[Symptom Distress, Social Support, Spiritual Well-Being, and Quality of Life Among Women With Gynecologic Cancer].

BACKGROUND: Women with gynecological cancers experience physical and mental distress due to their diagnosis, surgery, adjuvant chemotherapy, and radiotherapy, all of which have adverse physical, mental, social, and spiritual impacts on their quality of life. PURPOSE: This study was designed to examine the correlations among symptom distress, social support, spiritual well-being, and quality of life as well as the predictors of quality of life in women with gynecological cancers. METHODS: This was a cross-sectional correlational study. A total of 91 women with gynecologic cancer were recruited from a medical center in central Taiwan. A demographic characteristics questionnaire, the World Health Organization Quality of Life Brief Questionnaire Taiwanese version, the Chinese Modified Symptom Distress Scale, the Chinese Simplified Social Support Scale, and the Spiritual Well-Being Scale were used for data collection. Correlation and multiple regression analyses were performed on the data. RESULTS: Symptom distress was found to correlate negatively with spiritual well-being as well as with the physical health, psychological health, and environmental health domains of quality of life. Social support and spiritual well-being were found to correlate positively with all four domains of quality of life. Social support was identified as the main predictor of quality of life. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Symptom distress, social support, and spiritual well-being should be incorporated into nursing education to improve medical staff awareness of these issues and promote the timely evaluation of patient needs. Moreover, medical staff should provide appropriate social and spiritual support and multi-disciplinary care as well as make referrals when necessary to related support groups to improve clinical care quality to enhance patient quality of life.

The relationships between stress, coping strategies, and quality of life among gynecologic cancer survivors.

Many studies have reported that gynecologic cancer diagnosis, surgery, adjuvant therapy, and survivorship can be extremely stressful for many people during their cancer journey, and most cancer survivors have experienced stress after cancer, which impacts their quality of life. Importantly, healthy stress management will assist patients in overcoming obstacles in their lives and enhance both the quality of life and the cancer adjustment process. This study aimed to investigate the relationships between stress, coping strategies, and quality of life among gynecologic cancer survivors and to assess the mediating effects of coping on the relationship between quality of life and stress. A series of regression models and Sobel test were conducted to investigate whether coping strategies mediated the relationship between stress and quality of life. Stress was a predictor of quality of life. Acceptance was the mediator between stress and quality of life. Tailored programs that foster coping strategies, such as the strategy of acceptance, to reduce stress and maintain quality of life in this vulnerable group need to be developed.

Psychometrics and measurement invariance: Health Literacy Scale for Vietnamese and Indonesian married immigrants.

AIMS: To examine the psychometrics and measurement invariance of the Short-Form Health Literacy 12-item questionnaire (HL-SF12) among Vietnamese and Indonesian married immigrants. DESIGN: A cross-sectional survey design. METHODS: In total, 1171 Vietnamese and Indonesian married immigrants were enrolled between September 2019 and December 2019. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to verify the structural validity of the suggested factor structure. The multiple-group CFA (MGCFA) used a series of hierarchical nested-in models as a measurement invariance test which confirmed the adequacy of the model fit at each stage. RESULTS/FINDINGS: The Kaiser-Meyer-Olkin coefficient was 0.898, and the Bartlett test of sphericity was statistically significant (χ2 [66] = 1965.97, p < 0.01). According to a scree plot and Kaiser's criterion for eigenvalues of >1, the EFA explained 61.6% of the total variance and confirmed three theoretically supported factors of health care, disease prevention and health promotion. The 12 items showed factor loadings of >0.4 and four items were in each subscale. The CFA showed adequate structural validity, including a relative chi-squared/degrees of freedom (X2 /df) of 2.01, a comparative fit index (CFI) of 0.98 and a root mean square error of approximation (RMSEA) of 0.04 (95% confidence interval [0.03, 0.05]) in married immigrants. For the measurement invariance, a change in the goodness-of-fit measures did not exceed 0.02 for the RMSEA or 0.01 for the CFI. The results indicated Cronbach's α values of 0.87 for the HL-SF12 scale in Vietnamese and Indonesian combined samples (n = 1171). A t-test showed that the HL-SF12 and its three subscales were unable to significantly differentiate between Vietnamese and Indonesian groups (all p > 0.05). CONCLUSIONS: The HL-SF12 scale showed acceptable theoretically supported structural validity, equivalent measurement invariance and reliable internal consistency among Vietnamese and Indonesian married immigrants. Measurements of immigrants' HL using the HL-SF12 could be integrated into future immigrant health policies. IMPACT: As the first study of the measurement invariance of the HL-SF12 instrument among immigrants. Related factors of immigrants' HL can be further explored to increase immigrants' health and empowerment.

