Comparing the different viewpoints on overseas transplantation demands between genders and roles

This study examined the different demands for overseas liver transplantation between genders and roles from the perspective of overseas liver transplant recipients and primary caregivers. An exploratory qualitative method was employed using a purposive sample of individuals who had received overseas liver transplantation. We recruited 28 recipients and 29 family members from a leading hospital in Taiwan. Face-to-face semi-structured interviews were conducted with each participant, and data were analyzed using qualitative content analysis. Three demands were identified across gender and roles: (a).. sufficient information related to overseas liver transplantation, (b).. domestic availability of the liver source, and (c).. supportive policy for receiving continuous treatment and health insurance cover. Different patterns and meanings related to gender and roles were discussed. Male recipients were less enthusiastic about receiving the overseas liver transplantation. Rather, they complained about losing the economic and decision-making power due to body deterioration after overseas liver transplantation. Their primary need was to increase their dignity and significant position in the family. Female recipients were apprehensive for overseas liver transplantation and required more psychological support and positive experiences from other transplant recipients. Most male primary caregivers required a nursing aide quickly. Most female primary caregivers would engage in the health care task but needed more medical personnel, assistance, and high emotional support from relatives. This study revealed the common and urgent demands of overseas liver transplant recipients and primary caregivers. The unique demands of recipients and primary caregivers based on their gender and roles were rooted in the potential influences of traditional cultures and modern medicine in an ethnic-Chinese society.

Using an informatics education strategy to resolve the dilemma of teaching transplantation in medical institutions: Multidisciplinary medical team perspectives

In Taiwan, the current survival rate 1 year after transplantation exceeds 80%. However, the number of organ/tissue donors per year in Taiwan is extremely low, resulting in increased mortality. This is also true in Europe and in the United States. Recently, data from the Taiwan Organ Registry and Sharing Center showed that, although fundraising for organs/tissues slightly increased, the number of donors did not exhibit a corresponding growth trend. Identifying appropriate donors and the provision of good quality transplantation care by medical team members are current challenges. Hence, the application of information technology to in-service education for organ transplantation professionals has been suggested.This was a qualitative study that employed qualitative content analysis with purposive and snowball sampling. The study participants (n = 8, mean age 39.88 ± 3.06 years) included medical staff involved in tissue/organ transplantation from 4 leading medical centers and 3 regional teaching hospitals, and those who participated in the informatics education system.The interviewees from multidisciplinary medical teams showed the status of and dilemma in organ fundraising/donation/transplantation, noting 6 core themes. Regarding relevant education and training, 4 core themes were identified.Current educational courses for organ fundraising/donation/transplantation are inadequate and seem to provide insufficient information to multidisciplinary medical teams. Hence, it is necessary to develop a theoretical construct to create a complete curriculum framework and to establish complete fit-in professional and ethical organ transplantation learning programs based on informatics technology to increase the interdisciplinary exchange of experience.

Death and Help Expected from Nurses when Dying

This project was undertaken to ascertain the perceptions of a group of Taiwan’s fourth-year bachelor of science in nursing (BSN) students regarding death and help expected from nurses during the dying process. Within the Chinese culture, death is one of the most important life issues. However, in many Chinese societies it is difficult for people to reveal their deepest feelings to their significant others or loved ones. It was in this context that this project was developed because little is known about how Taiwan’s nursing students perceive death and the dying process. Using an open-ended, self-report questionnaire, 110 senior BSN students recorded their thoughts on: (1) their fears before physical death; (2) afterlife destinations; and (3) the help they would expect from nurses when dying. The data were analyzed using a three-layer qualitative thematic analysis. The students’ reported needs during the dying process were directed towards three main goals: (1) help in reaching the ‘triple targets of individual life’; (2) help in facilitating in-depth support so that both the dying person and significant others can experience a blessed farewell; and (3) help in reaching a destination in the afterlife. The results support the belief of dying as a transition occurring when life weans itself from the mortal world and prepares for an afterlife.

The needs and expectations of overseas liver transplant recipients' families in Taiwan: across different transplantation stages

AIMS

This study explored the needs and expectations of Taiwanese overseas liver transplant recipients' families (OLTRFs) across three liver transplantation stages.

PATIENTS AND METHODS

An exploratory qualitative method was applied to a purposive sample of OLTRFs who received guided face-to-face, semi-structured interviews. Data were subjected to content analysis.

RESULTS

Nineteen OLTRF members (15 females, 4 males) aged between 29 and 71 years (mean, 55.1 years) for 19 patients who had end-stage liver diseases were interviewed regarding overseas liver transplantation (OLT) across three stages: pre-departure (first stage), stay in mainland China (second stage), and re-entry into Taiwan (third stage). Five types of needs across OLT stages were reported: (a) knowing precise operation schedule in advance (first to second stages); (b) sharing the caring burdens (second to third stages); (c) knowing the updated health status if possible (all stages); (d) obtaining timely psychological support (all stages); and (e) effective communications between health professionals in Taiwan and mainland China to ensure the caring quality (all stages). Furthermore, five expectations were reported: (a) more donor sources (first stage); (b) comprehensive caring strategies for OLT (first stage); (c) a comprehensive consultation system and timely assistance channels for OLT recipients and their families (second to third stages); (d) a legal and accessible therapy process (all stages); and (e) the cooperation with foreign countries and allowed experience sharing for better quality of patient care (all stages).

CONCLUSIONS

Most ethnic Chinese believe that family is an integrated system; moreover, there is close attachment between OLT recipients and their families. The needs and expectations of the recipients' family across three transplantation stages were first reported in this project. With this knowledge, the health providers of related countries are empowered by a better understanding of the family's needs and expectations of these OLT recipients at different stages.

Difficulties in organ procurement and transplantation in the aboriginal minority people in Taiwan

BACKGROUND

Aboriginal people (AP) are a minority group in Taiwan. Little information on their perspectives on organ transplantation (OT) is available. Their rights for organ donation (OD) and as OT recipients (OTR) are constrained as a vulnerable population in society. This research sought to explore various Highland Aborigine Tribes beliefs systems and concepts related to OT.

