Four psychological processes navigated by patients during their journey of healing and recovering from depression: a grounded theory study.

This study explored the psychological processes that patients navigated when healing and recovering from depression. A grounded theory approach was used. Twenty patients who had recovered from depression participated. Four categories emerged depicting the psychological processes navigated by the participants during the recovery process: (1) acceptance: acceptance of depression and agreement to treatment; (2) transformation: change of mindsets and behaviours; (3) adaptation: stress regulation and change of focus; (4) integration: progress of depressive symptoms and moving on with 'regular' life. Each phase is related to the other phases, mental health professionals could assist patients with depression achieve the integration phase.

Exploring the meaning of life from the perspective of patients with depression: A phenomenological study.

This study explored the perceptions of meaning of life for patients with depression. A qualitative phenomenology approach was used. Patients with depression (n = 20) were recruited until data saturation occurred. Findings revealed four themes all related to their value of: (1) accepting depression; (2) appreciating work (paid and non-paid); (3) embodying love and taking on responsibilities; (4) receiving spiritual comfort. Healthcare professionals could facilitate patients with depression to explore their meaning of life while enduring and transforming the emotional pain that accompanies depression, hence, perhaps, decreasing their suicidal ideations.

The psychological processes voiced by nursing students when caring for suicidal patients during their psychiatric clinical practicum: A qualitative study.

AIMS AND OBJECTIVES: This study was designed to explore the psychological processes experienced by nursing students caring for suicidal patients during their first psychiatric clinical practicum. BACKGROUND: Nursing students expressed fear when caring for patients who presented with suicidal behaviours. Yet, there is a lack of research exploring nursing students' feelings and thoughts when caring for suicidal patients. DESIGN: A grounded theory study. METHODS: A theoretical sample of 22 undergraduate nursing students who had cared for suicidal patients for at least 5 days during their psychiatric clinical practicum. Data were collected from 2016-2017, in three universities in Taiwan, using a semi-structured interview and constant comparative analysis. COREQ reporting guidelines were utilised. RESULTS: Four categories emerged depicting the psychological processes and revealing that the student nurses navigated four phases when caring for patients exhibiting suicidal behaviours. The phases were as follows: (a) apprehension and fear: involving students being frightened about patients attempting suicide; (b) frustration and powerlessness: concerning students finding it challenging to focus on changing patients' suicidal ideations; (c) support and catharsis: covering the students having to ask for psychological support from other people and explore their painful emotions; (d) confidence and empathy: meaning that the students incorporated enhanced confidence and cultivated advanced empathy, leading to the integration of competent care competencies towards suicidal patients. CONCLUSIONS: Findings could help nursing teachers to understand students' psychological processes when caring for suicidal patients. Teachers could provide appropriate support to help reduce students' negative thoughts and feelings and increase their care competencies when nursing suicidal patients during their psychiatric clinical practicum. RELEVANCE TO CLINICAL PRACTICE: Clinical nurse teachers could support and facilitate students to develop their competencies and confidence as they negotiate the four phases and, actually, complete their internship goals on their clinical practicums.

Modeling Body-Mind-Spirit Well-Being and the Possibility of Relapse Intention in Adults Who Have a History of Substance Use in Taiwan.

BACKGROUND: Substance use is a global mental health issue. There has been limited research exploring the relationships among body, mind, and spirit well-being and the possibility of relapse across different categories of substance users. AIMS: The purpose of the current path analysis was to examine the relationship between body-mind-spirit well-being and the possibility of relapse intention as well as other relevant predictors in people who had a history of substance use. METHODS: A cross-sectional survey was used. Participants were recruited in Southern Taiwan between December 2015 and June 2016. Data were collected from 467 participants who had a history of using controlled substances. RESULTS: Path analysis results revealed that body-mind-spirit well-being was negatively predictive of the possibility of relapse intention. Out of several predictors, stress influence and duration of substance use had direct effects on body-mind-spirit well-being and the possibility of relapse intention, respectively. Stress influence and duration of substance use were associated with decreased body-mind-spirit well-being and increased relapse intention scores. In addition, no history of health problems and male gender were associated with increased body-mind-spirit well-being. CONCLUSIONS: Stress management and the duration of substance use play an important role in body-mind-spirit well-being and relapse intention in people with a history of substance use. Health care professionals could teach substance users coping strategies to address their stress and problems, which may improve their health and reduce the possibility of relapse intention.

Development and psychometric testing the Health of Body, Mind and Spirit Scale for assessing individuals who have drug abuse histories.

