Using the Kipling method to explore the contextual factors of decision-making during advance care planning for older cancer patients, their family, and health-care professionals: A qualitative secondary analysis.

OBJECTIVES: Advance care planning (ACP) interventions are supposed to affect patients' autonomy and family health-care outcomes positively. However, the clinical benefits of ACP actualization and associated contextual factors merit questioning. Therefore, this study explores the critical contextual and procedural factors related to ACP decision-making based on the actual situation of older patients with cancer encountering end-of-life care in Taiwan. METHODS: This retrospective qualitative secondary analysis used the Kipling method (5W1H) to explore further the critical contextual and procedural factors related to ACP decision-making processes. We applied thematic analysis and dual coding for 35 narratives, including 10 patients with cancer, 10 family caregivers, and 15 health-care staff, derived from a preliminary qualitative study regarding palliative care decision-making among patients with advanced cancer, their families, and health-care staff. RESULTS: We identified 6 domains detailing the contextual factors for ACP decision-making: (1) WHO (decision makers); (2) WHAT (discussion content); (3) WHEN (care plan for which disease stage); (4) WHERE (patient's situational location); (5) WHY (reasons underpinning the decisions); and (6) HOW (the way to form the decisions). SIGNIFICANCE OF RESULTS: Using the Kipling method to elaborate the contextual factors for ACP decision-making among older patients with cancer strengthens the understanding of complicated end-of-life care decision-making procedure. This study also demonstrates the dynamic and cultural complexity and the various factors considered during end-of-life care and future ACP discussion.

Care and management of stillborn babies from the parents' perspective: A phenomenological study.

AIM: To explore parents' perspective on hospital's care and management of the remains of stillborn babies. BACKGROUND: Each year, 2.6 million of pregnancies end as stillbirth. Recent literature began to understand parents' traumatic experience in stillbirth and its profound impact on parents' mental health and psychosocial effect. But there is limited understanding on the actual care and management of the stillborn baby, nor is there an agreement on how hospitals should care for the stillborn baby to mitigate parents' profound loss. DESIGN: A descriptive phenomenological approach was applied to conduct this study. METHODS: A purposive sample of twenty couples (40 individuals) who had encountered how to care for the remains of their stillborn babies participated in the study. The data were collected through in-depth interviews, which involved semi-structured and open-ended questions. The phenomenological methods of Giorgi were applied to analyse the data. The COREQ checklist was used preparing the manuscript. RESULTS: Parents felt unprepared and lack of support when they had to handle their stillborn babies' remains. The research results revealed two major themes: (1) Handling stillborn babies remain ignorantly; (2) Pacifying the disturbed soul on both sides. CONCLUSIONS: It was found in the study that reflection and identification were the emerging themes, which can enable healthcare professionals to understand parents' concerns in a meaningful way, as they deal with the remains of stillborn babies. Moreover, it is hoped that hospital administration and health care personnel should consider stillborn parents' concerns and incorporate their needs into nursing assessment and treatment practices. RELEVANCE TO CLINICAL PRACTICE: Given stillbirth's profound implication for parents' identity and psychosocial role, hospitals need to be more sensitive and proactive to parents' cultural and religious needs when they care for stillborn baby and handle its body.

[The Experience and Coping Process of Women With Breast Cancer Undergoing Neoadjuvant Chemotherapy].

BACKGROUND: Neoadjuvant chemotherapy is commonly performed to reduce the size of tumors before partial mastectomy to improve the rate of breast-conservation. Few studies have been conducted to assess the neoadjuvant chemotherapy experience of women diagnosed with breast cancer and their responses to it. PURPOSE: To explore the experience of women diagnosed with breast cancer who received neoadjuvant chemotherapy and their responses to it. METHODS: The grounded theory was adopted as the methodology. Participants were recruited using purposive sampling. The data were collected using semi-structured, in-depth interviews and analyzed using open, axial, and selective coding. RESULTS: A total of 15 women newly diagnosed with breast cancer participated in this study, with information showing that the core category oscillated between the sizes of the tumor. The three categories included difficulty in coping with the physical response to chemotherapy, absence of role fulfillment, and uneasy emotions. The coping strategies used by the participants included: body and mind adjustment, hiding, family labor adjustment, and changing the pace of social life. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The participants experienced tremendous physical and psychological stress during their neoadjuvant chemotherapy, in which tumor response assessment served as a critical time point. Medical professionals, in addition to noting changes in women's physiological response, must pay attention to their psychological burden and provide emotional support and treatment information as needed.

