Development of a family resiliency model to care of patients with schizophrenia.

Families who care for schizophrenia suffer stress and lose the ability to treat. Family stress can be mediated by resilience. Objective: This study aimed to develop a family resilience model based on family-centred nursing for persons with schizophrenia. This study used a mixed-method cross-sectional approach. The population was a family of caregivers for persons with schizophrenia at Mental Hospital in Surabaya, Indonesia. The respondents were 137 families recruited by simple random sampling. Variables include family factors, risk factors, protective factors, patient factors, family stress, family resilience and family ability to care for persons with schizophrenia. The data were collected using questionnaires and then analysed with partial least squares. The statistical results afforded material for focus group discussions with six families and 10 health workers (psychiatrists, psychologists and nurses) in order to improve the model. The result showed family stress was influenced by family factors (path coefficient = -0.145; t = 2.26), risk factors (path coefficient = 0.753; t = 16.7) and patient factors (path coefficient = 0.159; t = 3.23). Family resilience is influenced by risk factors (path coefficient = 0.316; t = 2.60), protective factors (path coefficient = 0.176; t = 2.22) and family stress (path coefficient = 0.298; t = 2.54). Family resilience affects the family ability to treat persons with schizophrenia (path coefficient = 0.366; t = 5.36). The family resilience model increases family capability by 13.4%. The model helps families through stress management by controlling the burden and stigma so that families are able to survive, rise, growing stronger and be better at caring for persons with schizophrenia.

Factors influencing patient-perceived quality of care in psychiatric hospitals in Taiwan.

Patient-perceived quality of inpatient/outpatient psychiatric care remains under-researched. A cross-sectional survey with purposive sampling comprising 567 inpatients and 549 outpatients was conducted among eight psychiatric care facilities in Taiwan to examine the factors influencing patient-perceived care quality. Inpatients and outpatients perceived moderate quality of care, where "Encounter" was reported as the highest dimension. Inpatients perceived "Secure environment" as the lowest; outpatients rated "Discharge/Referring" as the lowest. Hospital region and customer loyalty were significantly associated with patient-perceived care quality. Other significant factors were also identified: inpatient employment, perceived mental health and treatment effects, understanding diagnosis, previous treatment, and visited by appointment.

Perception of Spirituality and Spiritual Care among Muslim Nurses in Indonesia.

This cross-sectional study was conducted to examine 256 Muslim nurses' perception of spirituality and spiritual care in Indonesia. The Spirituality and Spiritual Care Rating Scale (SSCRS) was translated and culturally adapted. Moderately high degrees in five domains and total SSCRS were found. Specialty, education level, clinical seniority, having spiritual training, and previous spiritual caring experience could impact on the SSCRS. Most nurses have cared for patients with spiritual needs, but denied having any formal training in providing spiritual care. Providing adequate curriculum and on-job training to equip nurses' knowledge and competence of spiritual care is urgent in Muslim healthcare environment.

An exploration of the correlates of nurse practitioners' clinical decision-making abilities.

AIMS AND OBJECTIVES: This study investigated nurse practitioners' clinical decision-making abilities and the factors that affect these abilities. BACKGROUND: Nurse practitioners play an important role in clinical care decision-making; however, studies exploring the factors that affect their decision-making abilities are lacking. DESIGN: A cross-sectional descriptive survey was employed. METHODS: A purposive sample of 197 nurse practitioners was recruited from a medical centre in central Taiwan. Structured questionnaires consisting of the Knowledge Readiness Scale, the Critical Thinking Disposition Inventory and the Clinical Decision-Making Model Inventory were used to collect data. RESULTS: The intuitive-analytical type was the most commonly used decision-making model, and the intuitive type was the least frequently used model. The decision-making model used was significantly related to the nurse practitioners' work unit. Significant differences were noted between the nurse practitioners' clinical decision-making models and their critical thinking dispositions (openness and empathy). The nurse practitioners' years of work experience, work unit, professional knowledge and critical thinking disposition (openness and empathy as well as holistic and reflective dispositions) predicted the nurse practitioners' analytical decision-making scores. Age, years of nurse practitioner work experience, work unit and critical thinking disposition (holistic and reflective) predicted the nurse practitioners' intuitive decision-making scores. CONCLUSIONS: This study contributes to the topic of clinical decision-making by describing various types of nurse practitioner decision-making. The factors associated with analytic and intuitive decision-making scores were identified. These findings might be beneficial when planning continuing education programmes to enhance the clinical decision-making abilities of nurse practitioners. RELEVANCE TO CLINICAL PRACTICE: The study results showed that nurse practitioners demonstrated various clinical decision-making types across different work units. Consideration of nurse practitioners' knowledge readiness and their specific needs while planning on-duty education programmes is necessary.

