Living with constipation and communication taboos surrounding constipation among older adults: An interpretive phenomenology analysis study.

Chronic constipation is a prevalent problem that significantly impacts older adults' well-being. This study aimed to explore how older adults describe constipation symptoms and impacts and understand the perceived taboo surrounding discussions on related issues. Twenty older adults with constipation were interviewed using a semi-structured format in Taiwan. The Interpretive Phenomenology Analysis approach was utilized for data analysis. Five techniques recommended by Lincoln and Guba (1985) were implemented to ensure the study's trustworthiness. The primary themes encompassed comprehensive portrayals of fecal characteristics, the discomfort symphony of constipation, emotional turbulence in the struggle against constipation, daily activities shadowed by constipation, and underlying factors contributing to communication taboos. Most participants considered the discussion of constipation taboo due to its association with an embarrassing secret, an unacceptable social norm and stigma, and apprehensions of potential gossip. Geriatric caregivers need to consider individual perspectives, communication taboos, and sociocultural contexts when addressing older adults' constipation.

Work-related flow and its correlates among frontline nurses during the COVID-19 pandemic.

BACKGROUND: Ample evidence across non-healthcare fields highlights the role of work-related flow in enhancing resilience against work stress and work engagement. Understanding flow and its factors can support staff development and management. AIMS: This study aimed to investigate the level of work-related flow and its associated factors among frontline nurses during the COVID-19 pandemic. METHODS: A cross-sectional multicenter study included 336 nurses caring for COVID-19 patients between March and April 2022. Cluster random sampling was used to select 9 nurse groups from 29 Taiwanese hospitals specialized in COVID-19 care. A web survey link was shared on the selected nurses' social media. Hierarchical regression analyses examined predictor-outcome relationships, following the STROBE checklist for reporting findings. RESULTS: Among demographic characteristics, sex (ß = -0.11; p = 0.016) and living arrangement (ß = -0.12; p = 0.017) reached statistical significance in model 3. Social support from family, friends, and significant others, managerial position, and sufficiency of personal protective equipment showed significant associations with work-related flow (all ß > 0.12; p < 0.05). The variables included in the final model accounted for 35% of the variance in work-related flow for COVID-19 patient care tasks. CONCLUSIONS: Flow experience is influenced by factors associated with demographics, work conditions, and social support. Nurse administrators should consider these factors when evaluating nurses' flow at work. IMPLICATIONS FOR NURSING PRACTICE AND MANAGEMENT: Allocating care tasks to nurses based on their flow levels can be beneficial, particularly during healthcare crises. Ensuring a sufficient supply of personal protective equipment and offering social support to nurses are vital strategies for facilitating their flow experience in the workplace.

Effects of an ice roller on chronic kidney disease-associated pruritus in patients receiving haemodialysis.

BACKGROUND: Chronic kidney disease-associated pruritus is a distressing symptom and has a far-reaching impact on patients' sleep and quality of life for most patients receiving haemodialysis. Traditional therapies have limited effectiveness. OBJECTIVES: This study aimed to invent a self-operated ice roller and evaluate its efficacy in relieving pruritus, sleep quality, and quality of life. DESIGN: This study was experimental with a two-arm parallel group design. PARTICIPANTS: A convenient sampling method was used to recruit 60 patients receiving haemodialysis who reported pruritus (5D-Itch Scale score >5) lasting over 4 weeks in Taiwan. The participants were randomly assigned to one of two groups: the intervention group used an ice roller for 7 days, while the control group received no anti-pruritus treatment. MEASUREMENTS: This study was experimental with a two-arm parallel group design. The measurement instruments included the 5D-Itch Scale, Pittsburgh Sleep Quality Index and WHOQOL-BREF-Taiwan Version. The analysis of covariance, chi-square, Independent t tests, and partial Eta2 (η2 p) were used to analyse the data. RESULTS: The participants' mean age was 62.77 years. Application of the ice roller significantly decreased overall pruritus (p < .05; η2 p = .09) and distribution of pruritus-associated bodily parts (p = .03; η2 p = .08). There were no statistically significant differences in sleep quality and related indicators between the experimental and control groups at the study endpoint. Regarding quality of life, only the social relationship domain significantly differed between the two groups (p = .02; η2 p = .08). CONCLUSIONS: The ice roller can decrease pruritus and its distribution in patients receiving haemodialysis, serving as an adjunct therapy alongside conventional anti-pruritus treatments.