METHODS

We employed a qualitative design on a purposive sample including seven categories of Taiwanese AP. Data collected by face-to-face interviews were evaluated by content analysis.

RESULTS

Seventy-five informants (45 female and 30 males) of 18 to 82 years from seven tribes completed interviews: Bunun (n = 20), Shao (n = 18), Tsou (n = 15), Amis (n = 12), Truku (n = 4), Rukai (n = 3), and Puyuma (n = 3). Of there, 33% had no idea of OT. All informants reported lack of knowledge of OD, organ procurement, and OTR. Eighty percent (45-82 years) had no willingness for OD or OTR; others might consult family members and health professionals (HP) to learn about OT. Seven hindering factors were identified: (1) having no background of OT; (2) limited impressions obtained from television news reports; (3) negative concepts of donating one's organs to others; (4) OT concepts contrast with cultural meanings of death; (5) possibility of being stigmatized; (6) fear of being rejected by others; and (7) HP had never mentioned OT.

CONCLUSIONS

Taiwan APs' perspectives of OT concepts showed the majority to be unfamiliar with the concept and benefits of OT. Future research is necessary to explore the possible avenues to facilitate communications between HP and AP leaders, as well as elders in each AP category in Taiwan.

Motivations and decision-making dilemmas of overseas liver transplantation: Taiwan recipients' perspectives

PURPOSE

This study sought to explore the motivation and dilemmas in the decision-making process encountered by Taiwan overseas orthotopic liver transplant (OLT) recipients.

PATIENTS AND METHODS

We used an exploratory qualitative research method on a sample of transplant recipients. Face-to-face in-depth interviews were performed with a semistructured interview guide. Data were evaluated by qualitative content analysis.

RESULTS

We interviewed 15 patients including 11 males and 4 females aged between 41 and 68 years (mean = 57.3) including 14 who received OLT in China and one in the United States. The most important motivations were saving lives from end-stage liver disease and avoiding a hopeless sense of their residual lives with the psychological torture of a waiting death. Their decision-making process leading to overseas OLT could be divided into several phases among which the phase of transplant data evaluation and decision was the most critical one. Nevertheless, every stage and phase had its unique contents, factors, and dilemmas.

CONCLUSION

This study demonstrated that patients encountered various dilemmas at different phases in the decision-making process of considering overseas OLT. This information is important for care providers and policy makers in dealing with patients who consider overseas OLT.

An exploration of spiritual needs of Taiwanese patients with advanced cancer during the therapeutic processes

AIMS AND OBJECTIVES

This study explores the spiritual needs of patients with advanced cancer during their therapeutic process in Taiwan and analyses the influence of Chinese culture in addressing their spiritual needs.

BACKGROUND

Many nurse clinicians have concerns about the difficulties of providing spiritual care for ethnic-Chinese cancer clients within their cultural context, possibly as a result of lack of knowledge and training. There has been little research exploring the potential impact of Chinese cultural values on the spiritual needs of patients with advanced cancer.

DESIGN

Explorative qualitative enquiry was used.

METHODS

Data were collected through participant observation and in-depth face-to-face interviews. Transcribed interview data were analysed by using qualitative content analysis. The purposive sample (n = 33) was drawn from a leading medical center (n = 19) with 3000 beds in the capital and a community-based rural teaching hospital (n = 14) with 581 beds in Taiwan.

RESULTS

Four spiritual needs emerged from the analysis: the need to foster hope for survival and obtain a peaceful mindset, to fulfil the meanings of life and preserve one's dignity, to experience more reciprocal human love and finally, to receive assistance in facing death peacefully.

CONCLUSION

This research has shown that patients with advanced cancer need caregivers, friends and the help of their religion to meet their spiritual needs during the therapeutic processes.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study could assist health professionals to detect the unmet spiritual needs of ethnic-Chinese patients with cancer in the context of their cultural or religious background as early as possible.

Dark-recovery experiences, coping strategies, and needs of adult heart transplant recipients in Taiwan

AIMS

The aim of this project was to identify the dark-recovery experiences (DRE) that adult heart transplant recipients (AHTRs) perceived as causing the most suffering after heart transplantation (HT). In artition, we sought to explore the stage-specific difficulties, coping strategies, and helpers for transplant recipients DRE in Taiwan.

METHODS

A qualitative design was employed using a sample group of patients with DRE. Retrospective data collected by face-to-face in-depth interviews were subjected to content analysis.

RESULTS

A total of 20 AHTRs (16 men, 4 women) participated in this research. Their ages ranged from 32-70 years (mean, 46.95 years). Their post-HT timeframe ranged from 3 months-2.10 years. The subjects reported DRE the across preoperative intensive care unit (ICU), postoperative floor unit, and even after the hospital discharge stages. Four major difficulties during DRE were reported: (1) becoming a burden for families (all stages); (2) unfamiliar with medical protocols, environment, and policy (ICU stage); (3) mental and physical discomforts caused by the invasive examinations and unstable health condition (post-ICU to postdischarge stages); and (4) sense of uncertainty about health progression and quality of life in the future (post-ICU to postdischarge stages). Four coping strategies were used for DRE: (1) asking religious support (all stages); (2) changing mindsets and taking positive attitudes to live with difficulties (ICU to postdischarge stages); (3) setting goals for health maintenance and recovery (post-ICU to postdischarge stages); and (4) planning to look for an appropriate job in the future (postdischarge stages). Families and religious persons were cited as helpers (all stages), as well as health professionals (ICU to postdischarge stages), other AHTRs (post-ICU to postdischarge stages), and the social welfare systems (postdischarge stages).

CONCLUSION

DRE, coping strategies, and related helpers in Taiwan were systematically explored in this project. With this information, the transplantation team will be empowered to provide better care for AHTRs during their most vulnerable time.

