A qualitative study of psychosocial factors affecting expecting mothers who choose to continue a cleft lip and/or palate pregnancy to term.

BACKGROUND: Prenatal detection of cleft lip and/or palate (CL/P) leads to high rates of induced termination of pregnancy. There has been little research in Taiwan done on the psychosocial factors affecting those who decide to continue their CL/P pregnancy. PURPOSE: This study identified the principal psychosocial factors that affect expecting mothers who chose to continue their CL/P pregnancy to term. METHODS: Purposive sampling recruited expecting mothers with CL/P-diagnosed fetuses. Recruiting took place between May 2000 and March 2002 at a tertiary referral hospital in Taipei, Taiwan. Those who had decided to continue their pregnancy to term were asked to participate. Researchers obtained oral informed consent to be interviewed during the week following CL/P diagnosis. Interviews for each participant were completed within a 2-week period. All information was given to the interviewees in written and verbal forms before providing their written informed consent to participate. RESULTS: The five major themes central to participant experiences included (1) loss of self-value as a mother, (2) blaming the mother, (3) indecision about whether to continue the pregnancy, (4) anxiety triggered by insufficient information, and (5) burden of care and concerns about potential disadvantaged status. CONCLUSIONS: Significant psychological distress was identified among participants following their fetus' CL/P diagnosis. It was encouraging to learn that all participants told researchers in postpartum interviews that they did not regret the decision to take their child to term.

[Challenges and strategies for nursing education in Taiwan from a public health needs perspective].

An increasingly elderly population and prevalence of chronic health problems have transformed the healthcare landscape in Taiwan and necessitated a shift in the focus of healthcare toward chronic rather than acute illnesses. This is a challenge to the domestic healthcare system, which was initially designed to address and cure primarily acute illness. Traditional nursing education and training programs are no longer adequate to meet current population healthcare needs. The first part of this article highlights the challenges posed by changing healthcare needs, e.g., the rise in prevalence of age-related chronic conditions and the increased acuity of hospitalized patients. Such developments are making new demands and expectations of nurses in terms of education, skills and roles. The second part of this article explores the weaknesses of current nursing education. Recommendations for the future include: making high school graduation a minimum requirement for entering nursing college and university programs, restructuring the nursing master's education program to prepare advanced nurse practitioners, redesigning curriculum content, and teaching approaches based on public healthcare needs. Upgrading clinical competencies and increasing nursing school faculty numbers are issues of the most immediate priority.

[Perspectives on nursing education, licensing examinations and professional core competence in Taiwan in the context of globalization].

There are today some 130,000 nurses in Taiwan, practicing in different specialties and in various capacities and positions. Good nurses are society's "guardian angels of health" who provide protection and safe healthcare for the people. Improving nursing education quality and ensuring nurse competency by licensure examination are essential to both helping nurses realize the full potential of their role and earning recognition for Taiwan healthcare as positive contributors to the global community of nations. Three themes were explored in this paper, including: (1) Issues and problems with the current nursing education, license examination and nursing education quality monitoring systems in Taiwan; (2) Comparing Taiwan's situation with that in certain other countries; and (3) Recommending changes ÷ revisions in Taiwan's nursing educational system and license examinations based on comparative findings. In order to plug into the rapid pace of globalization, Taiwan should upgrade and limit its pre-licensure nursing programs at the bachelor level. Also, nursing education quality should be continuously improved through peer-review.

Clinical applicability of the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) to mothers of children with asthma in Taiwan.