Exploring the Difficulties and Strategies of Family Caregivers in Caring for Patients With Dementia in Acute Care Wards.

BACKGROUND: Providing appropriate care to patients with dementia in acute care settings can be a challenge for healthcare professionals. A key factor is working closely with family caregivers. PURPOSE: This study aims to explore the difficulties and strategies involved in caring for patients with dementia who have been admitted to an acute care ward from the perspective of family caregivers. METHODS: Exploratory research was conducted using a qualitative data collection approach. Data were collected by means of in-depth interviews carried out with participants. Semistructured interviews were conducted with nine participants. Content analysis was performed to analyze the data. RESULTS: A number of themes and subthemes were identified based on the primary research purposes. The first theme is "vicious cycle due to multiple factors," with the following subthemes: (a) communication disturbance, (b) endless worries, (c) inadequate care skills of paid caregivers, and (d) physical and psychological exhaustion. The second theme is "do everything," with the following subthemes: (a) management of the behavioral and psychological symptoms of dementia, (b) constant accompaniment of the patient, and (c) seeking sources of support. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results may be used to help healthcare professionals better anticipate the difficulties faced by family caregivers while providing assistance to patients with dementia and understand the related strategies they use. Acute care wards should consider the specific needs of family caregivers to ensure patients with dementia receive adequate care from the relevant parties in the ecological care chain during the care process.

Symptom perception and self-care practice for uraemic pruritus in patients receiving haemodialysis.

BACKGROUND: Due to the recurrent nature of uraemic pruritus among patients receiving haemodialysis, self-care can offer patients a means to ameliorate this symptom. Qualitative data on self-care of uraemic pruritus are limited. OBJECTIVE: To explore how patients on haemodialysis perceive uraemic pruritus, implement self-care practice, and appraise the outcome of self-caring uraemic pruritus. DESIGN: The Common Sense Model of Self-Regulation guided the study design. PARTICIPANTS AND APPROACHES: Data were collected through face-to-face interviews with 30 patients receiving haemodialysis who were aged from 50 to 89 years and had had uraemic pruritus for more than 6 weeks. Interviews were audio recorded, and verbatim transcriptions of interviews were analysed. FINDINGS: Our participants generally used life-related analogies to describe uraemic pruritus, which they reviewed as a momentarily controllable symptom with an endless timeline. Most participants reported limited knowledge of the aetiology and multifaceted impacts of uraemic pruritus on their daily life and emotional status. The impacts on daily life included decreased zest for activities and sleep disturbances. Physical management of uraemic pruritus involved daily substance use and interventions employed during pruritic episodes. Psychological managements involved preferences for indoor activities and a fatalistic outlook. Unsatisfactory outcomes and psychological burdens from self-care practice were reported. CONCLUSIONS: Life experiences shape symptom presentation and self-care practice in patients on haemodialysis. The modalities for self-caring for uraemic pruritus are diverse but not remarkably effective. Performing self-care tasks places a substantial burden on patients. Individualised educational programs should be developed to improve the outcome of self-care practice.

New insight into chronic pruritus' characteristics and association with the demographic characteristics and sleep of community-dwelling older adults in Taiwan.

This study aimed to understand the characteristics of chronic pruritus (CP), its correlations with sleep quality and demographic characteristics, and its impacts on sleep of older adults. This study used convenience sampling to recruit adults aged 65 or older and living at home. The prevalence rate of CP in older adults was 25.8%. Most subjects with CP reported mild pruritus on 1-2 anatomical parts, especially the lower extremities. Overall, the five domains of CP were correlated with the seven components of sleep quality (r > .14; p > .05) except for sleep disturbance. The global itchy scores were significantly different between different sexes, educational attainments, and marital statuses (p<.05-.001). CP, sex, and the number of comorbid diseases significantly contributed to global sleep quality (ß = .26, -.19, .15, respectively; .000 ≤ p ≤ .011). This study provides new insight into the correlations of CP with marital status and educational attainment.

Effect of ethanol extracts of Hericium erinaceus mycelium on morphine­induced microglial migration.

