Treatment withdrawal experiences of women with breast cancer: A phenomenological study.

AIM: To obtain an in-depth understanding of the lived experiences, values, and beliefs of Taiwanese women with breast cancer who withdrew from cancer treatment. BACKGROUND: Fear of side effects, negative experiences and personal beliefs were identified as reasons for withdrawing from cancer treatments. Body-mind consciousness and body autonomy play a crucial role in cancer treatment decisions. DESIGN: Descriptive phenomenological approach. METHODS: We conducted semi-structured, face-to-face and in-depth interviews with 16 women diagnosed with breast cancer. Participants were purposefully selected from the Cancer Registry database. Employing a phenomenological approach, our aim was to explore the lived experiences of these individuals. Data analysis followed Giorgi's five-step process. To ensure a comprehensive report the COREQ checklist was applied. FINDINGS: 'The Determination to Preserve Me' is the essence of treatment withdrawal, identified by three themes and seven sub-themes. 'Raising Body-Mind Consciousness' was generated using body autonomy and preventing repeated psychological trauma from the participant's view. Their lifestyles, maintaining the family role, and returning to a normal trajectory help develop 'Maintaining Stability for Being a Patient and a Family Carer'. 'Self-Defending Against the Body Harm' was generated by concerns about maintaining health and preventing harm. CONCLUSION: Women's behaviours became transformed by suffering. Actions were influenced by physical and psychological distress, misconceptions about treatments, and appearance changes by self-determination through self-protection. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should respect women's autonomy and work collaboratively to ensure their decision-making with accurate information and awareness of the potential risks and benefits of treatment withdrawal need to concern.

Holistic Nursing and Quran Recitation and its Impact on Floods Survivors in Indonesia.

Purpose: The purpose of the study was aimed to explore the trajectory of thoughts and feelings related to religiosity and spirituality using a holistic approach following attendance at group-Quran Recitation (QR) sessions among annual flood victims. Design: This is a qualitative study with an in-depth retrospective interview conducted data in 2019. Methods: The purposive sampling was applied to conduct face-to-face individual video-recorded semistructured interviews. Seventeen participants followed six QR chanting sessions in Bandung, Indonesia. Data were transcribed verbatim and analyzed using inductive analysis. Findings: After extracting evidence expressions of participants, the research team generated the central theme of "Holism of Religiosity and Spirituality," using three influential sub-themes, including obedience to God's will, growing a positive mindset through spirituality and life started to be delighting from nine categories. Conclusion: The relationship of body-mind concepts of holism through QR among flood sufferers was explored. The effect of QR chanting is beneficial to change awareness about the wisdom of spirituality. The holistic approach of religiosity and spirituality in nursing care is recommended to promote all service settings, especially community and disaster nursing in the Indonesian context. Future research is needed to develop QR chanting activities among multiethnic and socio-cultural groups as alternative therapy quantitatively.

Impact of early palliative care on the quality of life in caregivers of cancer patients: A systematic review.

BACKGROUND: Maintaining caregivers' quality of life (QoL) is critical to sustaining the care needed for cancer patients. One of the interventions applied to cancer patients' caregivers is early palliative care (EPC). AIMS: This systematic review synthesized the implementation of EPC on the QoL of caregivers of cancer patients. METHODS: The search was undertaken using seven electronic databases: Medline, Embase, CINAHL, CENTRAL, Web of Science, Scopus, and ProQuest Dissertation & Theses (PQDT). The search strategy integrated relevant terms of early palliative care, caregivers, cancer, and quality of life and was conducted until March 14, 2022. The thematic data analysis approach was used to integrate the results. RESULTS: Using advanced search features, 4193 studies were obtained on the initial search. After screening and quality assessment, eight studies were included. Eight studies depicted that EPC interventions were delivered for caregivers of patients with advanced cancer, that is, those with a life expectancy of at least 4-24 months or considered intermediate to poor prognosis. One study provided the intervention for caregivers of patients newly diagnosed with cancer. None of the studies had the same protocol or content in delivering EPC for caregivers. Four studies gave similar details on addressing the strategies for caregivers in several aspects, including physical, psychological, social, and spiritual. There was no difference in the QoL between caregivers with cancer patients who received EPC compared with usual care. EPC was noted to influence other factors, such as caregivers' psychological distress and burden. LINKING EVIDENCE TO ACTION: The data on EPC interventions portray no beneficial effects on the QoL of caregivers with cancer patients. Further studies on developing standard protocols of EPC, multidisciplinary team, and how early it should be given to caregivers are strongly recommended.

