Family caregiver distress with children having rare genetic disorders: a qualitative study involving Russell-Silver Syndrome in Taiwan.

AIM: To extend nursing knowledge of distress experienced by family caregivers of children with rare genetic disorders, by exploring the perspectives of caregivers of children with Russell-Silver Syndrome in Taiwan. BACKGROUND: Caring for a child with a rare genetic disorder often has profound effects on families, especially when diagnosis and treatment is complex or not yet well developed, such as that in Russell-Silver Syndrome (or Silver-Russell syndrome). This disorder causes dwarfism and developmental difficulties, requiring long-term care planning. Previous research has focused mostly on medical care, but little is known about families' perspectives of caring difficulties, the help they need and nursing care required. DESIGN: An exploratory qualitative approach was used to inform this study. METHODS: Family caregivers, whose children were undergoing medical care in a leading Taiwan medical centre, were invited to participate in face-to-face, in-depth interviews. Data were analysed by content analysis. RESULTS: Fifteen caregivers including 11 mothers, two fathers and two grandmothers participated. Five major themes and 13 sub-themes of care-giving distress were identified: endless psychological worries; the lengthy process to confirm a medical diagnosis; adjustment efforts in modifying family roles; dilemmas in deciding between Western or Chinese traditional medicine; and negative responses to society's concerns. Their primary sources of support were spouses, parents and health professionals, accordingly. CONCLUSION: Complex physio-psycho-social and decision-making distress in caring for children with a rare genetic disorder were systematically revealed from the perspectives of ethnic-Chinese family caregivers. RELEVANCE TO CLINICAL PRACTICE: Long-term care plans for children with a rare genetic disorder such as Russell-Silver Syndrome need to focus on positive dynamic family interactions, life-stage development and family caregiver support. Research on care-giving in rare genetic disorders is also warranted across cultures and countries to develop a substantial knowledge basis for nursing practice.

An exploration of spiritual needs of Taiwanese patients with advanced cancer during the therapeutic processes.

AIMS AND OBJECTIVES: This study explores the spiritual needs of patients with advanced cancer during their therapeutic process in Taiwan and analyses the influence of Chinese culture in addressing their spiritual needs. BACKGROUND: Many nurse clinicians have concerns about the difficulties of providing spiritual care for ethnic-Chinese cancer clients within their cultural context, possibly as a result of lack of knowledge and training. There has been little research exploring the potential impact of Chinese cultural values on the spiritual needs of patients with advanced cancer. DESIGN: Explorative qualitative enquiry was used. METHODS: Data were collected through participant observation and in-depth face-to-face interviews. Transcribed interview data were analysed by using qualitative content analysis. The purposive sample (n = 33) was drawn from a leading medical center (n = 19) with 3000 beds in the capital and a community-based rural teaching hospital (n = 14) with 581 beds in Taiwan. RESULTS: Four spiritual needs emerged from the analysis: the need to foster hope for survival and obtain a peaceful mindset, to fulfil the meanings of life and preserve one's dignity, to experience more reciprocal human love and finally, to receive assistance in facing death peacefully. CONCLUSION: This research has shown that patients with advanced cancer need caregivers, friends and the help of their religion to meet their spiritual needs during the therapeutic processes. RELEVANCE TO CLINICAL PRACTICE: The findings of this study could assist health professionals to detect the unmet spiritual needs of ethnic-Chinese patients with cancer in the context of their cultural or religious background as early as possible.

Religiosity influences on bereavement adjustments of older widows in Taiwan.

