Factors associated with attitudes of mental health nurses towards the importance of families in mental health nursing care.

Family involvement in mental healthcare is a key ingredient in the recovery of patients with mental illness. Research on the attitudes of mental health nurses regarding family involvement in mental healthcare remains limited. This study aimed to examine factors that affect the attitudes of mental health nurses towards the importance of family involvement in mental health nursing care. A descriptive, correlational study with a cross-sectional design was conducted with 162 mental health nurses at two psychiatric hospitals in Taiwan. Descriptive statistics, independent t-tests, one-way analysis of variance, and stepwise multiple linear regression analyses were applied to analyse data. Mental health nurses generally demonstrated positive attitudes towards incorporating families into nursing care. Older age, more clinical experiences in mental healthcare, and workplace (such as working in chronic psychiatric inpatient wards) were found to be key factors for mental health nurses' attitudes. Particularly, greater competence in working with families and job satisfaction were the most significant factors associated with positive attitudes of mental health nurses towards involving families as important in nursing care. Insight into correlates of mental health nurses' attitudes towards the importance of focusing on families in care is pivotal for targeted interventions to improve nurses' attitudes towards families and, thus, implement family engagement in mental healthcare practices.

Changes in family functioning among primary family caregivers of patients with schizophrenia.

INTRODUCTION: Family functioning, particularly among primary family caregivers for patients with schizophrenia, is a global concern that poses unprecedented challenges. The family unit is a pivotal agent for the preservation of the integrity of individual members. Little attention has been paid to the changes in family functioning and their predictors in primary family caregivers. This study aimed to examine the changes in and the correlates of family functioning in primary family caregivers of individuals with schizophrenia over a 6-month post-discharge period. DESIGN: A prospective, longitudinal study was conducted. METHODS: A total of 58 primary family caregivers of patients with schizophrenia were recruited from two psychiatric hospitals in Taiwan. Data were collected four times, including 1 week before hospital discharge and at 1-, 3-, and 6-month intervals post-discharge. Demographic and clinical questionnaires, the Affiliate Stigma Scale, the Family Empowerment Scale, and the General Functioning subscale were used to collect data. Generalized Estimating Equations were applied for data analysis. RESULTS: Approximately 59.6%-77.6% of primary family caregivers presented unhealthy family functioning during the 6-month post-discharge period. Significant reductions in family functioning of primary family caregivers were noted in the group with unhealthy family functioning; however, family functioning of primary family caregivers remained unchanged in the group with healthy family functioning over 6 months. Affiliate stigma and family empowerment significantly accounted for the changes in family functioning of primary family caregivers in the groups with unhealthy and healthy family functioning, respectively. CONCLUSION: This study highlights affiliate stigma and family empowerment as long-term predictors of changes in family functioning for primary family caregivers and as pivotal targets of mental health care. CLINICAL RELEVANCE: Family-centered interventions with a focus on ameliorating affiliate stigma and enhancing family empowerment are recommended to improve family functioning for primary family caregivers of patients with schizophrenia at different periods after hospital discharge.

High internalized stigma among community-dwelling patients with schizophrenia: Associations with sociodemographic and clinical characteristics, personality traits and health-related quality of life.

Stigma attached to schizophrenia among patients is a global concern to mental health advocates. The extent of internalized stigma experienced by consumers with schizophrenia living in the community and its correlates have not been fully explored. This study aimed to examine the prevalence of high internalized stigma and its association with sociodemographic and clinical characteristics, personality traits and aspects of health-related quality of life among community-dwelling consumers with schizophrenia. A descriptive, correlational study with a cross-sectional design was conducted with 149 consumers from outpatient psychiatric clinics of two hospitals in Taiwan. Face-to-face interviews with structured questionnaires were adopted. Data were analysed with descriptive statistics, chi-squares tests, independent t-tests and a binary logistic regression analysis. Approximately 41.6% of consumers with schizophrenia experienced high internalized stigma. In the subscales, a high experience of discrimination experience (43.6%) was reported, followed by alienation (34.2%), social withdrawal (28.2%), stereotype endorsement (24.8%) and stigma resistance (20.8%). Being younger at the onset of schizophrenia, attaining lower education, having a history of suicidality, fewer positive personality traits and poor aspects of health-related quality of life were significantly associated with high internalized stigma. Personality traits in the domains of emotional stability and conscientiousness and social and environmental aspects of health-related quality of life appeared to be the most relevant to risk of high internalized stigma. Anti-stigma initiatives coupled with personality-traits modules and modifications of health-related quality of life are suggested for mental health professionals and policy makers to ameliorate internalized stigma among community-dwelling consumers with schizophrenia.