AIMS: This study examined the clinical applicability of the World Health Organization Quality of Life Scale brief version (WHOQOL-BREF) to mothers of children with asthma in Taiwan. BACKGROUND: The WHOQOL-BREF scale has been culturally adapted for Taiwan and applied to a variety of ill and healthy subjects in hospitals and the community and to the general population in the 2001 National Health Interview Survey in Taiwan. Its application to explore the QOL of mothers of children with asthma in Taiwan allows future cross-population comparisons. DESIGN: A cross-sectional survey. METHODS: Internal consistency, test-retest reliability; content validity, criterion-related validity and discriminant validity were assessed. A total of 229 mothers participated in the study. RESULTS: The WHOQOL-BREF showed acceptable psychometric properties. Internal consistency of 0.63-0.84, content validity r = 0.39-0.65 (p < 0.01) and criterion-related validity r = 0.28-0.65 (p < 0.05) were reported. Discriminant validity was also found, especially in the domain of physical health. Issues of QOL for mothers, especially in the realm of physical health need more support and attention from health professionals. CONCLUSIONS: This study supports the clinical applicability of the WHOQOL-BREF scale as a measure of QOL of mothers of children with asthma. Future studies to compare the QOL measured by WHOQOL-BREF in female caregivers of children with other chronic health conditions are suggested. RELEVANCE TO CLINICAL PRACTICE: Our findings show that mothers are hardly ever free from the strains of the daily-care of an asthmatic and bear the uncertainties for the unending illness. The health care team is responsible for providing collaborative care approaches in hospital, home and school health care settings for children with asthma and their mothers.

[Good nursing: perspectives of patients and family].

This qualitative study aimed to explore patients' perspectives on good nursing for comparison with nurses' perspectives, as identified in a previous study. Purposive sampling was employed to recruit 53 patients and six family members from three medical centers and three regional hospitals, in northern, central, and southern Taiwan. The 59 participants were clustered into nine groups for focus-group interviews for data collection purposes, from March to June, 2003. Most of the participants were male (62.7%), and their mean age was 51.9 years (SD=15.6), with a range from 18 to 81 years old. All of the participants were hospitalized for at least three days and had the physical and mental strength to participate in a 60-90 minute group interview. The interviews were both hand-recorded and audio-taped on site, with permission from the participants, and then transcribed into verbatim narratives for data analysis. Content analysis was used to identify items in relation to good nursing/not-good nursing across narratives. The findings showed that four major categories of good nursing inductively emerged, including: (1) Providing professional nursing as a guardian angel, (2) Demonstrating professional skills with humanity, (3) Being accountable and competent, and (4) Showing self-improvement. The findings indicated that professional nursing competence is the essence of good nursing. Treating patients as relatives is also perceived as good nursing. In comparing the patients definitions of good nursing with those of nurses it was observed that there are similarities in terms of the main categories of the definitions. Patients, however, tend to use negative examples or normative moral terms, such as "should" or "ought to" to connote what is expected of good nursing and how good nursing is expressed in the context of patient-nurse interaction.

[Good nursing from the perspective of nurses].

This qualitative study used an in-depth interview method to explore nurses' perspectives on good nursing practices. A balanced stratified sampling approach was employed to recruit 83 nurses from 18 hospitals that were relatively evenly distributed around Taiwan. Fifteen nurses educated to the masters' level and well trained in the in-depth interview approach collected research data from January through May 2002. Interviews were audiotaped and transcribed in verbatim narratives. Content analysis was used to identify good nursing practices common across narratives. Four good nursing practice categories emerged inductively. These included (1) good decision making and execution, (2) dexterous professional skills, (3) good patient-nurse relationships, and (4) a mature self. Findings present quality nursing care as a relationship that combines professionalism and humanism. In order to provide better care, a nurse must incorporate knowledge from empirical research into his or her practice and internalize his or her value as a nurse. A discussion of the process of self-maturation acquisition and reflective learning offers new insights to guide the construction of nursing education curricula and activities for clinical nursing practice. Further research in good nursing is suggested.

[Perspectives on body: embodiment and body image].