AIMS: To describe difficulties encountered by older widows in Taiwan and the impact of intrinsic or extrinsic religiosity on their coping strategies during early widowhood. BACKGROUND: There is very limited information about how Taiwan's widows cope with their bereavement and no studies reporting the relationship between religious beliefs and healthy adjustment during this distressing period. DESIGN: Between-method qualitative and quantitative triangulation was used. Semi-structured interviews were conducted and transcribed data were analysed by critical thematic analysis. RESULTS: Twenty women in Taiwan, >65 years old, (mean = 72.95) were interviewed within three years of being widowed. There were two informant groups: those with intrinsic religious beliefs and those with extrinsic religious beliefs. They all reported intrapersonal and interpersonal problems. Several major coping strategies arose: 'practising positive or negative attitudes for adaptation'; 'using person-focused actions'; and 'taking the initiative or passively seeking help from others or helping others'. Informants with intrinsic religious beliefs reported fewer coping problems by holding positive attitudes and taking multiple actions for adaptation. The extrinsic religious group had more negative adaptation attitudes, such as withdrawal and low self-esteem and practised less faith religious activities in worshipping ancestors, experiencing fatalism and using divination. They reported more coping problems than the intrinsic religious group. CONCLUSION: Widows in Taiwan have different coping problems and strategies in postbereavement adjustment, affected by their different religious beliefs systems. More research is required to establish the generalisabilty of these findings. RELEVANCE TO CLINICAL PRACTICE: Widows in Taiwan need to be assessed for their religious belief systems and how this affects their ability to cope during bereavement. Clinicians should actively provide grief support and encourage new methods of social adaptation, especially with widows with extrinsic religious beliefs who may have less self-esteem and negative adaptation behaviours.

Asia-Pacific nursing scholarship development: qualitative exploration of nurse scholars in Taiwan (Republic of China).

AIM: From the perspective of scholars, to describe a contemporary view of the development, facilitators of and barriers to nursing scholarship in Taiwan, to enhance policy-making about research, education and practise development. BACKGROUND: Nursing scholarship in the Asia-Pacific region is in different stages of development, depending on in-country resources and socio-economic conditions. Little is known about the facilitators or barriers to nursing scholarship in some of these countries, including Taiwan, where nursing education has changed considerably over the last decade. DESIGN: A qualitative exploratory design. METHOD: The study used snowballing to identify scholars who underwent semi-structured in-depth interviews. These were digitally recorded, transcribed verbatim and subjected to content analysis. RESULTS: Interviews were held with 12 scholars and six major themes arose: 'fulfilling our missions'; 'active research productivity'; 'low levels of collaborative research'; 'increasing demands on time'; 'gender issues' and 'developing effective collaborative networks across Taiwan and Asia'. Participants described Taiwanese scholarship development in terms of fulfilling the missions of universities; trying to balance work and culturally relevant family responsibilities, against a background of decreasing pressures to produce more qualified nurses and being more research productive in rapidly changing and challenging work environments. CONCLUSIONS: Taiwan's nursing scholarship is in a dynamic early stage of development, with increasing graduate programmes and research productivity, evidenced by rising international publications and the research productivity indexes of academics. However, scholars are facing increasing pressure because of high workloads and balancing family and work responsibilities. RELEVANCE TO CLINICAL PRACTICE: Understanding scholarship development and its facilitators and barriers in Taiwan helps inform policy makers, the higher education sector and nurses in the country and across the region about what needs to be done to improve nursing practice, raise health outcomes and enhance nursing research productivity and education.

'Caring Across Thorns'--different care outcomes for borderline personality disorder patients in Taiwan.

AIM: To explore the contributing factors and effects of Taiwan's mental health nurses' decision-making patterns on care outcomes for patients with borderline personality disorder. BACKGROUND: Patients with borderline personality disorder have been identified as difficult to care for. Taiwan's mental health nurses have complained about the lack of successful outcomes with existing care regimes, and few studies have explored these nurses' perceptions of how their decision-making process impacts quality of care for their clients. DESIGN: Descriptive qualitative research. METHODS: Data collected through semi-structured, face-to-face, in-depth interviews were analysed by qualitative content analysis. Fifteen mental health nurses were purposively recruited from a psychiatric centre in northern Taiwan. RESULTS: The informants' caring outcomes for borderline personality disorder patients were involved with interactions of the following five themes: (a) shifting from the honeymoon to chaos stage, (b) nurses' expectations for positive vs. negative outcomes, (c) practicing routine vs. individualised nursing care, (d) adequate or inadequate support from healthcare team members and (e) differences in care outcomes (satisfactory experiences, unsatisfactory experiences and superficial relationships). A conceptual framework of a 'two-stage care process' was developed to depict the relationships among these five themes with different care outcomes. CONCLUSIONS: Although Taiwan's mental health nurses reported more unsatisfactory than satisfactory care outcomes, more satisfactory patient outcomes might be obtained by nurses' positive attitudes, unrelenting efforts towards promoting the health of these patients and receiving timely and constant support from healthcare team members. RELEVANCE TO CLINICAL PRACTICE: Mental health nurses should not give up too readily on borderline personality disorder clients, but adopt a positive attitude and coach them in learning to relax and work with others. Nurses are encouraged to establish supportive team relationships to motivate each other to work for positive care outcomes, to better understand their clients' needs and to develop individualised in addition to routine care strategies.