What influences patients' decisions regarding palliative care in advance care planning discussions? Perspectives from a qualitative study conducted with advanced cancer patients, families and healthcare professionals.

BACKGROUND: The concept of advance care planning is largely derived from Western countries. However, the decision-making process and drivers for choosing palliative care in non-Western cultures have received little attention. AIM: To explore the decision-making processes and drivers of receiving palliative care in advance care planning discussions from perspectives of advanced cancer patients, families and healthcare professionals in northern Taiwan. METHOD: Semi-structured qualitative interviews with advanced cancer patients, their families and healthcare professionals independently from inpatient oncology and hospice units. Thematic analysis with analytical rigour enhanced by dual coding and exploration of divergent views. RESULTS: Forty-five participants were interviewed (n = 15 from each group). Three main decision-making trajectories were identified: (1) 'choose palliative care' was associated with patients' desire to reduce physical suffering from treatments, avoid being a burden to families and society, reduce futile treatments and donate organs to help others; (2) 'decline palliative care' was associated with patients weighing up perceived benefits to others as more important than benefits for themselves; and (3) 'no opportunity to choose palliative care' was associated with lack of opportunities to discuss potential benefits of palliative care, lack of staff skill in end-of-life communication, and cultural factors, notably filial piety. CONCLUSION: Choice for palliative care among advanced cancer patients in Taiwan is influenced by three decision-making trajectories. Opinions from families are highly influential, and patients often lack information on palliative care options. Strategies to facilitate decision-making require staff confidence in end-of-life discussions, working with the patients and their family while respecting the influence of filial piety.

Developing a Decision-Aid Website for Breast Cancer Surgery: An Action Research Approach.

BACKGROUND: Patients with early-stage breast cancer have numerous options when choosing the type of breast surgery method to be applied. Each of these options lead to a similar long-term survival rate, but result in significant differences in appearance, function, cost, recurrence rate, and various other relevant considerations. However, the time available for detailed communication with each patient is often limited in clinics, which puts these women under great psychological stress and can hinder their surgery-related decision making. OBJECTIVE: The objective of this study was to develop a multipurpose surgery decision-making website providing medical information, psychological support, and decision-related simulation for women during breast cancer surgery-related decision making. METHODS: Using the 4 steps of action research, which involve multigroup teamwork via regular team meetings, the following were performed: (1) Planning: searching, analyzing, and evaluating health websites to consensually decide the major infrastructure; (2) Action: work was performed simultaneously in 4 groups, which consisted of medical information collection and editing, patient interviews and data extraction, webpage content design, and programming to create or host the website; (3) Evaluation: the website was tested by clinical experts and focus groups of former breast cancer patients to assess its effectiveness and pinpoint appropriate improvements; and (4) Reflection: constant dialogue was conducted between the various participants at each step, which was used as the foundation and motivation of next plan-action-evaluation-reflection circle. RESULTS: Using the action research approach, we completed the development of our website, which includes the following: (1) "Woman's Voice"-an animated comic depicting the story of a female breast cancer patient with interspersed questions for the users that will help them better empathize with the experience; (2) "Cancer Information Treasure House"-providing breast cancer surgery-related information through text, tables, pictures and a presentation video; (3) "Decision-making Simulator"-helping patients think through and check the pros and cons of the different surgical options via visual-based interactions including "Stairs Climbing" and "Fruit of Hope"; and (4) "Recommended Links"-providing reliable websites for further reference. Additionally, we have further improved the website based on the feedback received from postsurgery breast cancer patients and clinicians. We hope to continue improving to better meet both the patients' and health providers' needs and become a practical decision-making aid for patients undergoing breast cancer surgery. CONCLUSIONS: We have created the first breast cancer surgery decision-making assistance tool in Taiwan using a "Web-based" and multifunctional website design. This site aims to provide health care knowledge, psychological healing, and emotional support functions, as well as decision-making capability enhancement simulations. We look forward to assisting breast cancer patients in their decision-making process and expect our website to increase patient's autonomy and improve their communication with clinicians.