Is abnormal non-high-density lipoprotein cholesterol a gender-specific predictor for metabolic syndrome in patients with schizophrenia taking second-generation antipsychotics?

Evidence supports an association between metabolic syndrome (MetS) and schizophrenia. However, specific risk factors for MetS and gender differences in patients with schizophrenia taking second-generation antipsychotics (SGAs) have not been well explored. A cross-sectional cohort of 329 Han Chinese patients was recruited in a psychiatric hospital in central Taiwan. Using the definitions of the International Diabetes Federation for Chinese, the prevalence of MetS was 23.7% (men: 25.7%; women: 21.2%). Logistic regression analyses showed that patients with a BMI ≥ 24 and an abnormal non-high-density lipoprotein cholesterol (non-HDL-C) were significantly (p < 0.001) more likely to develop MetS. A BMI ≥ 24 was a significant risk factor in men (OR: 6.092, p < 0.001) and women (OR: 5.886, p < 0.001). An abnormal non-HDL-C was a significant specific risk factor for men with MetS (OR: 4.127, p < 0.001), but not for women. This study supports a greater prevalence of MetS in patients with schizophrenia taking SGAs than in the general population. Abnormal BMI and non-HDL-C were significantly associated with developing MetS, and an abnormal non-HDL-C was a specific risk factor for men. Future development of specific interventions and regular monitoring for MetS is imperative for early identification and prevention.

[A Survey of the Perception of Nurses Toward the Practice Environment at a Regional Teaching Hospital in Central Taiwan].

BACKGROUND: The nursing practice environment has been shown to wield significant influence on nursing retention and nursing quality of care. Because a large percentage of Taiwan nurses currently work at regional teaching hospitals, exploring the perception toward the practice environment of nurses working at this type of hospital is important. PURPOSE: This study explored the perception of nurses working at a regional teaching hospital in central Taiwan toward their practice environment. METHODS: A cross-sectional research design with a sample of 474 nurses from a regional hospital in central Taiwan was conducted. Instruments including the demographic data and the Chinese-version Practice Environment Scale-Nursing Work Index (CPES-NWI) were anonymously self-administered. RESULTS: Overall, participants were moderately satisfied with their practice environment, with the greatest dissatisfaction focused on staffing and resource adequacy. Work unit and nursing level, respectively, had significant impacts on perceptions regarding the practice environment. Furthermore, discriminant analysis identified two new compound variables: 1) adequate staffing resources and partnership in the workplace and 2) supportive administrative management environment. Participants who worked in medical and surgical units were significantly more dissatisfied with the adequacy of staffing resources and partnership in the workplace than participants who worked in acute/intensive and special units. Participants at the N2 level were significantly more dissatisfied with the supportive nature of the administrative management environment. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: These findings support that the nursing practice environment of regional hospitals may be improved using several measures, including: modifying the staffing and resource adequacy of nurses, fostering collaborative nurse-physician relationships, and further involving nurses in administrative management and decision-making.

MoodSensing: A smartphone app for digital phenotyping and assessment of bipolar disorder.