Surviving a life-threatening crisis: Taiwan's nurse leaders' reflections and difficulties fighting the SARS epidemic.

AIM: This study explored Taiwan's nurse leaders' reflections and experiences of the difficulties they encountered and survival strategies they employed fighting the severe acute respiratory syndrome epidemic and the background context framing these phenomena. BACKGROUND: On several continents in 2002-2003, the highly infectious severe acute respiratory syndrome overwhelmed health care systems and health professionals who had to provide care in situations involving high personal risk and stress, some becoming infected and dying. Nurse leaders in Taiwan had to develop new strategies and support systems for nursing care. DESIGN: A two-step within-method qualitative triangulation research design. METHODS: Focus group in-depth interviews held with 70 nurse leaders from four Northern Taiwan hospitals involved in the severe acute respiratory syndrome epidemic. Participants then completed an open ended questionnaire. Content analysis was undertaken with data and stages and themes generated. Data were then analysed using Hobfall's concepts of conservation of resources to further discuss participants' reactions and actions in the severe acute respiratory syndrome crisis. RESULTS: Participants worked under incredible stress to lead the profession through a period of crisis. Five stages arose in the participants' involvement against severe acute respiratory syndrome over 12 weeks: facing shock and chaos; searching for reliable sources to clarify myths; developing and adjusting nursing care; supporting nurses and their clients; and rewarding nurses. CONCLUSION: Nurse leaders become important executors of intervention in this health disaster, requiring emotional intelligence to manage their internal conflicts and interpersonal relationships effectively. They developed sociopolitical and analytical abilities and crucial requirements for planning and implementing strategies in areas where none previously existed. Building support systems was an important resource for managing conflicts between familial and professional roles. Relevance to clinical practice. Findings will assist nurse leaders to prepare themselves and the profession to better deal with disaster management in similar infectious outbreaks in the future.

Perspectives on professional values among nurses in Taiwan.

AIM: The purpose of this study was to identify the most important contemporary professional nursing values for nursing clinicians and educators in Taiwan. BACKGROUND: Nursing values are constructed by members of political and social systems, including professional nursing organisations and educational institutions. Nurses' personal value systems shape the development of these professional values. An understanding of nurses' perceptions of professional values will enable the profession to examine consistencies with those reflected in existing and emerging educational and practice environments. DESIGN: A qualitative descriptive study was conducted using the focus-group discussion method. METHODS: A purposive sample of 300 registered nurses in Taiwan, consisting of 270 nursing clinicians and 30 faculty members, participated in 22 focus-group interviews. Data were analysed using a systematic process of content analysis. RESULTS: Six prominent values related to professional nursing were identified: (a) caring for clients with a humanistic spirit; (b) providing professionally competent and holistic care; (c) fostering growth and discovering the meaning of life; (d) experiencing the 'give-and-take' of caring for others; (e) receiving fair compensation; and (f) raising the public's awareness of health promotion. Four background contexts framed the way participants viewed the appropriation of these values: (a) appraising nursing values through multiple perspectives; (b) acquiring nursing values through self-realisation; (c) recognising nursing values through professional competency and humanistic concerns and (d) fulfilling nursing values through coexisting self-actualisation. A conceptual framework was developed to represent this phenomenon. CONCLUSION: The most important professional nursing values according to the perspectives of nurses in Taiwan were identified. These values reflect benefits to society, to nurses themselves and to the interdisciplinary team. RELEVANCE TO CLINICAL PRACTICE: Nurses' awareness of their own values and of how these values influence their behaviour is an essential component of humanistic nursing care. Nursing educators need to develop better strategies for reflection and integration of both personal and professional philosophies and values.

Using an informatics education strategy to resolve the dilemma of teaching transplantation in medical institutions: Multidisciplinary medical team perspectives.

