Needs for providing overseas organ transplant medical function and information with eHealth telecare systems-instrument development for health professionals in Taiwan.

BACKGROUND: The use of eHealth systems for facilitating overseas organ transplantation (OOT) between 2 medical parties has been discussed. Nevertheless, little information is available about organ transplant health professionals' (OTHPs') needs in using the eHealth telecare systems (eHTSs) for providing OOT medical service. This project attempted to answer this question. METHODS: A purposive sample including OT surgeons (OTSs), registered nurses (RNs), and organ transplant coordinating nurses (OTCNs) was obtained from 5 hospitals in Taiwan. A Delphi research method was used in this research. The subjects were invited to respond to a sequence of surveys to learn their appraisal of the needs in using eHTSs for providing OOT medical service. RESULTS: Twenty-two subjects including surgeons (n = 10), RNs (n = 9), and OTCNs (n = 3) participated in this research. Their years working in the field ranged from 3 to 45 (mean 15.77) years. To learn OTHPs' appraisals of their needs in using eHTSs for providing OOT medical service, system function requirements (SFR) and system information requirements (SIR) for telecare were produced. SFR were identified to encompass the following 9 aspects: (a) safety in the supervisor mechanism for protection of privacy including account, password, and unediting mode of medical prescriptions; (b) unlimited to particular software or hardware; (c) options of related medical term language in English and traditional and simplified Chinese; (d) available any time and anywhere; (e) being able to save print and export medical records by E-mail systems under authorization; (f) friendly operation; (g) real-time and accurate information; (h) tape-recording functions (OTHPs may convey important medical information to others); and (i) online mutual communications between OTHPs and their clients. SIR included: (a) a comprehensive preoperative medical profile before departure for another country; (b) a comprehensive medical profile of OOT performed in another country; (c) a comprehensive postoperative treatment profile after return to original country; and (d) physiologic health indicators of long-term recovery in the community. CONCLUSIONS: In this project, OTHPs addressed their tangible needs for operating an eHTS to facilitate OOT. These findings would serve as a valuable reference for eHTS experts to continue to work with OTHPs to move to the next development stage.

The needs and expectations of overseas liver transplant recipients' families in Taiwan: across different transplantation stages.

AIMS: This study explored the needs and expectations of Taiwanese overseas liver transplant recipients' families (OLTRFs) across three liver transplantation stages. PATIENTS AND METHODS: An exploratory qualitative method was applied to a purposive sample of OLTRFs who received guided face-to-face, semi-structured interviews. Data were subjected to content analysis. RESULTS: Nineteen OLTRF members (15 females, 4 males) aged between 29 and 71 years (mean, 55.1 years) for 19 patients who had end-stage liver diseases were interviewed regarding overseas liver transplantation (OLT) across three stages: pre-departure (first stage), stay in mainland China (second stage), and re-entry into Taiwan (third stage). Five types of needs across OLT stages were reported: (a) knowing precise operation schedule in advance (first to second stages); (b) sharing the caring burdens (second to third stages); (c) knowing the updated health status if possible (all stages); (d) obtaining timely psychological support (all stages); and (e) effective communications between health professionals in Taiwan and mainland China to ensure the caring quality (all stages). Furthermore, five expectations were reported: (a) more donor sources (first stage); (b) comprehensive caring strategies for OLT (first stage); (c) a comprehensive consultation system and timely assistance channels for OLT recipients and their families (second to third stages); (d) a legal and accessible therapy process (all stages); and (e) the cooperation with foreign countries and allowed experience sharing for better quality of patient care (all stages). CONCLUSIONS: Most ethnic Chinese believe that family is an integrated system; moreover, there is close attachment between OLT recipients and their families. The needs and expectations of the recipients' family across three transplantation stages were first reported in this project. With this knowledge, the health providers of related countries are empowered by a better understanding of the family's needs and expectations of these OLT recipients at different stages.

Difficulties in organ procurement and transplantation in the aboriginal minority people in Taiwan.

