The changes of parental functioning of the patients with bipolar disorder and major depression since discharging from hospital: A longitudinal study.

AIMS AND OBJECTIVES: This study examined the changes in patients' parental functioning and the associated factors, including manic, depressive symptoms and social support from before discharge to 6 months post-discharge. BACKGROUND: For parents with bipolar disorder and major depression, parenting is a recovery factor for patients, but little research examines the dynamic parental functioning from acute hospitalisation to a remission stage. DESIGN: A longitudinal design was used. The STROBE Checklist were used in presenting this research. METHODS: Participants were inpatients with bipolar disorder or major depression (n = 33) recruited within one week before discharge from the acute psychiatric ward in Taiwan. Data on parental functioning was collected four times: before discharge (T1), the 1st (T2), the 3rd (T3) and the 6th (T4) months of post-discharge. Baseline parental functioning before admitting to the acute word was retrospectively assessed at T0. The questionnaires included positive and negative domains of parenting practice, hypomanic/manic symptoms, depressive symptoms and social support. Generalised estimating equations were applied for data analysis. RESULTS: The negative parenting domains (poor monitoring, inconsistent discipline) decreased during hospitalisation but increased at one month post-discharge, except corporal punishment at 3-months discharge. The positive parenting domains (parental involvement and nurturance/responsiveness) did not recovery to baseline. While clinical symptoms remained stable during 6 months post-discharge, social support decreased at 3 and 6 months post-discharge. Higher depressive symptoms and low social support were associated with positive parenting domains but not related to negative parenting domains. Manic symptoms were not associated with positive or negative parenting domains. CONCLUSIONS: Positive parenting domains did not fully return to the usual situation during 6 months post-discharge. RELEVANCE TO CLINICAL PRACTICE: Parenting functioning recovery program targeting at the impacts of depressive symptoms on the parenting functioning and insufficient social support is needed from hospitalisation to post-discharge.

The experiences of family resilience from the view of the adult children of parents with bipolar disorder in Chinese society.

AIMS: This study explored how adult children perceived family resilience, barriers to develop family resilience and how cultural values influence their experience of parents with bipolar disorder in Chinese society. DESIGN: A qualitative design with an interpretive phenomenological analysis of data was employed. METHODS: Twenty adults who had lived with parents with bipolar disorder during childhood were recruited from the acute psychiatric ward when their parents were admitted to the hospital. They described their experiences of perceived family resilience and barriers to resilience (October 2013-September 2015). Semi-structured interviews were conducted in the hospital meeting room or at a convenient location. FINDINGS: Six themes were identified in family resilience: ill parents try to be good parents, parents' personal strengths, parents' positive attitudes towards mental illness, flexibility of family role, cohesive relationships between family members, and families' social connections. Three themes were identified in the barriers to develop family resilience: poor parenting/family function, conflict between parents and poor mental health literacy. CONCLUSION: Children's views of family resilience could transform their suffering from lived experiences with a mentally ill parent to a positive growth experience. Family resilience includes well and ill parents' efforts and social network's help to maintain family function. However, the conflicts between well and ill parents and poor family function result in a traumatic growth experience. IMPACT: To enhance a positive growth experience, family resilience programs for a parent with bipolar disorder aiming to cultivate both the ill and well parents' inner strength and their competence of parenting skills with connecting their social network to maintain family function is needed. Moreover, early stress-reduction intervention needs to be developed for children who did not experience family resilience.

[The development of psychiatric and mental health nursing in Taiwan].

Psychiatric mental health is critical to ensuring the health and wellbeing of individuals, families, and communities. While psychiatric mental health work continues to become increasingly complex and challenging, the demand for psychiatric nurses with evidence-based skills continues to grow. Psychiatric mental health nurses (PMHNs) are the primary providers of professional psychiatric mental health care services. PMFNs emphasize humanistic values and focus on servicing patient and family needs. In Taiwan, the Psychiatric Mental Health Nursing Association constructs the competence-credentialing model for psychiatric mental health nursing that underpins the values, attitudes, and beliefs of PMHNs and ensures that the mental health nursing practice promotes public health and wellbeing. In addition, this association promotes advanced psychiatric nursing education, research, and practice, influences the national health agenda, and discusses and disseminates information on psychiatric mental health care issues in order to influence the direction, nature, and quality of psychiatric and mental health care.

Applicability of the Chinese version of the Prodromal Questionnaire.