Psychological distress among immigrant women who divorced: Resilience as a mediator.

PURPOSE: The purpose of this study was to investigate relationships among the demands of immigration, resilience, and psychological distress in divorced immigrant women, and determine the mediating effects of resilience on the relationship between demands of immigration and psychological distress. DESIGN: The cross-sectional study included 117 women who had immigrated and married Taiwanese men but later got divorced. METHODS: The Chinese health questionnaire-12 scale, the resilience scale-Chinese version, and the demands of immigration (DI) scale were used to measure in this study. A multiple regression and Sobel test were used to examine whether resilience mediated the relationship between demands of immigration and psychological distress. FINDINGS: In this study, 47% of the divorced immigrant women were experiencing psychological distress, and 25.6% exhibited high levels of demands of immigration. Women with psychological distress had higher demand scores (t = 2.592, p = 0.011) and lower resilience scores (t = -3.965, p < 0.001) compared to women without psychological distress. The demands of immigration negatively predicted resilience (t = -3.050, p = 0.003). Finally, resilience mediated the association of demands of immigration with psychological distress (z = 2.497, p = 0.0125). CONCLUSIONS: Relationships among the demands of immigration, resilience, and psychological distress in divorced immigrant women were demonstrated in this study. Resilience played an important role in the relationship between demands of immigration and psychological distress. CLINICAL RELEVANCE: Tailored programs that foster resilience to reduce risks of demands of immigration and psychological distress in this vulnerable population should be developed.

[Action Research on the Use of the Flipped Teaching Model in Obstetric Nursing Laboratory Classes].

BACKGROUND: Obstetric nursing laboratory courses typically involve both time and credit limitations. Using traditional teaching methods such as "teacher demonstrate, students imitate" in these courses provides insufficient opportunities for students to develop the ideal level of maternity nursing expertise. Lack of sufficient familiarity with the relevant techniques, procedures, and clinical scenarios prior to participation in internships reduces the level of safety in clinical care environments. PURPOSES: (1) To explore the effectiveness as perceived by baccalaureate nursing students of an obstetric nursing laboratory classes based on a flipped teaching model; (2) To examine the application of a flipped teaching model in obstetric nursing laboratory classes as well as the problems encountered and the actions necessary to resolve these problems. The findings may be used as a reference for future teaching and guidance. METHODS: This study used an action research framework as a guide and employed focus groups and questionnaires to collect student perceptions of the flipped teaching model. RESULTS: The feedback of students was highly positive because the classes involved repeated practice, were integrated into the clinical context, and allowed active learning independent of time and space restrictions. These attributes affected learning efficiency positively. The following four themes emerged from the focus group analysis: helps improve self-directed learning, helps integrate into the clinical context, helps peers learn from each other, and helps bring teachers and students closer. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study demonstrated an actual implementation of the flipped teaching model in obstetric nursing laboratory classes as well as assessed the learning perceptions of students. This teaching method provides opportunities for teachers and students to discuss and practice nursing skills, strengthen students' self-directed learning capabilities, and improve students' learning motivation. The author recommends that this innovative teaching strategy may be used to teach various subjects and different disciplines in nursing.

[Correlation Among Anxiety, Depression, and Quality of Life in Women With Gynecologic Cancer].