BACKGROUND: Aboriginal people (AP) are a minority group in Taiwan. Little information on their perspectives on organ transplantation (OT) is available. Their rights for organ donation (OD) and as OT recipients (OTR) are constrained as a vulnerable population in society. This research sought to explore various Highland Aborigine Tribes beliefs systems and concepts related to OT. METHODS: We employed a qualitative design on a purposive sample including seven categories of Taiwanese AP. Data collected by face-to-face interviews were evaluated by content analysis. RESULTS: Seventy-five informants (45 female and 30 males) of 18 to 82 years from seven tribes completed interviews: Bunun (n = 20), Shao (n = 18), Tsou (n = 15), Amis (n = 12), Truku (n = 4), Rukai (n = 3), and Puyuma (n = 3). Of there, 33% had no idea of OT. All informants reported lack of knowledge of OD, organ procurement, and OTR. Eighty percent (45-82 years) had no willingness for OD or OTR; others might consult family members and health professionals (HP) to learn about OT. Seven hindering factors were identified: (1) having no background of OT; (2) limited impressions obtained from television news reports; (3) negative concepts of donating one's organs to others; (4) OT concepts contrast with cultural meanings of death; (5) possibility of being stigmatized; (6) fear of being rejected by others; and (7) HP had never mentioned OT. CONCLUSIONS: Taiwan APs' perspectives of OT concepts showed the majority to be unfamiliar with the concept and benefits of OT. Future research is necessary to explore the possible avenues to facilitate communications between HP and AP leaders, as well as elders in each AP category in Taiwan.

The dilemma of "to be or not to be": developing electronically e-health & cloud computing documents for overseas transplant patients from Taiwan organ transplant health professionals' perspective.

AIMS: The development of mutually accessible e-health documents (ehD) and cloud computing (CC) for overseas organ transplant health professionals (OTHP) in two medical parties (domestic and overseas) would ensure better quality of care. This project attempted to compare pro and con arguments from the perspective of Taiwan's OTHP. METHODS: A sample was obtained from three leading medical centers in Taiwan. RESULTS: Eighty subjects including transplant surgeons (n = 20), registered nurses (RN; n = 30), coordinating nurses (OTCN; n = 15), and e-health information and communication technologies experts (ehICTs; n = 15) participated in this research. The pros of developing ehD were: (1) better and continuous care through communication and cooperation in two parties (78%); (2) better collaborative efforts between health professionals, information technology experts in two medical parties is (74%); (3) easier retrieval and communication of personal health documents with the trustworthy OTHP in the different countries (71%); and (4) CC may help develop transplant patients medical cloud based on the collaboration between medical systems in political parties of Taiwan and mainland China (69%). The cons of developing ehD and CC included: (1) inadequate knowledge of benefits and manuals of developing ehD and CC (75%); (2) no reliable communication avenues in developing ehD and CC (73%); (3) increased workload in direct care and documentation in developing new ehD and CC (70%); (4) lack of coaching and accreditation systems in medical, electronic, and law aspects to settle discrepancies in medical diagnosis and treatment protocols between two parties (68%); and (5) lacking systematic ehD and CC plans developed by interdisciplinary teams in two parties (60%). CONCLUSION: In this initial phase, the establishment of an interdisciplinary team including transplant leaders, transplant surgeon, RN, OTCN, ehICTs, and law experts from two parties might be helpful in working out developing plans with careful monitoring mechanisms.

Changes in health-related quality of life across three post-heart transplantation stages: preoperative extracorporeal membrane versus non-extracorporeal membrane group/clinical trial plan group versus non-clinical trial plan group in Taiwan.