Microglia serve important roles in chronic pain signal transduction pathways. Glia cells, especially microglia, seem to share mechanisms that lead to chronic pain and morphine­induced tolerance. Evidence has suggested that downregulating cytoskeleton activity in microglia provides pain relief in chronic pain and morphine tolerance. The purpose of the present study was to evaluate the effect of ethanol extracts of Hericium erinaceus (EHE) mycelium on morphine­induced BV2 microglial cell activation. BV2 cells were starved for 4 h in DMEM before being incubated with 100 ng/ml EHE for 30 min, followed by 1 µM morphine for 2 h. Subsequently, the cells were harvested and used for migration experiments and western blotting. The results showed that 1 µM morphine enhanced BV2 cell activation and chemotactic reaction, and it increased histone deacetylase 6 (HDAC6) expression and heat shock protein 90 (HSP90) deacetylation as well as HSP90 cleavage. Pretreatment with 100 ng/ml EHE significantly inhibited the morphine­stimulated effects on BV2 cells. The present study demonstrated that EHE inhibited morphine­induced BV2 activations by regulating the HDAC6/HSP90 deacetylation signal transduction pathway.

Correlates and influences of taking an afternoon nap on nocturnal sleep in Chinese elderly: A qualitative study.

Taking afternoon naps is common among elderly people, but the information about napping from qualitative viewpoints is limited. This study aimed to describe napping experience from the perspectives of Chinese elderly, specifically on nap taking correlates and its influences on nocturnal sleep. Data were gathered via individual in-depth interviews with 50 Chinese elderly in Taiwan. The majority of the nappers napped for 1-2 hours between 12 PM and 1 PM. Nap promoting factors included "belief in afternoon nap taking benefits," "nothing to do," "low energy level," "compensation -for disturbed sleep" and "extreme weather." Nap taking (>1 hr.) was found to be associated with delay of the onset of sleep, reduction of sleep duration, and light sleep. Short afternoon napping (<1 hour) is recommended for the elderly. Future research should determine the direction of the causative association between afternoon nap-taking and nocturnal sleep.

Gender Differences in Self-Perceptions About Aging and Sleep Among Elderly Chinese Residents in Taiwan.

BACKGROUND: Previous research has revealed the existence of gender differences in sleep patterns among older adults from various ethnic groups. Data on how gender affects the sleep patterns of Taiwanese are limited. PURPOSE: The purposes of the current study were to (a) describe perceptions about aging and the influence of these perceptions on sleep in elderly men and women, respectively, and (b) determine whether there are gender differences in perceptions and appraisal of sleep. METHODS: A mixed method design was used. In-depth interview data from 23 men and 27 women were integrated with data from the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). RESULTS: The mean CPSQI score for the entire sample was 6.1 ± 3.5 (men: 4.8 ± 1.6, women: 7.1 ± 4.3). Participants who held negative attitudes about aging were more likely to report poor sleep quality, short sleep duration, and difficulty in falling asleep than those who did not hold negative attitudes. Women had more negative perceptions about aging (e.g., feelings of powerlessness) and more sleep complaints than men. Furthermore, women reported significantly poorer sleep quality (p = .02) and lower sleep efficiency (p = .03) on the CPSQI than men. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Negative perceptions about aging are associated with reports of poor sleep quality. There are gendered differences in perceptions about aging and appraisals of sleep. As the process of aging and patterns of sleep change over time, longitudinal research designs are recommended for future studies.

[Caring for a terminal patient with nasopharyngeal carcinoma in the ICU who refuses treatment: a nurse's experience].

This article describes the experience of a nurse directly responsible for the care of a patient with terminal stage nasopharyngeal carcinoma who refused all medical treatment. Tumor bleeding had caused loss of consciousness, which led to the family arranging ICU admission. While in the ICU, the patient was overwhelmed by feelings of hopelessness regarding his disease and believed his family was not emotionally supportive. The patient was verbally non-responsive, angry and lethargic. He also refused to accept any medical care or treatment. The author collected data through observation, physical assessment, interviews and written communication between May 9th, 2007 and May 23rd, 2007. The author confirmed the diagnosis and found that the patient had some related mental health problems, including imbalanced nutrition (less than body requirements), chronic feelings of hopelessness and anxiety. The author established a positive relationship with the patient utilizing Watson's caring theory and case-establishment trust in the nursing process. The author provided disease-related information to the patient, worked as an intermediary to encourage greater family member support and encouragement, helped the patient interact with visitors and encouraged development of the patient's self-esteem. This experience can benefit nursing professionals by fostering a greater understanding of patient self-esteem and the benefits of a positive treatment environment.