Developing a Web-Based Comic for Newly Diagnosed Women With Breast Cancer: An Action Research Approach.

BACKGROUND: Personal narratives have been seen as a useful way of communicating about cancer treatment options and providing recovery information. Many printed versions of such material are available, including comics that explore the individual memories of patients who have gone through cancer treatment. These studies have been used to orientate patients, patients' relatives, and physicians. However, only a few Web-based comics have been specifically designed for patients with breast cancer and used as aids to decision making. OBJECTIVE: We aimed to describe the developmental process of creating an animated comic as a Web-based surgery decision-making tool; the comic was aimed at illustrating the feelings, thoughts, and meanings when a patient suffers from breast cancer. This was done by recounting the symptoms, diagnostic process, treatments, and treatment effects of such women from the diagnosis stage onward. METHODS: Using cycles of planning, action, evaluation, and reflection, which involved collaborative work, action research was conducted to develop a Web-based animated comic. The stages of action research consisted of (1) semistructured and in-depth interviews to collect experiences of women with breast cancer; (2) construction of an animated comic by editors, graphics designers, dubbers, and information technology engineers; (3) redrawing of pictures of the comic after gathering feedback from a breast surgeon; and (4) evaluation of the Web-based animated comic using 6 patient focus groups. RESULTS: The comic was produced and showcased on the website "The Network of Making-decision Aids for Breast Cancer Surgery"; the comic was accompanied by soft music and audio explanations. The comic functions as a personal statement that describes experiencing breast cancer. The animated comic consists of 8 chapters, based on the 8 themes deducted from the findings obtained during the analysis of relevant interviews. The 8 chapters include (1) the appearance of a lump; (2) confirmation by medical diagnosis; (3) the uncertainty of waiting (4) fear of life-threatening disease; (5) choosing life over despair; (6) being brave and deciding to undergo treatment; (7) choosing the type of surgery; and (8) being reborn. CONCLUSIONS: Using action research, this study illustrated that the comic that sheds light on issues of feelings, emotions, and thoughts that are present when a woman is diagnosed with breast cancer and provides a communication medium to explain the steps in the process. Meanwhile, it implies that hope will be able to overcome the challenges that will be faced. Within the Web-based decision aid for patients with breast cancer, the animated comic acts as an information resource and is aimed at patients' understanding of impacts of emotions arising when suffering from breast cancer. It is potentially applicable as a therapeutic tool that facilitates self-reflection and self-healing among newly diagnosed patients with breast cancer.

[A Survey of the Factors of Influence and Interventional Strategies for Breast Cancer Survivors' Transition Care Across Multiple Theoretical Perspectives].

Breast cancer significantly threatens the life of women, while the adverse effects of cancer treatment degrade quality of life and psychological well-being. The quality of transitional care following the completion of treatment significantly affects the ability of breast cancer patients to transition successfully into survivorship. This paper introduces multiple theoretical perspectives and provides an overview of the tenets of each in order to identify the positions of breast cancer survivors and to highlight the factors and strategies that influence their transitional care. The theoretical perspectives that are introduced include the social-ecological model, transition theory, and the strengths perspective. In order to improve the holistic care of women with breast cancer, factors relevant to transition are categorized into the individual, interpersonal, organizational, community, and policy levels. Furthermore, empirical interventions, which are based on the respective advantages of the various levels of the social-ecological model, are proposed in order to conform to the sociocultural context and clinical practices. Healthcare providers should leverage the strengths and resources at each level to develop feasible strategies and to provide quality of care in order to assist breast cancer patients to transition successfully from treatment to survivorship and to holistically improve their subsequent quality of life and function.

[The physical activity and life healing in psychiatric patients: taijiguan as an example].

