A novel curriculum for the Same-Sex Marriage Act and Patient Right to Autonomy Act (SMPRA) module based on two new laws in Taiwan: a mixed-methods study.

BACKGROUND: The establishment of laws has had a tremendous impact on holistic medical care. The Patient Right to Autonomy (PRA) Act and the Same-Sex Marriage Act have been passed in Taiwan, and both have sparked intense societal debate. The Same-Sex Marriage Act and PRA Act (SMPRA) teaching module was created for the Gender, Medicine, and Law (GML) course of the medical curriculum. This video trigger-assisted problem-based learning (VTA-PBL) software has integrated content on the aforementioned legislative proclamations. It upends conventional beliefs and fosters reflective practices on sexual rights and the right to representation among medical students. This study examined how the SMPRA module affected the knowledge and attitudes of medical students taking up the GML course. METHODS: A simple pre-/post-test design evaluated the outcomes of the PBL module to examine the changes in knowledge and attitudes of medical students toward same-sex marriage rights. In 2019 and 2020, 126 and 49 5th-year medical students took up the GML course, respectively. The GML components included a video scenario representing advanced decision-making and a healthcare agency with a same-sex couple, a PBL discussion, and student feedback presentations. The mechanisms of feedback collection and measuring student knowledge and attitudes toward sexual rights differed between one cohort in 2019 and the other in 2020. Pre- and post-lecture tests were used in the first school year, whereas a post-lecture open-ended questionnaire survey was used in the second school year. RESULTS: In total, 90 and 39 eligible questionnaires were received in the first and second school years, respectively, which corresponded to response rates of 71% and 80%. Students showed a better understanding of and positive enhancement of proficiency in legal and ethical content and relevant clinical practice. Qualitative analysis revealed that students viewed healthcare providers as checkpoints for conflicts of interest; medical ethics as the cornerstone of clinical practice; cultural background as a significant influence on decision-making; and empathetic communication as the cornerstone of relationships between patients, family members, and doctors. CONCLUSION: The GML course of the SMPRA module fosters reflective practices on ethical and legal sexual rights issues.

Attitudes Toward Male and Female Sexuality Among Men and Women With Intellectual Disabilities.

Studies comparing the sexual attitudes of men and women with intellectual disabilities (ID) have been limited. A mixed-methods approach was employed to explore attitudes toward sexuality among men and women with ID in Taiwan and to ascertain the disparities between attitudes among men and women with ID. First, fifty-six men and forty-four women with mild and moderate ID completed a face-to-face interview survey. After this, focus groups were conducted for men and women with ID. Results indicated that women with ID were more likely to have negative attitudes toward parenting and non-reproductive sexual behavior than their male counterparts. Qualitative data indicated that men and women with ID had different sexual attitudes and experiences and were subject to different expectations from people around them. Both men and women with ID had very limited opportunities to develop romantic relationships and a healthy sexual identity. Sexual rights awareness and practice should be matters of concern for this group of adults and women with ID in particular.

[Sexual attraction: a concept analysis using an evolutionary perspective].

BACKGROUND: Medical technology has transformed the body image of women and altered perceptions of beauty and sexual attraction. While "sexual attraction" is a fundamental concept in sexology, the characteristics of this concept have not been studied in the field of nursing. Because nurses provide advice and health education for women, it is essential to clarify the concept of sexual attraction for the benefit of related nursing research and for the further development of nursing knowledge. PURPOSE: This study explores the concept of sexual attraction in a Taiwanese social context using concept analysis based on an evolutionary perspective. METHODS: Inductive inquiry is used to compare and contrast articles from the academic literature, magazines, and newspapers, and data from participant observation and interviews are used to generate exemplars. The process by which the concept of sexual attraction has evolved over time is captured from three distinct aspects: significance, use, and application. RESULTS: The definitional statement of sexual attraction includes the five dimensions of: 1. sexual-oriented psychological dynamics; 2. personal aesthetics and sensory experience; 3. instinct body forces; 4. body language of self; and 5. social and cultural norms. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study scrutinized the changes in attributes that emphasize the biological, objectified body, and stereotyped gender roles of women. Further directions for research and nursing knowledge development are suggested. Examples include identifying the changes in the concept of sexual attraction that result from technological advancement and further clarifying the experiential knowledge of sexual attraction that represents the selfhood and independence of women in Taiwan.

Menopause experiences and attitudes in women with intellectual disability and in their family carers.