AIMS AND OBJECTIVES: To develop the Health of Body, Mind and Spirit Scale (HBMSS), which was designed to assess drug abusers' health condition. BACKGROUND: Helping drug abusers to become healthy is important to healthcare professionals. However, no instrument exists to assess drug abusers' state of health. DESIGN: A cross-sectional questionnaire survey was implemented to examine the validity of the HBMSS. METHODS: Data were collected from 2015-2016 at one drug abuse prevention centre in Taiwan. Participants (N = 320) who had abused drugs were invited to complete a preliminary 64-item version of the HBMSS. An item analysis, criterion-related validity analysis (using the Relapse Prediction Scale [RPS] score), split-half reliability testing and confirmatory factor analysis (CFA) were conducted to examine the psychometric properties of the HBMSS. RESULTS: The final version of the HBMSS contained 15 items that were divided into three subscales: the health of the body, mind and spirit. Cronbach's α and split-half reliability coefficients were all above .85. The factor loading of each item was between .74-.95. The HBMSS had satisfactory criterion-related validity with the RPS score (r = -.50, p < .001). A second-order CFA was conducted on the HBMSS. The fit indexes were good, χ2  = 184.060, df = 94, χ2 /df = 1.958 (p = .000). CONCLUSIONS: The entire HBMSS and the subscales had satisfactory reliability and validity. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals could use the HBMSS to evaluate the condition of the health of individuals with a drug abuse history.

Development and Psychometric Testing of the Suicidal Recovery Ability Scale (SRAS) for Assessing Individuals Who Have Attempted Suicide.

Assessing the recovery ability of individuals who have attempted suicide is crucial for psychiatric health nurses. The purpose of this study was to develop and test a psychometric Suicidal Recovery Ability Scale (SRAS). Confirmatory factor analysis (CFA) indicated that three subscales with 15 items best fit the data. The global SRAS score showed significant negative correlation with the Beck Hopelessness Scale (BHS) score. The Cronbach's α and test-retest reliability scores for the global SRAS and the subscales all exceeded 0.70. Nurses can use the SRAS to assess the recovery ability of individuals who have attempted suicide and provide proper care to help them.

Factors predicting recovery from suicide in attempted suicide patients.

AIMS AND OBJECTIVES: The aim of this study was to explore the factors predicting suicide recovery and to provide guidance for healthcare professionals when caring for individuals who have attempted suicide. BACKGROUND: The high rate of suicide is a global health problem. Suicide prevention has become an important issue in contemporary mental health. Most suicide research has focused on suicidal prevention and care. There is a lack of research on the factors predicting suicidal recovery. DESIGN: A cross-sectional design was adopted. METHODS: A correlational study with a purposive sample of 160 individuals from a suicide prevention centre in southern Taiwan was conducted. The questionnaires included the Brief Symptom Rating Scale-5, Suicidal Recovery Assessment Scale and Beck Hopelessness Scale. Descriptive statistics and linear regressions were used for the analysis. RESULTS: The mean age of the participants was 40.2 years. Many participants were striving to make changes to create a more stable and fulfilling life, had an improved recovery from suicide and had a good ability to adapt or solve problems. The linear regression showed that the Beck Hopelessness Scale scores (ß = -.551, p < .001) and Brief Symptom Rating Scale-5 (ß = -.218, p = .003) and past suicidal behaviour (ß = -.145, p = .008) were significant predictors of individuals' recovery from suicide. They accounted for 57.1% of the variance. CONCLUSIONS: Suicidal individuals who have a lower level of hopelessness, a better ability to cope with their mental condition and fewer past suicidal behaviours may better recover from suicide attempts. RELEVANCE TO CLINICAL PRACTICE: The nurses could use the results of this study to predict recovery from suicide in patients with attempted suicide.

Category 3 and 4 Controlled Drugs Users' Perceptions of Participating in Drug-Abuse-Health Prevention Lectures in Taiwan.

This study was designed to explore Category 3 and 4 controlled drug users' perceptions of participating in health-prevention lectures. A phenomenological approach was used. Twelve participants were interviewed after completing the lectures. Findings revealed five themes (1) mixed emotions; (2) self-development; (3) finding the lectures lacked practicality and relevance; (4) highlighting three stages for discontinuing drug-usage; and, (5) suggesting tips for the advancement of lectures. These findings could be used as a map to help health professionals understand drug users' perceptions of attending health prevention lectures and provide insight into how young people might stop using drugs.

