Nursing students' first-time experiences in pediatric clinical practice in Taiwan: A qualitative study.

BACKGROUND: A pediatric nursing practicum is essential in equipping students with basic knowledge of theory, professional attitudes, and skills for the clinical setting. However, students often face multiple challenges in the practicum due to gaps between theory and practice. PURPOSE: To describe nursing students' first-time experiences in pediatric clinical practice in Taiwan. METHODS: A phenomenological approach with purposive sampling was used. Twenty participants were interviewed individually, in person, within a month of completion of a pediatric nursing practicum. Interviews were semi-structured and digitally recorded. Data analysis followed Colaizzi's methods; epochs (bracketing) focused analysis on students' experiences and maintained objectivity. FINDINGS: Three themes and related subthemes emerged: (a) orienting to the pediatric unit (becoming familiar with common treatments and surroundings in the pediatric unit; recognizing people in the unit); (b) encountering challenges in pediatric and family-centered care (navigating communication between child and families; student nurse-patient relationships: maintaining a good rapport with children and their families; being prepared for quick role changes); (c) translating knowledge into clinical practice thoughtfully (providing desirable and correct responses for children and their families; providing a safe and friendly environment for children and their families). CONCLUSIONS: Student nurses engaged in a variety of care practices necessitated by patients' differing ages, developmental levels, and family needs. Ensuring students' successful completion of the demanding pediatric practicum, including innovative communication, technical skills, and role transitions, is challenging yet achievable. CLINICAL RELEVANCE: Gaining a fuller understanding of nursing students' experiences in the pediatric nursing practicum can assist nursing professionals in preparing students to provide competent care for children and their families.

Child-rearing experiences and home environment concerns among Southeast Asian immigrant mothers in transnational marriage families in Taiwan.

AIMS: To explore the child-rearing experiences of immigrant mothers and their concerns about children's home environments in the contexts of transnational marriage families and non-native culture. BACKGROUND: Immigrant mothers are often disadvantaged by a relative lack of information on and access to children's healthcare, but little research exists on the experiences of mothers in transnational marriage families as they attempt to provide a secure home environment while navigate an unfamiliar culture. DESIGN: A descriptive phenomenological research design based on intuition was employed to explore immigrant mothers' unique lived reality through their subjective experiences and perceptions. METHODS: Semi-structured interviews with 15 immigrant mothers from 15 transnational marriage families were conducted between May 2016-February 2017. Narratives were analyzed using the descriptive phenomenological method because it permits systematic discovery of the lived experiences from the perspective of the study's participants. RESULTS: Three major themes were identified: (a) striving to maintain a secure home for children; (b) suffering and struggling with difficulties; and (c) trying to overcome difficulties and build an adequate family environment. The essential, prevailing concept of immigrant mothers' experience in child-rearing was identified as 'Where my child is, is home.' CONCLUSION: Immigrant mothers bond emotionally and physically to their new land via their children. Their child-raising experiences are interwoven with their roles in their new familial and cultural homes. IMPACT: Immigrant brides often become mothers soon after marrying to continue their husbands' family line. Understanding their unique child-rearing experiences and challenges in providing a secure home in a non-native culture will help nurses provide effective care. Study results will benefit paediatric/family nurses in any setting where care for transnational marriage families is provided, those families themselves, public policymakers and future researchers.

Evaluation of nursing students' perceptions of their cultural care competency: A mixed method study in Taiwan.

Growing cultural diversity among immigrants has challenged health care practice in Taiwan. This study used mixed methods to evaluate how the implementation of a course on cultural competence embedded in a nursing course affected nursing students' perceptions of their cultural care competency. An evaluation survey with a quantitative questionnaire comprising pre- and post-test measures of self-perceived cultural care competency was implemented for 48 participants at the commencement and completion of the course. A focus group interview (n = 10) was conducted and a thematic approach applied to analyze qualitative data. The results found a significant improvement in self-perceived cultural care competency (t = 7.15, p < 0.001). Two themes emerged from the qualitative analysis: (1) the thought-provoking nature of the course and (2) appreciation for the multiple learning strategies of the course. The findings suggest that embedding cultural competence education in nursing courses is essential to improving nursing students' perceptions of their cultural care competency.

