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Background: Family caregivers have a vital role to play in palliative care for chronically ill patients. In Taiwan, caregiver demographics are evolving, with the number of male caregivers increasing. Gender differences influence psychosocial behaviours, thought processes and communication styles. In healthcare, acknowledgement of gender differences facilitates effective delivery of high-quality care. Aim: The aim of this study is to explore male caregivers' decision-making process for palliative care for chronically ill family members. Methods: This study employed grounded theory to generate a substantive theory of male caregivers' decision-making process for palliative care for chronically ill family members. We recruited 22 male participants from three inner-city teaching hospitals in Taiwan. Findings: Regarding the decision-making process of palliative care of chronic ill family, where male caregivers do not want their loved ones suffering anymore, the male caregivers' decision-making process was impacted, first, by caregivers' views on the last stage of life; second, by their wish for good care during the end of life; and third, by their conviction that the patients' wishes should be respected. Furthermore, caregivers' philosophy of life and death is also a supportive ground for decision-making. This philosophy was influenced by their education in palliative care, financial status and religious beliefs and practices. The core category emerging from this study is encapsulated by a participant's assertion, 'How difficult is it? There are no male and female differences'. Conclusion: We found that palliative care experiences of male caregivers are important for the decision-making process for palliative care for their chronically ill family members. Caregivers want their loved ones to receive good care as the last step in life, to respect their wishes and no more suffering for the patient. Therefore, health professionals should be familiar with the palliative care process that caregivers go through to offer updated information when needed.

Objective: To summarize the current evidence on registered nurses (RNs) perspectives, attitudes and experiences related to e-learning. Design: A systematic review of the literature. Data sources: The CINAHL, PubMed, Embase, the Cochrane Library, Scopus and Web of Science databases were searched for studies published in English from 2000 to 2021. Review methods: The study followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria comprised studies with cross-sectional, quasi-experimental, qualitative, and randomised control designs on the attitudes toward, perspectives and experiences of registered nursing about e-learning. Quality appraisal for each study, based on their designs, was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Data were synthesized using a narrative approach. Results: In the 15 included studies, 4 were high quality while 11 were moderate quality. Four themes were revealed in this review including e-learning approaches, facilitators of e-learning and barriers to e-learning barriers to e-learning among RNs and learning in practice barriers. Conclusions: The systematic review uncovered that E-learning is an effective method for integrating knowledge with practice and promoting professional development among RNs in healthcare settings. However, RNs may lack motivation to engage with E-learning and face challenges associated with user-friendly platforms.

Purpose: This study evaluated the effectiveness of a multiple-intervention program (MIP) on the life satisfaction, social support, and depressive tendencies of older adults. Design: A cross-sectional, pretest-posttest design involving a questionnaire survey was adopted. Methods: Thirty-seven older adults were recruited from 2 daycare centers for an 8-week MIP comprising 60-min sessions conducted once a week. The questionnaire comprised the Short Portable Mental Status Questionnaire, Geriatric Depression Short Form-15 (GDS-SF15), Life Satisfaction Scale (LSS), and Inventory of Social Support Scale (ISSB). Findings: The participants' average GDS-SF15 score decreased considerably (by 35.3%), their average ISSB score increased from 61.9% to 80.9%, and their average LSS score increased from 48% to 64%. Conclusions: The outcomes for depressive tendencies, social support, and life satisfaction were measured before and after the intervention, and the participants successfully engaged in the MIP throughout its duration and exhibited improvement. The MIP can serve as a basis for planning group activities for older adults. Clinical Evidence: The MIP benefits older adults at daycare centers. Incorporating multiple activities into daily care can help increase the diversity, uniqueness, and innovativeness of a daycare center.

Purpose: To explore the decision-making and coping processes of women with newly diagnosed breast cancer receiving breast-conserving therapy. Methods: The grounded theory methodology approach was employed in this study. Purposive and theoretical sampling methods were used to enroll 27 women with stage I¿III breast cancer. Individual interviews were conducted using a semi-structured interview guide, and data were analyzed using open, axial, and selective coding. Results: The core category is "limitations of boundaries," which includes three categories: feminine body boundary, emotional boundary, and knowledge boundary. Clusters, conflicts, and changeability were among the unique contextual conditions. The decision-making process became more challenging because of the differences between the levels of knowledge of physicians and patients receiving treatment information. Women's actions and interactions included information seeking, controlling, negotiating, and accepting nondecision-making support. The consequences of decisions included redecision and reoperation, and most women did not regret receiving breast-conserving therapy. Conclusion: Even after choosing breast-conserving therapy, some women may experience changes in treatment procedures. Medical professionals should identify women's challenges and limitations during their decision-making process, explain the benefits and drawbacks of different surgical modalities, address concerns about the outcome of breast-conserving surgery, and provide intellectual and emotional support for decision-making.