BACKGROUND: Anxiety and depression are common emotional distresses experienced by women during gynecologic cancer treatment. These often have dangerous effects on physical and mental health and may impact quality of life (QoL). PURPOSE: To investigate the factors influencing anxiety, depression, social support, and QoL in women with gynecologic cancer. METHODS: This was a cross-sectional correlational study. A total of 111 women with gynecologic cancer receiving treatment at a medical center in central Taiwan were selected as subjects using convenience sampling. A demographic characteristics questionnaire, the World Health Organization Quality of Life-Brief-Taiwan version (WHOQOL-BREF-Taiwan version) questionnaire, the International Support Evaluation List (ISEL), and the Hospital Anxiety and Depression Scale (HADS) were used for data collection. RESULTS: Of the 111 subjects, 41.4% and 24.3% had tendencies for anxiety and depression, respectively, and a moderate QoL score (mean = 3.46; SD = 0.73). The physical health domain had the highest mean QoL score (14.93; SD = 2.24), followed by environmental health (14.76; SD = 1.97), social relationships (14.13; SD = 2.33), and psychological health (13.92; SD = 2.44). Anxiety, depression, marital status, and social support respectively explained 18.5%-37.0% of the total variation in QoL scores. Of the four QoL domains examined in this study, anxiety was the most significant predictor of QoL. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: It is recommended that healthcare professionals strengthen the early assessment of anxiety, depression, and social support in women with gynecologic cancer. In addition, sensitivity towards emotional status should be increased in these cases. Healthcare professionals should provide care, support, and timely completion of referrals. Finally, psychological and social support and related interventions should be provided based on patient needs in order to maintain QoL.

As they see it: A qualitative study of how older residents in nursing homes perceive their care needs.

OBJECTIVES: Meeting care needs of nursing home residents is a significant element in providing the best quality care. A literature review revealed that there is poor understanding of the care needs of older residents from their own viewpoints within a nursing home context. Therefore, this study aimed to explore the older nursing home residents' care needs from their own perspectives. METHODS: This was a qualitative study. In-depth interviews were conducted by a purposive sample of 18 nursing home residents with a mean age of 80.7 years in Taiwan. All data was transcribed and coded for emerging themes. RESULTS: A qualitative data analysis generated six themes including the body, economics, environment, mind, preparation for death, and social support, referred to subsequently as BEEMPS. CONCLUSIONS: These findings can provide nursing home managers with information on how to improve nursing home care protocols to accommodate residents' expressed needs and also inform healthcare professionals about the care needs of older residents, thus fostering better care.

Doing the month in a Taiwanese postpartum nursing center: an ethnographic study.

Traditionally Chinese and Taiwanese postpartum women conducted postpartum ritual practices, called "doing the month," at home. Today, many Taiwanese women undertake this ritual in postpartum nursing centers. However, little is known about how the traditional practices are being transformed in relation to contemporary health care in Taiwan. In this ethnographic study observations were carried out in a large post-partum center attached to a major hospital in Taipei for nine months, and 27 postpartum women were interviewed. Data were analyzed using ethnographic approaches to extract codes and categories. Doing the month was reshaped by being relocated from the home to a healthcare setting. Midwives took on roles traditionally taken by family members, which had an impact on family roles and relationships. Some postpartum practices were maintained, based on traditional explanations. However, many were modified or challenged, based on explanations from contemporary scientific knowledge. Midwives need to be aware that there could be differences between their culture of care and the cultural values of the women they care for. This study informs culturally appropriate postpartum care and support for women with traditional and contemporary cultural beliefs and attitudes to doing the month in a range of healthcare contexts.

Student Satisfaction with Audio-Visual Flipped Classroom Learning: A Mixed-Methods Study.

The purpose of this mixed-methods study was to investigate the influential factors of student satisfaction with online digital audio-visual flipped classroom learning. A total of 103 students enrolling in the two-credit compulsory code course participated in this flipped classroom research. Descriptive data analysis and grey relational analysis demonstrated that student respondents were most satisfied with repeated practice (1st), followed immediately by peer learning (2nd), and active learning (3rd). In terms of qualitative data, three themes emerged from the focus group analysis, including: improving independent learning, enhancing peer learning, and increasing teacher-student interaction. The flipped classroom model provided opportunities for students to strengthen their self-directed learning capabilities, improved students' learning motivation, and to be a team player among third-year nursing students. The results were consistent with the actual circumstance. The results integrated descriptive data, the mathematic model, and interviews to validate the accuracy and rationality of the data. According to this study, an online digital audio-visual flipped classroom could improve student independent learning and enhance peer communication. The results provide an accurate assessment tool suitable for Taiwanese nursing students' flipped classroom model learning experience.