BACKGROUND: Daily life tracking has proven to be of great help in the assessment of patients with bipolar disorder. Although there are many smartphone apps for tracking bipolar disorder, most of them lack academic verification, privacy policy and long-term maintenance. METHODS: Our developed app, MoodSensing, aims to collect users' digital phenotyping for assessment of bipolar disorder. The data collection was approved by the Institutional Review Board. This study collaborated with professional clinicians to ensure that the app meets both clinical needs and user experience requirements. Based on the collected digital phenotyping, deep learning techniques were applied to forecast participants' weekly HAM-D and YMRS scale scores. RESULTS: In experiments, the data collected by our app can effectively predict the scale scores, reaching the mean absolute error of 0.84 and 0.22 on the scales. The statistical data also demonstrate the increase in user engagement. CONCLUSIONS: Our analysis reveals that the developed MoodSensing app can not only provide a good user experience, but also the recorded data have certain discriminability for clinical assessment. Our app also provides relevant policies to protect user privacy, and has been launched in the Apple Store and Google Play Store.

[The relationship between medication adherence and rehospitalization: a prospective study of schizophrenia patients discharged from psychiatric acute wards].

BACKGROUND: Antipsychotics have been regarded as the most effective therapy for schizophrenia; however, Taiwan's non-adherence rate for prescribed antipsychotics of 50-80% is an important issue that relates directly and significantly to schizophrenia patient relapse rates. PURPOSE: This study examines the correlational and predictive relationships between medication adherence and rehospitalization in schizophrenia patients discharged from an acute ward. METHODS: This study used a prospective research design. Schizophrenia patients discharged from a psychiatric acute ward who stated their plan to live in the community were recruited as participants. Participant medication adherence was assessed via home visits during the 6-month follow-up period using scales including the Medication Adherence Questionnaire (MAQ), drug attitudes, and regimen knowledge. Rehospitalization data were retrieved from electronic medical records. Relationships between medication adherence and rehospitalization were analyzed using t-tests and regression analysis. RESULTS: Seventy-seven patients with schizophrenia discharged from the acute ward were recruited in accordance with sampling criteria. The majority were male, young, unmarried, had poorer global function, had 12 years of education, and were not rehospitalized during the past 6-month period. Using binomial regression analysis, we found the relative risk for number of rehospitalizations during the 6-month period to be significantly less and the average scores for the total scale, attitude subscale, and knowledge subscale of medication adherence to have increased (0.194-0.79 times). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Our findings support that better medication adherence in people with schizophrenia decreases rehospitalization risk. We urge clinicians to develop sensitive interventions to promote antipsychotics adherence in this population.

Ethical Challenges of Nonreading Older Adult Women's Autonomy in Receiving Percutaneous Coronary Intervention Under Familial Paternalism in Taiwan.

In the context of familial paternalism in Taiwan, nonreading older adult women (NOAWs) may passively disengage from treatment and submit to the decisions of their families. The purposes of this case study were to examine the ethical conflicts regarding the autonomy of hospitalized NOAWs receiving percutaneous coronary intervention in a cultural environment of familial paternalism and to propose a theoretical framework based on a literature review to resolve the ethical challenges specific to this cultural context. The proposed framework "Nursing advocacy model for engaging NOAWs with their medical treatment" was established on the basis of relational ethics, nursing advocacy, and shared decision making. Our argument does not question traditional Chinese cultural values. Instead, we advocate for NOAWs to engage with their treatment, express their preferences, and communicate with their families in a decision-making process that incorporates mutual respect and understanding within the context of Chinese culture.

Associations among smartphone app-based measurements of mood, sleep and activity in bipolar disorder.

The recent popularization of smart technology presents new opportunities for continual, digital-monitoring of patient status. In this project, we used a smartphone app to track the mood, sleep, and activity levels of 159 outpatients with bipolar disorder (BD). The participants were asked to report their daily wake/sleep time and emotional status in the app, while daily activity data were automatically collected via GPS. We performed repeated-measures correlation analysis to examine possible correlations between the readouts. Mood, sleep and activity levels all showed intra-variable correlations with readings on the next day, in the next week, and in the next month. Furthermore, mood and sleep at the reference time were positively correlated with activity in subsequent weeks or months, and activity was positively correlated with mood and sleep in the same time ranges. Thus, our results were in line with previous studies, showing that mood, sleep, and activity levels are interdependent in patients with BD. With the association between mood on future activity level was most significant, and the correlations between each readout and the others were dependent on time frame. Our findings suggest our smartphone app has potential to provide an informative and reliable means for real-time tracking of BD status.