Short-term effects of a suicide education intervention for family caregivers of people who are suicidal.

AIMS AND OBJECTIVES: To evaluate the short-term effects of a suicide care educational intervention on the family's ability to care, family's caring stress levels and family's attitudes towards attempted suicide. BACKGROUND: Research has demonstrated that suicide prevention educational programmes are provided mostly for professional staff and not for the family caregivers of people who are suicidal. DESIGN: A experimental design, using two groups and a pre- and postintervention survey method, was used. METHODS: A randomised controlled study was conducted with 74 family caregivers of people who are suicidal (37 using suicide education and 37 in the control group). The experimental group was provided with a two-hour suicide care education intervention, and the control group received normal suicide care support. Participants were recruited at a Suicide Prevention Centre and two acute psychiatric hospitals between October 2009-December 2010. Three questionnaires were collected: (1) the Suicidal Caring Ability Scale (2) the Caring Stress Scale and (3) the Suicide Attitudes Scale. Descriptive statistics, independent t-tests or Mann-Whitney U-tests were used to analyse the data. RESULTS: The results demonstrated that there were statistically significant differences in the Suicidal Caring Ability Scale and the Suicide Attitudes Scale but no statistically significant differences in the Caring Stress Scale. That is, the suicide education programme can promote the ability to care for people who are suicidal and can generate a positive attitude towards people who are suicidal from their caregivers. CONCLUSIONS: Family caregivers of suicidal individuals who attended the psycho-education programme had an increased caring ability and positive attitudes for their suicidal relatives. RELEVANCE TO CLINICAL PRACTICE: Nurses could use the two-hour personal suicidal education programme to increase one's ability to care for their relatives who had attempted suicide and promote one's positive attitudes towards attempted suicide.

Development and psychometric testing of the Suicide Caring Competence Scale (SCCS) for family caregivers in Taiwan.

Suicide caring competence is important for family caregivers to care their relatives with suicidal tendencies. The purpose of this study was to develop and test the psychometric properties of the Suicide Caring Competence Scale (SCCS) for family caregivers in Taiwan. A 20-item SCCS was tested on 165 family caregivers. Confirmatory factor analysis indicated that five subscales with 19 items best fit the data. The Cronbach's α and test-retest reliability of the SCCS was 0.90 and 0.81, respectively. The SCCS demonstrated acceptable construct validity and reliability. Nurses can use the SCCS to assess the suicide caring competence of family caregivers.

Undergraduate nursing students' learning experiences using design thinking on a human development course: A phenomenological study.

AIM: To explore nursing students' perceptions of their design thinking learning experiences on a human development course. BACKGROUND: Design thinking is a person-centered analytic and creative learning process that promotes higher order thinking skills rather than knowledge retention alone. Currently, this is the first study that has investigated the use of the design thinking process for nursing students on a human development course. DESIGN: A phenomenological research design. METHODS: The participants were first-year nursing students enrolled on a human development course at a Taiwanese university. In-depth, semi-structured interviews were conducted in 2022 and sufficiently high information power was obtained after 15 participants were interviewed. Data were systematically analysed, summarized and decoded using Colaizzi's seven analysis steps. RESULTS: Three themes and twelve subthemes emerged from the data. (1) Challenges experienced with the design thinking learning process: participants experienced anxiety because of the unfamiliar assignments, and they found the assignments to be thought-consuming, time-consuming and energy-consuming, plus the students needed to adapt to working in teams with classmates. (2) Adjustment strategies employed by participants: participants highlighted the importance of teamwork during the design thinking learning process. They achieved consensus through communication and sought support from others to overcome challenges related to design thinking; however, they ultimately needed to engage in problem-solving by themselves. (3) Developing the diversity of academic capabilities: after the human development course, participants experienced enriched mindsets, cognitive abilities, problem-solving skills, interpersonal relationships and knowledge application. CONCLUSIONS: Design thinking provides creative teaching opportunities and encourages nursing students to engage in experimental and creative learning, which is a meaningful experience for them. Nurse educators could use the insights thus obtained to design a curriculum that sources design thinking as a learning process while facilitating the complexity and diversity of students' higher order thinking skills and not just repetitive learning.

Social functioning, depression, and quality of life among breast cancer patients: A path analysis.