BACKGROUND: Chronic psychiatric patients tend to have cognitive and functional impairments. Participation in physical activity has been shown to improve their health and independence. Regular practice of Taijiquan may help improve mood and life stresses, promoting physical and mental health. PURPOSE: This research explores the effect of a 13-week Taijiquan learning program on the daily life experience of chronic psychiatric patients. The process and the essential meaning of the entire learning experiences are presented. METHODS: Data were collected from a psychiatric daycare center at a Teaching Hospital in Taipei. The 6 patients who participated in this study included 3 with bipolar disorders and 3 with schizophrenia. Narrative inquiry and focus-group interviews were used for qualitative data collection and analysis. RESULTS: The initial results of participant experiences were categorized into 3 themes: 1. Learning kung fu in the Taijiquan; 2. Releasing binding through the practice of Taijiquan; and 3. Pursuit of excellence through the learning of Taijiquan. The views of illness, body, and interpersonal interaction as well as the three stages of dilemma, transcendence / acclimation, and acquaintance for the psychiatric patients and their Taijiquan's learning world were described and the potential therapeutic effects on the body and daily life of these patients were explored. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Learning Taijiquan is highly challenging for the novice, especially those with chronic psychiatric illnesses. However, after familiarization with the postural actions and key concepts of this exercise, Taijiquan facilitated body relaxation, heightened perception, and postural balance. Consequently, this exercise stabilized the mood, disease status, and capacity for handling interpersonal relationships of participants and consequently may enhance their long-term life quality and disease recovery status. Results of this study recommend strongly that Taijiquan be included as a therapeutic activity for psychiatric patients to improve their health, healing, and recovery.

Decision-making process for choosing an elective cesarean delivery among primiparas in Taiwan.

A significant proportion of cesarean deliveries in Taiwan were without medical indications and/or on maternal request. The purpose of this study was to understand the decision-making process of choosing an elective cesarean delivery (ELCD) among primiparas in Taiwan. This qualitative exploratory study was guided by grounded theory. Data were collected through in-depth interviews with 20 primiparous women, 15 of whom chose ELCD. Verbatim transcriptions were analyzed using constant comparative analysis and methods of open, axial, and selective coding. The core category that describes the process of ELCD decision making among primiparas is "controlling risks of childbirth and ensuring well-being." The decision process can be divided into three phases: (1) Pre-decision: risk perception, including two subcategories, negative pre-existing ideas about normal spontaneous delivery (NSD) caused worry, and desire for ELCD as the solution; (2) In-decision: risk assessment. Women proactively collected information about NSD and cesarean delivery, and then weighed the personal risk between NSD and ELCD. Risk assessment focused on seven dimensions including safety, health, comfort, efficiency, feminine charms, time and economy; (3) Post-decision: marching onward fearlessly, including two subcategories, belief in ELCD and stress relief, and persuading stakeholders to agree and gaining the required resources for ELCD. At different phases of decision-making, women revealed different concerns, though the sequence of phases was not necessarily unidirectional. Health care providers should be aware of the decision phase and intervene at appropriate times. It is difficult to change a women's decision to have ELCD in the post-decision phase.

[Exploration of nursing art and aesthetic experiences: cross-disciplinary links and dialogues].

Interdisciplinary understanding is crucial for readers today. This article integrates the ideas of four care-aesthetics-column writers in order to illustrate and discuss nursing art and aesthetic care experiences in a cross-disciplinary conversation. This article reflects critically on the art, culture, and nature of nursing in the five themes of: 1) the shape of nursing knowledge, "science" or "art"?; 2) the caring arts: passively regulative or consciously creative labor?; 3) busy hospital workers: a landscape of persons and objects or the creators of the scenery?; 4) nursing skills, arts, and the Tao; and 5) art liberation: is the nursing profession in need of a revolution or fundamental reform? This article utilizes diverse and occasionally contradictory points of view together with practical examples in order to encourage readers to interlink their disparate professional nursing skills and draw aesthetic knowledge from multiple sources and experiences.

Decision-making process for breast-conserving therapy from the perspective of women with breast cancer: A grounded theory study.