Asia-Pacific nursing scholarship development: qualitative exploration of nurse scholars in Taiwan (Republic of China)

AIM

From the perspective of scholars, to describe a contemporary view of the development, facilitators of and barriers to nursing scholarship in Taiwan, to enhance policy-making about research, education and practise development.

BACKGROUND

Nursing scholarship in the Asia-Pacific region is in different stages of development, depending on in-country resources and socio-economic conditions. Little is known about the facilitators or barriers to nursing scholarship in some of these countries, including Taiwan, where nursing education has changed considerably over the last decade.

DESIGN

A qualitative exploratory design.

METHOD

The study used snowballing to identify scholars who underwent semi-structured in-depth interviews. These were digitally recorded, transcribed verbatim and subjected to content analysis.

RESULTS

Interviews were held with 12 scholars and six major themes arose: 'fulfilling our missions'; 'active research productivity'; 'low levels of collaborative research'; 'increasing demands on time'; 'gender issues' and 'developing effective collaborative networks across Taiwan and Asia'. Participants described Taiwanese scholarship development in terms of fulfilling the missions of universities; trying to balance work and culturally relevant family responsibilities, against a background of decreasing pressures to produce more qualified nurses and being more research productive in rapidly changing and challenging work environments.

CONCLUSIONS

Taiwan's nursing scholarship is in a dynamic early stage of development, with increasing graduate programmes and research productivity, evidenced by rising international publications and the research productivity indexes of academics. However, scholars are facing increasing pressure because of high workloads and balancing family and work responsibilities.

RELEVANCE TO CLINICAL PRACTICE

Understanding scholarship development and its facilitators and barriers in Taiwan helps inform policy makers, the higher education sector and nurses in the country and across the region about what needs to be done to improve nursing practice, raise health outcomes and enhance nursing research productivity and education.

Spiritual needs of Taiwan's older patients with terminal cancer

PURPOSE/OBJECTIVES

To explore the core constitutive patterns from the perspective of the older patient with terminal cancer, the major foci of spiritual needs, and professional actions that manifest tangibly as spiritual care.

DESIGN

Hermeneutic inquiry.

SETTING

Two leading teaching hospitals in Taiwan.

SAMPLE

35 older patients with terminal cancer with a life expectancy of three months.

METHODS

Participatory observation and in-depth interviews were the major data collection strategies. Hermeneutic inquiry was used to disclose, document, and interpret participants' lived experiences.

MAIN RESEARCH VARIABLES

The perceptions of older Taiwanese patients with terminal cancer and their particular healthcare needs across various transition stages.

FINDINGS

Two constitutive patterns, "caring for the mortal body" and "transcending the worldly being," each with three themes and a related transformational process emerged from the data analysis. Two foci of spiritual needs were discovering patients' concerns about their dying bodies and their worldly being and facilitating the transcendence of the spiritual being from the physical realm.

CONCLUSIONS

Caring for older Taiwanese patients with terminal cancer and helping them transcend the fear of the unknown when they give up worldly being can produce insights into patients' primary concerns, perceptions, and spiritual needs to help them achieve a "good" death.

IMPLICATIONS FOR NURSING

The knowledge gained in this study and the six major spiritual care actions identified may empower oncology nurse educators to develop culturally valid spiritual care courses. Research-based guidance for nurse clinicians who are taking care of older Taiwanese patients with terminal cancer will be provided.

Surviving a life-threatening crisis: Taiwan's nurse leaders' reflections and difficulties fighting the SARS epidemic

AIM

This study explored Taiwan's nurse leaders' reflections and experiences of the difficulties they encountered and survival strategies they employed fighting the severe acute respiratory syndrome epidemic and the background context framing these phenomena.

BACKGROUND

On several continents in 2002-2003, the highly infectious severe acute respiratory syndrome overwhelmed health care systems and health professionals who had to provide care in situations involving high personal risk and stress, some becoming infected and dying. Nurse leaders in Taiwan had to develop new strategies and support systems for nursing care.

DESIGN

A two-step within-method qualitative triangulation research design.

METHODS

Focus group in-depth interviews held with 70 nurse leaders from four Northern Taiwan hospitals involved in the severe acute respiratory syndrome epidemic. Participants then completed an open ended questionnaire. Content analysis was undertaken with data and stages and themes generated. Data were then analysed using Hobfall's concepts of conservation of resources to further discuss participants' reactions and actions in the severe acute respiratory syndrome crisis.

RESULTS

Participants worked under incredible stress to lead the profession through a period of crisis. Five stages arose in the participants' involvement against severe acute respiratory syndrome over 12 weeks: facing shock and chaos; searching for reliable sources to clarify myths; developing and adjusting nursing care; supporting nurses and their clients; and rewarding nurses.

CONCLUSION

Nurse leaders become important executors of intervention in this health disaster, requiring emotional intelligence to manage their internal conflicts and interpersonal relationships effectively. They developed sociopolitical and analytical abilities and crucial requirements for planning and implementing strategies in areas where none previously existed. Building support systems was an important resource for managing conflicts between familial and professional roles. Relevance to clinical practice. Findings will assist nurse leaders to prepare themselves and the profession to better deal with disaster management in similar infectious outbreaks in the future.

Dying and caring on the edge: Taiwan's surviving nurses' reflections on taking care of patients with severe acute respiratory syndrome

In 2003, Taiwan's nurses were terrified by severe acute respiratory syndrome (SARS), and four of them sacrificed their life in the course of their work with SARS patients. This study attempted to identify the stage-specific difficulties encountered by Taiwan's surviving frontline nurses during the anti-SARS process. A two-step within-method qualitative triangulation research design was used to obtain the in-depth and confidential thoughts of 200 participants during the precaring, tangible caring, and postcaring stages. Six major types of stage-specific difficulties with and threats to the quality of care of SARS patients were identified according to each specific stage of the caring process. Four themes were further explored; these are discussed to provide a background context in obtaining better understanding of the multifaceted needs of nurses during this crisis. Consequently, a conceptual framework was developed to depict this complex phenomenon.