Symptom distress, stress, and quality of life in the first year of gynaecological cancers: A longitudinal study of women in Taiwan.

PURPOSE: To assess changes in symptom distress, stress, and quality of life (QOL) during chemotherapy and three months after its completion, as well as to identify predictors of QOL in the first year after a gynaecological cancer diagnosis in Taiwanese women. METHODS: A prospective, longitudinal study was conducted from August 2017 to July 2019, recruiting 97 patients with gynaecological cancer at a large teaching hospital in central Taiwan. Data were obtained at four time points: after the first, third, and sixth chemotherapy cycles, and three months after treatment completion. Participants completed Chinese versions of three validated questionnaires: World Health Organization QOL Brief version, Symptom Distress Scale, and Perceived Stress Scale. Linear regression analyses with generalised estimating equations were used to examine the associations between symptom distress, stress, and QOL over time. RESULTS: Fatigue, feeling desperate about the future, and peripheral limb numbness were the three major problems during the first year of gynaecological cancers. Feeling desperate about the future and stress were significant predictors of QOL in all domains. Noticeably, the level of stress increased over time, especially at three months after treatment completion. Participants reported fair QOL levels that gradually improved over time. CONCLUSIONS: Stress and chemotherapy-induced symptom distress were factors that most interfered with QOL in women with gynaecologic cancers. Therefore, integrating psychological care and symptom support is an essential part of meeting patients' QOL needs.

Associations between perceived stress and quality of life in gynaecologic cancer patient-family caregiver dyads.

PURPOSE: This study aims to explore the level of stress perceived and quality of life (QOL) by gynaecologic cancer (GC) patients and family caregivers' dyads. METHODS: In this cross-sectional study, 86 dyads were recruited from the gynaecological oncology department of a general hospital in Taichung City, Taiwan. The patients and family caregivers completed a sociodemographic information sheet, the Perceived Stress Scale, and the Taiwanese version of World Health Organization Quality of Life-BREF questionnaire. Data were analysed using descriptive statistics and Pearson's correlations. This study used the actor-partner interdependence model (APIM) with distinguishable dyads to examine the effect of patients' and caregivers' perceived stress on QOL in patient-caregiver dyads. RESULTS: GC patients' and caregivers' level of QOL was influenced by their own stress level (actor effect). Caregivers' stress was statistically negatively associated with the patients' QOL (partner effect); however, there were no partner effect from GC patients to caregivers. Both patients and family caregivers with higher perceived stress had poorer QOL. Therefore, we identified that stress has some level of actor and partner effects on QOL in GC patient-family caregiver dyads. CONCLUSIONS: Family caregivers' stress displayed both actor and partner effects within the first year of the cancer diagnosis; therefore, patient-and caregiver-based interventions, such as stress reduction strategies, should be developed to enhance patients' and caregivers' QOL and stress management ability.

Development and psychometric testing of the Chinese version of the Resilience Scale for Southeast Asian immigrant women who divorced in Taiwan.

BACKGROUND: Only a few studies exist on the resilience of divorced women. Furthermore, relevant instruments for assessing the resilience of divorced immigrant Southeast Asian women are rare. Accordingly, the aim of this study was to develop and examine a new Resilience Scale-Chinese version (RS-C) that is specific to divorced immigrant Southeast Asian women in Taiwan. METHODS: The study was conducted in two phases. In phase 1, 20 items were used to evaluate face and content validities. In phase 2, a cross-sectional study was conducted. In total, 118 immigrant women participated in this study and were recruited from three nongovernmental organizations providing services for immigrants in Taipei City and Miaoli and Chiayi Counties. Psychometric properties of the instrument (i.e., internal consistency, test-retest reliability, item-to-total correlation, construct validity, and convergent validity) were examined. Significance was set at p < 0.05 for all statistical tests. RESULTS: The final 16-item RS-C resulted in a three-factor model. The three factors, namely personal competence, family identity, and social connections, were an acceptable fit for the data and explained 54.60% of the variance. Cronbach's α of the RS-C was 0.85, and those of its subscales ranged from 0.77 to 0.82. The correlation value of the test-retest reliability was 0.87. The RS-C was significantly associated with the General Self-Efficacy scale and the Chinese Health Questionnaire-12. CONCLUSION: The RS-C is a brief and specific self-report tool for evaluating the resilience of divorced immigrant Southeast Asian women and demonstrated adequate reliability and validity in this study. This RS-C instrument has potential applications in both clinical practice and research with strength-based resiliency interventions. However, additional research on the RS-C is required to further establish its reliability and validity.