BACKGROUND: Little is known about how middle-aged and older women with intellectual disability (ID) cope with life transitions such as perimenopause and postmenopause. METHOD: A mixed methods approach was employed to explore the attitudes toward and experiences of menopause among women with ID and their family carers in one city in Taiwan. RESULTS: A survey found that how the carers perceived the level of menopausal symptoms in their female family members with ID was affected by their attitudes toward menopause; and carer age and education were significant factors associated with carer menopausal attitudes. The results of in-depth interviews indicated the carers' gender, age, kinships with the women with ID, and the carers' own menopausal experiences were related to how the carers felt about the menopausal transition of the women with ID. CONCLUSIONS: Both quantitative and qualitative findings show that little attention has been paid to either the menopausal transition experiences or the wellbeing of women with ID.

Caring for a daughter with intellectual disabilities in managing menstruation: a mother's perspective.

BACKGROUND: The concerns of mothers and their experiences while providing help to their daughters with intellectual disability (ID) and considerable support needs during menstruation have rarely been addressed. This qualitative study explored mothers' experiences and perceptions of managing their daughters' menstruation. METHOD: Twelve Taiwanese mothers of 13 daughters with ID (1 mother had twins) were interviewed to explore their experiences of providing help to their daughters with high support needs during menstruation. RESULTS: Support networks were limited and mothers developed their own strategies for managing their daughter's menstruation. Surgical hysterectomy or use of medication to cease or postpone menstrual bleeding was never considered by the mothers. The financial cost of menstrual pads and nappies was significant. CONCLUSIONS: Both an appropriate allowance for families involved in the menstrual care of women with ID and access to appropriate support are needed. More information and educational programs need to be provided to relevant professionals and carers.

[Attachment theory and baby slings/carriers: technological network formation].

Healthcare providers recognize the important role played by attachment theory in explaining the close relationship between mental health and social behavior in mothers and their children. This paper uses attachment theory in a socio-cultural context to ascertain the mechanism by which baby slings/carriers, a new technology, produced and reproduced the scientific motherhood. It further applies a social history of technology perspective to understand how baby carriers and attachment theory are socially constructed and historically contingent on three major transformations. These transformations include the use of attachment theory-based baby carriers to further scientific motherhood; the use of baby slings/carriers to further the medicalization of breastfeeding and enhance mother-infant attachment; and the use of baby slings/carriers to transform woman's identities by integrating scientific motherhood, independence and fashion. Implications for nursing clinical policy are suggested.

Awareness of Sexual Rights and Empowerment: Quantitative and Qualitative Evaluation of a Sexual Health Intervention for Adults with Intellectual Disability.

Young people with intellectual disability (ID) rarely have opportunities to form intimate relationships or receive long-term interventions promoting their sexual health and awareness of sexual rights. To promote sexual health in adults with ID in Taiwan, we utilized intervention research and inclusive research to introduce three interventions that involved adults with ID, their parents, and service workers. This paper primarily evaluates the outcomes of a two-year intervention to promote sexual and reproductive health knowledge/positive attitudes and quality of life for adults with ID. A non-equivalent multiple-groups with replications design was used to gather data from 87 adults with ID. In-depth interviews and focus groups were used to collect the experiences and perspectives of adults with ID, service workers and parents. Although the experimental groups did not show a strong quantitative increase in sexual knowledge and sexual attitudes, the qualitative data indicated that the dialogues with and among the participants transformed their perceptions of sexual needs from being sexual problems to being sexual rights, which was empowering for adults with ID. Involving parents and service workers in the intervention and facilitating dialogue between these groups are essential to transform sexual problems of adults with ID into sexual rights.

Irritable bowel syndrome: the bodily experiences of Taiwanese women.

Irritable bowel syndrome (IBS) results in a poor quality of life and absenteeism due to unpredictable abdominal pain, diarrhea, and bloating. IBS has prevalence rates of approximately 6% to 22% in various countries, and more women than men are diagnosed with this disorder. This study explored how Taiwanese women with IBS gain knowledge about the disorder and studied their experiences in using alternative remedies. An ethnographic study design involving interviews and Internet online discussions was used. Women (18-45 years) either diagnosed with IBS or with self-reported symptoms that met the Rome II criteria were included. All interviews were transcribed verbatim and analyzed by the constant comparison method. Results showed that symptom pattern recognition was used most often by participants to interpret symptoms. The bodily practices of the IBS women followed Taiwanese gender norms, with bodily experiences being represented as a dialogue between the disordered body and the social body. Linking diarrhea with social norms of female slenderness, IBS women applied cultural strategies to manage symptoms. The findings facilitate a partnership between healthcare professionals and IBS women, which can facilitate the development of an appropriate self-management manual, self-help groups, and Internet discussion groups to facilitate symptom management. It is hoped that this study will enhance nurse understanding of the traditional Chinese view of the body and the corresponding dietary practices used to harmonize the body's yin and yang. Although Asian women may resist Western medications due to their side effects, study results provide nurses with information on alternative therapies that may be more acceptable in the Asian context. In conclusion, the bodily experiences and practices of women with IBS are developed from personal cultural views of the body and gender norms.