[The Effectiveness of Acupressure in Reducing Cancer-Related Fatigue: A Systematic Review and Meta-Analysis].

BACKGROUND: Acupressure is one of the recommended non-pharmacologic treatments for cancer-related fatigue (CRF) according to the National Comprehensive Cancer Network guidelines. However, few systematic review or meta-analysis studies have focused on the effect of acupressure on CRF. PURPOSE: The purpose of this study was to examine the effectiveness of acupressure in reducing CRF and to identify the effective acupoints and frequencies of acupressure treatments. METHODS: The search and screening procedures were conducted in accordance with PRISMA 2009 guidelines. The search database included Embase, CINAHL, Cochrane Library, MEDLINE and Google Scholar. RoB 2.0 and ROBINS-I were used as appraisal tools. The statistical analysis, including effect size estimation, was computed using RevMan 5.4. RESULTS: Twelve studies (15 sets of data) were included in the review and analysis. Nine hundred sixty patients with cancer who were currently undergoing or had completed treatment were enrolled as participants and received different levels of acupressure. The result showed the overall effect size of CRF in reducing acupressure to be SMD= -0.77, 95% CI [-0.90, -0.65]. In the subgroup analysis, the effect size of auricular acupressure was SMD= -0.98, 95% CI [-1.25, -0.71] and the body acupressure effect size was SMD= -0.70, 95% CI [-0.84, -0.56]. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Based on the results of this systematic review, acupressure may be applied to the body acupoints Hegu (LI4), Zusanli (ST36), and Sanyinjiao (SP6) once daily for 1-3 minutes each and to the auricular acupoints shenmen and subcortex once daily for 3 minutes each to effectively reduce cancer-related fatigue.

Effects of Aerobic Walking on Memory, Subjective Cognitive Complaints, and Brain-Derived Neurotrophic Factor Among Older Hypertensive Women.

Background:Hypertension is prevalent in older women and is associated with increased cognitive impairment. Exercise has demonstrated beneficial effects on cognitive function, but the impact of exercise on older hypertensive women remains unclear. We investigated the effects of an aerobic walking program on memory, subjective cognitive complaints, and brain-derived neurotrophic factor in older hypertensive women. Methods: A quasi-experimental study with a pretest-posttest design was conducted. Older hypertensive women were randomly assigned to the aerobic walking group or a control group with routine care. The intervention group received a 24-week aerobic walking program. Data were collected at baseline and 24 weeks after enrollment. Participants' characteristics, memory, subjective cognitive complaints, and plasma brain-derived neurotrophic factor were analyzed. Results: The aerobic walking group (n = 30) reported improvements in total recall, delayed recall, and subjective cognitive impairment after 24 weeks of aerobic walking. Compared to the control group (n = 28), the aerobic walking group showed significantly greater improvement in delayed recall at 24 weeks. However, aerobic walking had no significant effect on subjective cognitive complaints or brain-derived neurotrophic factor. Conclusion: The aerobic walking training significantly improved memory performance among older women with hypertension. A longer randomized controlled trial with a larger sample is necessary to confirm and further explore the effects of this intervention.

Predictors of cancer-related fatigue in women with breast cancer undergoing 21 days of a cyclic chemotherapy.