PURPOSE: To identify associations among social functioning, depression, and quality of life in breast cancer patients. METHOD: A cross-sectional study was conducted. A total of 180 breast cancer patients were recruited from the surgical units in southern Taiwan hospital in 2021. Path analysis was employed to analyze the relationships between background information and social functioning, depression, and quality of life. Structural equation modeling (SEM) was used for examining the path analysis in this study. RESULTS: The path model showed that respondents with a religious belief (ß = 0.18, p < .000) and less severe disease (ß = -0.29, p < .01) showed better social functioning. Income did not affect social functioning directly but was directly related to the social interaction dimension (ß = 0.30, p < .000). Moreover, younger age (ß = -0.29, p < .000, lower income (ß = -0.10, p < .05) and more severe disease (ß = 0.35, p < .000) increased the level of depression. Less severe disease would also result in a better quality of life (ß = -0.45, p < .000). Breast cancer patients with better social function levels have low levels of depression (ß = -0.82, p < .000) and better quality of life (ß = 0.76, p < .000). CONCLUSION: Age, religion, income, and severity are crucial predictors of social functioning, depression, and quality of life. Furthermore, severity variables which combined clinical variables to make this variable a stronger predictor for SF, depression, and QOL.

Meaning in life as a mediator of the associations among depression, hopelessness and suicidal ideation: A path analysis.

WHAT IS KNOWN ON THE SUBJECT: The meaning in life consists of an individual's values, experiences, goals and beliefs. It has been shown to be negatively associated with depression, hopelessness and suicidal ideation. Depression and hopelessness are related to increased suicidal ideation. Meaning in life has been shown to be a protective factor against depression, hopelessness and suicidal ideation. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: A path model was developed to clarify the associations among meaning in life, depression, hopelessness and suicidal ideation. For clarity, the outcomes were depression and suicidal ideation, the independent variable was hopelessness, and the mediator was meaning in life. Hopelessness had a direct association with meaning in life, and meaning in life had a direct association with depression, supporting the mediating effect of meaning in life from hopelessness to depression. Meaning in life had the strongest association with depression, and depression had the strongest association with suicidal ideation. Meaning in life did not have a significant direct association with suicidal ideation; it did have an indirect association with suicidal ideation through depression. This study estimated that one-point increase in meaning in life score was associated with 0.47-point decrease in depression score and 0.13-point decrease in suicidal ideation score, respectively. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Logotherapy is a meaning-centred therapy to find meaning in life. This study reveals that increased levels of meaning in life are associated with decreasing degrees of depression. Mental health nurses could help patients to find meaning in life by logotherapy and thus associated with reductions in depression. Mental health nurses could help patients to find hope by exploring meaning in life and promoting positive attitudes towards life from meaningless life to meaningful life, there is a reduction in depression, which in turn reduces suicidal ideation indirectly. ABSTRACT: Introduction Meaning in life can be good protective factor against depression, hopelessness and suicidal ideation. Aim To analyse the mediating effect of meaning in life on the associations among hopelessness, depression and suicidal ideation. Method A cross-sectional study was conducted among 90 patients diagnosed with depression. A structural equation modelling approach was applied for this path analysis to examine the mediating effect of meaning in life on the association among hopelessness, depression and suicidal ideation. Results The results showed that meaning in life mediated the association between hopelessness and depression. Hopelessness had a direct positive association with depression (ß = 0.23, p < .03), and meaning in life had a direct negative association with depression (ß = -0.51, p < .01) and indirect association with suicidal ideation through depression; this indirect association was -0.21 (p < .01). Discussion Meaning in life revealed strong mediating association with the relationship between hopelessness and depression. By reducing the level of depression, meaning in life demonstrated its mediator association with suicidal ideation. Implications for Practice Logotherapy is a meaning-centred therapy to find meaning in life. Mental health nurses could help patients to manage their depression through logotherapy, thus leading to reductions in suicidal ideation.

The effects of logotherapy on meaning in life, depression, hopelessness, and suicidal ideation, in patients with depression: An intervention study.

PURPOSE: To evaluate the efficacy of logotherapy on meaning in life, depression, hopelessness, and suicide ideation in patients with depression. DESIGN AND METHODS: A quasi-experimental approach was used and 86 participants were recruited from a psychiatric department in Taiwan. The experimental group received logotherapy for 12 weeks. The control group received depression education as usual. FINDINGS: The results revealed significant differences between and within the groups for meaning in life, depression, hopelessness, and suicide ideation. PRACTICE IMPLICATIONS: Logotherapy was an effective method for increasing meaning in life, reducing the degree of depression, hopelessness, and suicidal ideation for patients with depression.