BACKGROUND/PURPOSE: Early detection and intervention of psychosis is clinically important. This study aimed to test the applicability of the Chinese version of the Prodromal Questionnaire (CPQ) for identifying prodromal states of psychosis. METHODS: This is a two-group cross-sectional comparative study. The Prodromal Questionnaire (PQ) was translated into traditional Chinese based on Brislin's Revised Model. Like the PQ, the CPQ provides results on four subscales: (1) positive symptoms, (2) negative symptoms, (3) disorganized symptoms, and (4) general symptoms. An expert panel of five senior psychiatrists established the content validity of the CPQ. The experimental group was a sample of 100 first-visit patients to a psychiatric outpatient department (FVPOD). The comparison group comprised 98 nursing students without any history of psychiatric disturbances. Both the CPQ and the Chinese Health Questionnaire-12 were administered to all 198 subjects. Clinical psychosis was assessed using the Chinese version of the Diagnostic Interview for Genetic Studies, and 30 of the 100 FVPOD subjects were thus identified as psychotic patients and the remaining 70 were non-psychotic. RESULTS: Content validity of the CPQ was confirmed by an expert panel of five senior psychiatrists, achieving an overall reliability in the range of 0.86-0.93. The FVPOD group and comparison group had significantly different mean scores on all four subscales of the CPQ. In identifying psychotic cases, the 35-item positive symptom subscale had high sensitivity (97%) and low specificity (30%) with a cutoff value of 8. Due to the low specificity, patients identified as potential psychotic cases were referred for further clinical evaluation. CONCLUSION: Applicability of the CPQ was demonstrated by its high reliability and good ability to discriminate between clinical patients and a comparison group. The 35-item positive symptom subscale can be useful alone in general mental health settings for screening psychotic cases.

When a problem-based learning tutor decides to intervene.

PURPOSE: To appropriately contribute to group discussion, tutors should be experts in their field and possess facilitative skills. However, knowing when to interject is always a difficult question. This study investigated the specific scenarios or cues during group tutorial sessions that prompted or motivated tutors to interject and participate in the group discussion. METHOD: From 2005 through 2008, the authors, using the interpersonal process recall method, videotaped 40 tutorial discussions led by eight experienced tutors from the departments of medicine, nursing, and clinical psychology. The tutors were later shown the tapes and asked to explore their intentions and analyze the contexts for the 636 episodes in which they had intervened in the discussions. RESULTS: Qualitative analyses revealed three themes for the tutors' interventions: (1) Tutorial group process included 10 categories related to discussion sequence, students' roles, and group dynamics, (2) quality of discussion included nine categories related to clarity and accuracy of the information brought forward by the students, and relevance and critical appraisal of the information in relation to the major objectives, and (3) quality and quantity of the materials discussed included eight categories related to amount, datedness, accuracy, representativeness, and source (whether primary or secondary). CONCLUSIONS: These findings provide valuable insights into the contextual situations that lead problem-based learning tutors to intervene and provide material to build a framework for training new tutors.

[Being personal: the development of community psychiatric mental health nursing].

Community psychiatric mental health nursing care emphasizes humanistic values and focuses on serving patient and family needs. In Taiwan, such care is delivered largely as part of patient discharge care plans and hospital / community based service models. Issues involved underscore the importance of operating an effective and integrated transfer system, the role and function of nurses and training in relevant competencies (Shiau, Huang & Lin, 2005). This article again emphasizes the importance of 'being personal' in the development of community psychiatric mental health nursing in Taiwan. Critical issues to consider include humanization, empowerment, nursing competencies, regulations, relating on a personal level, and facilitating empowerment and enlightenment on the healing process.

Child-oriented family nursing intervention process in a single-encounter setting.

The purpose of this study was to develop nursing intervention skills emerging from the process of single-encounter child-oriented family nursing. This study was a part of a long-term research project by Shiau, conducted from 1990. The participants chosen for this study were patients with schizophrenia or mood disorders from an acute psychiatric ward of a medical center in Taipei. They lived with their spouses (or primary caregiver) and children after being discharged from that medical center. Each nursing intervention program for each family was arranged beforehand. The data of the family nursing intervention process with interview were tape-recorded and transcribed into narrative form and analyzed by content analysis. Results showed that family nursing intervention skills could be categorized into three stages: construction, problem oriented, and hope bridge. The unique point of the family nursing intervention in this study was its child orientation in the context of a single encounter. Providing such an affordable and accessible service for clients is necessary in modern society typified by busy lifestyles, nuclear family structures, and the dominance of cost-effectiveness in medical care delivery.

Reflection and critical thinking of humanistic care in medical education.

