Development of the Interstitial Cystitis Self-Help and Medical Resources Scale (ICSR) for Women with Interstitial Cystitis.

Background and Objectives: Women with interstitial cystitis (IC) suffer from spontaneous serious bladder pain symptoms without immediate resolution. Women with IC may lack knowledge of how to help themselves. Therefore, a measurement of IC self-help and medical-resource-seeking for women with IC is needed. Materials and Methods: This study recruited 100 women with IC from a teaching hospital in Northern Taiwan. The reliability and validity of the Interstitial Cystitis Self-Help and Medical Resources Scale (ICSR) were assessed using expert validity, confirmatory factor analysis (CFA) to test the construct validity, composite reliability to evaluate the internal consistency, and item analysis to test the discrimination validity of each item. Results: The results showed that the ICSR had accurate goodness-of-fit indices and the component reliability ranged from 0.42 to 0.83, indicating good reliability and validity. Conclusions: The ICSR is recommended for screening the self-help and medical-resource-seeking abilities of women with IC to aid in diagnosing IC and providing more precise medical treatments.

Decision difficulties of long-term-care facility nurses in transferring residents to the emergency department: A cross-sectional nationwide study.

AIMS: To examine the level of decision difficulties of long-term-care facility (LTCF) nurses when transferring residents to the emergency department (ED) and associated influencing factors. DESIGN: A cross-sectional nationwide study. METHODS: The LTCFs were selected through random stratified sampling across the whole Taiwan during February 2018 to January 2019. LTCF nurses who met the selection criteria were invited to participate with two or three nurses selected from each LTCF. The Patient Transfer Decision Difficulty Scale (PTDDS) was used to measure the level of difficulty in making decisions related to the transfer of residents to the ED. Data were collected by mailing the questionnaires and asking the nurses to return the completed form in 2 weeks. Data were analysed using simple linear regression and multiple regression with stepwise methods. RESULTS: In total, 618 valid questionnaires with an 85.32% response rate from 319 LTCFs were used for the data analysis. Decision difficulties that LTCF nurses experienced were moderate, the nursing personnel-bed ratio, LTCF professional training and basic life support training were predictive factors of the level of difficulty experience (scores of PTDDS) for the LTCF nurse (F = 6.81, p < .001). CONCLUSIONS: Enhancing emergency training in LTCF can improve nurses' decision-making ability to refer LTCF residents to emergency treatment. IMPACT: What problem did the study address? The study addressed the difficult decision LTCF nurses may experience when transferring a resident to the emergency department. What were the main findings? All LTCF nurses faced a moderate level of difficulty in decision-making. 'Transfer timing' was most often considered in the decision-making process when a resident was transferred to the ED. Where and on whom will the research have impact? Results of this study have considerable reference value for LTCF managers and nurses in the decision-making ability and suitability of transferring residents for emergency treatment.

The effect of the electronic platform of menopausal health screen system and counseling intervention on the empowerment of menopausal women: a quasi-experimental study.

This article explores the efficacy of the electronic platform of menopausal health screen system (EPMHSS) and counseling intervention on the empowerment of menopausal women, seventy four participants were randomly assigned to this study. The intervention group significantly relieved menopausal disturbance, reduced uncertainty, increased health behaviors, and decreased waist circumference after the fourth and eighth week compared with the control group. Our results proved that EPMHSS and counseling would help menopausal women to become more aware of their health, as a result, effectively empowered themselves to take actions for improving their health.

Development and validation of a Chinese version of the Sleep Apnea Quality of Life Index.