BACKGROUND: Breast cancer is the most common diagnosis and the leading cause of cancer death among women worldwide and ranks first among Asian and Taiwanese women. Cancer-related fatigue (CRF) affects patients' functioning significantly. AIMS: The aim of this study was to examine changes in cancer-related fatigue (CRF) and related factors among women with breast cancer undergoing a single chemotherapy, and to identify predictors of CRF's change over the course of the chemotherapy cycle. METHODS: Four self-report questionnaires were administered to assess CRF, sleep quality, depression and anxiety, and symptom distress. Heart rate variability (HRV) was assessed to evaluate autonomic nervous system activation related to CRF. Data were collected four times: (1) before initiation of the single chemotherapy cycle (T0), (2) after completion of the single cycle (T1), (3) 1 week post-chemo (T2), and (4) 3 weeks post-chemo (T3). Repeated measurement of variance and generalized estimating equations (GEE) were conducted to estimate the trajectories and predictors. RESULTS: One-hundred women with breast cancer (mean age 50.4 ± 9.42) participated. CRF (F = 7.46), sleep quality (F = 2.74), symptom distress (F = 9.99), anxiety (F = 5.72), and depression (F = 4.14) varied significantly over the single cycle of chemotherapy (p < .001), which the trajectories showed exacerbating at T2. HRV indicated a higher variation only on the day of injection (T0, T1). Results of the GEE revealed that anxiety, depression, and symptom distress were predictors of CRF's change over the single cycle of chemotherapy. LINKING EVIDENCE TO ACTION: CRF worsens at 1 week after a chemotherapy injection among Taiwanese women with breast cancer. Based on the risk predictors in CRF that included anxiety, depression, and symptom distress, multistrategy CRF-alleviating interventions should be provided prior to chemotherapy and targeted at the most disturbed period, that is, 1 week after injection.

Mediating Effects of Coping Strategies on the Relationship Between Mental Health and Quality of Life Among Indonesian Female Migrant Workers in Taiwan.

INTRODUCTION: Mental health is a major concern among migrant workers worldwide. More than 200,846 female migrant workers in Taiwan are from Indonesia. The study's purpose was to investigate mediating effects of coping strategies on the relationship between mental health problems and the quality of life (QoL). METHOD: This cross-sectional study was conducted in Taiwan. In total, 500 Indonesian female migrant workers completed four questionnaires. A mediation test was conducted to estimate direct and indirect effects. RESULTS: Coping strategies, namely substance use, behavioral disengagement, denial, and religious dedication, partially mediated the relationship between mental health problems (depression, anxiety, and stress) and QoL among Indonesian female migrant workers in Taiwan. DISCUSSION: Health promotion programs should be developed for Indonesian female migrant workers in Taiwan to help them detect and overcome their mental health problems. Interventions that facilitate effective coping strategies should be administered to improve their QoL.

Can the Paro be my Buddy? Meaningful experiences from the perspectives of older adults.

This study aimed to explore meaningful experiences of older Taiwanese adults who had received a Paro (social robot) companion. Semi-structured qualitative interviews elicited the perspectives of 25 older adults living in a long-term care facility after they had interacted with an individual Paro companion for 8 weeks. Thematic analysis was used in this study as it allows for rich, detailed, and complex descriptions of qualitative data. Analysis identified four themes: Bridging my social bonds; Acting as a comfort Buddy; Relieving my emotional distress; and Encountering Paro with distancing. Although Paro's functioning has some limits, such as lacking speech, most participants expressed that the experience was positive. These findings revealed that the meaningful experiences expressed by participants at the end of the intervention with Paro might provide the value of companionship and improve interpersonal relationships for older adults in geriatric nursing.

Beneficial Exercises for Cancer-Related Fatigue among Women with Breast Cancer: A Systematic Review and Network Meta-Analysis.