"Body" is a basic concept of both the natural and human sciences. This extensive review of the literature explores the various philosophical approaches to the body, including empiricism, idealism, existentialism and phenomenology, as well as the relationship between body and mind. Embodiment and body image are the two main concepts of body addressed in this article. Merleau-Ponty's perspective on embodiment, an important new area of theory development, emphasizes that embodiment research must focus on life experiences, such as the study of body image. Using Schilder's framework of psychosocialology, this article provides a comprehensive understanding of the concept of body image and women's perspectives on the "body" in both Western culture and Eastern cultures. Body size and shape significantly influence the self-image of women. Body image is something that develops and changes throughout one's life span and is continually being constructed, destructed, and reconstructed. Personal body image has important psychological effects on the individual, especially women. This integrative review can make a significant contribution to knowledge in this area and, consequently, to related practice and research.

I am a woman and i'm pregnant: body image of women in Taiwan during the third trimester of pregnancy.

BACKGROUND: Women's body image in late pregnancy and its relationship to the assumption of the maternal role have not been fully addressed in transitional cultures like that of Taiwan. The purpose of this qualitative study was to explore body image and body satisfaction of women in Taiwan during the third trimester of pregnancy. METHODS: Eighteen women in the 29th to 39th week of pregnancy who were receiving prenatal examinations at clinics at a medical center in Taipei, Taiwan, took part in open-ended, face-to-face interviews concentrating on the women's reactions to the changes in their bodies. Interviews were analyzed using a phenomenological approach. RESULTS: Two major themes central to women's experience of their bodies during late pregnancy were identified. One theme, "My body: where did it go?" reflects women's use of nonpregnant adult female standards of beauty to assess their pregnant bodies and their hope of regaining their "feminine self" after childbirth. The other theme, "My body = my baby's body," reflects women's view of the changes in their bodies as an indication of their baby's health and growth and as a sign of their adequacy as mothers. CONCLUSIONS: Conflict between "what is good for me as a woman" and "what is good for my child or for me as a mother" is very apparent when examining women's experience of late pregnancy. Awareness of the complexity of body-related experiences of pregnant women will help to identify sources of stress and concern that may interfere with the pregnant woman's self-identity, her social functioning, and even her experience of birth itself, and may help health care professionals provide better social support and care for women approaching the end of pregnancy.

[The process of curriculum redesign for the nursing baccalaureate program: an analysis of teacher actions].

The purpose of this study is to define the teacher's actions in the process of developing a new curriculum for the Faculty of Nursing, in National Yang-Ming University. The authors defined three tasks of teachers developing the curriculum: Relocating, strategizing, and reflective practice. Relocating implied reflecting on the dilemmas of nursing education, world trends in nursing education, the experience of medical schools with problem-based learning, and the philosophy of the university. Strategizing meant developing guidelines that included humanistic education, faculty development, and course content of the new curriculum. Reflective practice included intersubject integration, dialogue teaching, and shifting the focus from hospital care to community and family care.

Appropriateness of hysterectomy in Taiwan.

BACKGROUND AND PURPOSE: Hysterectomy is among the most frequently performed surgical procedures in developed countries, but few studies from the Asia-Pacific region have assessed the appropriateness of hysterectomy. The purpose of this study was to examine the rate of inappropriate hysterectomy in Taiwan and its association with patient characteristics and indications for the procedure. METHODS: A random sample of hysterectomies for which claims were submitted to the Taiwan Bureau of National Health Insurance from July 1, 1997 to June 30, 1998 was selected. A total of 658 charts were reviewed by an expert panel composed of 5 senior gynecologists. RESULTS: Overall, 74.2% of patients underwent hysterectomy for appropriate reasons, 5.6% for uncertain reasons, and 20.2% for inappropriate reasons. Inappropriate procedures were positively associated with younger age and premenopausal status. Primary indications that accounted for over 25% of inappropriate procedures were chronic pelvic pain (42.9%), abnormal uterine bleeding (37.5%), and endometriosis (27.7%). CONCLUSIONS: This study found a high rate of inappropriate hysterectomy in Taiwan. Gynecologists and physician organizations should take action to improve physician agreement on the use of hysterectomy, especially for indications associated with high rates of inappropriate procedures.