OBJECTIVE: A Chinese version of the Sleep Apnea Quality of Life Index (SAQLI) for patients with obstructive sleep apnea (OSA) undergoing treatment with continuous positive airway pressure (CPAP) was developed and validated. No Chinese versions of the SAQLI have been previously validated. METHODS: A convenience sample of 78 patients with OSA who received CPAP therapy at a Taiwanese teaching hospital was enrolled. The SAQLI is organized into four domains: daily functioning, social interactions, emotional functioning, and symptoms. This study evaluated the equivalence (forward translation and back translation), validity, and reliability of a Chinese version of the SAQLI. RESULTS: The content validity index (CVI) values of the daily functioning, social interactions, emotional functioning, and symptom domains were .93, .93, .96, and 1.00, respectively. Construct validity of one factor was generated by exploratory factor analysis, and the factor explained the following: (A) daily functioning 54%, (B) social interactions 59%, (C) emotional functioning 64%, and (D) symptoms 75% of total explained variance. The Cronbach's α internal consistency values for the daily functioning, social interactions, emotional functioning, and symptom domains were 0.68, 0.94, 0.93, and 0.92, respectively. The repeatability of the SAQLI at 7 days and 30 days after the first administration showed reliability coefficients of .94 and .93 (p = 0.001), respectively. CONCLUSIONS: The results indicate that the Chinese version of the SAQLI has good reliability and validity, as well as refined indicators for assessing the tool's accuracy. Clinicians may thus use the scale to examine the quality of life in Chinese-speaking patients with OSA undergoing CPAP therapy.

Acute exacerbations of chronic obstructive pulmonary disease (COPD) experiences among COPD patients with comorbid gastrooesophageal reflux disease.

AIMS AND OBJECTIVES: To explore perceptions of experience exacerbations of chronic obstructive pulmonary disease among chronic obstructive pulmonary disease patients with comorbid gastrooesophageal reflux disease by focusing on unravelling how patients differentiate and react to symptoms of chronic obstructive pulmonary disease and gastrooesophageal reflux disease. BACKGROUND: While gastrooesophageal reflux disease has been suggested to be a risk factor for chronic obstructive pulmonary disease exacerbations, no study has explored perceptions of the symptoms leading up to severe exacerbation of chronic obstructive pulmonary disease events among chronic obstructive pulmonary disease patients with comorbid gastrooesophageal reflux disease. DESIGN: Qualitative design. METHODS: The analysis was performed in accordance with principles of Grounded Theory methodology. Data were collected via semi-structured interviews from 12 chronic obstructive pulmonary disease patients with endoscopy-diagnosed gastrooesophageal reflux disease who had experienced a chronic obstructive pulmonary disease exacerbation with hospitalisation. Appraisal and analysis using consolidated criteria for reporting qualitative research (COREQ) checklist were undertaken. RESULTS: The core category of this study was the ineffective management of exacerbation symptoms, which was associated with perceived symptoms pre-exacerbation which contained three overlapping categories of symptom presentation experienced, and chronic obstructive pulmonary disease-related coping strategies, high anxiety and a sense of helplessness in disease management. CONCLUSIONS: Patients with severe chronic obstructive pulmonary disease with comorbid gastrooesophageal reflux disease presented with some distinctly different atypical symptoms yet used common respiratory symptom management strategies. Patients and practitioners alike need to be more aware of the possibility of other symptoms such as nonspecific symptoms being clues of exacerbation onset for a more effective intervention. RELEVANCE TO CLINICAL PRACTICE: The medical community needs to educate patients to understand and manage not only chronic obstructive pulmonary disease but also gastrooesophageal reflux disease symptoms so that they are better able to identify the cause of their symptoms, treat them appropriately and seek out medical assistance when necessary.

Living with my small stomach: The experiences of post-bariatric surgery patients within 1 year after discharge.

AIMS AND OBJECTIVES: To explore how patients adapt to their changed body and life within the first year of receiving bariatric surgery. BACKGROUND: Bariatric surgery is used to treat severely obese patients. Most studies investigating the postsurgery period are about weight loss related issues. However, few studies have investigated these patients' subjective live experiences within the first year after discharge. DESIGN: A qualitative research using grounded theory method was applied. METHODS: In-depth interviews were conducted with 17 participants with a mean age of 34.5 years. The constant comparative method was used to analyse the interview data. FINDINGS: The core concept of "living with my small stomach" indicates that postbariatric patients are confronted with multidimensional challenges over time in their live experiences. Post-bariatric surgery patients felt "unexpected body discomforts" in the initial period after discharge. Qualitative analysis generated two different types of living processes-either in the "life modification" process or a "suffering" process. The associated categories and subcategories delineated the living process after discharge. In the life modification process, five categories were identified: "being forced to change meal habits," "bad feelings due to unsatisfied eating desires," "choosing food for quality rather than quantity," "persisting and confronting" and "getting support from family members." In the suffering process, three categories were identified: "health becoming worse due to loss of albumin," "suffering from bad health" and "emotional disturbances." Finally, most participants would engage in "valuing my changed body" by "doing the right things and maintaining my new life." CONCLUSIONS: How to modify one's life is the main concern of postbariatric patients. These patients need to either engage in the process of making life modifications or suffer from complications. RELEVANCE TO CLINICAL PRACTICE: Patients need support and health education regarding living with their small stomach. In addition, we should be more sensitive about the need to detect malabsorption early.