CONTEXT: Cancer-related fatigue (CRF) is the most common cause of physical powerlessness in women with breast cancer (BC). The practice of continuous effective exercise is beneficial with respect to reducing CRF. OBJECTIVE: To explore exercise efficacy and respective ranks with respect to reducing CRF in women with BC within the inter-treatment and post-treatment periods. METHODS: Throughout this systematic review and network meta-analysis, articles published from 2000 to March 2022 were included. Article searches were conducted on the MEDLINE, Embase, CINAHL, and CENTRAL databases. Adult women with BC and different exercise programs were compared with those involved in regular care as a control during or after treatment. In addition, randomized controlled trials (RCT) were also included. A risk-of-bias assessment, with the revised Cochrane risk-of-bias tool regarding RCT and probability-based ranking, was established based on the surface under the cumulative rank (SUCRA) method via network meta-analysis. RESULTS: a total of 5747 women with BC followed seven exercise interventions. Yoga (SMD = -0.54, 95% CI [-0.86, -0.22]) was ranked first (94.5%), with significant effects in respect of mitigating CRF, followed by resistance exercise (66.2%), and aerobic resistance (63.3%), while Qigong ranked last (22.2%) among the 36 RCT in inter-treatment. Aerobic resistance exercise (SMD = -0.52, 95% CI [-0.98, -0.07]) induced significant effects in respect of mitigating CRF in the 38 RCTs in the post-treatment period. Yoga, aerobic yoga, and aerobic resistance exercise ranked as the top three (75.5%, 75.0%, and 72.4%, respectively), whereas relaxation ranked last (38.8%) in the post-treatment period. CONCLUSION: Yoga, aerobic resistance, and aerobic yoga are recommended for the purposes of inter- and post-treatment exercise to reduce CRF in women with BC by enhancing their physical resilience and long-term quality of life.

Cognitive function and associated factors among postmenopausal women with hypertension and natural menopause in Taiwan.

Hypertension is prevalent among postmenopausal women worldwide and is a risk factor for cognitive impairment. This study examined the cognitive differences between Taiwanese postmenopausal women with and without hypertension after natural menopause and identified factors associated with cognitive function in hypertensive postmenopausal women. A two-group comparative design study of 171 Taiwanese postmenopausal participants (mean age = 64.8±6.6) was conducted in southern Taiwan. Cognitive performance on neuropsychological tests was evaluated, and demographic, health, menopausal, and disease related variables were assessed. Compared to the non-hypertensive group, women with hypertension showed significantly worse performance and a higher percentage of impairment in global cognitive functioning and memory. Fewer years of education and longer duration of hypertension were associated with lower global cognitive function, and increased age was associated with lower scores in delayed memory. Cognitive screening as well as training on global cognitive functioning and memory are needed for postmenopausal hypertensive women. (148 words).

Correlations among life stress, smoking behavior, and depressive symptoms in adolescents: A descriptive study with a mediating model.

The major objective of this study was to investigate how smoking behavior mediates the relationship between life stress and depressive symptoms in adolescents. A descriptive correlational study was conducted from February to June 2017 at a vocational high school in northern Taiwan, and 226 students were recruited through convenience sampling. Results indicated that smoking behavior played a pivotal role by partially mediating the relationship between life stress and depressive symptoms in adolescents. Life stress in adolescents significantly increased the risk of experiencing depressive symptoms, and adolescents who smoked were also at a greater risk. Assessments between the objective and self-reported smoking behavior were significantly correlated. Therefore, integrated methods for assessing life stress, smoking behavior, and depressive symptoms in adolescents are needed for teachers and clinical professionals. Implementing appropriate policies for discouraging tobacco use for adolescents experiencing life stress in order to decrease depressive symptoms in school settings is paramount.

Music, heart rate variability, and symptom clusters: a comparative study.

PURPOSE: This study aimed to explore the possible range of change of a single-session music intervention (SMI) on symptom clusters and neurological reactivity for women with breast cancer undergoing chemotherapy. METHODS: A parallel and randomized, controlled study with repeated measures design was used. A total of 100 women with breast cancer were randomly assigned to the SMI or a control group. The outcome measurements of symptom cluster were collected using the Multidimensional Fatigue Symptom Inventory, Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and the neurological reactivity with heart rate variability at four time points: before commencement of the intervention (T0), immediately afterward (T1), 1 week later (T2), and 3 weeks after the intervention (T3). RESULTS: Of the 50 women in each group, 46 in the SMI and 48 in the control group completed the post-test at T3. Multivariate analysis of variance indicated that the SMI group had a medium effect in change of symptom clusters compared to the control group at T2. Moreover, after adjusting for baseline between normal and higher levels of sympathetic tone activity, significant differences existed in fatigue and depression at T2 and sleep disturbance at T3. CONCLUSIONS: A single-session music intervention can be effectively used to reduce symptom clusters for women with breast cancer. Targeting those who have a higher level of sympathetic tone activity is recommended.

