Experiences and preferences of truth-telling in families of children with cancer: A phenomenological study.

Objective: The delivery of bad news is an unpleasant but necessary medical procedure. However, few studies have addressed the experiences and preferences of the families of school-aged children with cancer when they are informed of the children's condition. This study aimed to explore families of school-age children with cancer for their preferences and experiences of truth-telling. Methods: This descriptive phenomenological qualitative research was conducted using focus group interviews and semistructured interview guidelines were adopted for in-depth interviews. Fifteen families participated in the study. The data were analyzed using Colaizzi's analysis. Data were collected from August 2019 to May 2020. Results: The study identified two major themes: "caught in a dilemma" and "kind and comprehensive team support." The first major theme focused on families' experiences with cancer truth-telling. Three sub-themes emerged: (1) cultural aspects of cancer disclosure, (2) decision-making regarding informing pediatric patients about their illness, and (3) content of disclosure after weighing the pros and cons. The second major theme, which revealed families' preferences for delivering bad news, was classified into three sub-themes: (1) have integrity, (2) be realistic, and (3) be supportive. Conclusions: This study underscores the dilemma encountered by the families of children with cancer after disclosure and their inclination toward receiving comprehensive information and continuous support. Health care personnel must improve their truth-telling ability in order to better address the needs of such families and to provide continuous support throughout the truth-telling process.

Appropriate volumes of water for non-invasive swallowing assessments of nursing home residents: A descriptive correlational study.

Background: The volume of water that can be swallowed without risk of choking or aspiration is a common way to assess swallowing function in patients with dysphagia in institutional settings. However, no evidence-based study has established what volumes of water are safest and most effective for testing. Objective: A validated portable non-invasive device for swallowing and respiration (NIDSAR) was employed to determine safe swallowing volumes for nursing home residents with different levels of dysphagia. Methods: Participants (N = 94) were grouped by the absence or presence of a nasogastric (NG)-tube: those without an NG-tube (n = 60) and those with an NG-tube (n = 34).Swallowing 1 ml, 3 ml, and 5 ml of water was assessed with the Functional Oral Intake Scale (FOIS) and compared with measures with objective scores from the portable NIDSAR. In addition, swallowing measures were compared between groups, as well as relationships with participant-reported choking frequency. Results: Participants without an NG-tube had significant different scores for swallowing during the respiration phase and pharyngeal stage for both 3 ml (t = 3.894 to 4.277, p < .001) and 5 ml (t = 1.999 to 2.944, p < .05 to p < .01) compared with participants with an NG-tube. Discussion: Our research revealed that participants with frequent episodes of choking required more time to swallow 1 ml compared with 3 ml or 5 ml which might be a function of piecemeal swallowing. Conclusions: NIDSAR measures with 3 ml and 5 ml boluses of water are effective volumes for safely assessing swallowing ability of nursing home residents with dysphagia without risk of choking or aspiration.

Psychometric testing of the SF-36 Taiwan version on older stroke patients.

AIM AND OBJECTIVE: To assess the psychometric properties of the SF-36 Taiwan version on a sample of older stroke patients in Taiwan. BACKGROUND: The Medical Outcomes Study Short Form-36 (SF-36) has proven to be a valid and reliable instrument in evaluating outcomes among stroke patients in western countries; however, less is known regarding its value for Asian stroke patients. DESIGN: A descriptive correlational study design was used to explore the reliability and validity of the SF-36 Taiwan version. METHOD: Older stroke patients (n = 87) from a medical centre in northern Taiwan were interviewed at the end of the first and sixth months after hospital discharge. RESULTS: Items on each subscale of the SF-36 Taiwan version had similar standard deviations, supporting the scaling assumption of equal-item variance in measuring the same concept. Correlations between items and their subscale were generally >or=0.70 with a few being 0.50 or 0.60. Cronbach's alpha coefficients were >0.70 for almost all subscales, supporting internal consistency. At both the first and sixth months after discharge, participants had lower scores, especially on the physical- and social function-related scales, than the norm for older people. At both times, patients with physical dependence had lower scores across subscales than those without physical dependence, supporting construct validity. CONCLUSIONS: The SF-36 Taiwan version demonstrated good reliability and validity when applied to stroke patients at either a transitional or stable time point after hospital discharge. However, the SF-36 Taiwan version has a potential to underestimate changes in certain domains due to floor or ceiling effects. RELEVANCE TO CLINICAL PRACTICE: Health care providers who deal with Taiwanese/Chinese stroke patients can use the SF-36 Taiwan version to assess health outcomes at either a transitional or a stable time point after hospital discharge.