[Reflections on technology and nursing profession development].

Discussions of the impact of technological innovation on nursing practices have focused on how technology enhances nursing professional abilities to deliver quality nursing care, on one hand, and the sacrifice of artistic and humanistic aspects of nursing on the other. The debate highlights the fundamental incompatibilities between technology and nursing. Instead of examining the interplay of technology and nursing with the view of technological optimism and romanaticism, the authors apply a social history of technology perspective and emphasize that technology is socially constructed and historically contingent. The technological system and its dissemination produce and reproduce the enduring patterns of power relations in areas such as gender, class and self-identity. This article discusses medical technology in the context of the nursing practice in an attempt to reveal the interplay between technology and nursing with four major themes including the transformation of the ownership of technology, the transformation of nurses' professional identity, the transformation of the relationship between physicians and nurses, and the transformation of the nursing labor process. Implications for nursing practice and directions for future research are suggested.

A traditional Chinese herbal medicine used to treat dysmenorrhoea among Taiwanese women.

AIM: The purposes of this study were twofold, firstly to ascertain the relative effectiveness of the alternative drug, Si-Wu-Tang (SWT), for dysmenorrhoea treatment and secondly to compare two different timings for consumption of SWT in terms of menstrual pain. DESIGN: A two-group time series experimental design. METHODS: A total of 49 participants were alternately assigned into two study groups. The experimental group was provided with 15 g of SWT daily for seven consecutive days, subsequent to the cessation of menstrual bleeding, for two consecutive menstrual cycles and the comparison group was provided with a similar intervention as soon as menstrual bleeding was noted. The degree of menstrual pain was recorded daily using a visual analogue scale and the duration of pain was also recorded during menstrual bleeding for five consecutive menstrual cycles. RESULTS: The results indicated that the decrease in menstrual pain levels and the duration of pain between the experimental group and the comparison group was not significant. However, the decrease in menstrual pain over the five menstrual cycles within the experimental group (from 2.07 to 1.42; 2.71 to 1.21; p < 0.05) and within the comparison group (from 1.94 to 1.23; 2.66 to 1.68; p < 0.05) were significant. CONCLUSIONS: The SWT formula has been continuously standardised for effective use as part of menstrual health and can be integrated as an alternative therapy within Western medicine. RELEVANCE TO CLINICAL PRACTICE: This study provides information for health care professionals not only about the general principles of traditional Chinese medicine, but also about the selection and consumption of an appropriate SWT formula among Asian women with dysmenorrhoea. Moreover, nurses should build up a partnership with their clients of Asian origins based on the use of an alternative therapy using different assessment criteria that are related to healing and recovery based on bodily constitution balance.

[Osteoporosis screening policy for menopausal women: risk and discipline].

The community-based osteoporosis screening program for menopausal women is an important service provided by community health nurses. This paper discusses how normalization technologies such as bone density screening help to discipline menopausal women conformed to normative behavior as to reduce bone loss risk. An analysis of osteoporosis screening policies found that mass surveillance technology perpetuates the knowledge of diseased menopausal body with osteoporosis. In addition, voluntary practices of self-surveillance represent the governmental strategy of disciplinary power by which menopausal women are monitored in the framework of neoliberalism emphasizing individual choice and freedom. Although unreliable, the Quantitative Ultrasound promoted by pharmaceutical companies has been participated eagerly by women in community osteoporosis screening activities. Self-surveillance measures further involve modifications in lifestyle (e.g., diet, exercise, daily activity, garments) to prevent bone loss and to lessen the risks of facing costly medical care bills. This paper suggests that health care professionals pay greater attention to menopausal women's opinions about their screening experiences and to the results of discussions on screening results. Better assessing screening policies should help facilitate a transformation in policy focus from self regulation to environmental modification.

[Risk discourse in Hormone Replacement Therapy].

