The Transformation Process in Nurses Caring for Dying Patients.

BACKGROUND: Despite the recent increase in attention to end-of-life hospice care, little empirical evidence regarding the process of emotional or mental transformation in caregivers is available. PURPOSE: This study explores the transformative process that occurs in nurses because of the spiritual suffering and conflict associated with after caring for dying patients. METHODS: A phenomenological approach was used to investigate eight nurses (27-40 years old) working in the hospice ward of a medical center in Taipei. Data were collected through open-ended questions using semistructured interviews and were analyzed reflectively. RESULTS: A three-stage transformation in the emotional processes of participants was observed. In the first stage, the participants experienced acute emotional suffering because of facing the death of their patients, potentially exacerbated by their own memories of losing family members. In the second stage, the participants adopted coping strategies to improve self-care. These strategies included attempting to soothe patients, helping patients face or deal with unfulfilled business, and participating in funeral or memorial services. In the third stage, the participants learned to provide better care through emancipatory reflection and a reassertion of responsibilities toward the self, patients, and patient families. After the third stage, the initial emotional impact morphed into a medium for self-strengthening, and participants became more adept at detecting patient needs and at providing care to complete the transformational process fully. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Emotional suffering was the primary factor that induced participants to transform their personal and professional selves. Adequate emotional self-management, dialogue with other nurses, and personal reflection are crucial actions that nurses may use to cultivate personal growth, implement ethical practice, interact with other nurses, and engage in personal reflection. Strategies such as caring for patients, implementing reflective nursing practices, focusing on patient needs, and utilizing past experiences enable nurses to develop a heightened sense of responsibility and awareness, thus empowering them to take better care of themselves and their patients.

Anxiety, Decision Conflict, and Health in Caregivers of Children with ADHD: A Survey.

The purpose of this study was to test a theoretical model to determine the effect of caregiver anxiety and decision conflict on the health of caregivers of children with ADHD. Cross-sectional analyses were conducted on data derived from caregivers (aged 24-70). Participants completed the Decision Conflict Scale, the Zung Anxiety Scale, the Duke Health Profile, and a demographic form. A path model that fit well indicated that anxiety and decision conflict had direct and indirect effects on the caregivers' health. Future study is needed to clarify factors contributing to uncertainty and to decrease emotional symptoms for caregivers, thus promoting their mental health.

Factors affecting perceptions of family function in caregivers of children with attention deficit hyperactivity disorders.

BACKGROUND: Attention deficit and hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. ADHD has been shown to persist into adulthood in 30%-70% of cases. The long-term and escalating nature of ADHD creates an increasing burden on families because of the influence of hyperactivity and impulsivity on academic achievement and social interaction. There is a lack of information on factors influencing function in the families of children with ADHD. PURPOSE: The purpose of this study was to test theoretically derived relationships among family demographic characteristics; family factors such as support, hardiness, and caregiver health; and family-functioning outcomes. METHODS: This study used a cross-sectional study and structural equation modeling approach. A self-report questionnaire collected information from 122 caregivers on demographics, income, employment, and marital status data as well as on personal health, family support, family hardiness, and family function statuses as determined, respectively, using the Duke Health Profile, Family APGAR score, Family Hardiness Index, and Family Assessment Device. RESULTS: Structural equation modeling provided a reasonable fit to the data using AMOS (χ = .249, df = 1, p = .613, minimum discrepancy C = .249), goodness-of-fit index (.999), adjusted goodness of fit index (.990), normed fit index (.999), comparative fit index (1.0), and root mean square error of approximation (.000). Results indicated a 55.6% probability of becoming the construct model, with family hardiness and family support directly affecting family function and caregiver health. Family support functioned as a mediator in the relationship between family hardiness and family function. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study help nurses improve professional assessments and interventions for families of children with ADHD by highlighting the importance of increased family support, promoting family hardiness, and promoting caregivers' health to improved family function.