Psychometric evaluation of the Chinese version of the Cornell Scale for Depression in Dementia.

Elders with cognitive impairments frequently experience concomitant unidentified depressive symptoms due to an impaired capacity for verbal communication. Therefore, determination of a valid and reliable instrument with which to detect depression in this population requires confirmation through observation. The Cornell Scale for Depression in Dementia (CSDD) has been employed worldwide. However, no formally established psychometric properties have yet been made available for its Chinese version. For this study, we attempted to translate and test the validity and reliability of the CSDD Chinese version (CSDD-C). After completing translation and expert validity, a convenient sample of 145 older adults with dementia was assessed by their caregivers in several care facilities in Southern Taiwan. The CSDD-C was administered to collect data along with the Geriatric Depression Scale short form (GDS-SF). Results found an expert content validity index (CVI) of .92 and concurrent validity between CSDD-C and GDS-SF of .322 (p < .001). The number of factors extracted through our samples is consistent with the original CSDD; inter-rater agreement over a two-week period on each item was significant (Kappa = .43-.89); and the Cronbach's alpha for internal consistency reliability was .84. Results indicate the CSDD-C to be a reliable and valid instrument to help Chinese speaking caregivers determine signs and symptoms of depression in elders with dementia under their care.

The effects of a Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults living in long-term care facilities: a single group design with multiple time points.

BACKGROUND: Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred. OBJECTIVE: To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities. DESIGN: A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started. SETTINGS: Two 300-400 bed veteran homes in Taiwan. PARTICIPANTS: The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded. METHODS: The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization. RESULTS: A drop in systolic blood pressure (p=.017) and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p=.035). Participants also had better lower body flexibility after practicing STEP (p=.038). CONCLUSIONS: Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

A feasible method to enhance and maintain the health of elderly living in long-term care facilities through long-term, simplified tai chi exercises.

Practicing Tai Chi offers the potential to enhance the physical and mental health of older adults. Identifying a feasible way to encourage regular Tai Chi practice is essential if Tai Chi is to be promoted as a long-term, daily activity for elderly care facility residents. The purpose of this study was to test the effectiveness and feasibility of using an audiovisual, simplified Tai Chi exercise module to enhance and maintain the health of long-term care facility residents. A quasi-experimental, one-group, time-series design was used. Data were collected six times (twice before the intervention; four times after intervention started) at three-month intervals. Fifty-one elderly male subjects were recruited by convenience sampling. A 50-minute Simplified Tai-Chi Exercise Program (STEP) was implemented in two small groups three times a week for 12 months. During the first six-month period, participants received guidance from an actual instructor. During the second six-month period, guidance was delivered via a video tape and displayed on a television screen. Results indicated that participants' physical health (cardio-respiratory function, lower body flexibility, and hand-gripping strength) and mental health (quality of sleep) had both improved significantly six months after intervention started, with improvements maintained throughout the end of the 12-month study (all p values < .05). Instructor-led STEP training followed by practice using appropriate audiovisual aids represents a feasible and effective method to implement a long-term activity program in long-term elderly care facilities.

Psychologically abusive behavior by those caring for the elderly in a domestic context.

Psychological abuse of elders is a growing but hidden problem. This study attempted to determine whether caregivers psychologically abuse their elderly care recipients and identify risk factors contributing to such abuse. Ninety-two caregivers completed this study. The Demographic Sheet, the Caregiver Psychological Elder Abuse Behavior scale (CPEAB), and the Caregiver's Burden Scale were used to collect data. The CPEAB scores for caregivers of the elderly were 20 to 51 (mean 30.45 +/- 7.03). The level of abusive behavior was positively associated with gender, education level, and caregiver's burden and negatively correlated with age (P < .01-.05), suggesting that female caregivers, caregivers with higher levels of education, and caregivers with high burdens demonstrated more severe psychologically abusive behavior. Burden and age accounted for 25.9% of the variance for abusive behaviors. This study provides preliminary data estimating caregiver psychologically abusive behavior and its related risk factors. Analytical results provide important information for medical and social interventions and policies for improving the quality of life of elderly people.