PURPOSE: To explore the decision-making and coping processes of women with newly diagnosed breast cancer receiving breast-conserving therapy. METHODS: The grounded theory methodology approach was employed in this study. Purposive and theoretical sampling methods were used to enroll 27 women with stage I-III breast cancer. Individual interviews were conducted using a semi-structured interview guide, and data were analyzed using open, axial, and selective coding. RESULTS: The core category is "limitations of boundaries," which includes three categories: feminine body boundary, emotional boundary, and knowledge boundary. Clusters, conflicts, and changeability were among the unique contextual conditions. The decision-making process became more challenging because of the differences between the levels of knowledge of physicians and patients receiving treatment information. Women's actions and interactions included information seeking, controlling, negotiating, and accepting nondecision-making support. The consequences of decisions included redecision and reoperation, and most women did not regret receiving breast-conserving therapy. CONCLUSION: Even after choosing breast-conserving therapy, some women may experience changes in treatment procedures. Medical professionals should identify women's challenges and limitations during their decision-making process, explain the benefits and drawbacks of different surgical modalities, address concerns about the outcome of breast-conserving surgery, and provide intellectual and emotional support for decision-making.

[Exploring the temporal flow phenomenon in the family care of psychiatric patients].

BACKGROUND: Caring consciousness and care action are core nursing values. The concept of internal temporal flow offers the potential to provide patients a richer and more meaningful life and better care. The family care phenomenon of psychiatric patients merits re-exploration. PURPOSE: This study identifies and describes relationships and issues within and between caring consciousness, care actions, and internal temporal flow by describing and interpreting the family care phenomenon of psychiatric patients. This study targets the care-recipient as a primary subject and highlights the orientation of co-existing and co-presenting caring-temporal flow for family and professional care applications and references. METHODS: This study conducts secondary data analysis using hermeneutic phenomenology inquiry. Research work was completed using multi-perspectives and multi-methods of data collection, including participant observation, individual in-depth and focus group interviews with psychiatric patients and their family members regarding their feelings, and thoughts and experiences of psychiatric family care. RESULTS: Data analysis results are divided into two parts: (1) the intersection of caregiver's and care receiver's caring-temporal flow and (2) The trajectory and construction of psychiatric patients' self-care temporal flow. Multiple appearances of the caring-temporal flow were formed when caregivers and care receivers engaged in different time and diverse care patterns. CONCLUSION: Fluctuation and competition among psychiatric patients' and their family members' control and transfer in terms of their lived temporality were influenced by mutual maturity as well as the demand and offering of caring consciousness and care action. The psychiatric patient as a primary subject should return and take control over his or her own mainstream lived temporality, which is the core essence of care.

[Exploring the illness disclosure process through the intimacy relationship experiences of chronic psychiatric patients].

BACKGROUND: Issues related to psychiatric patient intimacy relationships are often neglected, sometimes to the point of being treated as taboo. Nevertheless, intimacy relationships are very important to the life of psychiatric patients. PURPOSE: The authors designed this study to understand the processes used by psychiatric patients to make decisions about disclosing information on their illness to their dating partners. METHODS: This study used grounded theory techniques, and data were collected using four focus group interview sessions and six in-depth individual interview sessions held at a psychiatric hospital in Taipei. Study subjects included twenty chronic psychiatric patients. RESULTS: Data analysis identified three distinct stages of illness disclosure, including: 1) Considerations before disclosure: avoiding, struggling, or withdrawing; 2) Experiences during disclosure: hastening, facing confidently or choosing the easiest way; and 3) Results after disclosure: accepting, blaming, doubting, or refusing and adjusting their mind. CONCLUSIONS: The authors hope study results will help nurses understand better the stresses and impacts of illness disclosure and gender interaction experiences that psychiatric patients undergo and provide nurses with more ideas and approaches on counseling psychiatric patients about the illness disclosure process in the dating process in order to improve quality of care to this population.

[Anti-stigmatization and ethical perspectives on mental illness and genetic technologies].

People with mental illness suffer from their disorder as well as from social stigma. This paper explores the bio-psycho-social reasons that underlie human stigma and proposes potential anti-stigmatization strategies. Furthermore, this paper presents a multi-component, multi-level intervention genetic psychiatry protocol addressing stigma prevention. Significant levels of social stigma still pervade Taiwanese culture, and a potential crisis of genetic psychiatry exists in cases where mental illness is identified. Promoting humanistic, ethical, and caring attitudes and enhancing genetic nursing education at both the community level and amongst health professional are central to ensuring the rights and quality of life of the mentally ill in Taiwan society.

[The exploration of the lived experiences of schizophrenic patients and family members facing the fear of illness hereditary].