Attitudes Toward People With Schizophrenia Among Undergraduate Nursing Students.

BACKGROUND: Negative attitudes toward mental disorders are not only an interpersonal issue but also a concern of mental health care. Given that nursing students are future health care providers, it is pivotal to improve their attitudes toward individuals with mental disorders prior to their transition into clinical practice. However, research on nursing students' attitudes in relation to schizophrenia in Taiwan remains unexplored. AIM: The aim of this article is to examine the correlates of attitudes toward individuals with schizophrenia among Taiwanese undergraduate nursing students. METHOD: A descriptive, correlational, and cross-sectional study was adopted. Self-reported questionnaires were conducted with a convenience sample of 306 Taiwanese undergraduate nursing students. Descriptive statistics, independent t tests, one-way analysis of variance, Pearson's correlations, and a stepwise regression analysis were performed. RESULTS: Nursing students expressed negative attitudes toward individuals with schizophrenia. Nursing students, who were female, had contact with individuals with mental disorders, and expressed greater empathy and personality traits held more favorable attitudes toward individuals with schizophrenia. The study found that empathy, personality traits, and academic year were the most crucial attributes contributing to attitudes of nursing students toward individuals with schizophrenia. CONCLUSION: Findings suggest that nursing education programs with empathy- and personality-tailored modules in mental health are pivotal to provide humanistic approaches with supportive attitudes regarding schizophrenia.

Psychiatric morbidity and its correlates among primary family caregivers of individuals diagnosed with schizophrenia in Taiwan.

BACKGROUND: Caregiving for patients with schizophrenia is often challenging and may increase the risk of psychiatric morbidity among primary family caregivers. However, the associated factors of psychiatric morbidity among caregivers have not been fully investigated. AIMS: This study aimed to screen psychiatric morbidity and its correlates among primary family caregivers of persons with schizophrenia receiving inpatient psychiatric rehabilitation services. METHODS: A cross-sectional, correlational design was used. A total of 184 Taiwanese primary family caregivers in inpatient psychiatric rehabilitation units participated in the study. Descriptive statistics, Chi-square tests, independent t-tests, and a stepwise binary logistic regression analysis were performed to examine the association among primary family caregivers' psychiatric morbidity and primary family caregivers' sociodemographic characteristics and mutuality and patients' sociodemographic and clinical characteristics. RESULTS: The prevalence of psychiatric morbidity among primary family caregivers was 48.4%. Unemployment, lower mutuality, additional dependents in need of care, and caring for patients with more psychiatric hospitalizations were the most significant factors for psychiatric morbidity among primary family caregivers. CONCLUSION: Mental healthcare professionals should recognize patients and their primary family caregivers as a unit of care. Primary family caregivers must receive increased assistance, including supportive resources and therapeutic interventions, to reduce psychiatric morbidity.

Effectiveness of a brief family strengths-oriented therapeutic conversation intervention for patients with schizophrenia and their caregivers.

PURPOSE: To examine the effects of a brief family strengths-oriented therapeutic conversation (FAM-SOTC) intervention on symptom severity of patients with schizophrenia and family coping and caregiver burden for family caregivers. DESIGN: A quasi-experimental research design with repeated measures. METHODS: A convenience sample of 72 dyads of patient-family caregivers was recruited from randomized inpatient psychiatric rehabilitation units in a psychiatric hospital in Taiwan. Sixty-one patient-family caregiver dyads that comprised the intervention group (n = 29) and control group (n = 32) completed questionnaires at four time points (baseline, immediate, one- and three-months post-intervention). Demographic questionnaires and clinical information, Brief Psychiatric Rating Scale, Family Crisis-Orientation Personal Evaluation Scales, and Zarit Burden Interview were used to collect data. Generalized estimating equations were used to assess the differences in symptom severity, family coping, and caregiver burden between the two groups. FINDINGS: As compared to the control group, the intervention group showed statistically significant improvements over three months in symptom severity as well as family coping, especially acquiring social support, reframing, and mobilizing social support for family caregivers. Caregiver burden in the intervention group was ameliorated immediately and one month after the intervention rather than a three-month post-intervention. CONCLUSIONS: A brief FAM-SOTC intervention proved to be favorable for alleviating psychiatric symptoms of patients coupled with an improvement in family coping and burden in family caregivers encountering schizophrenia. CLINICAL RELEVANCE: Integration of a brief family therapeutic conversation intervention into the routine psychiatric rehabilitation services delivery is recommended to help patients and their family caregivers effectively manage schizophrenia.