Self-care behavior, hope, and social support in Taiwanese patients awaiting heart transplantation

OBJECTIVE

The purpose of this study was to examine the self-care behavior, hope, and social support in patients awaiting heart transplantation and to explore all the correlative and related factors.

METHODS

In total, 45 participants who met the selection criteria were selected by purposive sampling from four medical centers in Taiwan. The three instruments Self-Care Behavior Scale, Herth Hope Index (HHI), and Social Support Inventory were used for data collection.

RESULTS

Significant, positive correlations among self-care behavior, hope, and social support were observed. Social support was the best predictive factor for both self-care behavior and hope.

CONCLUSION

The outcomes of this study can help medical care personnel better understand the self-care behavior, hope, and social support in patients awaiting heart transplantation and can also serve as a reference when developing relevant interventions for these patients.

Health Needs Instrument for hospitalized single-living Taiwanese elders with heart disease: triangulation research design

AIM

The aims of this study were (a) to explore the health needs of hospitalized Taiwanese older people with heart disease who live alone in the community; (b) to develop an instrument to assess their health needs and (c) to examine relationships among their health needs.

DESIGN

Three phases were involved in this between-method triangulation design.

METHODS

The first phase explored the contextual content of the health needs from the perspectives of a purposive sampling of 34 subjects by the use of an explorative qualitative method. The second phase developed the Health Needs Instrument (HNI) and established its reliability and validity. The last phase implemented the instrument in a cohort and examined their appraisals of each type of health need as well as the relationships among different types of health needs.

RESULTS

The HNI encompasses the following five types of health needs: help in managing tangible things, psychological support, medical support, obtaining health information and participation in decision-making. In the last phase, a purposive sample of 54 subjects (48 men and 6 women) with an average age of 75.3 years was obtained. Subjects' health needs were ranked as obtaining health information (100%), participation in decision-making (96%), managing tangible issues (87%), medical support (86%) and psychological support (67%). Detailed items for each type of health need were revealed. By examining the relationship between their health needs, the psychological needs in confronting the subjects' physical discomfort had a significant correlation with medical support (r = 0.469, P < 0.01), with tangible needs after surgery or an invasive examination (r = 0.460, P < 0.01), with informational needs (r = 0.393, P = 0.034) and with tangible needs of maintaining daily living activities during the hospitalization period (r = 0.290, P = 0.034). The need for tangible help in maintaining daily living activities during the hospitalization period was significantly correlated with the need for medical support (r = 0.341, P = 0.012), with help in managing admissions and discharge procedures (r = 0.374, P = 0.05) and with help after an invasive examination or in the postsurgery period (r = 0.334, P = 0.013).

CONCLUSION

Finally, a conceptual framework was developed to depict this phenomenon. With the help of this HNI, both Eastern and Western health care providers can be empowered to detect the complex health needs of this particular population earlier and more accurately in order to promote their well-being as well as their health-related quality of life.

RELEVANCE TO CLINICAL PRACTICE

Empowering nurse clinicians to assess health needs of hospitalized single-living Taiwanese elders with heart disease.

Professional career development for male nurses

AIM

The aim of this paper is to report a study to: (a) explore Taiwanese male nurses' motivations for becoming a nurse; (b) reveal their professional developmental process in nursing; (c) understand the difficulties hindering their professional development from both professional and gender aspects; and (d) identify the strategies they use to cope with these difficulties.

BACKGROUND

Hindered by historical, cultural, economic and warfare factors, the proportion of male nurses in Taiwan remains low. Taiwanese male nurses' career development process has not been well investigated yet.

METHODS

A descriptive qualitative research design was used, with a convenience sample of 15 male nurses (mean age 30.8 years) with a Bachelor's degree in Nursing Science. Data were collected by semi-structured interviews and analysed by content analysis.

RESULTS

Taiwanese male nurses' entrance into the nursing profession involved three phases: pre-study, study and employment. The difficulties encountered during career development were related to the gender expectations of patients and the general public. The nurses received support more from superiors than from colleagues. The strategies they used included (a) improving their professional knowledge and skills to obtain higher levels of satisfaction and better opportunities for promotion; (b) thinking aggressively about job promotion; (c) choosing specialist departments as appropriate environments for graduate study and personal growth; and (d) changing their professional track for personal growth.

CONCLUSIONS

Based on the nature of nursing work and clinical experiences, Taiwanese male nurses believed that nursing was a profession suitable for both men and women. Their preparation for career development started at the pre-study phase. The major strategies they used were related to a strong desire for personal growth and professional promotion. Finally, a conceptual framework was developed to depict this complex phenomenon.

The impact of the 9-21 earthquake experiences of Taiwanese nurses as rescuers

The powerful earthquake of September 21, 1999 wrought incalculable havoc on lives and properties in Taiwan. Although the scars of the earthquake can never be erased, the calamity can lead to a more full understanding of the experiences, perceptions and reflections of nurses involved directly in post-rescue situations. The purpose of this study was to compare the impacts of rescue experiences on Taiwanese female and male nurses who worked as rescuers following the earthquake of 21 September. A purposive sample of 46 nurses (40 women, 6 men) (mean age 26) who worked in a renowned hospital with a reputation for high quality of emergency care in Northern Taiwan was obtained. Data were collected by in-depth semi-structured interviews and analyzed by a unique mode of between-method triangulation. The majority of the subjects (38 female, 6 male) reported various impacts from their rescue experiences. They are: (a) recognition of the impermanence of life and wishing to lead a more significant life (32 female, 3 male); (b) more caring relationships with others and for their homeland (19 female, 5 male); (c) a clearer concept of disaster care (19 female, 4 male); (d) a better appreciation of the value of nursing and their own self-worth (11 female, 3 male); (e) enhanced knowledge of the survivors' needs (3 female); and (f) enhanced ability to identify the factors hindering rescue operations (1 female, 2 male). However, one female nurse complained of having been bothered by feelings of fear of earthquake disasters resulting from her rescue experience. Rescue experiences help to strengthen most Taiwanese nurses' professional competency, reinforce their commitment to nursing, and lead them to have positive life goals. The relative weight of the impacts for male and female nurses were somewhat different. The vulnerability of nurses, which was manifested in the post-rescue stage, requires attention and long-term follow-up. A comprehensive and organized pre-rescue training program which recognizes the need to care for both acute and chronic post-disaster conditions, along with spiritual care for the survivors, as well as a "disaster reduction" course for health professionals are suggested.