The effects of integrated nursing education on quality of life and health-related outcomes among obstructive sleep apnea patients receiving continuous positive airway pressure therapy.

PURPOSE: This study sought to examine the effects of a nursing education program on quality of life and sleep disturbance among obstructive sleep apnea (OSA) patients receiving continuous positive airway pressure (CPAP) therapy. METHODS: This study was a randomized controlled trial with an intervention group consisting of a nursing education program. The intervention group received the instruction of the CPAP nursing education program, and the control group received routine care. Data was collected for both groups before the intervention (pre-test), on the 7th day measurement after the intervention, and on the 30th day measurement after the intervention. RESULTS: The results showed, first, that the intervention group reported a significantly reduced level of disturbance from wearing CPAP compared with that of the control group after the intervention (ß = -1.83, p = .040). Second, the Calgary sleep apnea quality of life index (SAQLI) total scores significantly improved after the intervention (ß = 1.669, p = 0.014). Also, symptoms of the SAQLI sub-items were improved and significantly different (ß = 5.69, p = 0.007) after the intervention in the intervention group. CONCLUSIONS: According to the results of the study, the disturbance from wearing CPAP, the total score of the SAQLI and the symptoms of the SAQLI were significantly improved after the nursing education intervention. Therefore, an adequate nursing education program is recommended for the initial period of CPAP use among OSA patients.

Life Experiences of Caring for Pets Among Taiwanese Community-Dwelling Older Adults: Pets as an Integral Part of the Family and Beyond.

The purpose of the current study was to use grounded theory to explore the experiences of caring for pets from the perspective of Taiwanese community-dwelling older adults. Twelve participants ages 65 to 73 were interviewed. Data were analyzed using the constant comparative method of qualitative analysis. Pets as an integral part of the family unit and beyond was the core category. The pet becomes part of my family was identified as the antecedent condition; this process undertakes action and interaction among the categories of the pet is part of my daily life, the pet provides positive life energy, and the pet is a sweet companion. Older adults believe caring for pets can bring them self-affirmation and lead them to blessings and luck. The results provide a framework to understand the experiences of older adults who reside with their pets, and serve as a guide for the design of animal-assisted therapy in future research and practice. [Journal of Gerontological Nursing, 43(1), 44-49.].

[The Life Impacts and Symptom Distress in Women With Pelvic Organ Prolapse Syndrome Before Pelvic Reconstruction Surgery].

BACKGROUND: The decision whether or not to undergo pelvic reconstructive surgery is difficult for women suffering from pelvic organ prolapse. However, little research has examined the symptom distress and life impacts that these women face prior to this surgery. Thus, it is crucial that gynecology nurses learn about these life impacts and symptom distresses in order to help these women make the best decisions with regard to surgery. PURPOSE: To explore the life impacts and degree of symptom distress in pre-surgery women with pelvic organ prolapse; to explore the relationships between demographic data and the variables of life impact and degree of symptom distress; and to identify the factors that relate to the explainable variance in the life impacts of these women. METHODS: A cross-sectional and correlational research design was used and a total of 110 women with pelvic organ prolapse who had not yet undergone pelvic reconstruction surgery were recruited in the gynecological clinics of one medical center in Taiwan. RESULTS: Daytime urination frequency was the most prevalent urinary tract symptom noted by the participants; vaginal protrusion was the most prevalent pelvis-related symptom noted; and depression and anxiety were the most prevalent life impacts noted. Moreover, greater lower-urinary-tract symptom distress was associated with greater pelvic-symptom distress. Furthermore, greater lower urinary tract and pelvic symptom distresses were associated with a greater negative impact on life. Education background and pelvis-related symptoms were the explained variances in pre-surgery life impacts. CONCLUSIONS: Women with pelvic organ prolapse should pay particular attention to symptoms that include: daytime urinary frequency, vaginal protrusion, and emotional problems including depression and anxiety. Education background and level of symptom distress should be taken into consideration when caring for the life impacts of this vulnerable group of women.

