to receiving Papanicolaou tests, intention for receiving Papanicolaou tests within the next year, and intention for receiving Papanicolaou tests within the next 3 years, were evaluated. Repeated measures analyses of variance showed significant interactions between the intervention group and time for cervical cancer knowledge, knowledge of Papanicolaou test, attitudes towards cervical cancer, and intention for receiving a Papanicolaou test within the next 3 years; in addition, 71.4 % reported being satisfied or very satisfied with the intervention. The results of this study can provide information for governments to make appropriate health policies for screening behavior of cervical cancer, increase healthcare professionals' competencies towards Vietnamese women, and increase Papanicolaou test screening rates to decrease cervical cancer mortality. Effective interventions may require particular consideration of married immigrant women.