Empirical validation of a teaching course on spiritual care in Taiwan

AIM(S) OF STUDY: The aims of this study were threefold: (a) to develop the first spiritual care program for master of science in nursing degree students (MSNDS) in Taiwan, since most of these students are or will be nursing leaders in clinical practice, education, administration, or research; (b) to facilitate the MSNDS in applying the contents of this program to care of their clients; and (c) to understand the MSNDS' appraisals of the usefulness of the program in helping them provide spiritual care in clinical settings.

BACKGROUND

The World Health Organization (WHO) (1998) proclaimed that health needs should include spiritual well-being in addition to physical, mental, and social domains. Nevertheless, many dominant medical educational systems have not yet encompassed spiritual care as part of their comprehensive or core curricula.

DESIGN/METHODS

The methodological triangulation research design used in this project included various strategies of developing a novice course entitled 'Spirituality in Nursing Practice' which was given to the subjects over 18 weeks from September 1998 to February 1999. The course included classroom lectures, field trips, clinical implications, and presentation-appraisal. A convenience sample of 22 female MSNDS who were or had the potential to be nursing leaders from two schools of nursing in northern Taiwan was obtained.

RESULTS

Four types of help were identified: (a) help in clarifying the theoretical concepts of spiritual care (100%); (b) help in providing a culturally bonded spiritual care plan (100%); (c) help in self-disclosure of the nurse's personal value systems and spiritual needs (91%); and (d) help in clarifying the symbolic meaning and the impact of religious rituals (86%). The explicit spiritual care plans and an empirical example of spiritual care were provided.

CONCLUSIONS

This study presented the first spiritual care program for MSNDS in Taiwan. All subjects considered the course helpful in providing spiritual care for their clients in various clinical settings. The concept of spirituality is arousing great interest in the world, and this is evident in the spiritual care courses appearing in nursing curricula for nursing leaders in Taiwan.

The dilemma of "to-be or not-to-be": needs and expectations of the Taiwanese cadaveric organ donor families during the pre-donation transition

There has been little study of the Chinese cadaveric donor family's decisions to donate organs within the Chinese cultural framework. A convenience sample of 25 cadaveric donor family members (12 men, 13 women) who gave their consent to donation at National Taiwan University Hospital agreed to participate in this study and completed in-depth interviews. Data were analyzed by a three-steps within-method qualitative triangulation method. The factors influencing the donor family's decisions to donate organs, the needs of donor families, and their expectations of health care providers during the pre-donation transition--the critical period of time between signing a donation and consent to organ harvesting--were examined. The background context and a conceptual framework were further developed to discuss and depict this phenomenon. This project aims to broaden the horizon on organ donation and contribute to the understanding of some of the psychodynamic issues in the Chinese family in Taiwan.

[The decision-making process of pregnant women with positive reaction to maternal serum screening for Down's syndrome when facing amniocentesis]

The purpose of this study was to explore the decision-making process of pregnant women with positive reaction to maternal serum screening for Down's syndrome when facing amniocentesis. Seventeen pregnant women consented to participation in this study. The data were collected through semi-structured interviews and analyzed using the grounded theory method. The findings revealed that there were four decision-making patterns. Each pattern could be grouped into three stages: post-acknowledgement transition, decision-making transition, and after-decision transition. Most participants had psychological reactions, which included shock, fear, nervousness, worry, sadness, and stress. Their concerns during the decision-making transition stage were: confirmation of health, normality, and safety of the fetus, fear of abortion due to amniocentesis, clarification of relations between amniocentesis and maternal serum screening, opinions from physicians and family members, and fear of artificial abortion for unhealthy fetus. Concerns during the after-decision transition stage were: information relating to amniocentesis, the management of an abnormal fetus, the place for amniocentesis, preparation before amniocentesis, and inadequate time for making a decision. Coping strategies were developed to deal with their concerns.

Impact of cadaveric organ donation on Taiwanese donor families during the first 6 months after donation

OBJECTIVE

Organ donation is a complex decision for family members of Asian donors. The impact of cadaveric organ donation on both Chinese and Western donor families has not been well investigated within a cultural framework. The purposes of this study were to follow Chinese family members' appraisal of their decision to donate organs, to explore the possible negative and positive impacts of organ donation on their family life, and to determine what help they expected from healthcare providers during the first 6 months after donation.

METHODS

Twenty-two family members (10 men and 12 women) of cadaveric organ donors who signed consent forms at an organ transplant medical center in Taiwan participated in this project and completed in-depth interviews during the sixth month after donation.

RESULTS

Participants were 25 to 56 years old (mean = 48.15 +/- 8.31 years). The type of kinship of the participants included the donor's parents, older sister, and spouse. Subjects reported several negative impacts: worry about the donor's afterlife (86%), stress due to controversy among family members over the decision to donate (77%), and stress due to others' devaluation of the donation (45%). Positive impacts reported by the subjects included having a sense of reward for helping others (36%), having an increased appreciation of life (32%), having closer family relationships (23%), and planning to shift life goals to the study of medicine (9%). Subjects expected the transplant team to provide information about organ recipients (73%), to submit the necessary documents so that family members could receive healthcare payments from the insurance company (68%), to help resolve legal proceedings and settlements associated with accidents (64%), and to not overly publicize their decision to donate (64%).

CONCLUSIONS

Although all of the subjects reported that organ donation was the right decision, the decision to donate did not protect Taiwanese donor families from negative psychocognitive bereavement. The impacts of organ donation were affected by the subject's social cultural, spiritual, and legal context and the nature of their bereavement.