Empowering self-care ability - a follow-up study of clinical-based perimenopausal women personal health counselling.

AIMS AND OBJECTIVES: This study aimed to evaluate the longitudinal effects of a personal counselling intervention for perimenopausal women in northern Taiwan. BACKGROUND: Women face a variety of physical changes during menopause. Counselling intervention could enrich individual health education for menopausal women. DESIGN: Quasi-experimental design. METHODS: The study used one-on-one personal health counselling with a 'menopausal health passport' for perimenopausal women. The Perceived Perimenopausal Disturbances scale, the Practice of Health Behavior scale and the Perceived Uncertainty scale were used to measure the intervention effects. Results were estimated by a Generalized Estimating Equation procedure at one and a half months, three months and six months post intervention. In addition, data regarding perceived health changes were collected qualitatively through interviews in the experimental group at the sixth month. RESULTS: A total of 34 women were included in the experimental group, while 33 were in the control group. Interaction effect results showed that personal health counselling significantly increased the practice of health behaviours at one and a half months and extended to three months post intervention. Additionally, content categories, including 'relief of symptoms', 'establishment of health behaviors', 'interaction with others' and 'consideration from others' were identified in quantitative analysis. CONCLUSIONS: The results suggest that perimenopausal personal health counselling can effectively improve healthy behaviours. This study can also serve as a future reference for effective perimenopausal counselling. RELEVANCE TO CLINICAL PRACTICE: It is crucial to set up personal health counselling for perimenopausal women in clinics and develop information technology systems to support menopausal women in the technological era.

[Developing and Verifying the Validity and Reliability of the Electronic Menopausal Health Screen System].

BACKGROUND: Menopausal women are in a transitional phase between health and sickness. Although the highest standards of menopausal care include clinical assessment and patient education on menopausal symptoms, current practices lack integrated care that aim to prevent chronic diseases for which menopause is a predisposing factor. PURPOSE: To integrate menopausal disturbances; to evaluate the risk factors for osteoporosis, cardiovascular disease, and diabetes; and to create a reliable and effective electronic menopausal health screen system (EMHSS). METHODS: The research was conducted in the four stages of assessment and analysis, design, development, and pretest stage in order to explore the effectiveness of the developed EMHSS. RESULTS: The EMHSS has a high degree of reliability and validity. Analysis found an expert validity of .97~.99, content validity of .99, and test-retest reliabilities of .80~.96 (Pearson's correlation) and .79~.96 (intra-class correlation). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The EPMHSS was developed using cross-disciplinary collaboration among nursing staff, medical practitioners, and information engineers in order to screen menopausal women. The EPMHSS provides tailored health education content for patients in a timely manner and compiles historical assessment data that may be referenced by nursing staff when providing health consultations and by physicians when delivering diagnoses and treatment.

Examining the psychometric properties of the brief 'Menopausal Symptoms Distress Affecting Sleep Quality Scale'.

