Jen-Jiuan Liaw

Improving neonatal caregiving through a developmentally supportive care training program

This study was performed to explore the effects of a training program in developmentally supportive care (DSC) on nurse caregiving and preterm infant behavior during bathing in a neonatal unit. The study applied a single-group pretest and posttest design to analyze behaviors. Twenty preterm infants were bathed 120 times by 13 nurses. Indirect observation was adopted to collect all behavioral data. Results showed that infants felt less stress and nurses were more supportive during posttraining baths. Caregivers should receive training in DSC, and its applications could be expanded to other nursing caregiving activities.

The lived experience of Taiwanese mothers of a child diagnosed with adrenoleukodystrophy

This research was conducted to describe Taiwanese mothers’ lived experience of caring for their child diagnosed with adrenoleukodystrophy. Analysis of eight interviews by Colaizzi’s method revealed six themes: (1) difficulty confirming the diagnosis; (2) powerlessness toward unsatisfactory treatment; (3) struggles with decisions around carrier testing; (4) guilt about being a carrier; (5) support from family, other parents, and religion; and (6) lack of integrated resources and support. The results suggest the need to raise public and physician awareness about adrenoleukodystrophy via the media and medical education. A central organization to provide parents with comprehensive information is needed.

Clinical characteristics of Acinetobacter baumannii complex bacteremia in patients receiving total parenteral nutrition

Background: Acinetobacter baumannii complex (Abc) comprises at least three phenotypically undifferentiated species, including A baumannii, Acinetobacter genomic species 3 (AGS 3) and Acinetobacter genomic species 13TU (AGS 13TU). Abc bacteremia had rarely been described in patients receiving total parenteral nutrition (TPN). In this study, we aimed to determine any differences in the clinical features of patients having TPN and bacteremia due to A baumannii and those due to nonbaumannii Abc (including AGS 3 and AGS 13TU). Methods: The data of patients who had received TPN and had Abc bacteremia in Taipei Veterans General Hospital between August 1998 and December 2007 were retrospectively reviewed. The Acinetobacter isolates were identified to genomic species level. Results: A total of 23 patients with A baumannii and 23 patients with nonbaumannii Abc (15 AGS 13TU and 8 AGS 3) bacteremia were identified. The two groups of the patients were comparable regarding their gender, age and APACHE II score at the onset of bacteremia. However, several clinical features were different between the two groups of the patients in the univariate analysis. Furthermore, A baumannii isolates were resistant to more classes of antibiotics than nonbaumannii Abc isolates. The multivariate analysis showed that a higher number of patients with A baumannii bacteremia had received TPN for ≥15 days before their onset of bacteremia [odds ratio (OR) 7.214, 95% confidence interval (CI) (1.108–46.989), p = 0.039]. Nevertheless, the 14‐day (30.4% vs. 21.7%, p = 0.737) and all‐cause in‐hospital mortality rate (60.9% vs. 39.1%, p = 0.238) did not differ significantly between these two groups. Conclusion: The patients with A baumannii bacteremia demonstrated a longer timeframe in the treatment of TPN prior to the onset of bacteremia than those with nonbaumannii Abc bacteremia, however the clinical outcomes between the two groups of the patients did not differ significantly.

Factors Associated With Preterm Infants’ Circadian Sleep/Wake Patterns at the Hospital

This prospective repeated-measures study explored potential factors (postmenstrual age, body weight, gender, chronological age, illness severity, and circadian rhythm) related to preterm infants’ circadian sleep/wake patterns. Circadian sleep/wake patterns were measured using an Actiwatch for 3 continuous days in preterm infants (gestational age of 28-36.4 weeks) in a neonatal intensive care unit and hospital nursery. Potential factors associated with circadian sleep/wake patterns were analyzed using the generalized estimating equation. For our sample of 30 preterm infants, better sleep/wake patterns were associated with male gender, younger postmenstrual and chronological age, lower body weight, and less illness severity. Preterm infants’ total sleep time (B = 41.828, p < .01) and percentage of sleep time (B = 3.711, p < .01) were significantly longer at night than during the day. These findings can help clinicians recognize preterm infants’ sleep problems, signaling the need to provide individualized support to maintain these infants’ sleep quality during their early life.