In Taiwan, the current survival rate 1 year after transplantation exceeds 80%. However, the number of organ/tissue donors per year in Taiwan is extremely low, resulting in increased mortality. This is also true in Europe and in the United States. Recently, data from the Taiwan Organ Registry and Sharing Center showed that, although fundraising for organs/tissues slightly increased, the number of donors did not exhibit a corresponding growth trend. Identifying appropriate donors and the provision of good quality transplantation care by medical team members are current challenges. Hence, the application of information technology to in-service education for organ transplantation professionals has been suggested.This was a qualitative study that employed qualitative content analysis with purposive and snowball sampling. The study participants (n = 8, mean age 39.88 ±â€Š3.06 years) included medical staff involved in tissue/organ transplantation from 4 leading medical centers and 3 regional teaching hospitals, and those who participated in the informatics education system.The interviewees from multidisciplinary medical teams showed the status of and dilemma in organ fundraising/donation/transplantation, noting 6 core themes. Regarding relevant education and training, 4 core themes were identified.Current educational courses for organ fundraising/donation/transplantation are inadequate and seem to provide insufficient information to multidisciplinary medical teams. Hence, it is necessary to develop a theoretical construct to create a complete curriculum framework and to establish complete fit-in professional and ethical organ transplantation learning programs based on informatics technology to increase the interdisciplinary exchange of experience.

Self-care behavior, hope, and social support in Taiwanese patients awaiting heart transplantation.

OBJECTIVE: The purpose of this study was to examine the self-care behavior, hope, and social support in patients awaiting heart transplantation and to explore all the correlative and related factors. METHODS: In total, 45 participants who met the selection criteria were selected by purposive sampling from four medical centers in Taiwan. The three instruments Self-Care Behavior Scale, Herth Hope Index (HHI), and Social Support Inventory were used for data collection. RESULTS: Significant, positive correlations among self-care behavior, hope, and social support were observed. Social support was the best predictive factor for both self-care behavior and hope. CONCLUSION: The outcomes of this study can help medical care personnel better understand the self-care behavior, hope, and social support in patients awaiting heart transplantation and can also serve as a reference when developing relevant interventions for these patients.

The impact of the 9-21 earthquake experiences of Taiwanese nurses as rescuers.

The powerful earthquake of September 21, 1999 wrought incalculable havoc on lives and properties in Taiwan. Although the scars of the earthquake can never be erased, the calamity can lead to a more full understanding of the experiences, perceptions and reflections of nurses involved directly in post-rescue situations. The purpose of this study was to compare the impacts of rescue experiences on Taiwanese female and male nurses who worked as rescuers following the earthquake of 21 September. A purposive sample of 46 nurses (40 women, 6 men) (mean age 26) who worked in a renowned hospital with a reputation for high quality of emergency care in Northern Taiwan was obtained. Data were collected by in-depth semi-structured interviews and analyzed by a unique mode of between-method triangulation. The majority of the subjects (38 female, 6 male) reported various impacts from their rescue experiences. They are: (a) recognition of the impermanence of life and wishing to lead a more significant life (32 female, 3 male); (b) more caring relationships with others and for their homeland (19 female, 5 male); (c) a clearer concept of disaster care (19 female, 4 male); (d) a better appreciation of the value of nursing and their own self-worth (11 female, 3 male); (e) enhanced knowledge of the survivors' needs (3 female); and (f) enhanced ability to identify the factors hindering rescue operations (1 female, 2 male). However, one female nurse complained of having been bothered by feelings of fear of earthquake disasters resulting from her rescue experience. Rescue experiences help to strengthen most Taiwanese nurses' professional competency, reinforce their commitment to nursing, and lead them to have positive life goals. The relative weight of the impacts for male and female nurses were somewhat different. The vulnerability of nurses, which was manifested in the post-rescue stage, requires attention and long-term follow-up. A comprehensive and organized pre-rescue training program which recognizes the need to care for both acute and chronic post-disaster conditions, along with spiritual care for the survivors, as well as a "disaster reduction" course for health professionals are suggested.

Taiwanese nurses' most unforgettable rescue experiences in the disaster area after the 9-21 earthquake in Taiwan.

