Systematic Review and Meta-Analysis of Prevalence of Depression Among Caregivers of Cancer Patients.

Background: Caregivers of cancer patients commonly experience depressive symptoms due to the heavy burden of caregiving responsibility. Objective: This meta-analysis examined the prevalence of depression among caregivers of cancer patients. Methods: We included 85 studies covering 23,317 participants published between 2001 and 2021 (25 countries) that reported the prevalence of depression among caregivers of cancer patients. We examined the pooled prevalence of depression and hypothesized moderators, including year, age, sex, geographic regions, percentage of spousal caregivers, depression measures, and cancer stage. Results: All 85 effect sizes included 6,077 caregivers of patients with depression. The weighted average prevalence of depression was 25.14% (95% CI, 21.42-29.27%) among caregivers. The prevalence rates were moderated by geographic region, patients' cancer stage, and measures for depression. The prevalence rates also varied among the different measures assessing depression. The prevalence rate decreased with the mean age of the caregivers and the percentage of spousal caregivers. Conclusions: This study revealed a high prevalence of depression among caregivers of cancer patients. The prevalence rates also varied with the study design, demographics of caregivers, and patients' medical information. These findings highlight that psychological support and intervention may be crucial for patients and their caregivers in clinical practice.

Ethical Bonds Transformation in Bereaved Taiwanese Families: A Preliminary Study.

Ethical bonds transformation is a cultural phenomenon in Taiwanese bereaved families. When the death event occurs, the absent status of the deceased invokes spontaneous change in whole family to cope with the irreparable loss. In the present study, 283 bereaved individuals were recruited to develop the ethical bonds transformation scale. Exploratory factor analysis has generated two factors: ethical bonds and symbolic bonds. Partial correlation has shown that ethical bonds was positively correlated with post-grief growth and negatively correlated with most of the grief related symptoms, indicating that ethical bonds might be a protective factor in the family grief process.

[Spatiality and Temporality: Body Image of Chronic Illness Patients].

This paper proposed the concepts of "body me" and "I body". Furthermore, the images of colostomy and fistula are used as examples to show that the body image of chronic illness has both temporal and situational meanings and shares a reciprocal relationship with self-identity (i.e., idem identity and ipse identity). Rather than providing an organic explanation, body image is an interactive relationship among time, situation, body, self, and others, which are all important aspects necessary to understand the individual and the world in which she/he lives. Finally, reflecting on humanistic clinical psychology, the ethical relationship practice of "we-ness" is proposed to shed illustrative light on the body image of chronic illness patients from a new perspective.

Revisiting the Continuing Bonds Theory: The Cultural Uniqueness of the Bei Dao Phenomenon in Taiwanese Widows/Widowers.

In the present study, we used the phenomenological approach to rediscover the ontological meaning of relationships with the deceased in Taiwanese widows/widowers. We first revised the original Western definitions of grief, bereavement, and mourning to fit Taiwanese culture. We used the word bei dao to indicate the mixed nature of grief and mourning in the Taiwanese bereavement process. Then we reanalyzed data from a previous study, which was conducted in 2006. In the previous qualitative research, each subject was interviewed 3 to 4 times in the mourning state over an 18-month interval that began at the point of the spouse's death. Results showed that two main themes emerged in the present analysis: (a) a blurred boundary of life and death and (b) a transformation of ethical bonds. The present study reveals the culturally unique aspects of the Taiwanese bei dao process. Limitations of the present study and future directions are discussed and reflected.

[Calamitous moments: rethinking the ethics of post disaster psychological reconstruction programs].

This article points out firstly that disaster and traumatic events resulting from calamitous moments must be the focus of dedicated long term research and of ontological caring in practice. Ethical issues related to the post disaster psychological reconstruction program represent an important agenda. Therefore, in the execution of serial programs and nursing care, it should not be taken for granted that sufferers are destined to be pathological clients. Rather, each sufferer should be attended to in a humanistic manner. In other words, the elimination of symptoms cannot be our only focus. Secondly, the author discusses the ethical dimensions of post-disaster psychological intervention within a "Five T" framework (namely, tears, time, talk, transformation, and trauma). The author then explores the meaning of posttraumatic psychological growth, which is relevant to the resilience that coexists with suffering. Finally, it is important to practice ontological care from the context of being "within" the relationship, rather from a rigid cognition regarding program efficiencies. 'Being' provides much greater depth than 'doing'.

Perspectives on professional values among nurses in Taiwan.

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

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

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

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

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

Testing a model of stress and health using meta-analytic path analysis.

The goal of this study was to use meta-analytic path analysis to evaluate a theoretical model of stress and health. A meta-analysis technique was adopted to combine and re-analyze 477 studies that investigated stress-related topics between January 1980 and December 2003 in Taiwan. Databases searched included PerioPath-Index to Chinese Periodical Literature, Electronic Theses and Dissertations System, and NSC (National Science Council) Science and Technology Information System. Variables recorded included stress, health, social support, coping strategies, and personality traits. A correlation matrix of these variables was derived from meta-analytic data and then analyzed using structural path analysis to test the fitness of the hypothesized stress-health model to the observed aggregated data. Results showed the revised hypothesized model to be a reasonable, good fit to aggregated data. Based on the theoretical stress-health model developed in this study, subjective stress was found to have a substantively important and direct effect on health, whereas objective stress required the mediating function of subjective stress to exercise an influence on health. Such variables as social support, coping strategies, and personality traits had comparatively weaker influences, either direct or indirect, on the stress-health process. This study provided a holistic view on the relationship between stress and health in the context of stress and proposed a direction for future research and practice.

A meta-analysis of the association between stress and health in Taiwan.

This study adopted the meta-analysis technique to analyze 354 journal articles, theses, and dissertations that had investigated the association between stress and health in Taiwan between January 1980 and December 2003. This study was conducted with the purpose of understanding the association between general stress and general health, the discrepant associations between different stress types and health facets, and the possible moderators between general stress and general health. A computer search for relevant studies was conducted on several databases using the key words "stress" and "life event". For each eligible study, the important study characteristics were recorded, and the effect sizes of the relationship between stress and health were computed. Furthermore, in order to investigate the moderating effects of the study characteristics on the stress-health relationship, the methods of categorical model analysis and correlation analysis were employed. The results of this study revealed that: (1) the correlations between general stress and general health as well as between general stress and various health facets fell between medium and high; (2) there existed different degrees of association between various stress types and health facets; and (3) none of the demographic and methodologic variables could by itself moderate the relationship between general stress and general health as the moderator effects were not sufficient and strong enough. This study presents a multidimensional framework of the issues on the relationship between stress and health, and it provides guiding references for future research. No evidence was found for moderating effects of social support, coping strategies, and personality traits on the stress-health relationship. Such findings may be due to methodologic limitations. This suggests that further investigation is needed.

Death and help expected from nurses when dying.

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

Meta-analysis of counseling and psychotherapy outcome studies in Taiwan.

This study applied the meta-analysis method to investigate the effectiveness of counseling and psychotherapy. It began with a systematic search of the literature through computer search and previous narrative reviews to locate counseling and psychotherapy outcome studies conducted in Taiwan between January 1971 and August 2000. Salient characteristics of each study were recorded systematically. These study characteristics included type of therapy, type of target problem, therapist experience, and type of outcome measure, among others. In total, 257 studies, which yielded 302 effect sizes, were examined, in which clients who received psychotherapy or counseling were compared with controls. Results demonstrated that the overall mean effect of counseling and psychotherapy was positive and significant. Further categorical model testing indicated that most coded study characteristics were significantly related to effect sizes.