Revision and validation of a short scale to assess home environment for elementary school children in transnational families in Taiwan.

PURPOSE: To develop and test a brief scale of the home environment of elementary school children in transnational families or vulnerable families. DESIGN AND METHODS: The scale development process took place in three phases. In the first phase, a 61-item scale was generated by an expert panel based upon related literature and Chinese Home Observation for Measurement of the Environment (C-HOME). In the second phase 15 individual transnational families with elementary school children were interviewed, and items were reduced from 61 to 55 due to understandability or other practical considerations. Phase three's item analysis with 200 such families, reduced items to 41. Factor analysis followed, further reducing items to 27. Finally, the resulting 27-item scale underwent a test-retest with 57 subsample participants. RESULTS: An iterative process of item and factor analyses identified a seven-dimensional, 27-item Home Environment Assessment Scale (HEAS), which accounted for 52.28% of the total variance. K-R 20 was 0.76. The test-retest reliability for the full sample total score was 0.97. CONCLUSIONS: The results provide evidence supporting the scale consistency, content validity, and construct validity, and offer a useful instrument for health care professionals, especially pediatric nurses, to identify home environment interventions for young children in vulnerable families. PRACTICE IMPLICATIONS: The findings of HEAS-27 can serve to guide pediatric health care professionals in promptly screening, evaluating, and teaching families so that children in a vulnerable population have adequate quality and quantity of support in the home environment.

Nurses' Views on the Potential Use of Robots in the Pediatric Unit.

PURPOSE: To describe nurses' views on the potential use of robots in the pediatric unit. DESIGN AND METHODS: A qualitative descriptive design was employed. Semi-structured interviews were conducted with 23 nursing staff who worked in the pediatric unit. The interviews were audiotaped, transcribed, and analyzed using qualitative content analysis. RESULTS: Three themes emerged related to the nurses' views on the potential use of robots in the pediatric unit (1) care impact - advantages, which included: (a) reducing healthcare providers' workload and (b) adequately meeting the needs of pediatric patients and their families; (2) care impact - shortcomings, which included: (a) deficiency of individualized care and (b) reduced employment opportunities for skilled nursing staff; and (3) attitude impact, including (a) lifelong learning and (b) integrating culture and technology to meet pediatric care needs. CONCLUSIONS: Robots' application may ameliorate the overall quality of pediatric care, allowing for better apportioning of nurses' time and energies to focus on direct patient care and reducing nurses' workloads. However, some possible disadvantages need attention, including robots' inability to provide genuine human touch, demonstrate human emotions associated with pediatric care, and exhibit cultural sensitivity. It is desirable to embed nursing practice needs in the advanced functions of robots and thereby ensure safe, reliable robotics suitable for pediatric care usage. PRACTICE IMPLICATIONS: The findings can be used as a reference for nurses encountering challenges in working with robots, and for lifelong learning needs for pediatric nurses.

Resilience enhancement among student nurses during clinical practices: A participatory action research study.

BACKGROUND: Clinical practice is an essential component of nursing students' preparation for applying theoretical knowledge in a real-life setting. However, students often experience clinical practice as extremely stressful, which may disrupt their clinical performance, impact the quality of patient care they provide as well as their own physical and psychological health, and hinder their continuation into nursing careers. Resilience, understood as the capability to overcome challenges, is critical for these students. PURPOSE: To develop and implement a resilience enhancement (RE)-based project for Taiwanese nursing students during their Last Mile practicum. DESIGN AND METHODS: A participatory action research (PAR) approach was used in which ongoing planning, action, and reflection informed real-time progress. Twenty-eight nursing students in clinical practice participated in the study. A six-workshop RE project was completed over the course of two months. Evaluation methods involved group discussion, individual interviews, and reflective diaries. Content analysis was applied to the data. RESULTS: Through a PAR-based project, participants achieved positive results. Three outcome themes were identified: Increasing self-exploration, Furthering confidence and competency, and Constructing resilience. CONCLUSIONS: The PAR-based RE project helped students to develop resilience by enhancing their nursing knowledge and skills and practicing positive thinking and behavior. CLINICAL RELEVANCE: The findings can be a reference for nursing educators in designing RE programs for students during clinical practice to increase their professional competence and provide psychological supports.