The purpose of this study was to reveal the most unforgettable rescue experiences of nurses at the central site of the 9-21 Taiwan earthquake during the crucial early recovery stage-the first 72h. A purposive sample of 46 nurses was obtained (40 women and 6 men, with an average age of 28). Data were collected using semi-structured interviews and analyzed by content analysis. The negative aspects of most unforgettable experiences reported by 87% of the subjects were primarily: (a) the prevalence of psychoneurotic syndromes (50%); (b) the severe destruction of geographic treasures (43%); (c) the buried-alive bodies of whole families or village populations (33%); (d) inadequate care for the children and teenagers that were left homeless (22%); (e) deterioration of the condition of patients with chronic health problems (15%); and (f) manifestation of the greedy or selfish nature of human beings (13%). Still 76% of the subjects reported the following positive aspects of their rescue experiences: (a) feeling rewarded from helping others (43%); (b) being deeply touched by residents' mutual support (33%); and (c) the good attitude and tangible help given by other health professionals (15%). This study highlights a need for long-term follow-up and attention of these nurse rescuers in the post-rescue stage. The implementation of a well designed "disaster reduction" course for the health professionals was also encouraged.

Experiences of living with myasthenia gravis: a qualitative study with Taiwanese people.

Myasthenia gravis (MG) is an auto-immune, neuromuscular disorder, which presents with symptoms of fluctuating muscle fatigue because of a dysfunction of the neuromuscular junction. This study explores the illness experience of patients with MG, their experiences of illness, its challenges, and their coping and support strategies. In-depth interviews were undertaken with nine participants with MG (six for a generalized type of MG, three for ocular type). Data were subjected to inductive content and thematic analysis. Four themes emerged from MG patients with associated subthemes. They were "perceptions of MG," "challenges of MG, "social support," and "adapting and adjusting to MG." The study reveals the way in which individuals respond to and cope with their diagnosis. The importance of social and peer support is a key factor as well as the development of psychological strategies to live with MG. The recognition that there was a need to recognize the role of Western medicine in controlling their disease was also an important finding.

Spiritual needs of Taiwan's older patients with terminal cancer.

PURPOSE/OBJECTIVES: To explore the core constitutive patterns from the perspective of the older patient with terminal cancer, the major foci of spiritual needs, and professional actions that manifest tangibly as spiritual care. DESIGN: Hermeneutic inquiry. SETTING: Two leading teaching hospitals in Taiwan. SAMPLE: 35 older patients with terminal cancer with a life expectancy of three months. METHODS: Participatory observation and in-depth interviews were the major data collection strategies. Hermeneutic inquiry was used to disclose, document, and interpret participants' lived experiences. MAIN RESEARCH VARIABLES: The perceptions of older Taiwanese patients with terminal cancer and their particular healthcare needs across various transition stages. FINDINGS: Two constitutive patterns, "caring for the mortal body" and "transcending the worldly being," each with three themes and a related transformational process emerged from the data analysis. Two foci of spiritual needs were discovering patients' concerns about their dying bodies and their worldly being and facilitating the transcendence of the spiritual being from the physical realm. CONCLUSIONS: Caring for older Taiwanese patients with terminal cancer and helping them transcend the fear of the unknown when they give up worldly being can produce insights into patients' primary concerns, perceptions, and spiritual needs to help them achieve a "good" death. IMPLICATIONS FOR NURSING: The knowledge gained in this study and the six major spiritual care actions identified may empower oncology nurse educators to develop culturally valid spiritual care courses. Research-based guidance for nurse clinicians who are taking care of older Taiwanese patients with terminal cancer will be provided.

A Health Need Satisfaction Instrument for Taiwan's single-living older people with chronic disease in the community.

