No abstract

Background Taiwan has a high national caesarean rate coupled with a low vaginal birth after caesarean (VBAC) rate. This study aims to develop and evaluate a web-based decision-aid with communication support tools, to increase shared decision making (SDM) about birth after caesarean. Methods A quantitative approach will be adopted using a randomized pre-test and post-test experimental design in a medical centre in northern Taiwan. The web-based decision aid consists of five sections. Section 1 provides a two-part video to introduce SDM and how to participate in SDM. Section 2 presents an overview of functions and features of the birth decision-aid. Section 3 presents relevant VBAC information, including definitions, benefits and risks, and an artificial intelligence (AI) calculator for rate and likelihood of VBAC success. Section 4 presents the information regarding elective repeat caesarean delivery (ERCD), involving definitions, benefits, and risks. Section 5 comprises four steps of decision making to meet women’s values and preferences. Pregnant women who have had one previous caesarean and are eligible for VBAC, will be recruited at 14–16 weeks. Participants will complete a baseline survey prior to random allocation to either the control group (usual care) or intervention group (usual care plus an AI-decision aid). A follow up survey at 35–38 weeks will measure change in decisional conflict, knowledge, birth mode preference, and decision-aid acceptability. Actual birth outcomes and satisfaction will be assessed one month after birth. Discussion The innovative web-based decision-aid with support tools will help to promote pregnant women’s decision-making engagement and communication with their providers and improve opportunities for supportive communication about VBAC SDM in Taiwan. Linking web-based AI data analysis into the medical record will also be assessed for feasibility during implementation in clinical practice. Trial registration ClinicalTrials.gov identifier (NCT05091944), Registered on October 24, 2021.

(1) Background: Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide. Uniformed nurses have played a critical role during the COVID-19 pandemic in the Philippines; however, uptake of literature is limited. This study assessed the relationship between quality of nursing work life (QNWL) and nurses’ attitudes and practices during the COVID-19 pandemic. (2) Methods: A descriptive cross-sectional design was used. Participants were recruited from four government hospitals in the Manila metropolitan area of the Philippines. Participants completed three questionnaires in an online survey: a demographic questionnaire, a QNWL questionnaire, and the attitude and practices toward COVID-19 questionnaire. Descriptive statistics, an independent t-test, a one-way analysis of variance, the Pearson correlation coefficient, and hierarchical linear regression were applied for data analysis. (3) Results: The mean age of the participants was 29 years. Most of the participants were single women who were not certified in their specialties. A total of QNWL scores were high, indicating that the participants displayed favorable attitudes and practices in relation to COVID-19. A statistically significant relationship was observed between QNWL, specialty certification, and practices related to COVID-19. Practices related to COVID-19 were a significant predictor of QNWL and one of its subscales, work design. (4) Conclusion: Young adult uniformed nurses in the Philippines have assumed numerous responsibilities during the COVID-19 pandemic. Providing these frontline nurses with comprehensive specialized education and training is crucial.

Background: Total knee replacement (TKR) can alleviate knee osteoarthritis (OA) effectively. Many women undergo TKR; however, research on women’s decision-making process remains scant. This study aimed to explore the decision-making process for undergoing TKR among Taiwanese women. Methods: A qualitative approach was used. Through purposive sampling, a total of 20 women aged > 40 years with knee OA undergoing TKR were recruited from a teaching hospital of Northern Taiwan. Data were collected 3–5 days and 6–8 weeks after TKR through in-depth interviews, observation, and field records and analyzed with constant comparative analysis. Results: “Hope for a new knee,” the core theme for TKR-related decision-making, comprised three stages (including six themes): before decision (impacts of pain and seeking nonsurgical methods), decision (intrinsic and extrinsic motivation), and after decision (assessing physical function and achieving the golden phase of rehabilitation). Conclusion: Women expected to have a new life after undergoing TKR. Impacts of pain and concern of becoming a burden on the family were main factors influencing the Taiwanese women’s decision for a TKR. These women strove to overcome difficulties related to post-TKR rehabilitation. An individual teaching programs and psychological support for women is imperative. The findings of women’s values and preferences for a TKR surgery will be helpful to develop an interventional decision support for shared decision-making.