[Applying the synactive theory of development to the care of a premature infant with sucking problems].

Sucking problems in an infant born prematurely at 24 weeks and 5 days were identified through systematic behavioral observation and family assessment. Reasons underlying the infant's sucking problems included poor sucking and swallowing skills due to an immature nervous system, a chaotic care environment and ecology, and unimplemented sucking and feeding care procedures. Due to the paucity of domestic diagrams related to oral-sucking training for premature babies, in addition to reviewing the literature and establishing a sucking training program to help the infant establish a regular sucking pattern, we also applied the synactive theory of development and improved the hospital feeding environment and ecology to reduce environmental factors that could affect sucking care such as ambient light and noise and feeding schedules. We observed implied infant sucking pattern actions such as restlessness, mouth shakes, and irritation and provided the mother with an appropriate feeding schedule. We helped foster parent-child attachment and enhanced the mother's post-discharge caring confidence. Home visits were also conducted after discharge to assess the home care environment and give instant consultation, providing holistic health care with sustained quality of care.

[Concept analysis of workplace bullying].

Workplace bullying is a complicated and imprecise concept. Research findings have highlighted it as an important issue in the nursing environment worldwide. Workplace bullying arises due to malfunctions in workplace organizational and cultural related antecedents and manifests in various forms. Many studies have reported that nurses experiencing workplace bullying face increased levels of physical, psychological and social distress, may adopt suicidal thoughts and negativity towards the nursing profession, and may even abandon the nursing profession completely. Although a large number of papers have discussed the antecedents, forms and interventions related to workplace bullying, there has yet been no systematic concept analysis of workplace bullying. This paper applied Walker and Avant's concept analysis process to verify concept definitions, identify defining attributes, antecedents, and consequences, and provide examples of model, borderline, and contrary cases. Findings can help nursing administrators understand and clarify the meaning of workplace bullying in order to take appropriate measures to improve the working environment for nursing professionals.

Problem-based learning: developing resilience in nursing students.

A society needs mature and confident nurse practitioners, who are able to think analytically and flexibly, recognize needs for further preparation, and willing to engage in self-development. Concern is raised regarding how educators will build the capacity of resilient students with a knowledge base and a minimum set of skills in responding to various issues and for engaging in self-reflection. Drawing on the framework of nursing competencies and global standards for the education of professional nurses, resilient students may contribute through their social competence, problem-solving ability, sense of purpose, and persistence in the process to achieve the goal of the project. Educators should know how to build the resilient attribute in students by encouraging them to engage in self-reflection. This article discusses four areas that help students build resilience from project-based learning of a small group: the impact of problem-based learning at clinical practice, project/problem-based learning, resilient nursing student, and developing nursing students' resilience. Self-assessment to check the promoting skills for teaching in a problem-based learning program helps the faculty holding the empowerment to encourage or support the students to face the challenge within the small team.

Family resources and parental health in families of children with Duchenne muscular dystrophy.

BACKGROUND: This study was based on two models, namely, the resiliency model of family stress, adjustment, and adaptation and the model for family stressors, resources, and function. Family resources, such as family hardiness and support, have previously been shown to improve family adaptation. There is little evidence for the potential buffering effects of family resources on parental health in families of children with Duchenne muscular dystrophy (DMD). PURPOSE: This article reports on relationships among family support, family hardiness, severity of child disability, and parental perceptions of child health status variables and their influence on parental health in families of children with DMD in Taiwan. METHODS: A total of 126 parents, all with children suffering from DMD, were recruited for this study. Associations between child health status, age at diagnosis, demographics, and family resource variables were examined using Pearson linear correlation, linear regression, and causal modeling. RESULTS: Parental employment and education, perceived child health, family hardiness, and family support were found to correlate with parental health. Age at diagnosis correlated with family hardiness but not directly with parental health. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Nursing intervention to promote family hardiness and support can help maintain parental health and promote family adaptation in the face of a child's chronic disease. Caregiving programs should also promote parental health by enhancing family hardiness and support. Family members' support through health promotion, psychological and spiritual care, financial support, and convenient community services can lead to better parental health and contribute to overall family health and adaptation.