AIMS: The aims of this study were to explore health needs and need satisfaction of Taiwan's single-living older people with chronic disease in the community, develop a culturally sensitive Health Need Satisfaction Instrument and examine the relationships between health needs and need satisfaction. BACKGROUND: Until now, there has been no reliable instrument for health professionals to assess, comprehensively, health needs and needs satisfaction for Chinese single-living older people with chronic disease in the community. DESIGN: Between-method triangulation design was used. The first phase explored the contextual content of health needs from the perspectives of a purposive sampling (n = 44) using the explorative qualitative method. The second phase developed the Health Need Satisfaction Instrument and established its reliability and validity. The final phase implemented the instrument in a cohort study (n = 110) and examined the relationship between the respective/overall health needs and need satisfaction. RESULTS: A Health Need Satisfaction Instrument with good validity and reliability encompassing tangible, psychospiritual and informational needs was developed. A significant correlation between tangible and psychospiritual needs (r = 0.238, p < 0.05) and between tangible and informational needs (r = 0.306, p < 0.01) was found. Three types of need satisfaction were inter-related (p < 0.01). A negative correlation between global health needs and need satisfaction (r = -0.223, p < 0.05) was found. Each domain of need satisfaction was negatively correlated with that particular type of health needs (p < 0.01), except for psychospiritual need (r = 0.339, p < 0.01). A measurement model between health needs and need satisfaction was established. CONCLUSION: This study set a successful example of a rigorous, cross-cultural instrument development process for community-based Taiwan's single-living older people. RELEVANCE TO CLINICAL PRACTICE: Using Health Need Satisfaction Instrument, the less satisfied multidimensional health needs of community-based Taiwan's single-living older people with chronic disease can be more accurately assessed and met.

The lived experiences of spiritual suffering and the healing process among Taiwanese patients with terminal cancer.

AIMS AND OBJECTIVES: The purposes of this study were to explore the lived experiences of spiritual suffering and the change mechanism in healing processes among Taiwanese patients with terminal cancer. METHODS: The approach to this study was phenomenological-hermeneutic. Twenty-one patients with terminal cancer were invited to participate in a semi-structured interview that dealt with their experiences of spiritual suffering and the healing process. This study was conducted in the inpatient unit of the oncology department in two general hospitals. The interviews were recorded, transcribed and later analysed using the approach of narrative analysis. RESULTS: According to the results of case narration, the causes of spiritual suffering included cancer, known as a life-threatening illness, physical pain, treatment complications, uncertain illness progression, disability problems and lack of support. Patients turned to internal resources (including regarding the suffering as a life challenge, volunteering to help other cancer patients and searching for life wisdoms) and external resources (including peer support groups and family support) as they endured spiritual suffering. Taiwanese patients turned to Eastern and Western philosophies of Taoism, Confucianism, Buddhism and Christianity as methods to interpret their spiritual suffering. CONCLUSION: Patients' positive views of misfortune because of cancer and sufficient social supports were the key elements of the healing process to alleviate spiritual suffering. RELEVANCE TO CLINICAL PRACTICE: Nurses who learn to participate in suffering assessment are better able to understand spiritual needs of cancer patients. Cancer patients' views on the change mechanism in healing processes could provide essential information for nurses in developing an effective intervention programme. If nurses consider cultural factors that shape patients' experiences of spiritual suffering and the healing process, they could learn how to meet the needs of patients better from different cultural backgrounds.

Dying and caring on the edge: Taiwan's surviving nurses' reflections on taking care of patients with severe acute respiratory syndrome.

In 2003, Taiwan's nurses were terrified by severe acute respiratory syndrome (SARS), and four of them sacrificed their life in the course of their work with SARS patients. This study attempted to identify the stage-specific difficulties encountered by Taiwan's surviving frontline nurses during the anti-SARS process. A two-step within-method qualitative triangulation research design was used to obtain the in-depth and confidential thoughts of 200 participants during the precaring, tangible caring, and postcaring stages. Six major types of stage-specific difficulties with and threats to the quality of care of SARS patients were identified according to each specific stage of the caring process. Four themes were further explored; these are discussed to provide a background context in obtaining better understanding of the multifaceted needs of nurses during this crisis. Consequently, a conceptual framework was developed to depict this complex phenomenon.

Death and help expected from nurses when dying.

This project was undertaken to ascertain the perceptions of a group of Taiwan's fourth-year bachelor of science in nursing (BSN) students regarding death and help expected from nurses during the dying process. Within the Chinese culture, death is one of the most important life issues. However, in many Chinese societies it is difficult for people to reveal their deepest feelings to their significant others or loved ones. It was in this context that this project was developed because little is known about how Taiwan's nursing students perceive death and the dying process. Using an open-ended, self-report questionnaire, 110 senior BSN students recorded their thoughts on: (1) their fears before physical death; (2) afterlife destinations; and (3) the help they would expect from nurses when dying. The data were analyzed using a three-layer qualitative thematic analysis. The students' reported needs during the dying process were directed towards three main goals: (1) help in reaching the 'triple targets of individual life'; (2) help in facilitating in-depth support so that both the dying person and significant others can experience a blessed farewell; and (3) help in reaching a destination in the afterlife. The results support the belief of dying as a transition occurring when life weans itself from the mortal world and prepares for an afterlife.