Spiritual Needs and Influencing Factors of Indonesian Muslims With Cancer During Hospitalization.

Introduction: Although Muslims constitute nearly one fourth of the global population, many non-Muslims are not familiar with Islam. To address this unique need from such a specific cultural context, the present study aimed to examine the spiritual needs and influencing factors of Indonesian Muslims with cancer. Method: A cross-sectional research design with 122 cancer patients was conducted by using the Bahasa-version Spiritual Needs Questionnaire. Results: The degree of spiritual needs was generally high. Religious needs were the strongest aspect, and "praying five times a day" was the highest scoring item. Gender (p = .04), age (p = .01), and duration of being diagnosed with cancer (p = .01) were associated with spiritual needs. Female gender (p = .005) and older age (p < .001) were predictors of spiritual needs. Discussion: As expected to provide cultural-congruent spiritual interventions, nurses could meet Muslim patients' need to pray five times a day during hospitalization, thus help them manage and endure the illness.

[Discharge planning: practical implementation in psychiatric care].

Care extension programs that bridge hospitals into the community are today a mainstream component of psychiatric care around the world. Stronger linkages amongst community resources can help patients and their families transition successfully through the hospital discharge process and reenter the community. Discharge planning is a service that provides the needs-oriented care necessary to link the hospital and community. Such planning, handled in accordance with case management procedures, focuses on medical team cooperation, follow-up services and recovery evaluation. Using a review of the literature and a real case study, this article demonstrates the practical use of discharge planning services, analyzes problems frequently encountered during the discharge process and related interventions. By increasing the proper disease management knowledge of patients and their families, strengthening staff support to families through the creation of "medical leagues", establishing community care and better support networks, and implementing a discharge process evaluation procedure, discharge planning services may provide efficient and continuous medical care essential to prevent re-admission, reduce hospitalization expenses, and strike a better balance between medical service quality and cost.

The associations between illness perceptions and social rhythm stability on mood symptoms among patients with bipolar disorder.

BACKGROUND: The association between illness perceptions and the effectiveness of patients' illness-management strategies has been supported across a range of medical and psychiatric disorders. Few studies have examined these variables or their association in bipolar disorder (BD). This study examined the main and interactive associations between illness perceptions and one important illness management strategy - social rhythms stability on mood symptom severity in adults with BD. METHODS: A cross-sectional study with 131 patients with BD in Taiwan was conducted using clinician- and patient-rated mood symptoms, self-reported illness perceptions, and a measure of daily and nightly social rhythms. RESULTS: Illness perceptions were associated with mood symptom severity, but social rhythms were not. Unfavorable illness perceptions (e.g., beliefs of experiencing more BD symptoms, having stronger emotional responses to the illness) were associated with more severe mood symptoms. Favorable illness perceptions (e.g., beliefs of being able to understand and control the illness) were associated with less severe mood symptoms, with personal control as the strongest correlate of mood symptom severity. Finally, social rhythm stability moderated the relationship between unfavorable illness perceptions and clinician-rated manic symptoms. LIMITATIONS: The cross-sectional design limits our ability to make causal conclusions. Also, the effects pertain to patients in remission and may not generalize to more severely ill or hospitalized bipolar patients. CONCLUSIONS: This study indicates that in patients with BD, illness perceptions are associated with symptom severity. Interventions to enhance favorable IPs and reduce unfavorable IPs may improve mood outcomes, particularly when patients have adopted regular social rhythms.

Evidence-Based Practice Curriculum Development for Undergraduate Nursing Students: The Preliminary Results of an Action Research Study in Taiwan.