AIMS AND OBJECTIVES: To examine the psychometric properties of the Menopausal Symptoms Distress Affecting Sleep Quality Scale. BACKGROUND: Sleep disturbances are an extensive and common problem among menopausal women. However, no unique and specific scale has yet been developed to detect the inductive symptoms distresses that cause poor sleep quality for menopausal women. DESIGN: A cross-sectional design. METHODS: The Menopausal Symptoms Distress Affecting Sleep Quality Scale was based on in-depth interviews with menopausal women and literature review. Convenience sampling was employed. One hundred and fifty three women participated in this study. Exploratory factor analysis, concurrent validity and contrasting group validity were used to examine the validity of the Menopausal Symptoms Distress Affecting Sleep Quality Scale. Cronbach's α was conducted to test the reliability. The accuracy of the scale was analysed with the receiver operating characteristic from MED CALC version 10.4.8.0 software. The scale's sensitivity, specificity, positive and negative predictive value were analysed to locate the best cut-off point. RESULTS: One factor was generated by Exploratory factor analysis, and this factor explained 49·07% of total variance. In addition, the Menopausal Symptoms Distress Affecting Sleep Quality Scale had significant positive correlations with the Greene Climacteric Scale and the self-evaluation of menopausal symptoms scale. Cronbach's α of the Menopausal Symptoms Distress Affecting Sleep Quality Scale was 0·89. Moreover, the diagnostic accuracy probability of the scale's receiver operating characteristic curve was 0·85. The best cut-off point was three with a sensitivity of 76% and a specificity of 87%. CONCLUSIONS: The Menopausal Symptoms Distress Affecting Sleep Quality Scale had good reliability and validity, as well as refined indicators for assessing the tool's accuracy. RELEVANCE TO CLINICAL PRACTICE: The Menopausal Symptoms Distress Affecting Sleep Quality Scale is easy to use, can quickly detect the sleep conditions of menopausal women who suffer from menopausal symptom distress, and provide efficient nursing interventions to relieve menopausal symptom distresses, and then improve sleep quality.

Weight loss experiences of obese perimenopausal women with metabolic syndrome.

AIMS AND OBJECTIVES: To develop a descriptive theory for the weight loss experiences of obese perimenopausal women with metabolic syndrome. BACKGROUND: Obesity and metabolic syndrome both pose a threat to the health of perimenopausal women; therefore, understanding perimenopausal women's subjective feelings and experiences is beneficial to establishing effective prevention strategies. However, studies have rarely explored these relevant experiences. DESIGN: A qualitative study using the grounded theory method to establish a descriptive theory. METHODS: Eighteen obese perimenopausal women with metabolic syndrome aged 45-60 years participated in comprehensive interviews. RESULTS: 'Crossing the gaps to making life modifications' was the core category, and 'the awareness of weight gain and health alarm' was the antecedent condition. In the weight loss experience, the following three interaction categories were identified: (1) 'experiencing bad feelings,' (2) 'encountering obstacles' and (3) 'making efforts to transition to a new life.' Some women adhered to new life habits through perceiving social support and by using self-incentives. Finally, women enjoyed and mastered self-monitoring of their health in their new life, and practiced new changes as part of their life. However, some participants felt that making changes to their life was too time-consuming. Therefore, these women chose to live with their abnormal health without making changes. CONCLUSIONS: Obese perimenopausal women with metabolic syndrome experienced various gaps in their weight loss process. Although they struggled with many obstacles, these women were able to learn from their experiences and face their health challenges. RELEVANCE TO CLINICAL PRACTICE: These findings can guide healthcare professionals to provide appropriate interventions to understand the hidden health problems of this particular group of women. Healthcare professionals should develop a set of plans by which women receive a complete weight loss program and support from professionals and family.

Improving sleep quality interventions among menopausal women with sleep disturbances in Taiwan: a preliminary study.

AIM: The aim of this study was to evaluate the effectiveness of improving sleep quality interventions in menopausal women with sleep disturbance. BACKGROUND: Sleep disturbances are an extensive and common problem among menopausal women. There is an increased trend in the use of non-pharmacological methods to alleviate sleep disturbances. Studies that have implemented two or more non-pharmacological strategies for menopausal women are scant. METHODS: A repeat measurement with a randomized assignment was conducted. A total of 59 menopausal women with sleep disturbance were recruited and randomly assigned to experimental (n = 29) and control (n = 30) groups. Participants in the experimental group received four 2-hour improving sleep quality activities, whereas the control group received regular greeting calls. Sleep quality was measured prior to intervention, and on the 5th and 8th weeks by using the Pittsburg's Sleep Quality Index, and Actiwatch was worn before and during the 8 weeks of intervention. Generalized estimating equation was used to analyze data. RESULTS: The results revealed that subjective sleep quality had significant main effect in group and time. The findings of the objective measurement showed that participants in the experimental group had significantly shorter frequency of awakening time and increased sleep efficiency. CONCLUSION: The improving sleep quality intervention is a healthy and cost-effective method to improve sleep quality in community-dwelling menopausal women with sleep disturbance.