A quasi-experimental investigation into the efficacy of a suicide education programme for second-year student nurses in Taiwan.

AIM: This study was designed to investigate the learning outcomes of a suicide education programme for second-year student nurses in Taiwan. BACKGROUND: Research demonstrates that nurses' attitudes impact on the care provided to suicidal patients. However, evidence is sparse on promoting positive caring attitudes in nurses towards suicidal patients. DESIGN: A quasi-experiment. METHOD: The total sample group (n = 174) comprised second-year student nurses. Some (n = 95) were randomly allocated to an experimental group who attended a four-hour suicidal education programme and others (n = 79) comprised a control group who did not attend the programme. All participants were given a questionnaire before and after the programme in 2008. The questionnaire contained 30 items and was divided into five categories. They were (1) the acceptability of suicidal behaviours, (2) morality and mental illness, (3) professional role and care, (4) communication and attention and (5) beliefs. RESULTS: Results demonstrated that the experimental group had higher scores on all five categories of the questionnaire than the control group did. Participants in the experimental group held more positive attitudes towards the acceptance of suicidal behaviours and were non-judgmental in their morality. Further, they showed more positive attitudes towards the provision of professional care and believed that people who attempt suicide are communicating their psychic pain. Moreover, participants in the experimental group held more positive beliefs about people who attempt suicide than the control group did. CONCLUSION: This suicide education programme raised student nurses' awareness about the phenomenon of suicide and promoted positive caring attitudes towards people who attempt suicide and hence their nursing care. RELEVANCE TO CLINICAL PRACTICE: A four-hour suicide education programme can promote positive caring attitudes towards people who attempt suicide and may have an affirmative influence on the nursing care provided to suicidal patients.

Developing a theory to guide nurse practitioners to accomplish [a] training programme: A grounded theory study.

BACKGROUND: Due to the lack of resident physicians in medical institutions, nurse practitioners must assist in clinical care. However, the quality of training courses in training hospitals is varied and, currently, there is no theory to guide nurse practitioners to complete training. OBJECTIVES: To develop a theory to guide nurse practitioners to accomplish training programme. DESIGN: This study adopted a qualitative grounded theory approach. SETTINGS: A regional teaching hospital in Taiwan. PARTICIPANTS: Seventeen nurse practitioners, who had passed the oral test within the past six months, were recruited until data saturation was achieved. METHODS: Data were collected using a semi-structured interview and data were collected between January 2018 and March 2019. Data were analysed using open, axial, and selective coding and using NVivo 11 to aid the process of coding. RESULTS: A substantive theory was formulated to help nurse practitioners complete their training programme. The core category was 'professional ability to improve nursing quality and excel'. Other important categories and subcategories were 'improving thinking ability' (improving critical thinking ability and differential diagnosis), 'improving clinical care ability' (improving clinical assessment and overall communication skills), and 'active learning' (multi-method learning, repeated practice, and self-improvement). CONCLUSIONS: The findings will facilitate the provision of guidance to nurse practitioner trainees in medical institutions. This will help them successfully complete their training, improve the passing rate for nurse practitioner selection, reduce the wastage of workforce training resources, and improve the quality of care that nurse practitioners provide. Hospitals could use this theory as a reference and create a warm and supportive training environment to help nurse practitioners complete their training programme and improve care quality.

The Effects of Logotherapy on Distress, Depression, and Demoralization in Breast Cancer and Gynecological Cancer Patients: A Preliminary Study.

BACKGROUND: Globally, cancer is the second leading cause of death. Breast cancer and gynecological cancer can damage patients' body image and lead to psychological distress, depression, and demoralization syndrome. No studies have explored the effect of logotherapy in gynecological cancer patients' psychological distress, depression, and demoralization. OBJECTIVE: To evaluate the effects of logotherapy on distress, depression, and demoralization in breast cancer and gynecological cancer patients. METHODS: A quasi-experimental design was used in this study, involving 61 breast cancer and gynecological cancer patients: 31 in the experimental group and 30 in the control group. Participants in the experimental group received logotherapy 4 to 6 times during the 12 weeks of intervention. Outcomes were measured by the (1) Distress Thermometer, (2) Patient Health Questionnaire, and (3) Demoralization Scale Mandarin Version (DS-MV). RESULTS: Distress Thermometer did not differ between groups, but significant differences in favor of the intervention group were noted in the Patient Health Questionnaire (U = 674.500, P = .002); the DS-MV subcategories of loss of meaning (U = 706.500, P = .000), dysphoria (U = 673.000, P = .002), disheartenment (U = 670.000, P = .003), helplessness (U = 621.000, P = .022), and sense of failure (U = 629.500, P = .016); and the total score of the DS-MV (U = 728.500, P = .000). CONCLUSION: Logotherapy was effective in the reduction of breast cancer and gynecological cancer patients' depression and demoralization. IMPLICATIONS FOR PRACTICE: Clinical professionals could add logotherapy to the treatment for breast cancer and gynecological cancer patients to reduce their depression and demoralization.