Association between Mutuality and Health-Related Quality of Life in Patient-Caregiver Dyads Living with Schizophrenia.

BACKGROUND: Although caregivers are a crucial support in the recovery of patients with schizophrenia, little is known about how mutuality is related to health-related quality of life within the dyadic (patient and caregiver) context. This study aimed to investigate the dyadic relationship between mutuality and health-related quality of life in patients with schizophrenia and caregivers. METHODS: A cross-sectional, correlational study was conducted with a sample of 133 dyads of patients with schizophrenia and caregivers. Structured questionnaires were used to collect data. Data were analyzed using descriptive statistics, paired sample t-tests, Pearson's product-moment correlations, and the Actor-Partner Interdependence Model. RESULTS: Mutuality of patients was significantly higher than that of caregivers. Compared with caregivers, patients had significantly lower total scores for health-related quality of life. Patients' and caregivers' mutuality was related to their own health-related quality of life (actor effect) and their partners' health-related quality of life (partner effect). CONCLUSION: Mutuality plays a critical role in health-related quality of life in dyads of patients with schizophrenia and caregivers. Viewing a dyad as a unit of nursing care reveals a promising approach for developing recovery-oriented modalities targeted at stimulating mutuality that may enhance health-related quality of life for both patients and caregivers.

Caregiver burden and health-related quality of life among primary family caregivers of individuals with schizophrenia: a cross-sectional study.

PURPOSE: This study aimed to examine correlates of caregiver burden and health-related quality of life (HRQoL) among primary family caregivers of individuals with schizophrenia in inpatient psychiatric rehabilitation facilities. METHODS: A cross-sectional study was conducted with 157 Taiwanese primary family caregivers of individuals with schizophrenia residing in inpatient psychiatric facilities. Measures included socio-demographic questionnaires and clinical information, Mutuality Scale, Family Crisis-Oriented Personal Evaluation Scales, Zarit Burden Interview, and World Health Organization Quality of Life-brief version. To describe the degree of caregiver burden and domains of HRQoL, descriptive statistics were computed. Independent sample t test, one-way analysis of variance, and Pearson's correlation analysis followed by multiple regression analyses were performed to determine correlations and relationships between characteristics of patients and primary family caregivers with caregiver burden and domains of HRQoL. RESULTS: Primary family caregivers experienced mild to moderate caregiver burden and poor HRQoL. Primary family caregivers who were older and unemployed, caring for patient's severe psychiatric symptoms, and had low monthly incomes, decreased mutuality, and fewer family coping strategies were associated with greater caregiver burden and poor HRQoL. Greater mutuality and family coping strategies of reframing and seeking spiritual support were the most significant factors in improving caregiver burden and all domains of HRQoL, respectively. CONCLUSION: Family-focused interventions for caregivers of institutionalized persons with schizophrenia that include psychological support and peer support groups are recommended to enhance mutuality and family coping strategies, reduce caregiver burden, and improve HRQoL.

Effects of Art and Reminiscence Therapy on Agitated Behaviors Among Older Adults With Dementia.