[The Design Requirements for an E-Health Management Platform: Addressing the Needs of Adolescent Girls at High Risk of Metabolic Syndrome].

BACKGROUND: The rising prevalence of metabolic syndrome among adolescents has not been effectively addressed by current campus-based health promotions. Using the Internet in these promotions may help health professionals achieve better healthcare management. PURPOSE: The purpose of the present study was to explore the design requirements of an e-health management platform from the subjective perspective of adolescent girls who were at a high risk of metabolic syndrome. The findings may provide a reference for designing nursing interventions that more effectively promote healthly lifestyle habits to adolescents. METHODS: This qualitative study employed a snowball approach and used a semi-structured interview guide to collect data. A total of 20 Taiwanese adolescent females who were at a high risk of metabolic syndrome, aged 16-20 years, able to speak Mandarin or Taiwanese, and willing to participate and to have their sessions tape-recorded were enrolled as participants and engaged individually in in-depth interviews. The constant comparative method was used to inductively analyze the interview data. RESULTS: Five main themes related to the e-health management platform emerged from the data. These themes included: an attractive and user-friendly website interface, access to reliable information and resources, provision of tailored health information, access to peer support, and self-monitoring and learning tools. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings highlight the key design needs of an e-Health management platform from the perspective of adolescent girls who are at a high risk of metabolic syndrome. The identified themes may be addressed in future revisions / developments of these platforms in order to better address the needs of this vulnerable population and to effectively reduce the incidence of metabolic syndrome. The authors hope that the results of the present study may be used to provide better healthcare and support for adolescent girls with metabolic syndrome.

[The Experiences of Obstructive Sleep Apnea in Women].

BACKGROUND: Obstructive sleep apnea (OSA) is a potentially lethal respiratory sleep disorder. However, few studies have studied OSA women. PURPOSE: The purpose of the current study was to explore the life experiences of women with OSA. METHODS: A qualitative study using the grounded theory method was used to establish a descriptive theory. RESULTS: The results were expressed in terms of three stages with related categories. Stage 1: No interest days due to poor sleep, including "uncontrollable sleep", "perceived health deteriorates", and "poor female image harmed by snoring"; Stage 2: Indecision and disappointments during treatment seeking, including "doctor shopping", "being urged by others to seek medical help", and "being shocked by the severity of disease"; and Stage 3: Accepting a new lifestyle with a continuous positive pressure respirator, including "adaptation of the new sleep", "adequate sleep", and "secret worry of being an OSA woman". CONCLUSIONS: Based on the findings of the present study, medical knowledge and treatments related to OSA should be widely promoted with appropriate professional education and counseling services in order to enhance the awareness of patients and to facilitate their acceptance of the healing process using a continuous positive airway pressure respirator.

[Nursing care for ovarian cancer patients with intraperitoneal chemotherapy].

Ovarian cancer, known as a "silent killer", is the leading cause of gynecologic cancer death. Standard treatments for ovarian cancer are debulking surgery combined with platinum chemotherapy drugs to prolong the survival of patients. According to clinical trials run by the American Society of Gynecologic Oncology, patients who received intraperitoneal (IP) chemotherapy survived longer on average than patients who received intravenous chemotherapy alone. Thus, intraperitoneal chemotherapy is a new potential approach for treating ovarian cancer patients. However, the toxicities and undesirable complications of IP chemotherapy are the major challenges of this treatment approach. This article helps nurses recognize the toxicities and complications of IP chemotherapy and may be used as reference for future revisions to patient care guidelines.

Life experiences among obstructive sleep apnoea patients receiving continuous positive airway pressure therapy.