Nursing graduates' lived experiences of anxiety during their final year at University: a phenomenological study.

BACKGROUND: Nursing students voiced that they were stressed or anxious during their final year at university. Further, they articulated that their anxiety affected their academic performance as well as their motivation to work on their clinical placement. OBJECTIVES: This study was designed to describe nursing graduates' perceptions of their lived experiences of anxiety during their final year. DESIGN: Phenomenology was chosen. SETTINGS: Three universities in Taiwan. PARTICIPANTS: A purposive sample of 18 nursing graduates with experiences of anxiety. METHODS: Data were collected using a semi-structured interview and analyzed utilizing Colaizzi's seven-step method. RESULTS: Four themes emerged from the findings. The first was: uncertainty about future employment. This included negative clinical practicum experiences impacted on future career choices and uncertainty about future workplace choices. The second theme was: emotional relationships and life experiences becoming chaotic. This included anxiety about the loss of established relationships and financial insecurities. The third theme was: three phases of anxiety experienced in preparation for the national examination. They comprised: feeling anxiety but not taking action to study; increasing anxiety and beginning to study and, exacerbated anxiety and cramming for the national examination. The fourth theme was: adjustment strategies. They involved; looking for support to release emotional stress; changing the situation and fine-tuning the stress; positive thinking and self-affirmations and also, self-reflecting and consolidating learning. CONCLUSIONS: Finding could inform nursing teachers on nurses' lived experiences of anxiety during their final year, especially that related to the national examination before registration. Further, findings could be used as a map to facilitate nursing teachers in the provision of suitable teaching and counselling for final year students to alleviate their anxiety.

The effects of a walking program on older Chinese American immigrants with hypertension: a pretest and posttest quasi-experimental design.

OBJECTIVE: Hypertension is known to have high rates among Chinese Americans. Identifying culturally specific interventions to reduce sedentary behavior may be effective in reducing hypertension. This study examines the effects of an 8-week walking program with and without cultural modification. DESIGN: The study used a 2-group, pretest and posttest, quasi-experimental design. SAMPLE: A total sample of 128 Chinese American immigrants with hypertension were assigned to walking groups. RESULTS: The results showed that the walking program had no significant effects upon participant blood pressure or walking endurance. The results also revealed that individuals in the maintenance stage walked longer than those in the preparation stage. A comparison of demographic data showed that subjects with a lower level of education walked more minutes per week, which contributed to lower systolic blood pressures among this group as compared with those with a higher level of education. CONCLUSIONS: These results suggest that this walking protocol, when translated into Chinese and when accompanied by a weekly telephone reminder and other interactions with a Chinese-speaking nurse, is appropriate to use without additional cultural modification. Future research should examine other components of Chinese culture or should apply this protocol for a longer period of time.

A grounded theory study of action/interaction strategies used when Taiwanese families provide care for formerly suicidal patients.

OBJECTIVES: There is a dearth of evidence on the care that families provide to their relatives after they have been discharged from hospital following an attempted suicide. The aim of this study was to explore ex-patients' and family caregivers' perceptions of the care provided at home following hospital discharge. DESIGN AND SAMPLE: A qualitative approach using Grounded Theory was adopted. Suicidal ex-patients (n=15) and family caregivers (n=15) were contacted in the south of Taiwan. MEASURES: Data were collected through interviews and the data were analyzed using open, axial, and selective coding. RESULTS: A substantive theory was developed from the findings. However, for the purpose of this paper, the section of the paradigm model named the action/interaction strategies is presented and discussed. Three categories emerged in the action/interaction section relating to the family care of relatives who had been suicidal. They were: (1) "guarding the person day and night," which helped to ensure that their relatives felt safe; (2) "maintaining the activities of daily living," which promoted their physical health and recovery; and (3) "creating a nurturing environment," which facilitated their mental and emotional healing. CONCLUSIONS: Public health nurses could use the findings of this study as a theoretical map when providing health information to family caregivers during home visits.