BACKGROUND: Cognitive degeneration and agitated behavior symptoms of dementia in older adults are the main causes of disability and inability and increase the cost of medical care. Agitated behavior symptoms of dementia are the main causes of early institutionalization and make caregivers exhausted. PURPOSE: The aim of this study was to examine the effects of art therapy and reminiscence therapy on the alleviation of agitated behaviors in older adults with dementia. METHODS: An experimental research design with two experimental groups and one comparison group was conducted to examine the effects for each group on agitated behaviors. Participants were recruited from two dementia care centers in central and northern Taiwan. The study included 54 older individuals who met the sampling criteria and completed the data collection process. The participants were randomly allocated into the art therapy group (n = 24), the reminiscence therapy group (n = 22), and the comparison group (n = 8). The intervention consisted of 50-minute sessions conducted weekly for 12 weeks. Regular activities were continued in the comparison group. The structured questionnaires were completed, and observations of agitated behaviors were collected before the intervention and at 1 and 6 weeks after the intervention. RESULTS: Significant differences were found in agitated behavior symptoms at the three time points in the art therapy group, whereas reminiscence therapy was found to have had a clear and immediate effect on decreasing agitated behavior. The generalized estimating equation exchange model test revealed a significant and sustained, postintervention effect of art therapy on agitated behavior. In contrast, no significant and sustained effect on agitated behavior was observed in the reminiscence therapy group. CONCLUSIONS: The findings of this study support that art therapy may have a positive effect on dementia-associated agitated behaviors in institutionalized older adults. Reminiscence therapy activities conducted weekly for 50 minutes each session did not reach statistically significant implications. It is suggested that future studies consider conducting art and reminiscence therapies for a 16-week duration with two weekly sessions to evaluate the effectiveness of the therapy. The duration of follow-up should be extended as well in future studies.

Factors associated with family functioning among people with a diagnosis of schizophrenia and primary family caregivers.

WHAT IS KNOWN ON THE SUBJECT?: Families act not only as the primary support for people with a diagnosis of schizophrenia but also as partners in the healthcare system. Families who have members with mental disorders, particularly schizophrenia, experience challenges in family functioning. Research on families in relation to schizophrenia primarily focuses on the determinants that affect family functioning from primary family caregivers' perspectives. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This report provides evidence that there is a concordance between family functioning and inpatient psychiatric rehabilitation facilities for the patient-caregiver dyad; both care-receivers and primary family caregivers considered family functioning as poor. Care-receivers with lower education levels, increased number of previous hospitalizations and poor quality of family-centred care experienced unhealthy family functioning. Primary family caregivers and care-receivers with higher education levels, lower suicidality and greater quality of family-centred care experienced healthier family functioning. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Understanding the degree of family functioning, particularly its concordance and correlates as perceived by patients and primary family caregivers, may serve as a platform for inculcating assessment of family functioning to achieve holistic patient care. Open dialogue in family-focused care planning is essential to facilitate collaborative partnerships and improve family functioning among people with a diagnosis of schizophrenia and their primary family caregivers. Further research on culturally relevant, evidence-based family interventions to enhance the functioning of affected families is warranted, especially for families with members in inpatient psychiatric rehabilitation facilities. ABSTRACT: Introduction Families provide frontline caregiving support for people with a diagnosis of schizophrenia. However, research primarily addresses correlates of family functioning from primary family caregivers' perspectives. Aim To examine perceived family functioning, particularly its concordance within patient-caregiver dyads and associated factors in families of people living with schizophrenia. Methods A cross-sectional, descriptive correlational design was used. A total of 133 dyads of patients and primary family caregivers from inpatient psychiatric rehabilitation services participated. Descriptive statistics, independent-sample t test, one-way ANOVA, Pearson's correlation coefficients, intraclass correlation coefficient and stepwise multiple linear regression analyses were applied. Results Family functioning was perceived as impaired by patient-caregiver dyads, and there existed a concordance in this regard. Patients' and family caregivers' education levels, patients' suicidality, number of previous hospitalizations and quality of family-centred care correlated with patients' and primary family caregivers' family functioning. Discussion Findings highlight the importance of patient- and family-reported family functioning with implications to address individual and collective concerns. Implications for Practice Evidence-based family interventions are crucial for assisting vulnerable families in promoting family functioning. Mental health nurses should facilitate collaboration and open dialogue concerning perspectives of patients and families to improve delivery of comprehensive mental health care.

Factors Associated With Primary Family Caregivers' Perceptions on Quality of Family-Centered Care in Mental Health Practice.