Effects of Acupressure on Sleep Quality and Psychological Distress in Nursing Home Residents: A Randomized Controlled Trial.

OBJECTIVE: To compare the efficacy of acupressure with sham acupressure in older-adult nursing home residents presenting with poor sleep quality and psychological distress. DESIGN: Prospective, randomized, double-blind, sham-controlled trial. SETTING AND PARTICIPANTS: Sixty-two nursing home residents with poor sleep quality and psychological distress participated in this study. Participants were randomly assigned to an experimental group (n = 31) receiving acupressure at true acupoints (Baihui, Juque, Neiguan, Tianzhu, and Yongchung) or control group (n = 31) receiving acupressure at sham points. All participants received 20 minutes of acupressure before sleeping 3 times a week for 8 weeks. All participants were blinded to group allocation. MEASURES: Sleep quality and psychological distress were measured using the Pittsburgh Sleep Quality Index and the Kessler Psychological Distress scale, respectively. Both groups' outcomes were assessed by assessors blinded to group allocation at the baseline, the end of the intervention, and 1 month after the intervention. RESULTS: The experimental group demonstrated significantly more improvement in sleep quality than did the control group at the end of the intervention (10.5 vs 13.3) and 1 month after the intervention (8.3 vs 14.2; both P ≤ .001). Moreover, the experimental group had lower psychological distress levels than did the control group at 1 month after the intervention (14.6 vs 17.9, P = .05). Furthermore, significant differences in mean sleep quality (F = 60.8, P < .001) and psychological distress (F = 24.6, P < .001) were observed in the experimental group between the measurements at baseline and after the intervention. CONCLUSIONS: Acupressure at true acupoints improves sleep quality, reduces psychological distress, and provides more clinically beneficial effects compared with that at sham points. Future studies should examine whether these effects are maintained in the long term.

The care needs of postpartum women taking their first time of doing the month: a qualitative study.

BACKGROUND: In contemporary Taiwan, after giving birth, many women undertake a traditional postpartum practice called 'doing the month', which occurs in the medical context of postpartum nursing centres instead of at home. Thus, healthcare workers must identify and address the care needs of new mothers in this setting to improve the care of new mothers and their baby and family. AIM: To explore new mothers' care needs from their own perspectives during the period of doing the month. METHODS: A qualitative study was performed. Eligible participants recruited through purposive sampling were interviewed comprehensively. RESULTS: Twenty-seven primiparous women participated (mean age: 32 years; mean marriage length: 3.4 years). Four themes were identified: the need to increase energy to gain more yang force, the need to internalise mothering, the need to be supported by the family and friends, and the need to be understood. CONCLUSIONS: For effective care, sufficient support and guidance must be provided to first-time mothers and their families, especially when mother-baby rooming-in is the standard of care.

Inside a Postpartum Nursing Center: Tradition and Change.

PURPOSE: The purpose of this study was to explore how traditional ritual practices are incorporated into the context of contemporary healthcare. METHODS: An ethnographic study was conducted, using observations and interviews with 27 first-time mothers and 3 nurses at a postpartum nursing center in Taipei, Taiwan. RESULTS: Nursing routines, policies and care provision at the center affected the way traditional ritual practices were conducted. New mothers in this study constructed their everyday activities at the center by incorporating and modifying the ritual practices inside and outside the postpartum nursing center setting. CONCLUSIONS: Social changes have an influence on traditional postpartum ritual practices so a postpartum nursing center becomes a choice for postpartum women. Thus, health care professionals should value their own functions and roles at the postpartum nursing center since the new mothers regard them as the primary support resource to help them recover from giving birth. Therefore, they need to re-examine their practices from the postpartum women's perspective to provide better support and sensitive care to postpartum women and their families.