[Factors related to health status in mothers of children with cancer].

BACKGROUND: Mothers are typically the primary caretakers of children with cancer, and the burden of caring responsibilities may influence their health status. Few studies have previously explored factors related to the health status of mothers with children suffering from cancer. PURPOSE: The purpose of this study was to examine factors related to health status in mothers of children with cancer. METHODS: A total of 120 mothers of children with cancer were recruited from two medical centers in southern Taiwan. Associations among demographic data, the Social Support: Personal Resource Questionnaire (PRQ85) part 2, and the Duke Health Profile (DUKE) were examined using one-way ANOVA and stepwise regression. RESULTS: A significant, positive relationship was found between social support and mother health status. Marital status was related to physical health, social health, general health, anxiety, depression, anxiety-depression and total health score. The mother's age and family monthly income were correlated with depression. Stage of child's disease was correlated with mother's mental health, general health, anxiety, depression, anxiety-depression and general health. Mother's social support and stage of child's disease were found to be significant predictors, accounting for 39% of variance in mother's health status. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Clinical staff should be aware that stage of (child's) disease may influence the health status of the mother care-giver. Clinical staff should also further enhance social support to promote the health of mothers with children who have cancer.

Morale and role strain of undergraduate nursing students in a pediatric clinical setting.

BACKGROUND: Studies have indicated that causes of anxiety, such as stress, satisfaction, and motivation, affect nursing students during their clinical practice. However, psychological issues that induce morale and role strain in nursing students, which lack quantitative measures, have not been studied well enough. PURPOSE: The purpose of this study was to examine the morale and the potential role strains of undergraduate nursing students in pediatric clinical practice and to identify their related factors. METHODS: Using qualitative methods, 42 undergraduate nursing students were interviewed twice by the author in a group setting (8-9 persons each time, once at the beginning and again at the end of their pediatric clinical experience), during which they were encouraged to express their perceptions of morale and role strain in a natural classroom setting. Content analysis was employed to analyze the data. RESULTS: The study found that the morale of nursing students in the pediatric clinic included positive morale aspects such as hope, attainment, love, safety, alertness, happiness, and interest and negative aspects such as anger, fear, depression, stress, helplessness, and irregularity. Factors influencing the morale of nursing students included self-perceived, personal, clinical, and environmental, in particular, and professional in general. Participants experienced lower morale and higher degrees of role strain mainly because the impact of their self-perceived role was derived from job reality and job expectations. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Various clinical settings, individual perceptions and capacities, and conflicts between expectative and ideal roles were found to induce morale reaction and role strain in nursing students. Development of positive morale among nurses can improve nursing care in clinical settings. Therefore, how to enhance morale in nursing students is very important in the professional socialization process through clinical practice experiences.

[Immigrant women & postpartum depression].

The immigrant population in Taiwan has increased significantly over the past decade, and immigrants now comprise a significant proportion of the women in Taiwan receiving maternal care. Postpartum stress and depression are important physical and mental health issues. This article used a systemic review of published articles to understand the general incidence of postpartum depression amongst immigrant women. Articles reviewed included those published in MEDLINE, PubMed, Proquest and CEPS in either English or Chinese. A systematic literature review of 20 identified original research papers was conducted to explore postpartum depression in immigrant women. One article addressed the experience of healthcare providers responsible to care for immigrant women suffering from postpartum depression. Other articles discussed factors of influence on postpartum depression in immigrant women or related experiences. Results show that immigrant women have a higher incidence of postpartum depression than the overall population. This incidence is even higher amongst immigrant women from minority groups. In addition to socioeconomic influence factors, social support and acculturation abilities were also found to be significant predictive factors of postpartum depression in immigrant women in Taiwan.

[New parenting education in maternal child nursing].