This study aims to explore how the families of patients with cancer respond to and act toward complementary and alternative medicine (CAM) use. A qualitative research design based on grounded theory was adopted in this study. Semistructured and face-to-face in-depth interviews were conducted. Each participant was involved in a one-to-one individual interview. Five categories emerged regarding how the families of patients with cancer responded to and acted toward CAM use: purposes of using CAM, CAM use between patients and families, role of family caregivers, actions when using CAM, and seeking religious practice. The core category following coding emphasized the paramount importance of patients' comfort. The findings revealed that the families of patients with cancer may respond and act differently regarding patients' use of CAM. During this process, patients may not inform family members that they are using CAM. Health care professionals should consider this in their interactions with family members.

Loneliness is a negative emotional feeling often experienced by older residents in long-term care facilities (LTCFs). Previous studies have shown that loneliness is related to depression, inferior quality of life, cardiovascular disease, and suicidal thoughts. Thus, it is important to understand older residents' viewpoints about loneliness to provide better care in the long-term care context. This study aimed to explore residents' perceptions of loneliness in LTCFs. For this qualitative research, data were collected from two LTCFs in northern Taiwan, and purposive sampling was used. In-depth interviews with 16 older residents were conducted using a semi-structured interview guide. Content analysis was performed to analyse the data. Four themes with nine subthemes were generated. The themes were: being cut off from continually meaningful relationships, experiencing tears of pain, feeling alone, and lacking a sense of belonging. The findings of this study can provide information for health care professionals to better understand older residents' views on loneliness and remind them to re-examine care protocols for psychological health care. Thus, this study found that in order to prevent or alleviate older residents' feelings of loneliness, the LTCFs should maintain continually meaningful relationships, accompany them, and give them a sense of belonging. The consolidated criteria for reporting qualitative research (COREQ) guidelines were used to report this study.

According to statistics of Ministry of Health and Welfare, accidents were the sixth com-mon causes of death in Taiwan in 2016. A total of 1200 new cases of spinal cord injury each year are caused by accidents and adverse effects. This study explored nurses' experience of caring for patients with spinal cord injury. Hermeneutic phenomenology was used in the data analysis. The five themes emerged: dramatic changes in life, life lost control, life after catastrophic injury, life takes turns for the worse for family, and the power of rebirth. This study revealed that accidents were the primary cause of spinal cord injury, and that nurses may neglect patients' mental and social care. Career guidance should be offered to spinal cord injury patients to ensure that they retain sociality. This study provides recommendations regarding a patient's and their family's post-injury adaption process. The sexual desire of patients should be further explored in future research.

Objective: Colorectal cancer is most commonly treated through surgery. Self-care knowledge and skills are instrumental for disease adaptation once the patient returns home. Therefore, this study examined the effects of a multimedia patient education intervention on improving self-care knowledge and skills in patients with colorectal cancer who underwent colostomy surgery. Methods: A quasi-experimental design was adopted to measure the self-care knowledge and skills of patients with colorectal cancer before and after surgery. The experimental group (n = 33) received a multimedia patient education intervention, whereas the control group (n = 30) was provided conventional instructions. Results: were evaluated using analysis of covariance. Results: On the day prior to discharge from hospital, the experimental group exhibited significantly greater improvement in self-care knowledge than did the control group. The experimental group also exhibited significantly greater improvement in self-care skills than did the control group on the day of gas passage, the day prior to discharge from hospital, and during the first clinic visit after discharge from the hospital. Conclusions: Multimedia patient education intervention yielded greater improvement in self-care knowledge and skills than did conventional instruction. Therefore, multimedia patient education is an adequate educational tool for patients with colorectal cancer who have undergone colostomy surgery.