BACKGROUND: Equipping undergraduate nursing students with sufficient competence in evidence-based practice (EBP) is essential to meeting future practice needs. Integrating necessary EBP knowledge and skills systematically into the formal curriculum allows students to obtain better learning experience and outcomes. However, in Taiwan, a systematic nursing curriculum that integrates EBP concepts across the 4-year nursing baccalaureate program has not yet been developed. Moreover, engaging students in the clinical application of evidence remains a key challenge facing nursing education. PURPOSE: This study aimed to construct an EBP undergraduate nursing curriculum and develop clinical scenarios that support EBP teaching. METHODS: Three cycles of action research, incorporating both focus group interviews and questionnaire surveys, were applied to construct and evaluate the appropriateness and feasibility of the EBP nursing curriculum and relevant teaching strategies. RESULTS: An EBP nursing curriculum was constructed that integrates the three levels of learning objectives and corresponding learning outcomes, teaching content, and learning activities. Scenario activities were developed to familiarize students with the EBP process and to maximize their learning with regard to the clinical application of evidence. Next, a preliminary evaluation showed the appropriateness and feasibility of the developed curriculum, which was shown to foster the EBP competency of students and increase their confidence and positive attitudes toward EBP. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: A systematic EBP bachelor nursing curriculum with effective pedagogical strategies was developed. The associated process and the elicited information may offer a valuable reference for other nursing schools.

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.

Delay in seeking medical evaluations and predictors of self-efficacy among women with newly diagnosed breast cancer: a longitudinal study.

BACKGROUND: Delaying a diagnosis of breast cancer directly and positively impacts survival. Self-efficacy has been shown to be a causal mechanism in a wide range of health behaviors, a measurable trait that predicts behavior across domains, which is strong associated with psychological variables. However, factors predicting self-efficacy of women with suspected breast cancer who delayed or did not delay seeking a breast cancer diagnosis over time have not been identified. OBJECTIVES: To examine the differences between women who delay and women who did not delay seeking a cancer diagnosis, and key factors predicting self-efficacy over time among women with newly-diagnosed breast cancer. DESIGN: Descriptive, longitudinal design over 2 months following breast cancer diagnostic evaluation. SETTING: A medical center is located in southern Taiwan. PARTICIPANTS: Eighty women with suspected breast cancer were approached and 67 subjects with a positive diagnosis of breast cancer were recruited. METHODS: Subjects were categorized into women who delayed their diagnosis and women who did not delay their diagnosis. A battery of 5 standardized questionnaires including self-efficacy, anxiety and depression, personality, spiritual support and hope was completed at the first three clinic visits. RESULTS: Stage of cancer, trait extroversion/neuroticism and spiritual support were significantly different between groups (p<0.05). Subjects who did not delay (ß=-1.613, p<0.05), and time that histology results were provided (ß=-2.4333, p<0.001) had a significantly predicted negative change in self-efficacy compared to the group that delayed. Hope at the first clinic visit contributed to the change in self-efficacy over time (ß=0.391, p<0.001). CONCLUSIONS: Personal factors affecting a woman's delay in obtaining medical assessment of breast cancer confirmation. Hope impacts self-efficacy of women with suspected breast cancer and interventions to enhance hope during the early stages of breast cancer evaluation require further study.

Using standardized patient with immediate feedback and group discussion to teach interpersonal and communication skills to advanced practice nursing students.

BACKGROUND: Interpersonal and communication skills (IPCS) are essential for advanced practice nursing (APN) in our increasingly complex healthcare system. The Standardized Patient (SP) is a promising innovative pedagogy in medical and healthcare education; however, its effectiveness for teaching IPCS to graduate nursing students remains unclear. OBJECTIVES: We examined the effectiveness of using SP with SP feedback and group discussion to teach IPCS in graduate nursing education. DESIGN: Randomized-controlled study. PARTICIPANTS: First-year APN students in Taiwan. METHODS: Participants were randomly assigned to the experimental (SP assessments with SP feedback and group discussion) or control (SP assessments only) group. There were two outcome indicators: IPCS and student learning satisfaction (SLS). The IPCS were assessed before and after the study in interviews with the SPs. SLS was measured when the study ended. RESULTS: All participants expressed high SLS (94.44%) and showed significant (p ≤ 0.025) improvements on IPCS total scores, interviewing, and counseling. However, there were no significant differences between groups. Qualitative feedback from encounters with SPs is described. CONCLUSIONS: Using SPs to teach IPCS to APN students produced a high SLS. The students learned and significantly improved their IPCS by interviewing SPs, but future studies are needed to confirm the effectiveness of SP feedback and group discussions.