Taiwan society is today typified by low birth rates amongst Taiwanese and a rising number of children born to immigrant and trans-cultural marriage families. Unhealthy behavior and anxiety on the part of pregnant women increase postpartum depression and complications and negatively affect neonatal heath. Such may further negatively impact upon romantic feelings between the new parents and the nascent parent-child relationship. New parenting education is a proactive and innovative strategy that may be used to improve maternal and child health. Therefore, it is worthy to explore how best to achieve cost-effective education interventions. First, the importance of new parenting education and its influence factors must be understood. Factors of women's health and nursing responsibilities potentially addressed by new parenting education include pregnancy complications, fetal death and malformation, accidents and traumas during childhood and adolescence, childhood obesity, and pediatric health-care delivery systems. It is the responsibility of nursing professionals to collect and interpret information on health promotion, disease prevention and childcare in cooperation with other disciplines. Nurses are also responsible to participate in family education and services that target new parents. Therefore, nursing professionals participate in planning and intervention actions related to health promotion, develop support group and counseling centers, collect and organize relevant information, and develop family education and health promotion models. Achieving preventive health service goals while maintaining family competencies and empowerment is an essential aspect of the parenthood mission and vision.

[Standardized nursing language: the bedrock of computerized nursing records].

Taiwan is currently in the initial phase of implementing a nursing information system. In order to successfully achieve effective communications across dispersed and diverse populations, care settings, and locations, standardized language within the nursing profession must be established and promoted. However, standardized nursing language is not well known among Taiwanese nurses. This article introduces the definition of standardized nursing language, the importance of standardized nursing language to the nursing profession, and the relationship between nomenclatures and standardized nursing language. Additionally, twelve language standards recognized by the American Nurse Association and the ICNP (International Classification for Nursing Practice) developed by International Council of Nurses are briefly introduced. In Taiwan, although cross-mapping of ICNP terms with handwritten nursing records has been done, further research must be done to reach practical conclusions. The authors hope this article will help Taiwanese nurses learn more about standardized nursing language and, consequently, contribute more toward the implementation of the nursing information system in Taiwan.

[Applying the transtheoretical model to tobacco prevention education in adolescence: a literature review].

The Transtheoretical Model (TTM) is a contemporary psychological model of behavioral change employed to develop efficient interventions to promote healthy behavioral changes. Interventions can be individualized to the needs of individuals in order to achieve optimal results. No integrated plan currently exists in Taiwan for reducing cigarette use among children. This article presents a systematic review of TTM, with the goal of constructing a model for protecting teenagers against tobacco-related health risks. Analysis results are hoped to be useful as a reference for developing systematic interventions aimed at reducing the health risks posed to teenagers by cigarette smoking.

[Exploration of social support available to mothers of children with cancer, their health status, and other factors related to their family function].

The mother is typically the primary caregiver for children suffering from cancer. The long-term care responsibilities involved with caring for a cancer-stricken child impacts upon the mother's family role and functions and causes lifestyle changes or imbalances. The aim of this study was to explore social support, health status, and related factors in families of children with cancer. This study adopted a cross-sectional descriptive design. Study subjects consisted of 120 mothers of children with cancer recruited from the outpatient and inpatient departments of two medical centers in southern Taiwan between January and April 2006. Research instruments included demographic characterizations of the children with cancer, their mothers, and families; the Social Support: Personal Resource Questionnaire (PRQ85) part 2, the Duke Health Profile (DUKE), and the Family Assessment Device (FAD). Results showed a mean score of social support for mothers of children with cancer was 131.21 out of a total possible 175. The standard score for social support was 75.0. The standard score for health was 67.15. The mean score of family functioning was 128.48 out of a total possible 240. The standard score of family function was 53.53. Mother's age, marriage, family type, family socioeconomic stage, disease stage, and relapse of child's disease all had a statistically significant relationship to family function. Significant positive relationships were identified between the two variables social support and health status and family function. Mother's health, social support, disease relapse, and mother's age were significant predictors of mother's family function, explaining 42% of variance in family function for mothers of children with cancer. We hope findings will help clinical health professionals identify and implement nursing strategies to increase the health of mothers and their children as well as promote social support to strengthen family functions.