Cataract is a global disease that may cause blindness. Due to the slow pace of disease progression, patients often presume incorrectly that their blurred vision is caused by excessive fatigue or lack of sleep. In addition to their role in causing blindness, cataracts that are diagnosed late into their progression are more difficult to treat with corrective surgery. Furthermore, many older individuals believe incorrectly that declines in vision are part of the natural course of aging and accept these declines as inevitable. Reduced vision has a significant and negative effect on quality of life. Although aging is one of the main causes of cataracts, other major factors include common chronic diseases and the side effects of drugs. In addition, lifestyle factors such as diet, activity, and environmental exposure to ultraviolet rays and radiation are factors in cataract development. Surgery is the only treatment for cataracts currently available. Healthcare professionals not only consider a patient's background but also whether surgery may promote quality of life. While preoperative evaluation requires a holistic and comprehensive approach, postoperative care is also important to the overall success of cataract surgery. For example, instructions in topical-drop application, wound assessment, and symptoms of comorbidities are crucial for patients. Therefore, a critical literature review was used in this article to establish a strategy for the holistic evaluation of and perioperative nursing care and prevention strategies for cataracts. In addition, recommendations for the comprehensive assessment of and nursing care for patients with cataracts are provided to healthcare professionals article in hopes of improving the quality of care provided to patients with cataracts.

Grandparents are primary resources of caregiving support for parents worldwide, regardless of the cultural background. In Chinese societies, grandmothers often fill the role of supportive caregiver. However, a knowledge gap in the literature exists about how Chinese culture influences caregiving for grandmothers of grandchildren with a disability, particularly in Taiwan. This phenomenological study explored the lived experience of grandmothers caring for a grandchild with a developmental delay or disability in the context of Chinese culture. Twenty-five grandmothers were interviewed. When grandmothers learned of their grandchild's disability, they experienced suffering, which was compounded by the stigma attached to persons with a disability in Chinese cultures, and they also experienced shame and fear of social rejection. Grandmothers' belief in the importance of family gave meaning to their suffering and prompted them to find new ways to deal with everyday difficulties. These findings can guide nurses and health care professionals responsible for supporting grandmothers caring for a child with a disability in the context of Chinese culture.

The health of breast cancer survivors (BCSs) is an essential concern worldwide. This review summarizes current knowledge and proposes a novel framework for understanding BCSs' transition experiences and adopting a more holistic view of transitional care to ensure a successful shift from patient-to-survivor. An integrative review was applied whereby we searched CINAHL, MEDLINE, PubMed, and ProQuest. Eleven qualitative and 16 experimental articles were extracted and evaluated. Constant comparison and matrix classification were used for data analysis, extraction, and synthesizing, which were circulated between the study findings and transitions theory. The breast cancer survivors' incorporated transition theory (BCSITT) encompasses the concepts of transition nature, conditions, intervention strategies, and patterns of response as developed from the data analysis. Facilitators and inhibitors of BCSs' transition experience in the personal, interpersonal, organizational, communal, societal dimensions as well as an empirical intervention of BCSs' transitional care from micro to macro levels are proposed. In conclusion, the BCSITT could provide comprehensive insights for understanding the phenomenon of BCSs' transition from primary treatment completion to self-management and serve as a holistic framework to guide clinical practice and research for BCSs' transitional care. Health care professionals need to assess the readiness of BCSs for transition and provide early interventions for enhancing BCSs' mastering of new skills to manage the challenges of transition. Incorporating stakeholders at each level and providing a comprehensive continuum of care may successfully assist BCSs' patient-to-survivor transition.

Background: Infection preventionists (IPs) play an important role in preventing health care¿associated infections in a health care system. However, the limitations of the clinical setting and the unique characteristics of psychiatric patients could be barriers to effective infection prevention. The purpose of this study was to understand how IPs perceived their challenges and how these challenges negatively affect their infection prevention work in psychiatric clinical settings. Methods: A descriptive, qualitative research approach was used in this study. Thirteen Taiwanese psychiatric IPs were interviewed in semistructured interviews. Data were transcribed and then analyzed by thematic analysis. Results: This analysis identified 6 themes: (1) lack of preservice training in psychiatric infection control, (2) insufficient staffing in practice, (3) working within environmental limits, (4) patient noncompliance, (5) undervaluation of the importance of infection control by professionals, and (6) involvement of hospital administrators. Conclusions: The implementation of effective infection prevention in psychiatric clinical settings may be strongly related to the factors of sufficient training and IP staffing while relying on collaboration among patients and clinical professionals and on the full support of administrators.