The forgotten faces: the lonely journey of powerlessness experienced by elderly single Chinese men with heart disease in Taiwan

The purpose of this study is to explore the content and background context of powerlessness experienced by elderly single Chinese men with heart disease and their coping behaviors during their hospitalization stage. Data were gathered by semi-structured interviews at a leading veterans' hospital in northern Taiwan and analyzed using a qualitative content analysis mode. Twenty-six men who were 65 or older, diagnosed with heart disease, and who lived alone during the preadmission stage were recruited. Eighty-one percent (N = 21) reported that their perceptions of powerlessness occurred either in the preadmission or hospitalization stage or were expected to occur after discharge. Other complaints of powerlessness were attributed to having no choices in appropriate living places during the preadmission stage, having no control over discomfort, being unable to obtain care and companionship from families and friends, failing to get medical information about their disease and options of treatment during hospitalization, or expecting deteriorating health and receiving no assistance during emergencies or in the dying stage after discharge from the hospital.

Priority-setting for nursing research in the Republic of China

The question of how public funds for research should be allocated has led to participatory priority-setting in prosperous democracies like Taiwan, Republic of China. Useful criteria for research priorities are scientific merit, social benefit and feasibility. Taking a health needs approach and using these criteria, nearly 200 nurses from service and education in a national forum participated in describing research priorities. Through the group method of idea-writing, for clinical nursing, of high priority were assessing quality, care of the elderly, and preventing infectious disease. For nursing education, research addressing advanced role preparation and bridging nursing education and practice were priorities. For nursing management, research of highest priority pertained to economic evaluation, personnel administration, and effectiveness. These suggestions from the deliberation of a committed group of nurses can help shape future national decisions about research funding and training.

Patient positioning and the accuracy of pulmonary artery pressure measurements (180f)

The measurement of pulmonary artery pressure (PAP) is a common nursing practice in hemodynamic monitoring of patients in the emergency room and intensive care unit. Several researchers have proposed that PAP should be measured with the patient in a supine position with legs horizontal in order to promote a relaxed state. The most widely used reference point is the phlebostatic axis, which is located at the intersection of the fourth intercostal space and the midchest level. However, this positioning requirement is in conflict with one of the goals of nursing care, which is to achieve comfortable positioning of the patient without compromising respiratory or cardiovascular function. In addition, since frequent readings are necessary, critically ill patients can lose valuable sleep time. The existing literature still fails to justify the validity of the phlebostatic axis as an external reference point for leveling the pressure transducer. In addition, findings on the accuracy of readings obtained in the supine, Fowler's and lateral recumbent positions are also in conflict. This paper reviewed research related to measurement of PAP in the supine, various Fowler's, and lateral positions in order to clarify the major factors which might have resulted in the conflicts in data on PAP measurements. Suggestions are also provided for nurse clinicians to obtain more accurate PAP measurements.

[The impact of caring experiences of the patients with borderline personality disorder on psychiatric nurses]

The purpose of this qualitative study was to explore the subjective perceptions of the impact of caring with the hospitalized patients with borderline personality disorder (BPD) on psychiatric nurses. A purposive sample of psychiatric nurses with experiences of caring with at least one hospitalized BPD patient was obtained at one leading psychiatric hospital in northern Taiwan. A semi-structured interview guide and audio-taped recording skill was employed, and data were analyzed by qualitative content analysis. Thirteen female nurses participated in this project. Eighty percent of them were aged between 26-35 (mean +/- SD = 31.77 +/- 4.92). Thirty-eight percent of nurses were registered professional nurses; 54% worked as psychiatric nurses for 5-7 years; and 69% ever took care of 3-4 subjects with BPD. Several impacts of the caring experiences on nurses were identified. They are as follows: (1) becoming more knowledgeable about the BPD patients' characteristics and the related nursing care; (2) having positive or negative motivation of nursing profession; (3) changing nurses' attitudes of interpersonal relationship; (4) valuing nurses' personal belongings; and (5) enhancing nurses' understanding and facilitating their personal growth. The result of this study may empower psychiatric nurses to better understand the BPD patients, and to increase nurses' motivation of caring them. It may also enhance the quality care for these patients and the nurses' sense of satisfaction.

Taiwanese nurses' appraisal of a lecture on spiritual care for patients in critical care units

The purpose of this study is to develop a lecture on spiritual care for adult critical care trainees, and to evaluate the trainees' appraisal of the effectiveness of this lecture in preparing them to provide spiritual care for their clients in a critical care setting. A between-method triangulation research design encompassing a questionnaire and descriptive qualitative content analysis was used. A convenience sample consisting of 64 registered nurses who attended an adult critical care nurse training programme in a leading medical centre in northern Taiwan were invited to participate in this study. A total of 64 female participants completed the questionnaire. Ninety-two per cent (59) of the subjects considered the lecture on spiritual care to be helpful in assisting them to provide holistic care for critically ill patients in the Intensive Care Unit (ICU). Three types of help were identified by the subjects: (1) help in clarifying the abstract concepts related to spiritual care (86%); (2) help in self-disclosing the nurses' personal beliefs and values regarding life goals, nursing, and spiritual needs (67%); (3) help in learning how to provide spiritual care to patients in a critical care setting (34%). Twenty per cent of the subjects thought that inclusion of the following content in the lecture would have been helpful to provide a more comprehensive picture of spiritual care: religious practices and rituals (11%); the culturally bonded nursing care plan (9%); the development of human spirituality (3%); patients' families' spiritual needs in the ICU (3%); and resources for nurses in providing spiritual care (2%). Thirteen per cent of the subjects suggested that the instructor might employ the following strategies to improve the quality of teaching: providing more empirical examples (5%); discussion with the students in classes of smaller size following the lecture or extending the instruction time (5%); and providing a syllabus with detailed information (3%).