AIMS AND OBJECTIVES: To generate a descriptive theoretical framework for experiences among obstructive sleep apnoea (OSA) patients undergoing continuous positive airway pressure (CPAP) therapy. BACKGROUND: Insufficient information is available about subjective experiences among OSA patients undergoing CPAP therapy. This study aims to address that lack of insight into patients' feelings. DESIGN: A qualitative study using the grounded theory method to establish a descriptive theory. METHODS: Twenty-two Taiwanese OSA patients undergoing CPAP therapy participated in comprehensive interviews. RESULTS: The patients, aged 37-68 years, participated in wide-ranging interviews. 'Living with CPAP' was the core theme describing the life experiences of OSA patients undergoing CPAP. Health warnings were identified as the antecedent condition, with subcategories including the following: severe snoring, choking and feelings of a terrible death during sleep, day and night sleepiness, easy tiredness, decreased memory, poor sleep, dry mouth, dry throat, headache, high blood pressure, poor blood sugar level control and falling asleep while driving. Analyses indicated seven subcategories of OSA patients with CPAP: (1) seeking medical information, (2) difficulties with CPAP, (3) trial and error for the 'right' CPAP, (4) long scheduled waiting times, (5) wondering, (6) high expectations, and (7) getting back good health. CONCLUSIONS: The results will assist healthcare providers with references for OSA health care based on patients' subjective perspectives. RELEVANCE TO CLINICAL PRACTICE: After interpreting and analysing results, suggestions include the following: (1) provide medical resource education for outpatients and inpatients to access self-care knowledge regarding OSA; (2) institute professional personnel for providing OSA health education in sleep clinics or sleep centres; (3) develop hospital standards for sleep examination processes to shorten waiting times; (4) establish case management for pursuing OSA patients receiving CPAP; (5) arrange regular forums for patients to share their experiences; and (6) provide community health education to promote awareness of snoring issues.

Relieving my discomforts safely: the experiences of discontinuing HRT among menopausal women.

AIM AND OBJECTIVES: To generate a descriptive theoretical framework about the experiences of women who discontinued hormone replacement therapy. BACKGROUND: Some menopausal women would depend on hormone replacement therapy for relieving their menopausal symptoms. However, most of them feared of hormone replacement therapy's side effects and tried to discontinue hormone replacement therapy immediately. How did these women self-manage their discomforts without using dependent medicine--hormone replacement therapy? There are few studies conducted on this issue. DESIGN: A grounded theory research was applied. METHODS: Nineteen Taiwanese women discontinuing hormone replacement therapy for three months, aged 45 to 67 years, participated in face-to-face audio-taped interviews. Data collection, and coding of interviews, and data analysis occurred simultaneously. All conversations were audio-recorded and then transcribed as verbatim text. The constant comparative method was used to analyse the interview data. RESULTS: 'Relieving my discomforts safely' was the core theme for describing and guiding the process of discontinuing hormone replacement therapy. 'Immediately discontinuing hormone replacement therapy--it would hurt my body' was identified as the antecedent condition. Analyses showed five dimensions to the women's relieving my discomforts safely: (1) symptoms bothered me again, (2) negative emotions, (3) learning to let it go, (4) trying to use nonhormone replacement therapy or products and (5) choosing safely therapies as first priority. Finally, some women would choose their suitable nonhormone replacement therapy way, and some women would reuse hormone replacement therapy cautiously. CONCLUSIONS: 'Relieving my discomforts safely' was the first-priority consideration for the menopausal women discontinuing hormone replacement therapy. It is the challenge to establish the health programme or management for helping these women felt safety and security to relieve their menopausal symptoms by using hormone replacement therapy or nonhormone replacement therapy. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers need to empower women the rights of decision-making of using hormone replacement therapy and assist them in monitoring their health status to reduce their fear and uncertainty.

The healing process following a suicide attempt: context and intervening conditions.

The purpose of this study was to explore the context and the intervening conditions that impacted on individuals' healing from a suicide attempt. Patients who had survived a suicide attempt (n=14) and their caregivers (n=6) were interviewed in this study. Findings revealed that the suicidal individuals who lived in a sheltered, friendly environment, and had support systems helped their suicidal healing process. Conversely, suicidal individuals who experienced negative aspects of self, family predicaments, environmental difficulties, and the re-emergence of stressors impeded their suicidal healing process. Consequently, health professionals need to promote healthy internal and external environments for suicidal individuals.