The purpose of this paper is to stress the importance and learning issues of humanistic care in medical education. This article will elaborate on the following issues: (1) introduction; (2) reflection and critical thinking; (3) humanistic care; (4) core values and teaching strategies in medical education; and (5) learning of life cultivation. Focusing on a specific approach used in humanistic care, it does so for the purpose of allowing the health professional to understand and apply the concepts of humanistic value in their services.

[The effect of family nursing on the lived experience of children living with schizophrenic fathers].

The purpose of this study was to explore by means of the phenomenological method the effect of family nursing on the experience of six adolescent offspring living with schizophrenic fathers. Data were collected by family intervention with low structured interview. Three themes of the lived experience of adolescents were identified: stalemate, coping and transcendence. The sub-dimensions of stalemate included encounter with "sick father" and unstable emotion, which resulted from the negative impacts of the father's illness. The sub-dimensions of coping included "sick father" or "my father", being with "sick father", trying to take care of "sick father", identification and differentiation, and the reformulation of "my father". These sub-dimensions emerged after family intervention and included coping in cognition, emotion, and behaviors. The sub-dimensions of transcendence included positive attitude toward psychiatric patients, caring for father's disease and medications, and family life restructuring. The findings from this study could help psychiatric mental health nurses to apply family interventions in order to gain a better understanding of the lived experience of children living with schizophrenic fathers and to enable them to cope positively with the father's disease.

Controlled trial of problem-solving therapy and consultation-liaison for common mental disorders in general medical settings in Taiwan.

OBJECTIVE: Common mental disorders (CMD) are prevalent high-impact illnesses seen in general medical settings worldwide. There has been no investigation on the efficacy of enhanced care in Chinese societies. The aim of this study was to compare the outcome of three interventions for treating CMD: usual care (UC), problem-solving therapy plus UC (PST-UC), and psychiatric consultation plus UC (PC-UC). METHOD: The sample for this randomized controlled trial consisted of 254 patients with CMD being managed in general medical care settings. Clinical and functional assessments were done at baseline and at 16 weeks. RESULTS: Two hundred six patients had complete data at 16 weeks (66 in the UC group, 63 in the PST-UC group, 77 in the PC-UC group). All patients had significant improvement on all scales over time, with no significant differences among the three treatment groups. CONCLUSION: This trial failed to demonstrate the efficacy of enhanced care with consultation-liaison by mental health professionals for patients with CMD in general medical settings in Taiwan. Improved outcomes may require more integrated interventions.

[Learning of life cultivation through nursing education].

This paper focuses on the learning of life cultivation through nursing education. Three perspectives are described, including (1) the learning of life cultivation, (2) the systematic approach to educational design, and (3) the faculty model of nursing clinical competency. It hoped that this study helps facilitate the learning of core values, fosters respect for life and encourages self expression in the nursing profession.

[Continuous care in community psychiatric mental health nursing: current state, future prospects].

On the basis of the human rights of patients with psychoses, community psychiatric mental health continuous nursing care holds the core value of "cherishing life, caring for the whole person", and integrates hospital and community medical resources, in order to improve patients' quality of life in the community. This article elaborates on the core value of continuous care in community psychiatric mental health nursing, and on its current state and future prospects, as a source of reference for further development in education and practice.

Professional career development for male nurses.

AIM: The aim of this paper is to report a study to: (a) explore Taiwanese male nurses' motivations for becoming a nurse; (b) reveal their professional developmental process in nursing; (c) understand the difficulties hindering their professional development from both professional and gender aspects; and (d) identify the strategies they use to cope with these difficulties. BACKGROUND: Hindered by historical, cultural, economic and warfare factors, the proportion of male nurses in Taiwan remains low. Taiwanese male nurses' career development process has not been well investigated yet. METHODS: A descriptive qualitative research design was used, with a convenience sample of 15 male nurses (mean age 30.8 years) with a Bachelor's degree in Nursing Science. Data were collected by semi-structured interviews and analysed by content analysis. RESULTS: Taiwanese male nurses' entrance into the nursing profession involved three phases: pre-study, study and employment. The difficulties encountered during career development were related to the gender expectations of patients and the general public. The nurses received support more from superiors than from colleagues. The strategies they used included (a) improving their professional knowledge and skills to obtain higher levels of satisfaction and better opportunities for promotion; (b) thinking aggressively about job promotion; (c) choosing specialist departments as appropriate environments for graduate study and personal growth; and (d) changing their professional track for personal growth. CONCLUSIONS: Based on the nature of nursing work and clinical experiences, Taiwanese male nurses believed that nursing was a profession suitable for both men and women. Their preparation for career development started at the pre-study phase. The major strategies they used were related to a strong desire for personal growth and professional promotion. Finally, a conceptual framework was developed to depict this complex phenomenon.