[The resilience and health status of primary caregivers of schizophrenia patients].

BACKGROUND: Resilience has been shown to have a positive effect on health status. However, little research has been conducted on the impact of resilience on the health of primary caregivers of schizophrenia patients. PURPOSE: This study investigated the correlations between resilience and the health status of caregivers of schizophrenia patients. METHOD: A cross-sectional, descriptive research design was used. Data collection was conducted using a set of questionnaires that included a demographic datasheet, the SOC-13 (Sense of Coherence), the DASS-21 (Depression Anxiety Stress Scales), and the SF-36 (short form). Seventy caregivers of schizophrenia patients were enrolled as participants at the psychiatric inpatient department of a medical center. SPSS 17.0 and SAS.9.2 statistical software packages were used to conduct descriptive analysis, the Sobel test, and Tobit model analysis. RESULTS: (1) The mean QOL (quality of life) scale score was 67.46 (SD = 17.74). Nearly one-fifth (18.6%) of caregivers were classified in the low to high depression range; 17.1% were classified in the low to high anxiety level; and 10% were classified in low to high stress level. (2) Duration of the caring period correlated negatively with caregiver QOL; having a concomitant disease significantly impacted QOL and resilience; and number of patient hospitalization days correlated negatively with level of caregiver anxiety. (3) The numbers of incidents of patient violence and patient suicide attempts correlated negatively with caregiver resilience and QOL. (4) Resilience was a mediator between care-giver demographic data and QOL. (5) Caregiver resilience was a predictor of QOL, depression, anxiety, and stress. CONCLUSIONS: The findings of the present study increase our understanding of the impact of resilience on the health status of caregivers of schizophrenia patients. The authors hope these finding may be referenced in the development of resilience-based nursing caring models in the future.

[The family transition experience: family-centered hospitalization care of bipolar disorder patients].

BACKGROUND: Differences in cognition and attitudes between bipolar disorder patients and their families frequently result in differences between the two in terms of opinions and perceptions on appropriate medical treatments and prognoses. Transforming patient-centered-care psychotherapy into an intervention that provides family-focused nursing, promotes interaction among family members, and changes communication styles may assist families to adapt and focus on pursuing the soundest medical treatment. PURPOSE: This qualitative study explores the healing process of family transition in terms of family-centered care for bipolar disorder patients and nursing strategy intervention. METHODS: A psychiatric nurse with clinical experience used four 60-90 minute semi-structured, in-depth interviews to collect data from 8 families. The process was recorded and transcribed verbatim. Content analysis was used to analyze and categorize the major themes. RESULTS: Results were generalized into three themes that addressed the interaction-in-transition between patients and their families. These themes were: "All of the blame comes from the disease", "There is love in the family", and "Agreement to start over". Nurses increased their positive interaction with the family by facilitating cognitive, emotional, and behavioral change in the family. The 3 nursing strategy interventions used in this study to promote family adaptation in this study were: (1) guiding family experiences of the disease situation; (2) inspiring the potential strength in the families; (3) mobilizing the internal and external resources of families. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Nurses may help family healing by identifying family strengths and resources, looking for solutions to problems, transforming effective communicating style, and making family contracts.

Prevention and treatment of oral mucositis among cancer patients in the hematology-oncology setting: a best practice implementation project.

INTRODUCTION: Oral mucositis refers to mucosal damage and occurs in the oral, pharyngeal, and laryngeal cavities. When patients with cancer get oral mucositis, the painful condition can cause difficulties in eating, drinking, and swallowing and may compromise the patient's nutritional status. It also may be drastically associated with infections, resulting in longer hospitalizations. OBJECTIVES: The aim of this project was to promote best practices related to oral mucositis prevention and treatment for patients in the hematology-oncology setting. METHODS: This implementation project was conducted in the hematology-oncology setting at a medical center in Taiwan. The current project adopted the clinical audit methodology and integrated Lewin's Change Theory, using the JBI Practical Application of Clinical Evidence System software. Seven audit criteria that represented best practice recommendations for prevention and treatment of mucositis were used. A preimplementation audit was conducted with 30 nurses and 30 patients to measure compliance between current practice and best practice. From that audit we identified barriers and facilitators to practice change by undertaking a Getting Research into Practice analysis. A post implementation audit was conducted with 50 nurses and 50 patients at 4 months after implementing the best practice recommendations for mucositis to determine long-term compliance. RESULTS: The seven criteria showed an improvement: nurses who received education about oral care protocols increased from 40 to 100%, patients who received education about oral care protocols increased from 23 to 98%, and patients who followed oral hygiene care protocols, including brushing of teeth, increased from 27 to 96%. There were small improvements in the following criteria: compliance with ongoing assessment of the oral cavity increased from 97 to 100%, nurses who conducted an oral pain assessment increased from 97 to 98%, and patients who followed the therapeutic oral care regimens increased from 88 to 100%. However, nurses who conducted initial assessment of the oral cavity remained at 96%. CONCLUSION: The implementation of best practice for enhancing prevention and treatment of oral mucositis for cancer patients in four hematology-oncology settings is possible. Lewin's Change Theory underpinned the project, which integrated blended learning strategies and communication skills which contributed to the success of this implementation project.

Randomized, controlled trial of a brief family-centred care programme for hospitalized patients with bipolar disorder and their family caregivers.