Health Needs Instrument for hospitalized single-living Taiwanese elders with heart disease: triangulation research design.

AIM: The aims of this study were (a) to explore the health needs of hospitalized Taiwanese older people with heart disease who live alone in the community; (b) to develop an instrument to assess their health needs and (c) to examine relationships among their health needs. DESIGN: Three phases were involved in this between-method triangulation design. METHODS: The first phase explored the contextual content of the health needs from the perspectives of a purposive sampling of 34 subjects by the use of an explorative qualitative method. The second phase developed the Health Needs Instrument (HNI) and established its reliability and validity. The last phase implemented the instrument in a cohort and examined their appraisals of each type of health need as well as the relationships among different types of health needs. RESULTS: The HNI encompasses the following five types of health needs: help in managing tangible things, psychological support, medical support, obtaining health information and participation in decision-making. In the last phase, a purposive sample of 54 subjects (48 men and 6 women) with an average age of 75.3 years was obtained. Subjects' health needs were ranked as obtaining health information (100%), participation in decision-making (96%), managing tangible issues (87%), medical support (86%) and psychological support (67%). Detailed items for each type of health need were revealed. By examining the relationship between their health needs, the psychological needs in confronting the subjects' physical discomfort had a significant correlation with medical support (r = 0.469, P < 0.01), with tangible needs after surgery or an invasive examination (r = 0.460, P < 0.01), with informational needs (r = 0.393, P = 0.034) and with tangible needs of maintaining daily living activities during the hospitalization period (r = 0.290, P = 0.034). The need for tangible help in maintaining daily living activities during the hospitalization period was significantly correlated with the need for medical support (r = 0.341, P = 0.012), with help in managing admissions and discharge procedures (r = 0.374, P = 0.05) and with help after an invasive examination or in the postsurgery period (r = 0.334, P = 0.013). CONCLUSION: Finally, a conceptual framework was developed to depict this phenomenon. With the help of this HNI, both Eastern and Western health care providers can be empowered to detect the complex health needs of this particular population earlier and more accurately in order to promote their well-being as well as their health-related quality of life. RELEVANCE TO CLINICAL PRACTICE: Empowering nurse clinicians to assess health needs of hospitalized single-living Taiwanese elders with heart disease.

Professional career development for male nurses.

AIM: The aim of this paper is to report a study to: (a) explore Taiwanese male nurses' motivations for becoming a nurse; (b) reveal their professional developmental process in nursing; (c) understand the difficulties hindering their professional development from both professional and gender aspects; and (d) identify the strategies they use to cope with these difficulties. BACKGROUND: Hindered by historical, cultural, economic and warfare factors, the proportion of male nurses in Taiwan remains low. Taiwanese male nurses' career development process has not been well investigated yet. METHODS: A descriptive qualitative research design was used, with a convenience sample of 15 male nurses (mean age 30.8 years) with a Bachelor's degree in Nursing Science. Data were collected by semi-structured interviews and analysed by content analysis. RESULTS: Taiwanese male nurses' entrance into the nursing profession involved three phases: pre-study, study and employment. The difficulties encountered during career development were related to the gender expectations of patients and the general public. The nurses received support more from superiors than from colleagues. The strategies they used included (a) improving their professional knowledge and skills to obtain higher levels of satisfaction and better opportunities for promotion; (b) thinking aggressively about job promotion; (c) choosing specialist departments as appropriate environments for graduate study and personal growth; and (d) changing their professional track for personal growth. CONCLUSIONS: Based on the nature of nursing work and clinical experiences, Taiwanese male nurses believed that nursing was a profession suitable for both men and women. Their preparation for career development started at the pre-study phase. The major strategies they used were related to a strong desire for personal growth and professional promotion. Finally, a conceptual framework was developed to depict this complex phenomenon.