Progressive muscle relaxation for patients with chronic schizophrenia: A randomized controlled study.

PURPOSE: To evaluate progressive muscle relaxation (PMR) as an intervention for anxiety, psychotic symptoms, and quality of life (QOL) in patients with chronic schizophrenia. DESIGN AND METHODS: Eighty patients were recruited from a Taiwanese psychiatry ward. The intervention group received group PMR; control group received treatment-as-usual. RESULTS: The results indicated that PMR might have a short-term effect on reducing anxiety, improving psychotic syndromes, and QOL among patients with chronic schizophrenia; however, the effectiveness at the 3-month follow-up was not evident. PRACTICE IMPLICATIONS: Both the psychiatric patients and the health institutions may be able to list PMR as a clinical routine care, and then become a mental health practice strategy for mental patients to improve the quality of mental care. IMPLICATIONS FOR NURSING PRACTICE: Our studies suggest that prevention of severe mental illness among patients with schizophrenia requires PMR interventions. PMR had an immediate effect, and it is possible that a shorter intervention period using this approach would also be successful.

The Efficacy of Metacognitive Training for Delusions in Patients With Schizophrenia: A Meta-Analysis of Randomized Controlled Trials Informs Evidence-Based Practice.

BACKGROUND: Metacognitive training (MCT) was developed in 2007 and widely used to modify the delusions for patient with schizophrenia. However, its effectiveness remains unclear. AIMS: To investigate the overall effectiveness of MCT for delusion in schizophrenia patients from 2007 to 2016, and to investigate the variables (intervention approach, intervention dose, and participant factors) of an MCT study that could influence the effect size. METHODS: Parallel-arm design of MCT for delusions published from 2007 to 2016 were collected and then cross-referenced using these keywords: delusion (psychosis or psychotic or schizophrenia) and metacognitive (training or therapy or intervention). The quality of the studies was evaluated and the effect size and the moderating variables of MCT on delusion were determined. RESULTS: A total of 11 studies on the effect of MCT for delusion were investigated. The MCT had a moderate immediate postintervention effect (g = -0.38) and a lasting effect after 6 months (g = -0.35). In terms of immediate effect, moderating variables with significant differences between them were (a) individual approach versus group-based approach and mixed approach, and (b) eastern country versus western country. LINKING EVIDENCE TO ACTION: MCT could be used as a valuable nonpharmacologic intervention to reduce delusions in clinical settings. The individual modularized MCT approach had a beneficial effect and is recommended to healthcare professionals as an application for patients with schizophrenia or delusional disorder.

[The Pain-Relief Efficacy of Passive Music-Based Interventions in Cancer Patients Undergoing Diagnostic Biopsies and Surgery: A Systematic Review and Meta-Analysis].

BACKGROUND: Music-based intervention is commonly used as a non-pharmacological strategy to reduce pain in hospitalized patients. PURPOSE: To conduct a systematic review and meta-analysis to examine the effects of passive music-based interventions on pain relief in cancer patients undergoing diagnostic biopsies and surgeries and to identify the moderating variables in order to identify clinically validated interventional strategies and related suggestions. METHODS: Studies using an RCT (randomized clinical trial) design that were published before 2016 were collected from the following databases: Cochrane Library/Trials, PubMed, PsycINFO, CINHAL, and Index to Taiwan Periodical Literature System. The high-quality studies, defined as those earning a modified Jadad scale score >3, were then analyzed using comprehensive meta-analysis software. RESULTS: The passive music-based interventions had a small-to-moderate overall effect (g = -.42, p = .02) on pain relief in the subjects undergoing diagnostic biopsies and surgery in the analyzed studies (n = 12). Subgroup analysis identified the moderating variables affecting pain reduction as the type of anesthesia administered and the settings, frequency, and music therapist that were used in the intervention. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Passive music-based interventions have a significant pain reduction effect and may be used as an effective, non-pharmacologic intervention for cancer patients undergoing diagnostic biopsies and surgery. Delivering 2-3 intervention sessions daily, using a certificated music therapist to deliver/guide the sessions, holding the sessions in waiting-room or ward settings, and administering a general anesthesia were identified as the crucial factors impacting the effectiveness of music intervention on pain relief.