Comparisons of American-Chinese and Taiwanese patients' perceptions of dyspnea and helpful nursing actions during the intensive care unit transition from cardiac surgery

OBJECTIVE

To compare perceptions by American-Chinese and Taiwanese patients who received ventilatory assistance of acute episodes of dyspnea and the related helpful nursing actions in the intensive care unit (ICU) after cardiac surgery.

DESIGN

A descriptive qualitative design.

SETTING

Two medical hospitals in northern California and Taiwan.

PATIENTS

A purposive sample consisting of 30 adult Chinese patients who experienced acute episodes of dyspnea while receiving assistance from a volume-cycled ventilator following cardiac surgery in the ICU from one study site in the United States (n = 10) and one study site in Taiwan (n = 20).

OUTCOME MEASURES

The perceptions, natures, helpful nursing actions, and conceptual definition of the acute episode of dyspnea from the patients' perspective.

INTERVENTION

Data were gathered through semi-structured interviews and analyzed by qualitative content analysis.

RESULTS

All American-Chinese and Taiwanese subjects experienced physical discomforts, including tightness and congestion in the chest, labored breathing, sweating, palpitations, pain, and loss of vitality. Seventy percent of American-Chinese subjects and 90% of Taiwanese subjects reported having a mortal fear of death during and after the acute episode of dyspnea. The nature of the patients' perceptions of dyspnea revealed in this study can be categorized as unpredictability, sequence, intercorrelation, and exhaustion. Data analysis shows that the acute dyspneic process includes the immediate, following, later, and final transitions. Helpful nursing actions were identified as comforting, companionship, allowing self-concentration, and providing information.

CONCLUSION

Both American-Chinese and Taiwanese patients' perceptions of acute episodes of dyspnea and helpful nursing actions were identified and compared. Finally, the conceptual definition of patients' perceptions of acute dyspnea and a conceptual framework for this phenomenon were further tentatively developed to depict and delineate this phenomenon.

Health needs of lone elderly Chinese men with heart disease during their hospitalization

Hospitalization is a unique health-illness transition for most elderly people. Whether the patient's health-related needs are met or not often influence his or her appraisal of quality of life during hospitalization. This qualitative study explored the health needs of elderly Chinese male cardiac patients during their hospitalization. Eighteen subjects were recruited from a veterans' hospital in northern Taiwan. These men all lived alone before their hospital admission. Data were gathered using semistructured interviews and then analysed by content analysis. Ninety-four per cent of the subjects described up to three categories of needs: met needs (72%), unmet needs (78%), and expected needs (50%). Needs that participants believed were met were those for psychological support, spiritual support, tangible support and information. Unmet needs were those for participation in decision making, maintaining daily activities and resuming a preadmission lifestyle. The expected needs included those for learning self-care strategies to maintain their daily activities after discharge from the hospital. The factors that framed the participants' perceptions of different health needs were identified to be lack of family support and locus of control. Finally, a discussion of the context background of this phenomenon, as well as some suggestions for its implications, are provided from a culturally sensitive ethical aspect.

Triangulation in nursing research: issues of conceptual clarity and purpose

The controversy concerning the value of qualitative, quantitative and triangulation approaches to nursing research for understanding human behaviour and increasing nursing knowledge has been an increasing source of debate among nurse scholars. However, the differences and similarities of these three perspectives have not been fully compared as either philosophies or methodologies. The purposes of this paper are to provide an understanding of the origin and development of the triangulation research method, clarify major sources of confusion in the presentation of a triangulation study, and discuss the problems and possible solutions of a triangulation study. Finally, an example of multiple triangulation in a nursing research within a Taiwanese cultural context -- turning points of recovery from cardiac surgery during the intensive care unit transition -- is presented. In the course of the paper, suggestions are also given to help nurse researchers recognize when it is most appropriate to use a certain research method, whether that be qualitative, quantitative or triangulation.

Colloids versus crystalloids for emergency patients

Emergency as well as critical care nurses are often responsible for the administration and regulation of fluid resuscitation for their patients. A serious and potentially fatal decline in vital organ performance can often occur as a result of inappropriate volume management. However, emergency and/or critically ill patients who require fluid resuscitation often receive concurrent therapy and monitoring that may have equal or greater impact on the survival and therapeutic end points than does the type of fluid received. These variables have made historical comparisons of crystalloid versus colloid resuscitation difficult. The purpose of this article is to critique three articles that examine crystalloid and colloid resuscitation for patients with various disease processes.

Taiwanese patients' concerns and coping strategies: transition to cardiac surgery

OBJECTIVE

To explore patients' concerns during the admission transition to cardiac surgery.

DESIGN

A descriptive qualitative design.

SETTING

Four hospitals in northern Taiwan, Republic of China.

PATIENTS

A purposive sample consisting of 40 adult patients (20 men and 20 women) who planned to have cardiac surgery. Age range was 20 to 70 years (mean 50.1 years).

OUTCOME MEASURES

The types, levels, components, coping strategies, context, and conceptual framework of patients' concerns.

INTERVENTION

Data were collected through semistructured interviews, and then analyzed using qualitative content analysis.

RESULTS

Ninety percent of subjects (N = 36) reported two types of concerns: certain (80%) and uncertain (10%). Their certain concerns reflected three levels of concerns: "Caring about" or "Thinking about" (52%); "Worrying about" or "Being afraid of" (43%); and "Experiencing a mortal fear of" (30%), ordered from the weakest to the strongest. The components of patients' concerns were the process of recovery; hospital experiences, including maintaining daily activities, pain at admission, and expectant discomforts and disabilities in the intensive care unit; death; unfinished responsibilities and life goals, significant persons, and places; financial needs; and poor quality of care. Strategies developed to manage their concerns included (1) The use of person-focused effort (both cognitive and psychomotor), (2) Seeking help from others, including family members, friends, other patients, and health professionals, and (3) Turning to metaphysical power. The context for the phenomenon of Taiwanese subjects' concerns concerning cardiac surgery during the admission transition were "Being a person," resuming normality, and empowerment of self.