Prescription patterns of traditional Chinese medicine amongst Taiwanese children: a population-based cohort study.

BACKGROUND: Traditional Chinese medicine (TCM) has been used by Chinese patients and in many other countries worldwide. However, epidemiological reports and prescription patterns on children are few. METHODS: A cohort of 178,617 children aged 18 and under from one million randomly sampled cases of the National Health Insurance Research Database was analyzed for TCM prescription patterns. SAS 9.1 was applied and descriptive medicine utilization patterns were presented. RESULTS: The cohort included 112,889 children treated by TCM, with adolescents (12- to 18-year-olds) as the largest group. In the children's TCM outpatient visits, Chinese herbal remedies were the main treatment. The top three categories of diseases treated with Chinese herbal remedies were respiratory system; symptoms, signs, and ill-defined conditions; and digestive system. The top three categories using acupuncture were: injury and poisoning, diseases of the musculoskeletal system and connective tissue, and diseases of the respiratory system. Of the top ten herbal medicines prescribed by TCM physicians, the top nine herbal formulae and the top ten single herbs were associated with diseases of the respiratory system. CONCLUSION: This study identified patterns of TCM prescriptions for children and common disease categories treated with TCM. The results provide a useful reference for health policy makers and for those who consider the usage of TCM for children.

Breaking through the dilemma of whether to continue nursing: Newly graduated nurses' experiences of work challenges.

BACKGROUND: Newly graduated nurses (NGNs) often encounter unique work challenges. PURPOSE: To discover Taiwanese NGNs' experiences of work challenges. METHOD: An interpretive qualitative design was chosen. In-depth interviews were completed with 25 NGNs working in clinical settings in Taiwan. Data were analyzed using content analysis. RESULTS: The essential structure of NGNs' experiences of work challenges was described as struggling and breaking through the dilemma of deciding whether to continue nursing or quit. Four themes with ten subthemes were identified: 1. being tense as if walking on thin ice (fear of making mistakes, uncertainty of decision making for care practice); 2. suffering physical exhaustion and mental stress(work overload and shiftwork, the burden to be expected, unfamiliar work culture); 3. entering and adjusting to the profession (assessing self and deciding whether to stay in nursing, building up competency); and 4. gaining more confidence(problem solving, emotional control, finding an appropriate way for oneself). CONCLUSIONS: Findings indicate the significance of such experiences, and the results are useful for clinical instructors and administration to help NGNs overcome challenges.

Indonesian caretaker experiences in providing child care to Taiwanese children.

The purpose of this study was to learn about the experiences of Indonesian nannies in caring for Taiwanese children in Taiwan. An ethnography method was adopted, using in-depth interviews with 52 respondents, 20 of whom were Indonesians employed as caretakers for Taiwanese children and 32 of whom were general informants. Twenty-six of the general informants were Indonesian child caretakers, and six were employers. Audio-taping of interview sessions was permitted by all respondents. Transcriptions of the interviews were written up verbatim. Leininger's (1991) Phases of Analysis for qualitative data was adopted to analyze data. Four themes were extracted from the analysis, including "Learning diverse information from the beginning--the employer's family," "Complying with the advice of the child's mother," "Maintaining the child's daily activities and health," and "Awareness of external context influences on child care." The findings indicated that Indonesian child caretakers carry with them the values, beliefs, and lifestyles of their own culture and have their own ingrained ideas regarding how best to provide care for their Taiwanese charges. Health care providers, by better understanding the general experiences of Indonesian caretakers in Taiwan, can apply competent intervention to help caretakers overcome the challenges of working within a different cultural environment. It is hoped that the results of this study can promote cultural competence in childcare within the context of internationalism.