BACKGROUND: Schizophrenia negatively affects both patients and their families. What are the effects of this incurable, potentially hereditary disease on daily life? Related research shows that schizophrenics tend to experience 'uncertainty' in daily life. Discussions on 'uncertainty' experienced in daily life in the context of concerns regarding hereditary illness remain scarce in Taiwan. PURPOSE: This research was designed to gather important data on schizophrenic patients and their family members related to their uncertainties about disease heredity. METHODS: Participants were recruited from the psychiatric unit and outpatient services department at two hospitals in Hsinchu County. Research subjects included a total of six schizophrenics and six family members. RESULTS: The three topics deduced from data analysis included: 1. marriage / family difficulties rooted in feelings of suffering and torture related to the psychosis and uncertainties regarding disease heredity; 2. evolution from doubt to trust as patients gradual accept choices and make decisions related to disease heredity; and 3. dealing with disease heredity again after having made a successful transition (i.e. persistence to maintain family ties). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Both patients and family members experienced worry and fear due to uncertainty about the hereditary condition of the disease. Some experienced emotional responses such as anxiety and helplessness. Research results are expected to help nursing personnel understand the multiple effects and impacts of uncertainty toward illness heredity experienced by the patients and their families in order to provide better consultation and medical care quality under differing circumstances depending on the individual characteristics of patients and their families.

Integrative review of breast cancer survivors' transition experience and transitional care: dialog with transition theory perspectives.

The health of breast cancer survivors (BCSs) is an essential concern worldwide. This review summarizes current knowledge and proposes a novel framework for understanding BCSs' transition experiences and adopting a more holistic view of transitional care to ensure a successful shift from patient-to-survivor. An integrative review was applied whereby we searched CINAHL, MEDLINE, PubMed, and ProQuest. Eleven qualitative and 16 experimental articles were extracted and evaluated. Constant comparison and matrix classification were used for data analysis, extraction, and synthesizing, which were circulated between the study findings and transitions theory. The breast cancer survivors' incorporated transition theory (BCSITT) encompasses the concepts of transition nature, conditions, intervention strategies, and patterns of response as developed from the data analysis. Facilitators and inhibitors of BCSs' transition experience in the personal, interpersonal, organizational, communal, societal dimensions as well as an empirical intervention of BCSs' transitional care from micro to macro levels are proposed. In conclusion, the BCSITT could provide comprehensive insights for understanding the phenomenon of BCSs' transition from primary treatment completion to self-management and serve as a holistic framework to guide clinical practice and research for BCSs' transitional care. Health care professionals need to assess the readiness of BCSs for transition and provide early interventions for enhancing BCSs' mastering of new skills to manage the challenges of transition. Incorporating stakeholders at each level and providing a comprehensive continuum of care may successfully assist BCSs' patient-to-survivor transition.

The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach.

BACKGROUND: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient's perspective. OBJECTIVE: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. METHODS: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. RESULTS: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. CONCLUSIONS: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer.

Using snowball sampling method with nurses to understand medication administration errors.

AIMS AND OBJECTIVES: We aimed to encourage nurses to release information about drug administration errors to increase understanding of error-related circumstances and to identify high-alert situations. BACKGROUND: Drug administration errors represent the majority of medication errors, but errors are underreported. Effective ways are lacking to encourage nurses to actively report errors. METHODS: Snowball sampling was conducted to recruit participants. A semi-structured questionnaire was used to record types of error, hospital and nurse backgrounds, patient consequences, error discovery mechanisms and reporting rates. RESULTS: Eighty-five nurses participated, reporting 328 administration errors (259 actual, 69 near misses). Most errors occurred in medical surgical wards of teaching hospitals, during day shifts, committed by nurses working fewer than two years. Leading errors were wrong drugs and doses, each accounting for about one-third of total errors. Among 259 actual errors, 83.8% resulted in no adverse effects; among remaining 16.2%, 6.6% had mild consequences and 9.6% had serious consequences (severe reaction, coma, death). Actual errors and near misses were discovered mainly through double-check procedures by colleagues and nurses responsible for errors; reporting rates were 62.5% (162/259) vs. 50.7% (35/69) and only 3.5% (9/259) vs. 0% (0/69) were disclosed to patients and families. High-alert situations included administration of 15% KCl, insulin and Pitocin; using intravenous pumps; and implementation of cardiopulmonary resuscitation (CPR). CONCLUSIONS: Snowball sampling proved to be an effective way to encourage nurses to release details concerning medication errors. Using empirical data, we identified high-alert situations. Strategies for reducing drug administration errors by nurses are suggested. RELEVANCE TO CLINICAL PRACTICE: Survey results suggest that nurses should double check medication administration in known high-alert situations. Nursing management can use snowball sampling to gather error details from nurses in a non-reprimanding atmosphere, helping to establish standard operational procedures for known high-alert situations.