Art Therapy for Chinese Canadian Breast Cancer Survivors in Toronto

Aims: The major purpose of this study was to evaluate the feasibility and efficacy of an art therapy support group program for Chinese Canadian breast cancer survivors. The sub-purpose was to understand the experiences of Chinese breast cancer survivors during and after the arts-based intervention. Study Design: A qualitative design was used in this study. Place and Duration of Study: The study was conducted at an urban community health centre in Toronto, Canada between February 2014 and June 2014. Original Research Article

Effects of Lipofundinî on the Measurement of Total Bilirubin by Spectrophotometry

Background: Jaundice occurs frequently in neonates and can cause severe neurological complications; hence, hyperbilirubinemia is usually monitored by direct spectrophotometry. However, lipemia, resulting from inborn disorders or parenteral feeding of preterm neonates with lipid emulsion, may interfere with certain laboratory assessments. Here, we evaluated whether artificial lipemia also interferes with bilirubin measurement by direct spectrophotometry. Methods: Total bilirubin levels were assessed by the spectrophotometry when serial concentrations of Lipofundin®, medium-chain triglycerides, or a stabilizer solution, were added to cord blood samples from five full-term and five preterm newborn infants. Results: In blood specimens from ten neonates, spectrophotometry-determined bilirubin levels proportionally and significantly increased in the presence of Lipofundin® at least 1% v/v or 10% medium-chain triglycerides at least 10% v/v in all pre-term and full-term infants. The stabilizer solution caused no interference. Conclusion: Lipofundin® in the cord blood interferes with spectrophotometric measurement of total bilirubin; this effect is mainly related to triglyceride levels and has implications for management of neonates with jaundice.

Psychometric Testing of Two Chinese-Version Scales on Attitudes Toward and Caregiving Behaviors for End-of-Life Patients and Families

The study purpose was to examine the validities and reliabilities of the Chinese-versions Frommelt Attitudes Toward Care of the Dying Scale (Attitudes Scale) and Caregiving Behaviors Scale for End-of-Life Patients and Families (Behaviors Scale). The scales were tested in a convenience sample of 318 nurses with ≥6 months work experience at three hospitals. Cronbach’s alphas of the Attitudes and Behaviors Scales were .90 and .96, respectively. Each scale had Kaiser–Meyer–Olkin index >.85 and Bartlett’s test of sphericity >4000 (p < .001). Attitudes Scale loaded on three factors: respecting and caring for dying patients and families, avoiding care of the dying, and involving patients and families in end-of-life care. The Behaviors Scale loaded on two factors: supporting dying patients and families, and helping families cope with grief. Factor loadings for both scales were ≥.49. Both Attitudes and Behaviors Scales are reliable and valid for evaluating nurses’ attitudes and caregiving behaviors for the dying.

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.

Role of Anti-neutrophil Cytoplasmic Antibodies in Kawasaki Disease

Background: Kawasaki disease (KD) is characterized by systemic vasculitis and may lead to coronary artery ectasia and aneurysm. Autoantibodies, in particular anti-neutrophil cytoplasmic antibodies (ANCAs), have been identified in association with the vasculitis. The relationship between ANCAs and KD is unclear. The purpose of this study is to investigate the role of ANCAs in KD in Taiwan. Methods: We assessed ANCAs in 10 KD patients (6 male and 4 female; age range, 4 months to 3 years) between January and December 2003. Results: Cytoplasmic (c)-ANCA staining was absent in all patients, but 5 patients showed perinuclear (p)-ANCA staining. C-reactive protein levels were significantly higher in p- ANCA-positive than p-ANCA-negative KD patients (12.672±3.05 vs. 4.186±2.60 mg．dL^-1, respectively; P ＜ 0.01); there was no significant difference in age, white blood cell count, or clinical presentation. Conclusions: Our data showed that CRP levels were significantly higher in p-ANCA-positive patients and c-ANCA was negative in all KD patients. Neither c-ANCA nor p-ANCA was linked to coronary artery abnormalities in KD patients, suggesting that ANCAs may play only a minor role in the pathogenesis of KD.