PURPOSE: This study aimed to examine the quality of family-centered care perceived by primary family caregivers and its influencing factors in mental healthcare practice. DESIGN: A cross-sectional, correlational study. METHODS: A convenience sample of 121 mental health nurses and 164 primary family caregivers of patients with schizophrenia was recruited from acute psychiatric wards and chronic psychiatric rehabilitation wards in three psychiatric hospitals in Taiwan. Structured questionnaires for mental health nurses were designed to examine nurses' attitudes toward schizophrenia and the importance of families in nursing care. Primary family caregivers were assessed to determine their perceptions of quality of family-centered care. At least one primary family caregiver of patients was matched to a nurse who took major responsibility for the patient during the hospitalization. Data were analyzed with descriptive statistics, Pearson's product-moment correlations, independent t-test, one-way analysis of variance, and stepwise regression analyses. RESULTS: Quality of family-centered care perceived by primary family caregivers regarding the provision of general and specific information, as compared to enabling and partnership, coordinated and comprehensive care, and respectful and supportive care, was relatively inadequate. Younger and more educated primary family caregivers, having relatives with schizophrenia in acute wards, less supportive nurses' attitudes toward schizophrenia, and the importance of family in nursing care were correlated with poor primary family caregivers' perceptions of quality of family-centered care. Nurses' supportive attitudes toward schizophrenia and chronic psychiatric rehabilitation wards where patients received care were key factors in determining better quality of family-centered care. CONCLUSIONS: Findings provide a platform for the development of effective continuing education and training programs to equip mental health nurses with supportive attitudes toward mental illness and an integration of the family in nursing care, which will ultimately improve mental health care for families experiencing mental health problems. CLINICAL RELEVANCE: Efforts in professional training to address stigma and encourage a family-centered approach into recovery-oriented practice for practicing mental healthcare providers, including mental health nurses, are recommended.

Effect of family sense of coherence on internalized stigma and health-related quality of life among individuals with schizophrenia.

Health-related quality of life is an increasingly critical outcome of mental healthcare, yet its disease-independent attributes, particularly family-focused resilient indicators, for individuals with schizophrenia have not been explicitly examined. The aim of this study was to explore the degree of health-related quality of life and to examine the mediating effect of family sense of coherence on internalized stigma and health-related quality of life in individuals with schizophrenia. A cross-sectional and correlational study design was used. A total of 111 individuals with schizophrenia were enrolled from the in-patient psychiatric rehabilitation services of two psychiatric hospitals in Taiwan. Face-to-face structured interviews were applied to collect information. Data were analyzed with descriptive statistics and multiple regression analyses. The results indicated that affected individuals experienced impaired health-related quality of life. Family sense of coherence partially mediated the relationship between internalized stigma and health-related quality of life. This study indicates that knowledge about the role of family sense of coherence in mental health rehabilitation may assist mental healthcare professionals to provide therapeutic interventions to address internalized stigma, thereby promoting health-related quality of life in individuals living with schizophrenia.

Comparison of the Quality of Informal Care of Community-Dwelling Taiwanese Older People.

BACKGROUND: With social structures changing and the average life-span of individuals increasing, Taiwan is experiencing a steady rise in its elderly population. Thus, caring for older parentsis an urgent problem. Many foreign caregivers have been hired tocare for older parents.However, measuring the quality ofinformal care has not yet been fully explored in Taiwan, particularly among older people who are cared for by foreign caregivers in home settings. PURPOSE: The purposes of this study were to understand the differences in quality of care for older Taiwanese and to explore the predictors of quality of care in two types of caregiving. METHODS: A comparative descriptive study design was conducted. The study was held in several community healthcare centers in the middle and southern regions of Taiwan. Study data were collected over an 18-month period between 2012 and 2014. t Tests were used to compare continuous variables according to the types of caregiving. Multiple linear regressions with group analyses were performed to evaluate the underlying statistical assumptions. RESULTS: One hundred fifty-nine participants were included. The study results showed that age, activities of daily living level, and quality of care were significantly different between the two types of caregiving. Relationships with caregivers, social support, and depressive symptoms contributed to the quality of care in family caregiving, explaining 50.2% of the variance. Social support and depressive symptoms contributed to the quality of care in foreign caregiving, explaining 36.6% of the variance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The study results support that the types of primary caregiving affect the quality of care that is received by elderly Taiwanese. This study may be used as a reference for families whose family members need long-term care when considering hiring foreign caregivers as an alternative option to Taiwanese caregivers.

Living with schizophrenia: Health-related quality of life among primary family caregivers.