Comparison of group vs self-directed music interventions to reduce chemotherapy-related distress and cognitive appraisal: an exploratory study.

PURPOSE: The purpose of this study was to determine effects of group music intervention and self-directed music intervention on anxiety, depression, and cognitive appraisal among women with breast cancer. METHODS: A quasi-experimental design randomly assigned 60 women undergoing chemotherapy to 3 groups: group music intervention, self-directed music intervention, or a control group. The Hospital Anxiety and Depression Scale and the Mini-Mental Adjustment to Cancer Scale were administered before, after the 8-week interventions, and at 3-month follow-up. RESULTS: Of the 52 women completing the study, results indicated that group music intervention had a significant (p < .01) immediate effect to decrease helplessness/hopelessness and anxious preoccupation and significant effects for reducing anxiety, depression, helplessness/hopelessness, and cognitive avoidance compared to the other two groups at 3-month follow-up. CONCLUSIONS: Group music intervention can be considered an effective supportive care in alleviating the chemotherapy-related distress and enhancing cognition modification of women with breast cancer. Further research is needed to determine the role of cognitive appraisal in the illness trajectory.

Effects of Home-Based Supportive Care on Improvements in Physical Function and Depressive Symptoms in Patients With Stroke: A Meta-Analysis.

OBJECTIVE: To examine the effects of home-based supportive care on improvements in physical function and depressive symptoms in home-dwelling patients after stroke. DATA SOURCES: Seven electronic databases (eg, MEDLINE, PubMed, CINAL, EMBASE, the Cochrane Central Register of Controlled Trials, ProQuest, and Google Scholar) and 4 Chinese databases (eg, WANFANG MED ONLINE, Chinese Electronic Periodical Services, China Academic Journals Full-text Database, and National Central Library) were fully searched for all relevant articles up to June 25, 2016. STUDY SELECTION: Randomized controlled trials examining the effects of home-based supportive care on physical function and depressive symptoms in home-dwelling patients after stroke were included. Finally, 16 articles in Chinese (n=4) and English (n=12) met the inclusion criteria. DATA EXTRACTION: Data on patient characteristics, study characteristics, intervention details, and outcome were extracted. Two reviewers independently extracted data and assessed methodological quality using the Cochrane risk of bias tool. DATA SYNTHESIS: Home-based supportive care had a small size effect on physical function (Hedges' g=.17; 95% confidence interval, .09-.26) and a moderate size effect on depressive symptoms (Hedges' g=-.44; 95% confidence interval, -.83 to -.05) in home-dwelling patients after stroke. The moderator analysis revealed that some components of study participants and intervention programs improved the effects on physical function and depressive symptoms; however, no significant moderators were further identified to have superiorly improved physical function and depressive symptoms. CONCLUSIONS: Regular performance of home-based supportive interventions should be considered for inclusion as routine care for managing and improving physical function and depressive symptoms in home-dwelling patients after stroke. The present findings provide further evidence with which to design appropriate supportive interventions for home-dwelling stroke survivors.

Validation and Cross-Cultural Adaptation of a Chinese Version of the Emotional and Social Dysfunction Questionnaire in Stroke Patients.