Mediators affecting family function in families of children with Duchenne muscular dystrophy.

Most families of children with Duchenne muscular dystrophy (DMD) first receive professional information about the disease at the time of their child's diagnosis. Generally, as the families begin to build a supportive care system for their children, the parents will research DMD on their own or gather formal knowledge about the disease from professionals. However, gaining access to care is a major challenge because they often do not know how to ask the right questions. In particular, vulnerable populations may experience difficulties in assisting their child's emotional adjustment to the disability and use of available services. The purpose of this study was to test the possible effects of psychosocial mediators of parental health, family hardiness and family support on family function in relation to the age at diagnosis of children with DMD. One hundred and twenty-six Taiwanese parents of children with DMD who are members of the Taiwan Muscular Dystrophy Association filled out questionnaires. Subjects received a phone call before and again within the first week after we mailed them a questionnaire, a stamped return-addressed envelope, and a consent form. The questionnaires included the Family Hardiness Index, Family Assessment Device, Family APGAR, Duke Health Profile and demographic questions. Hierarchical multiple regressions were conducted to test whether family hardiness, parental health, or family support mediated or moderated the association between age at diagnosis and family function. Family hardiness positively mediated the association between age at diagnosis and family function. These findings may help the design of interventions to develop family hardiness in families of children with DMD.

Family function in families of children with Duchenne muscular dystrophy.

This article investigates the relationships of child- and family-related variables with family function in families with children who have Duchenne muscular dystrophy. Child-related variables included level of disability (indicator: Barthel Index) and age at diagnosis. Family-related variables included caregiver health status (indicator: Duke Health Profile), family income and employment, family support (indicator: Family APGAR), family hardiness (indicator: Family Hardiness Index), and family functioning (indicator: Family Assessment Device). Family function displayed a significant correlation with age at diagnosis, but not with disability level. It was also significantly correlated with family hardiness, caregiver health status, and levels of family support, but not with income or employment variables. These findings highlight the need to assist families to cope with the presence of serious illness in their children.

[A stress model for parents of children with duchenne muscular dystrophy].

This study explored the problems encountered by parents in caring for children with Duchenne muscular dystrophy (DMD). Open questionnaires (N=21) designed to identify and gauge stress factors were used to collect study data. Results showed that key elements of the care stress model in parents of DMD children prior to joining a support group included: (1) recognition of the factors underlying the changes in their child's health condition (incomprehension, inference, rationalization, and acceptance of mutation and sexual heredity); (2) special assistance needs such as barrier-free facilities, government/social assistance (role substitution, coordination, and long-term care) and medical information (on treating disease causes, psychological adjustment, rehabilitation, and the welfare system); and (3) strains (physical, psychological, sleep disturbances, and feelings of powerlessness). Once families of DMD children began participating in DMD support groups, it is important to note the information exchanged, particularly with regard to medical, rehabilitation, psychological adjustment, role substitution, and welfare benefit information.

A comparison of the stress and coping strategies between the parents of children with Duchenne muscular dystrophy and children with a fever.

This university hospital-based case control study included 31 parents with a Duchenne muscular dystrophy (DMD) child and 30 parents (control group) of a child with a fever. The study was conducted in southern Taiwan. The study compared the differences of stress and coping strategies between the two groups using closed-ended questionnaires. The control group (fever group) showed higher "stress," "conflict," and "help needs." The DMD subjects had a tendency to use wish-fulfilling fantasy to cope. "Impact" was influenced by income and religion, and income and mother's age influenced coping strategies. Professionals need to manage the parent's conflict, to provide information and resources, and to support the parent's emotional reactions to caring for a child with acute and chronic illness.