Family interventions have been emphasized in the treatment of bipolar disorder (BPD) due to the bidirectional and entangled relationships between patients and the family system, and have benefits for patients' symptoms and health; however, the effects of family interventions on family function and caregivers' health-related outcomes have not been well investigated. This randomized, controlled trial with 47 hospitalized patients with BPD/family caregiver dyads at a medical centre in northern Taiwan compared the effects of a brief family-centred care (BFCC) programme with treatment as usual (TAU). All of the family caregivers in two groups were invited to attend a routine 60-min family discussion group about violence and suicide prevention. The TAU group without specific family interview for patient and family caregiver dyad. In the BFCC group, four 90-min BFCC programme sessions were additionally provided twice a week for each hospitalized family dyad. We hypothesized that, first, family caregivers in the BFCC group could increase their family function, and second, improve perceived health status and reduce caregiver's burdens compared to the TAU. The results showed that family caregivers in the BFCC group significant interaction effects in overall family function (P = 0.03) and subscale conflict (P = 0.04), communication (P = 0.01), and problem-solving (P = 0.04), but there were no significant interaction effects on the caregivers' perceived health status and caregivers' burdens. Our findings support both the feasibility of using the BFCC programme for inpatients and its specific benefits for family function. An intensive family intervention during hospitalization has been suggested in psychiatric practice to support patients with BPD and family caregivers.

[Ethical dilemmas in caring for patients with SARS].

This paper explored experiences caring for patients with severe acute respiratory syndrome (SARS), with a focus on the suffering between the "private" and "professional" selves, in order to describe the psychological impact and ethical practice of SARS events as related to nursing professionals. Eight small group interviews were conducted with a total of twenty-one nurses with experience caring for SARS patients. Group interviews were audio-taped and transcribed for analysis. Data, analyzed using the constant comparative method, revealed the following three ethical dilemmas: suffering in care giving, response to the calling, and distresses involved in decision making. In this study, the authors further addressed relationships between suffering and ethical practice, the calling and a nurse's professional responsibilities, and transcendence in intersubjectivity. The authors hope that the results of this study will lead to a new understanding of ethical practices nursing and help nurses develop reflected care that promotes personal and professional growth.

A comparison of the cost-effectiveness of hospital-based home care with that of a conventional outpatient follow-up for patients with mental illness.

The purpose of this study was to compare the outcomes of a hospital-based home-care model with those of a conventional outpatient follow-up for mentally ill patients in Taiwan by means of cost-effectiveness analysis. The study design was a two group posthoc design. We interviewed 40 mentally ill patients who were followed up in the psychiatric outpatient department. Another 40 mentally ill patients who participated in a hospital based home care program were also interviewed. The outcome measures we used for interviews were disease maintenance behavior, psychotic symptoms, social function, service satisfaction, and cost. The cost for each patient was the sum of costs for all direct mental health services. The cost-effectiveness ratio showed that the costs of the hospital-based home care model (4.3) were lower than those of conventional outpatient follow-up (13.5) and that over a one-year period, the hospital-based home care model was associated with improvements in mental conditions, social functional outcomes, and service satisfaction. The improved outcomes and the lower costs in the hospital-based home care program support the view that it is the most cost-effective of the two. Policy makers may consider this analysis as they allocate resources and develop policy for the care of mentally ill patients.

Truth-telling to patients' terminal illness: what makes oncology nurses act individually?

PURPOSE: Nurses encounter the challenge of truth-telling to patients' terminal illness (TTPTI) in their daily care activities, particularly for nurses working in the pervasive culture of family protectiveness and medical paternalism. This study aims to investigate oncology nurses' major responses to handling this issue and to explore what factors might explain oncology nurses' various actions. METHODS: A pilot quantitative study was designed to describe full-time nurses' (n = 70) truth-telling experiences at an oncology centre in Taipei. The potential influencing factors of nurses' demographic data, clinical characteristics, and truth-telling attitudes were also explored. RESULTS: Most nurses expressed that truth-telling was a physician's responsibility. Nevertheless, 70.6% of nurses responded that they had performed truth-telling, and 20 nurses (29.4%) reported no experience. The reasons for inaction were "Truth-telling is not my duty", "Families required me to conceal the truth", and "Truth-telling is difficult for me". Based on a stepwise regression analysis, nurses' truth-telling acts can be predicted based on less perceived difficulty of talking about "Do not resuscitate" with patients, a higher perceived authorisation from the unit, and more oncology work experience (adjusted R² = 24.1%). CONCLUSIONS: Oncology care experience, perceived comfort in communication with terminal patients, and unit authorisation are important factors for cultivating nurses' professional accountability in truth-telling. Nursing leaders and educators should consider reducing nursing barriers for truth-telling, improving oncology nurses' professional accountability, and facilitating better quality care environments for terminal patients.

Self-state of nurses in caring for SARS survivors.

The aim of this study was to analyze nurses' experiences of role strain when taking care of patients with severe acute respiratory syndrome (SARS). We adopted an interpretive/ constructivist paradigm. Twenty-one nurses who had taken care of SARS patients were interviewed in focus groups. The data were analyzed using thematic analysis. The self-state of nurses during the SARS outbreak evolved into that of professional self as: (1) self-preservation; (2) self-mirroring; and (3) self-transcendence. The relationship between self-state and reflective practice is discussed.