CONCLUSION

The types, levels, components, and coping strategies of patients' concerns during the admission transition to cardiac surgery were discovered and delineated. The background context and conceptual framework for the phenomenon also were developed from the data analysis to describe and depict this phenomenon.

Turning points of recovery from cardiac surgery during the intensive care unit transition

OBJECTIVE

To explore the turning points of recovery from cardiac surgery of patients during the intensive care unit recovery transition.

DESIGN

A descriptive qualitative design.

SETTING

Three hospitals in northern Taiwan, Republic of China.

PATIENTS

A convenience sample consisting of 30 adult patients (15 men and 15 women) who had undergone cardiac surgery. Age range was 20 to 67 years (mean, 46.6 years).

OUTCOME MEASURES

The component, context, type, and positive or negative impact of turning points on patients' health.

INTERVENTION

Data were collected through semistructured interviews and then analyzed by using qualitative content analysis.

RESULTS

Turning points, which included events, nursing actions, and time, were examined in terms of the preceding conditions and the positive or negative health outcomes. Participants in this study fell into four main groups with regard to turning point experiences during the intensive care unit transition: those having experiences of turning points with both positive and negative outcomes (57%); those having experiences of turning points with a positive outcome only (33%); those having no experience of a turning point with either a positive or negative outcome (7%); and those having experiences of turning points with a negative outcome only (3%). Four classes of turning point experiences identified from the data encompassed "precedingness," inclusiveness, comparativeness, and multiplicity.

CONCLUSIONS

We delineated the components, context, types, and positive or negative impact of turning points on patients' health after cardiac surgery during the intensive care unit transition. We also drew information on the nature, definition, and conceptual frameworks from data analysis to describe this phenomenon.

Perception of self in the intensive care unit after cardiac surgery among adult Taiwanese and American-Chinese patients

A descriptive qualitative design was used to compare Taiwanese and American-Chinese patients' perceptions of self during their ICU recovery transition from cardiac surgery. A convenience sample consisting of 35 adult patients having cardiac surgery was obtained from two study sites in Taiwan (N = 30) and the USA (N = 5). Data were gathered through semi-structured interviews and analyzed by qualitative content analysis. Patients' perceptions of self in the ICU included global sensations of abnormality, 'Tong-Kou' (Chinese, meaning physiologically and/or psychologically painful), and "Chin-Son' (Chinese, meaning physiologically and/or psychologically relaxed). The specific perceptions were the physical, psychological, cognitive, social, and spiritual self. The nature and conceptual definition of Chinese patients' perceptions of self, as well as the impact of these perceptions on their recovery in the ICU were further delineated.

Concepts related to Chinese patients' perceptions of health, illness and person: issues of conceptual clarity

Since most health professionals who care for Chinese patients are trained using Western medical educational systems, they are often unaware of the complex Chinese culture that influences their patients' responses to care. Discrepancies often exist between health professionals' and Chinese patients' perceptions of health and evaluations of the quality of care. In order to provide culturally sensitive care for this population, the complex Chinese traditional philosophies, such as the theory of yin and yang and the five phases, as well as the philosophies related to the concept of personhood including Confucianism, Taoism and Buddhism are examined first. This is because these theories and philosophies not only influence Chinese patients' values and beliefs, but also determine their perceptions of health, illness and nursing care. The discussion of implications for surgical cardiovascular nursing practice for this particular population are followed.

A multidimensional model of the antecedents of stress and coping appraisals: an approach to studying patients' perceptions of post cardiac surgery pain and their coping strategies

Lazarus' stress and coping theory has been recognized as a valued conceptual framework for nursing scholars who are interested in studying their client's experiences of stress and coping. However, little data provide in-depth critiques in concepts, availability and limitations of employing Lazarus' theory in nursing phenomena in Taiwan, nor did data provide culturally sensitive propositions for Taiwanese nursing scholars to better understand their clients' stress experience such as post cardiac surgery pain. In order to help Taiwanese critical care nurses better understand the process of theoretical development while assessing their clients' perceptions of post cardiac surgery pain, the historical perspective of the concept of stress and the core components of Lazarus' theory are examined. Following is a critical critique of Lazarus' theory as a conceptual framework with which to study how patients perceive post cardiac surgery pain as a stressor. A multidimensional model of the antecedents of stress and coping appraisals for nurses to assess their clients' perceptions of pain and the resulting coping behaviors is further developed based on the aforementioned critiques. Finally, suggestions for testing theoretical propositions related to this phenomenon, as well as implications for nursing practice, research, as theory are delineated and discussed.

Patients' needs and their coping strategies transition to cardiac surgery

Little data are available concerning Taiwanese patients' needs and the factors contributing to their needs before cardiac surgery. The purpose of this study was to explore the components, nature and definition of patients' needs and their coping strategies of preparation for cardiac surgery during admission transition from patients' perspectives. The admission transition in this study means the patients' stay in the cardiovascular floor unit before surgery. Thirty adult patients (15 men, 15 women) having cardiac surgery were theoretically sampled from three hospitals in Taipei, Taiwan. Data were obtained through a semi-structured interview with the investigator and were analyzed by employing the combination of strategies from grounded theory, qualitative content analysis, linking data, and constant comparison. Ninety percent of participants expressed two types of needs: certain- including met, unmet and expectant needs, and uncertain needs. Needs that participants believed to have been met were the needs for security, maintaining daily living activities, understanding the surgery and recovery process, the needs for optimal physical condition for surgery, receiving quality treatment, and coaching as to use of medical instruments. The unmet needs were the needs for maintaining daily activities, security, fulfilling unfinished family responsibilities, financial support, understanding the surgery and what to expect during the recovery process, freedom from pain, family members' companionship, and spiritual support. The expectant needs included those needs during the ICU and discharge-preparation recovery transitions, throughout the hospitalization and after recovery. The components, nature, definition, reasons, and suggestions for patients' needs and their coping strategies were delineated and discussed. Finally, a conceptual framework was developed to describe and depict this phenomenon.