Background: Most qualitative studies on caregivers of cancer patients have explored the experiences of family members and friends in Western or European countries. Little is known about the experience of spousal caregivers of patients recently diagnosed with cancer in a Chinese population. Aim: The aim of this study was to explore the lived experience of spouses of patients recently diagnosed with cancer in Taiwan. Methods: This qualitative study analysed focus groups interview data using thematic analysis. Participants were purposively sampled from a medical hospital in central Taiwan. Four focus group interviews were conducted; 15 spousal caregivers participated. Findings: Research findings from the spouses, seven husbands and eight wives, included four main themes: handling emotions to make decisions quickly, experiencing meaningful support from a right and good physician, struggling with changes in daily life, and placing a peaceful mindset at the centre of life. Discussion: Chinese collectivistic culture expects family members to make medical decisions and filter information a patient receives. Spousal caregivers informed patients about their cancer in order to avoid or reduce the amount of psychological harm. Spouses' strong commitments to caregiving provided them with power and motivation to continue caregiving. A peaceful mindset, influenced by the traditional Chinese philosophy of Buddhism, was considered critical for prolonging the patient's life and maintaining the caregiver's emotional health. Conclusions: It is important for healthcare professionals to understand Chinese cultural influences and concerns of spousal caregivers when caring for Chinese patients to manage patients and caregivers effectively.

Aims and objectives: To explore nurses' perceptions regarding providing psychological health care for older residents in long-term care facilities (LTCFs). Background: Loneliness and depressive symptoms are commonly observed among older residents living in LTCFs. Nurses are expected to provide holistic care including physical, psychological and social care for older residents in LTCFs to fulfil their needs. Therefore, understanding nurses' feelings and thoughts regarding providing care for older residents who feel lonely, sad, unhappy or depressed is important for delivering better care. Design: A qualitative research design was employed. The Standards for Reporting Qualitative Research (SRQR) was used to enhance for reporting quality. Methods: Purposive sampling and snowball sampling were applied in Northern Taiwan. One-to-one in-depth interviews were conducted using a semi-structured interview guide. Twenty-one nurses with a mean age of 38.4¿years were interviewed. Content analysis was performed for data analysis. Findings: Four themes were generated from the data: "insufficient psychological healthcare competency," "having a willing heart but not adequate support," "families playing an essential role in residents' mood" and "physical-oriented care model.". Conclusions: Long-term care facilitie nurses felt that they were not adequately prepared for taking care of older adults' psychological problems before their nursing career or during their practice. Unreasonable nurse-to-resident ratios and an absence of care consensus among healthcare providers can make nurses feel that they have a willing heart but not adequate support. Family members are essential in older residents' emotional status within the Taiwanese cultural context. Physical care evaluation indicators emphasised by LTCF accreditation resulted in the current care practice model. Implications for practice: This study provides valuable information for LTCF nurses, managers and directors to develop appropriate strategies to assist nurses in providing better psychological health care for older residents. Evaluation indicators required by LTCF accreditation in Taiwan must be re-examined at the earliest stage.

Stroke is ranked third among the top 10 causes of death in Taiwan. Besides a high mortality rate, stroke survivors are often left with physical or functional sequela. This study aimed to explore ischemic stroke patients' decision-making process using Western medicine (WM) and complementary and alternative medicine (CAM). This study is a qualitative study based on grounded theory. A total of 12 participants were recruited. Findings revealed that the participants accepted WM and CAM treatments following the onset of ischemic stroke. Three categories and several subcategories emerged from stroke patients' decision-making process. These are "uncertainty of stroke," "delicate balance between WM and CAM," and "reestablishing confidence and faith." Eventually, they exhibited the core category of "breakthrough and the pursuit of a sense of rebirth." This study also found that the participants were unwilling to inform their health care professionals on their use of CAM. Therefore, health care professionals should empathize with the views and needs of their patients and respect their decision to combine WM with CAM. The views of other medical teams concerning CAM into their analysis of patients' decision-making process are recommended. Therefore, comprehensive insight into ischemic stroke patients' decision-making process for using CAM can be further explored.

OBJECTIVE: Diabetes has been the fourth leading cause of death in Taiwan since 2002 and is one of the top four most prevalent chronic diseases worldwide. Patients who have diabetic foot, as well as their families, are faced with the burden of possible limb amputation. The aim of this study was to explore the amputation decision-making process with patients with diabetic foot and their families. METHODS: Grounded theory was used in this study. Data from 16 participants at a regional hospital in Taiwan were collected using purposive sampling. The data analysis was conducted through open coding, axial coding, selective coding, and memo writing. RESULTS: The study revealed that the core factor in the decision-making process was "amputation in order to survive." Patients and families additionally considered "the devastation of experiencing multiple diseases," "treatment of poorly healing wounds," and "facing the decision of whether to undergo amputation." CONCLUSIONS: After understanding the patients' decision-making process regarding amputation, healthcare providers should be encouraged to empathize with such patients. Further, providers should respect the patients' and families' decision and provide them with necessary care. Future research should explore professional perspective and family members' care process for amputees to understand the decision-making process of patients who require amputation.