AIMS AND OBJECTIVES: To examine influencing factors of health-related quality of life in primary family caregivers of people with schizophrenia receiving inpatient psychiatric rehabilitation services. BACKGROUND: Families, particularly primary family caregivers, have become more important than ever in mental health care. Yet, research on health-related quality of life among primarily family caregivers is limited. DESIGN: A correlational study design was used. METHODS: A convenience sample of 122 primary family caregivers participated in the study. Data were analysed with descriptive statistics, Pearson's product-moment correlation, t test, one-way analysis of variance and a hierarchical multiple regression analysis. RESULTS: Primary family caregivers who were parents, older, less educated, and had a lower monthly household income, increased affiliate stigma and decreased quality of family-centred care experienced poor health-related quality of life. Particularly, monthly household income, affiliate stigma and quality of family-centred care appeared to be the most critical determinants of health-related quality of life. CONCLUSIONS: Efforts to enhance satisfaction of life should focus on reducing affiliate stigma as well as increasing monthly household income and strengthening the quality of family-centred care. RELEVANCE TO CLINICAL PRACTICE: Findings may assist in the development of culturally integrated rehabilitation programmes to decrease affiliate stigma and increase family engagement as a means of promoting quality of life for primary family caregivers living with people who have schizophrenia.

Comparison of personality traits and successful aging in older Taiwanese.

AIM: The present study aimed to compare the difference of personality traits and successful aging among older Taiwanese adults. The proportions of successful agers who meet the criteria for successful aging was also be proposed. METHODS: A comparative descriptive study design was applied. To measure the definition of successful aging, three concepts proposed by Rowe and Kahn with five indicators were included. Demographic data were compared by the χ2 -test and Fisher's exact test across the subgroups defined by social economic status, marital status, and health habits. The comparison of personality traits and successful aging was applied by logistic regression. RESULTS: The results of the present study showed that the personality traits of conscientiousness, openness and emotional stability were found to be related to the dimensions of successful aging. In addition, except for the personality trait of openness, the personality traits of conscientiousness, extraversion, emotional stability and agreeableness were significantly different in the successful aging versus the non-successful aging group. CONCLUSIONS: The present study found the differences between personality traits and successful aging. Our study also provided essential information with regard to the differences of successful aging for older people. Geriatr Gerontol Int 2017; 17: 2239-2246.

Correlates of health-promoting lifestyle behaviors among Vietnamese female immigrants in Taiwan.

Immigration is a demanding and challenging life event that may cause married immigrant women to be likely to adopt unhealthy lifestyle behaviors. The aim of the authors of this study was to assess the prevalence of health-promoting lifestyle behaviors and their correlates among Vietnamese female immigrants in Taiwan. A cross-sectional study was conducted with 140 Vietnamese female immigrants from November 2012 to October 2013. Measures included demographic information, the Chinese Health Questionnaire, the General Functioning Scale of the Family Assessment Device, and a short version of the Chinese Health-Promoting Lifestyle Profile. Data analyses included descriptive statistics, Pearson's product-moment correlation coefficients, t-tests, one-way analysis of variance, and a hierarchical multiple regression analysis. Vietnamese female immigrants with better individual health status, higher education from their original country, greater communication ability, better health status of the husband, and adaptive family functioning demonstrated greater participation in health-promoting lifestyle behaviors. Particularly, better husband's health status and family functioning correlated with greater practices of health-promoting lifestyle behaviors after controlling for individual characteristics and experiences, with 38% of the total variance explained. Findings may serve to guide and design culturally specific, family-focused health promotion interventions to assist Vietnamese female immigrants and their families.

The Effects of an Empowerment Intervention on Renal Transplant Recipients: A Randomized Controlled Trial.