The medical world has used Hormone Replacement Therapy (HRT) on menopausal women for over 70 years, but controversy surrounding the treatment remains. Findings reported by the NIH, U.S.A. in July 2002 indicated that HRT might cause cardiovascular and cancer risks, and resulted in serious concern among menopausal women using HRT in Taiwan. One after the other, members of the medical profession in Taiwan have argued that the medicine used in the research was different (from that used in Taiwan) and that the constitutions of western women are different from those of Taiwanese women, attempting to limit the negative impact of this research. HRT is one of the most widely used, but also one of the most controversial of medical technologies. The technico-scientific and sociocultural perspectives are two major approaches to the conceptualization of risk in relation to technology. Based on cognitive science, the technico-scientific discourse of risk emphasizes human forecasting of harmful events and scientific measures for preventing risk. The sociocultural perspective emphasizes that the risk is socially constructed and applies to control deviance. In addition, surveillance and regulated measures are applied to high-risk populations, as normalizing technology with moral implications. This paper suggests that health care professionals examine how HRT users interpret the meanings of risk. Reflection on the process and criteria for identifying high-risk populations is also suggested. Partnership with and empowerment of HRT users is advocated in preference to the use of regulating and normalizing measures.

Nurses' Experiences in Safe Handling of Chemotherapeutic Agents: The Taiwan Case.

BACKGROUND: Nurses are the least compliant with the guidelines for use of personal protective equipment (PPE) among health professionals. While the literature regarding nurses not following the guidelines focuses on nonuse of PPE, the experiences of using PPE from nurses' perspectives have not been examined. OBJECTIVE: The aim of this study was to explore the concerns of nurses regarding their decision to use or not to use PPE in the cultural context of Taiwan. METHODS: An ethnographic design was used, and ethnographic interviews of 57 nurses working with chemotherapy for more than 2 years were conducted. The participating nurses were observed in 2 accredited medical centers with oncology care teams in Taiwan. The constant comparison method was applied for data analysis, and cultural themes were generated from all transcripts. RESULTS: Wearing PPE was identified as an obstacle to professional image and performance. Nurses transformed safety into efficiency and prioritized social roles over professional roles. Experienced nurses, as insiders, believed that they have gained clinical wisdom to avoid occupational exposure to chemotherapy toxicity. CONCLUSIONS: This study explored the characteristics of clinical wisdom regarding PPE use in the context of Taiwanese chemotherapy care. Perceived professional image, efficiency on the job, PPE cost, and hospital rules influenced the use or nonuse of PPE by oncology care nurses. IMPLICATIONS FOR PRACTICE: Acceptable nurse-patient ratios and refraining from chemotherapy toxicity exposure for pregnant and breast-feeding women are advocated for policy making. The experiential expertise of nurses should be shared as credible evidence in developing guidelines.

The social construction of cancer chemotherapy toxicity: the case of Taiwan.

BACKGROUND: Chemotherapy toxicity hinders cancer treatment outcomes. Healthcare professionals educated in biomedical-oriented systems tend to label patients who refuse or discontinue chemotherapy as "noncompliant." How diverse discourses in public texts related to chemotherapy toxicity, which may significantly shape patients' actions, has not been formally explored. OBJECTIVE: The aims of this study were to explore the 2 dominant discourses in Taiwan related to chemotherapy toxicity within their sociocultural context and to ascertain how chemotherapy toxicity is constructed in the texts of journals and newspapers. METHODS: Public, medical, and nursing texts about chemotherapy from 1950 to 2010 were collected and analyzed using Foucaultian discourse analytical techniques; juxtaposing dominant and marginalized discourses, we identified cultural themes. RESULTS: In traditional Chinese medicine, toxic chemotherapy drugs are believed to interfere with circulation of energy flow and blood and to disturb the harmony of yin/yang in the body. Findings indicate that biomedical and traditional Chinese medical doctors do not agree about the best management of chemotherapy toxicity. Moreover, lay knowledge and patient voices regarding chemotherapy toxicity are often ignored in medical discourses. CONCLUSIONS: Cultural beliefs and covert power relations between diverse medical traditions shape patients' experiences of chemotherapy toxicity. The preferential use by patients of traditional Chinese medicine over biomedicine to manage chemotherapy toxicity sustains its pivotal role. IMPLICATIONS FOR PRACTICE: The disparity of perceptions between healthcare professionals and patients regarding chemotherapy toxicity needs to be thoroughly assessed. Thus, culturally specific nursing care models may be developed.