Background: Stroke is a leading cause of death worldwide and the third leading cause of disease-related mortality in Taiwan. Furthermore, stroke is a major cause of functional disability in adults, causing physiological, psychological, and social impacts. Little qualitative research has been conducted on the primary adaptation process of patients with first-ever stroke in Taiwan. Purpose: The present study explored the primary adaptation process of patients with first-ever stroke. Methods: This qualitative study used purposive sampling to enroll 12 patients with first-ever stroke for interviews, followed by theoretical sampling. Grounded theory guided the methodology and data analysis. Data analysis was performed simultaneously in accordance with the coding process. Results: The primary adaptation process used by the participants involved the two main categories of "impacts of stroke" and "adaptation after stroke", with three subcategories associated, respectively, with the former (loss of physical autonomy, diminishing perceptions of self-value, and stroke-related hardships turning into social isolation) and with the latter (regaining autonomy after rehabilitation, receiving support from family without being a burden, and release from suffering / becoming more positive). The core category that emerged from the present study was: "Facing stroke, hoping for the best, transforming lives." Conclusions / Implications for Practice: The above findings on the primary adaptation process of stroke patients provide an important reference for clinical nurses / healthcare professionals who have responsibilities to care for patients with first-ever stroke. In addition, healthcare professionals should offer more health education and psychological support to stroke patients based on individual patient needs.

Background: The majority of cancer patients receive some form of complementary and alternative medicine (CAM), and the demand for CAM is growing among this patient population. Purpose: This study explored how health care professionals (HCPs) view and interact with people with cancer who use CAM. Methods: An exploratory qualitative approach was employed to analyze the data from 15 in-depth interviews with HCPs. Data analysis was based on the grounded theory (GT) process, which includes the levels of open, axial, and selective coding. Results: The results showed four categories of interaction between HCPs and cancer patients who use CAM. These were as follows: "personal experiences of using CAM," "outcome determination to use CAM", "family attitudes toward CAM" and "the role of CAM in the ward." The core category identified in this study was "respect patient's autonomy to use CAM.". Conclusion: In this paper, we discuss the interactions between HCPs and patients who use CAM, and the factors that influence HCPs' views and responses to CAM. The development of skills to enable HCPs to understand patients' perspectives and assess the usefulness of CAM should be encouraged. The implications of our findings may thus benefit nursing education and nursing practice.

Background: The possibilities that nurses will take care of persons 65 years of age or older in hospitals and communities are increasing due to a growing aged population. Nursing students should be prepared to face the challenges of their future practice. Therefore, factors associated with nursing students' willingness to care for older adults need to be identified. Aim: This study aimed to explore Taiwanese nursing students' willingness to work with older persons and factors associated with this. Methods: A cross-sectional research design was used. Stratified sampling was applied to recruit participants from seven nursing schools in northern, central, southern, and eastern areas of Taiwan. There were 612 nursing students who successful completed the questionnaire including demographic data, the Attitudes Toward the Elderly Scale, and the Willingness Toward the Elderly Care Scale. Data were collected between November 2012 and January 2013. A stepwise regression analysis was conducted to identify predictors of nursing students' willingness to care for older adults. Findings: The mean score of nursing students' attitudes toward older people was 73.86 (SD = 8.9), with a range of 44-106. The mean score on the willingness to care for older adults was 55.01 (SD = 6.4), with a range of 36-75. The length of time with older adults per week (r = 0.12, p =003) and grandparents having served as caregivers during the students' childhood (t = -2.147, ß =032) were both positively associated with the willingness to care for older adults. The best predictors of nursing students' willingness to care for older adults were students' attitudes toward older adults (ß = 0.38, p <.001), paying attention to issues related to older adults (ß = 0.24, p <.001), and having the experience of being a volunteer who served older people (ß = 0.10, p =005), which explained 26.8% of the total variance. Conclusions: Taiwanese undergraduate nursing students had neutral to slightly favorable attitudes toward working with older adults. Nursing students' positive attitudes about older adults, paying attention to issues related to older adults, and having been a volunteer that served older people were predictors of their willingness to care for older persons. Appropriate and practical strategies should be developed for students in order to increase their preference for caring for older people. Clinical Relevance: The findings of this study can provide information for faculty members and clinical preceptors for designing curricula and related activities or arranging practicum in the future.