A pilot study of an illness management and recovery program in discharged patients with schizophrenia.

BACKGROUND: Accumulated evidence supports the effectiveness of equipping chronically ill patients with illness management knowledge and skills. The Illness Management and Recovery (IMR) program developed by the United States government has been widely adopted for persons with mental illness. However, few studies support its effectiveness in patients with schizophrenia. PURPOSE: This pilot study developed a culturally adapted and abbreviated version of the IMR for Taiwanese patients with schizophrenia who were ready for discharge from the hospital. Furthermore, we investigated the impact of the program in terms of illness knowledge, drug attitude, insight, and psychopathology. METHODS: The original IMR was condensed and modified for implementation during participants' preparation for hospital discharge. Using a preexperimental design, pretest and posttest assessments for a single group of 26 participants received the new IMR twice a week for 3 weeks on the four outcome indicators of illness knowledge, drug attitude, insight, and psychopathology. RESULTS: Participants improved in terms of treatment-related illness knowledge, insight, and affective-domain psychopathology (p < .01) after intervention completion. Average participant attendance was 5.45 sessions out of 6 total sessions. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The intensive symptom and medication-focused IMR model for soon-to-be-discharged patients with schizophrenia had positive impacts on illness management. In the future, studies using a two-group randomized controlled design and extended follow-up should be conducted to determine the long-term effects of IMR.

A randomized controlled trial of an adapted Illness Management and Recovery program for people with schizophrenia awaiting discharge from a psychiatric hospital.

OBJECTIVE: Most research on the Illness Management and Recovery (IMR) program for people with severe mental illnesses has focused on individuals with stable symptoms living in the community, with less attention to persons being treated in an inpatient setting. We evaluated the feasibility and effects of an IMR program adapted for individuals with schizophrenia who were awaiting discharge into the community. METHOD: A randomized controlled trial was conducted at 2 hospitals in Taiwan to compare the adapted IMR program with treatment as usual (TAU). Ninety-seven individuals with schizophrenia were randomized to the adapted IMR program or TAU. Four outcome indicators including illness-management knowledge, attitudes toward medication, insight, and symptoms were assessed at baseline, posttreatment, and at a 1-month follow-up following discharge from the hospital. RESULTS: Participants in the adapted IMR group showed significantly greater improvements at posttreatment and 1-month follow-up in illness-management knowledge, attitudes toward medication, insight, and negative symptoms on the Brief Psychiatric Rating Scale (BPRS) than individuals in the TAU group. There were no significant differences between the 2 groups on other subscales of the BPRS. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This is the first controlled evaluation of a version of the IMR program in an East Asian culture, and the first to evaluate it in an acute care inpatient setting. Our findings support the feasibility and potential benefits of implementing an adapted IMR program, focused on the prevention of relapses and rehospitalizations, during the discharge period of an inpatient treatment stay to prepare individuals to reenter the community.

Lessons learned from the anti-SARS quarantine experience in a hospital-based fever screening station in Taiwan.

BACKGROUND: Severe acute respiratory syndrome (SARS) was the first major novel infectious disease to hit the international community in the 21st century. While SARS was sweeping over almost 30 countries, most hospitals in Taiwan instituted mandatory quarantine measures, one of the most effective public health strategies for preventing disease transmission. We explored the anti-SARS quarantine experience of patients in a hospital-based fever screening station. METHODS: We conducted a phenomenologic, qualitative study using semistructured telephone interviews during the SARS outbreak in Taiwan. Seventeen patients with fever who were quarantined in the fever screening station of a hospital emergency department for at least 2 hours were recruited into this study. RESULTS: Data analysis using Collaizi's 9 steps revealed 2 categories--external burden and internal struggle--and 6 themes regarding patients' quarantine experience. External burden included 3 themes: (1) bearing the uncomfortable surroundings, (2) facing discrimination, and (3) lacking in-person family support. Internal struggle consisted of 3 themes: (1) struggle with being quarantined, (2) struggle with emotional turmoil, and (3) struggle with possible SARS diagnosis. CONCLUSION: These results will contribute to sensitizing health care professionals to empathize with quarantined persons while providing quality quarantine care and other infection control measures.