The objectives of this study were to develop a cross-cultural Chinese version of the Emotional and Social Dysfunction Questionnaire (ESDQ-C) and test its validity and reliability among Chinese-speaking stroke patients. Various methods were used to develop the ESDQ-C. A cross-sectional study was used to examine the validity and reliability of the developed questionnaire, which consists of 28 items belonging to six factors, anger, helplessness, emotional dyscontrol, indifference, inertia and fatigue, and euphoria. Satisfactory convergence and known-group validities were confirmed by significant correlations of the ESDQ-C with the Profile of Mood States-Short Form ( p < .05) and with the Hospital Anxiety and Depression Scale ( p < .05). The internal consistency was represented by Cronbach's alpha, which was .96 and .79 to .92 for the entire scale and subscales, respectively. Appropriate application of the ESDQ-C will be helpful to identify critical adjustment-related types of distress and patients who experience difficulty coping with such distress.

Dose-Response Relationships of Multisensory Intervention on Hospitalized Patients With Chronic Schizophrenia.

BACKGROUND: Patients with chronic schizophrenia often show negative emotional responses because of cognitive impairment. Multisensory stimulation therapy has been shown effective in improving cognitive and emotional functions in cognitively impaired patients with dementia. However, very few studies have applied this multisensory intervention to patients with chronic schizophrenia. Furthermore, it is not known whether a dose-response relationship exists between the frequency and efficacy of this intervention. PURPOSE: The objective of this study was to evaluate the relationship between the effects and dose-response of the multisensory intervention on patients with chronic schizophrenia in a mental rehabilitation hospital. METHODS: A crossover study design with a sample size of 60 was conducted. Participants were divided equally between an experimental group and a control group. The experimental group received the intervention in a multisensory stimulation room. Six sessions of the 30-minute sensory intervention were conducted on experimental group participants, who were allowed to select their preferred stimulants. In contrast, the control group received routine care only. After a 2-week washout period, participants in the experimental group were reassigned to the control group, and those in the control group were reassigned to the experimental group. Standardized questionnaires were applied to evaluate psychotic symptoms, emotional responses, and well-being of all participants. The NeXus-4 model wireless biofeedback system was used to measure the psychological-physiological parameters of participants at baseline and after the first, third, and sixth sessions of the multisensory intervention. A generalized estimating equation model was used to analyze the effects of the intervention RESULTS:: Although multisensory stimulation therapy had no significant effect on psychotic symptoms and well-being, this intervention may improve the negative emotional reactions of patients. In particular, the intervention significantly reduced the subjective anxiety level of participants and stabilized their objective respiratory and heart rates. Moreover, a positive correlation was found between the efficacy of the treatment and the frequency of the intervention. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Evidence from this study validated the multisensory stimulation therapy protocol. Therefore, this protocol may be incorporated into clinical interventions to improve quality of care and to alleviate the negative emotions of patients with chronic schizophrenia.

Factors predicting emotional cue-responding behaviors of nurses in Taiwan: An observational study.

OBJECTIVE: Responding to emotional cues is an essential element of therapeutic communication. The purpose of this study is to examine nurses' competence of responding to emotional cues (CRE) and related factors while interacting with standardized patients with cancer. METHODS: This is an exploratory and predictive correlational study. A convenience sample of registered nurses who have passed the probationary period in southern Taiwan was recruited to participate in 15-minute videotaped interviews with standardized patients. The Medical Interview Aural Rating Scale was used to describe standardized patients' emotional cues and to measure nurses' CRE. The State-Trait Anxiety Inventory was used to evaluate nurses' anxiety level before the conversation. We used descriptive statistics to describe the data and stepwise regression to examine the predictors of nurses' CRE. RESULTS: A total of 110 nurses participated in the study. Regardless of the emotional cue level, participants predominately responded to cues with inappropriate distancing strategies. Prior formal communication training, practice unit, length of nursing practice, and educational level together explain 36.3% variances of the nurses' CRE. CONCLUSIONS: This study is the first to explore factors related to Taiwanese nurses' CRE. Compared to nurses in other countries, Taiwanese nurses tended to respond to patients' emotional cues with more inappropriate strategies. We also identified significant predictors of CRE that show the importance of communication training. Future research and education programs are needed to enhance nurses' CRE and to advocate for emotion-focused communication.