Integrating the nurturer-trainer roles: Parental and behavior/symptom management processes for mothers of children with autism.

When a child is ill, it is commonplace for his/her mother to become the major caretaker. However, little information could be found on the process by which mothers of children with intellectual disability care for their children in the context of a specific disorder. To explore this phenomenon in mothers of children with autism, this study used a grounded theory approach to develop a substantive theory for explaining the parenting and behavior/symptom management processes for such mothers in Taiwan. Data were collected by in-depth, tape-recorded interviews with 12 mothers of a child with autism, ages 3-7 years. Analysis of interview transcripts revealed that the process used by these mothers to deal with the complex needs of their children was "integrating nurturer-trainer roles." This process had four components: searching effective treatments, developing training and nurturing competencies, negotiating roles, and adjusting expectations. Different types of "integrating nurturer-trainer" processes were found: trying it all, going along, insisting on training, and facilitating the child's strengths. The "strength-facilitating" type of mothers seemed to be better at integrating the nurturer-trainer roles and had better role preparedness, less role strain, and positive emotional reactions. These results can sensitize health care providers to the conditions of these mothers, thus helping them to develop appropriate interventions to facilitate the process of integrating the nurturer-trainer roles.

Moderating effects of professional commitment on hospital nurses in Taiwan.

This study investigates the moderating effects of professional commitment on relationships among burnout, job satisfaction, and turnover intention. Two-hundred fifty-three nurses working in a single medical center in northern Taiwan were sampled and approached, and 238 questionnaires were used. All participants were female and aged <50 years. Moreover, 30.3% of the sample was married. Professional commitment moderated the influence of burnout on job satisfaction, but not the influence of job satisfaction on turnover intention. First, burnout (in terms of reduced personal accomplishment and emotional exhaustion) predicted job satisfaction for high-commitment nurses, but not for low-commitment nurses. Second, job satisfaction predicted turnover intention for both high-commitment and low-commitment nurses.

Caregiver's needs as predictors of hospital readmission for the elderly in Taiwan.

The problems of caregivers are identified as one of the major causes, as well as a preventable one, for the unplanned hospital readmissions of elderly patients. Family caregivers are found to be under intense stress and burden, and to encounter many difficulties preparing themselves, both physically and mentally, for the return home from the hospital of an elderly family member. However, few studies of rehospitalization of the elderly have focused on the point of view of the family caregiver. The purpose of this study was to explore the predictors, especially the needs of the family caregiver, for rehospitalization, within a month after having been discharged, for elderly patients in Taiwan. A prospective, descriptive and correlational study, using 216 elderly patients and their family caregivers from the internal medicine wards of a medical center in Northern Taiwan was conducted. It was found that elderly patients with caregivers requesting help from a support group were 5.3 times more likely to be rehospitalized than those with caregivers that did not request such help. In addition, the odds of rehospitalization for elderly patients with some self-care ability, whose caregiver reported at least one need for social services, was 9.03 (CI=2.32-35.16) times that of those whose caregivers reported no need for social services. Based on the findings of this study, health care providers need to assess the self-care ability of their elderly patients. In addition they should assess the need for support groups and social services to caregivers before the hospital discharge of Taiwanese elders, and perhaps other Chinese populations as well.

Development and testing of a scale to measure caregiving load in caregivers of cancer patients in Taiwan, the care task scale-cancer.

The purpose of this study was to develop and test an instrument to measure care tasks for Taiwanese spouse caregivers of cancer patients. A 37-item Care Task Scale-Cancer (CTS-C) was developed using both quantitative and qualitative approaches. The reliability and validity of the CTS-C was tested on a convenience sample of 150 spouse caregivers caring for patients with breast cancer, head neck cancer, or esophageal cancer. Factor analysis showed that the CTS-C had 4 underlying factors (subscales): (1) accompany patient and monitor care (12 items), (2) substitutive care for social and general affairs (12 items), (3) communication and emotional care (9 items), and (4) mobility maintenance care (4 items). These 4 factors explained 52.3% of the total variance. Cronbach alpha coefficients for these 4 subscales ranged from .83 to .88. Test-retest coefficients (r) ranged from 0.92 to 0.94. The construct validity of this scale was supported by demonstrating a negative correlation between CTS-C scores (demand, difficulty, and caregiving load) and functional performance status, and positive correlations with caregiver burden and symptom distress. These results showed satisfactory validity and reliability for the CTS-C.