Breastfeeding Experiences of Taiwanese Mothers of Infants with Breastfeeding or Breast Milk Jaundice in Certified Baby-Friendly Hospitals.

PURPOSE: The purpose was to explore the breastfeeding experiences of mothers of infants with breastfeeding or breast milk jaundice. METHODS: In-depth qualitative interviews and content analysis were conducted with nine mothers of newborns with breastfeeding and/or breast milk jaundice who breastfed their babies during the first year postpartum. RESULTS: Mothers' experiences can be described in four phases and six themes. (1) Prenatal stage: build breastfeeding belief, i.e., breastfeeding is best and a natural behavior, without awareness of neonatal jaundice; (2) stage after neonatal jaundice started to appear: include two themes, questioning beliefs in breastfeeding and happiness in being a mother. Mothers lacked knowledge and ignored the threat of neonatal jaundice, mainly focused on their physical discomforts and worried about insufficient breast milk; they also felt an intimate mother-infant bond through breastfeeding; (3) stage when newborns had confirmed diagnosis of breastfeeding or breast milk jaundice that required medical attention: include two themes, diagnosis of breastfeeding or breast milk jaundice and phototherapy caused negative emotions and regaining original beliefs about breastfeeding. They struggled through emotional swings and inconsistent advices about whether phototherapy and formula supplementation are needed. Then, they decided breastfeeding or breast milk jaundice is only temporary and retrieved initial beliefs of breastfeeding. (4) Stage after neonatal jaundice faded and mothers continued breastfeeding: insisting and adapting. CONCLUSION: Breastfeeding mothers were unaware of neonatal jaundice until medical attention was required; they experienced physical and mental distress and gradually learned to manage jaundice while insisting on breastfeeding through their breastfeeding beliefs and happiness in being mothers.

Women of advanced maternal age undergoing amniocentesis: a period of uncertainty.

AIMS: To generate a descriptive model for understanding patterns and interpretations concerning women's experiences of amniocentesis in Taiwan. BACKGROUND: In light of scientific technology and social change, it would be important to recognise the complexity of a woman's situation and the meaning of her in-depth experience while undergoing amniocentesis. Earlier studies on the experience of these women often relied on quantitative data obtained from questionnaires at only one point in time; however, the changes in older pregnant women, known to be at increased risk for foetal chromosomal abnormalities, from the time of pregnancy until test results of their amniocentesis has not been clearly understood. DESIGN: A grounded theory approach was applied. METHODS: Data were collected through in-depth interviews and participant observation. Sampling and major coding continued from 2002-2003 until theoretical saturation occurred; 20 women (> or =35 years of age) participated in this study; data were analysed using constant comparative and content analysis. RESULTS: A prevailing sense of uncertainty was the core category for describing and guiding the process of this study with five main stages identified: (1) ambivalence toward pregnancy; (2) decision to undergo amniocentesis; (3) concerns regarding maternal and foetal safety during procedure; (4) anxiety while awaiting results and (5) thoughts about a lifetime maternal commitment. CONCLUSIONS: Identification and appreciation for emerging themes enables nurses to address women's concerns in a meaningful way as they undergo amniocentesis. Also, it is hoped that understanding key themes allows nurses to facilitate constructive interactions between women, physicians and other members of the obstetric team. RELEVANCE TO CLINICAL PRACTICE: Women in Taiwan undergoing amniocentesis had concerns about safety and dealt with cultural taboos of pregnancy in advanced age; health education should include coping strategies and decision making in dealing with these issues. To facilitate constructive interactions between clients and health care teams, the ethical guidance of informed consent and respecting the women's autonomy should be emphasised.