[Body Image and Its Clinical Implications].

Although the concept of body image was first introduced to Taiwan nursing in 1975, its application in the context of clinical nursing with regard to promoting humanistic patient-centered care has yet to be examined. This paper adopts a field-study approach to reinterpret the concept of body image with deeper and broader strength using patient vignettes, nursing case studies, and the findings of prior nursing research. The four main issues covered in this paper are: 1. The body image concept, 2. Building body schema and a postural model based on body experiences, 3. The characteristics of body image, and 4. The extended meaning of body image, including self-concept and the role function of relationship. This paper is expected to help nurses better understand the concept of body image and further apply this concept in clinical practice in order to improve the provision of humanistic patient-centered care.

Discrepancy between physicians' perceptions and practices during pelvic examinations in Taiwan.

OBJECTIVE: This study explored (1) physicians' perceptions of pelvic examination (PE) procedures and (2) the discrepancy between physicians' perceptions and their practices as observed by their attending nurses. METHOD: Data were collected from 20 physician-completed questionnaires on the perceived importance of 23 PE procedures. Each physician's practice of the same 23 PE procedures was assessed by 4-6 attending nurses (100 nurse observations). Physicians and nurses were sampled by convenience from the obstetrics/gynecology outpatient departments of 3 teaching hospitals in central Taiwan. Discrepancies between physicians' perceptions and their practices as assessed by attending nurses were examined by the Mann-Whitney U test. RESULTS: Physicians' mean scores ranged from 3.15 to 4.00, indicating that PE procedures were generally perceived as important. The procedures were rank ordered according to the mean scores from highest to lowest. Physicians' 5 top-ranking procedures were wearing gloves during the PE, asking agreement for the examination, paying attention to privacy during the PE, protecting the woman's personal information, and protecting the woman's medical records. Physicians' 5 lowest ranking procedures were telling the woman before inserting the speculum that she will feel some pressure, explaining the procedure before the PE, proactively providing information, asking the woman how she feels during the PE, asking a woman's permission to examine prior to commencing the PE, and describing observations to the woman during the PE (the last two procedures were tied for 5th rank). For 15 of the 23 PE procedures, physicians' perceptions did not differ significantly from their practices as assessed by attending nurses. The remaining 8 procedures were statistically significant between physicians' perception and their practices, and were rated higher by physicians (perception) than by attending nurses (practice). CONCLUSION: The 5 top-ranking PE procedures in terms of perceived importance were related to procedural behaviors, whereas the 5 lowest ranking procedures were verbal statements with explicit affective content. During nurse-observed PEs, Taiwanese physicians consistently practiced the procedural aspects of PEs they perceived as important (e.g., communication and consultation, protection and skilled technique, and confidentiality). However, physicians' practices were less consistent in affective aspects (e.g., explanation and consent, information and instruction, and sensitivity). PRACTICE IMPLICATIONS: Our results suggest that physicians should concentrate not only on procedural behaviors, but also on affective behaviors. These findings could be incorporated in medical education, particularly for medical students training to become obstetric and gynecological physicians.