BACKGROUND: Renal transplantation is a vital treatment for end-stage renal disease. To help improve quality of life after renal transplant surgery, interventions are needed to strengthen the coping skills and self-care behaviors of patients. However, most research studies on self-care after renal transplantation have addressed related factors. Few studies have examined the effects of interventions on renal transplant recipients. PURPOSE: This study investigated the effects of an empowerment support group on the empowerment levels and self-care behaviors of renal transplant recipients. METHODS: This study was a randomized controlled trial. Eligible participants were individuals who had undergone a renal transplant within the past 20 years, were 18 years old or older, were able to read and write in Chinese, and were willing to participate. We recruited 122 renal transplant recipients from two medical centers in southern Taiwan. The renal transplant outpatients were randomly assigned into empowerment support (n = 56) and comparison (n = 66) groups. The developed measures as well as the content, protocols, and the two groups were assessed for reliability and validity. The intervention involved one 2-hour meeting every 2 weeks for a total of six meetings. The topics included goal setting, problem solving, coping with daily stress, seeking social support, and staying motivated. The sessions consisted of introductions that highlighted the topic, group discussions, identifying areas of difficulty with self-care behaviors after renal transplant, and developing a set of goals and strategies to overcome these problems. RESULTS: The empowerment group reported significant increases both in terms of level of empowerment (F = 5.29, p = .023) based on age and time interaction (F = 9.86, p < .001) and in terms of self-care behaviors (F = 7.15, p = .009). Moreover, these increases were significantly larger than the increases recorded by the comparison group. In addition, these increases were particularly large in the older empowerment-group participants with lower pretest scores for empowerment. CONCLUSIONS: Empowerment support may be critical to improve the empowerment and self-care behaviors of renal transplant patients. The results of this study may be applied to improve patient education and empowerment programs for renal transplant patients. Furthermore, these programs may be adjusted to take into consideration the learning preferences or needs of different age groups.

Factors Associated With the Perception of Family Nursing Practice Among Mental Health Nurses in Taiwan.

The aim of this study was to examine factors that influenced the perceptions of mental health nurses about involving families in their nursing practice. A sample of 175 Taiwanese mental health nurses who are employed in both inpatient and community settings completed structured questionnaires designed to measure empathy, attitudes about involving families in care, and perceptions of family nursing practice. Data were analyzed using descriptive statistics, Pearson's product-moment correlation, t test, one-way ANOVA, and a hierarchical multiple regression analysis. Positive perceptions of family nursing practice were correlated with more years of clinical experience in mental health, empathy, supportive attitudes toward the importance of family nursing care, and personal experiences with family members with serious illness in need of professional care. These findings may assist in the development of effective educational programs designed to help nurses integrate family nursing knowledge and skills in the care of patients and families experiencing mental illness.

Effects of music aerobic exercise on depression and brain-derived neurotrophic factor levels in community dwelling women.

A randomized clinical trial was utilized to compare the improvement of depression and brain-derived neurotrophic factor (BDNF) levels between community women with and without music aerobic exercise (MAE) for 12 weeks. The MAE group involved 47 eligible participants, whereas the comparison group had 59 participants. No significant differences were recorded in the demographic characteristics between the participants in the MAE group and the comparison group. Forty-one participants in the MAE group and 26 in the comparison group completed a pre- and posttest. The MAE group displayed significant improvement in depression scores (p = 0.016), decreased depression symptoms in crying (p = 0.03), appetite (p = 0.006), and fatigue (p = 0.011). The BDNF levels of the participants significantly increased after the 12-week MAE (p = 0.042). The parallel comparison group revealed no significant changes in depression scores or BDNF levels. In summary, the 12-week MAE had a significant impact on the enhancement of BDNF levels and improvement of depression symptoms. Middle-aged community women are encouraged to exercise moderately to improve their depression symptoms and BDNF levels.

Factors influencing mental health nurses' attitudes towards people with mental illness.

This study aimed to investigate the factors influencing mental health nurses' attitudes towards people with mental illness. A descriptive correlation design was used. A sample of 180 Taiwanese mental health nurses was recruited from mental health-care settings. Data were analyzed with descriptive statistics, Pearson's product-moment correlation, Student's t-test, one-way anova, and a hierarchical multiple regression analysis. Negative attitudes were found among mental health nurses, especially with respect to individuals with substance abuse compared with those with schizophrenia and major depression. Mental health nurses who were older, had more clinical experiences in mental health care, and demonstrated greater empathy expressed more positive attitudes towards people with mental illness. Mental health nurses working at acute psychiatric units demonstrated more negative attitudes towards mental illness compared with those working in psychiatric rehabilitation units and outpatient clinics or community psychiatric rehabilitation centres. Particularly, length of mental health nursing practice and empathy significantly accounted for mental health nurses' attitudes towards mental illness. Understanding nurses' attitudes and their correlates towards people with mental illness is critical to deliver effective mental health nursing care.