AIMS: The aims of this research were to compare changes in overall health-related quality of life (HRQoL), working competence (WC), physical functions (PF), and quality of sleep across 3 crucial post-heart transplantation (HT) stages (1 month, 6 months, and 1 year post-HT) between the following: (1) preoperative extracorporeal membrane (preop-ECMO) versus non-ECMO group and (2) postoperative Clinical Trial Plan (CTP) group versus non-CTP group in Taiwan. PATIENTS AND METHODS: A between-method triangulation design was used. Subjects who had undergone HT in the last 1-4 years were recruited from a leading medical center in Taipei. Quantitative data were collected using Visual Analog scale (VAS) and Taiwan's version of the World Health Organization Quality of Life (WHOQOL) questionnaire. Semistructured qualitative questions were added to explore the factors influencing the changes in social domains of HRQoL. RESULTS: A total of 62 heart transplant recipients (HTRs) participated in this study. Their ages ranged from 20 to 70 (mean, 47.16 ± 12.09) years; 80.6% were male. Compared with the subjects with preop-ECMO, HRQoL, WC, and PF of the subjects without preop-ECMO were less at 1 month post-HT; the difference reached statistical significance for HRQoL and PF for 1 month post-HT, but they recovered at the 6 months post-HT stage. HTRs who had participated in the CTP had higher HRQoL and perceived WC in the period of 1 month post-HT, 6 months post-HT, and 1 year post-HT as compared with the group not in CTP; meanwhile, the difference was statistically significant for HRQoL at 1 month post-HT and 6 months post-HT and for PF at 1 month post-HT. CONCLUSIONS: The efficacy of postop-CTP including HRQoL, WC, and PF was promising across the 3 post-HT stages. Postop-CTP was suggested both clinically and was shown to be statistically significant to HTR's recovery of their health status.

Dilemmas across different overseas liver transplant stages: Taiwan transplant recipient families' perspectives.

AIMS: This study aimed to explore the dilemmas of Taiwanese overseas liver transplant recipient families (OLTRF) across three overseas liver transplant (OLT) stages in Taiwan and Mainland China. PATIENTS AND METHODS: An exploratory qualitative method was employed using a purposive sample of OLTRF, who received guided face-to-face, semistructured interviews. Data were subjected to content analysis. RESULTS: Nineteen OLTRF (15 female, 4 male) aged between 29 and 71 years (mean 55.1) for 19 patients with end-stage liver diseases were interviewed. OLT stages including predeparture stage (first stage), stay in China stage (second stage), and reentry to Taiwan stage (third stage). Ten kinds of dilemmas were encountered: (1) unable to get transplantation immediately (first to second stages); (2) dilemma of choosing overseas transplantation (first to second stages); (3) uncertainty about the transplantation outcomes (second to third stages); (4) care pressure (second to third stages); (5) poor diet adaptation (second to third stages); (6) lack of trust in the medical care quality (second stage); (7) worry about not fulfilling family responsibilities (second stage); (8) lack of information (all stages); (9) financial pressure (all stages); and (10) frustration when seeking medical care (all stages). CONCLUSIONS: Taiwanese OLTRF's perspectives of their dilemmas through the OLT process were first revealed in this study. Both Western and Eastern health professionals might be empowered by better understanding of OLTRF's living experiences and concerns during the stages of overseas liver transplantation.

Motivations and decision-making dilemmas of overseas liver transplantation: Taiwan recipients' perspectives.

PURPOSE: This study sought to explore the motivation and dilemmas in the decision-making process encountered by Taiwan overseas orthotopic liver transplant (OLT) recipients. PATIENTS AND METHODS: We used an exploratory qualitative research method on a sample of transplant recipients. Face-to-face in-depth interviews were performed with a semistructured interview guide. Data were evaluated by qualitative content analysis. RESULTS: We interviewed 15 patients including 11 males and 4 females aged between 41 and 68 years (mean = 57.3) including 14 who received OLT in China and one in the United States. The most important motivations were saving lives from end-stage liver disease and avoiding a hopeless sense of their residual lives with the psychological torture of a waiting death. Their decision-making process leading to overseas OLT could be divided into several phases among which the phase of transplant data evaluation and decision was the most critical one. Nevertheless, every stage and phase had its unique contents, factors, and dilemmas. CONCLUSION: This study demonstrated that patients encountered various dilemmas at different phases in the decision-making process of considering overseas OLT. This information is important for care providers and policy makers in dealing with patients who consider overseas OLT.

Challenging issues of overseas transplantation in mainland China: Taiwan organ transplant health professionals' perspective.

OBJECTIVE: As the source of organs is limited in Taiwan, and communication systems are becoming more open between Taiwan and mainland China, the call for overseas transplantation in mainland China is increasing in Taiwan. This study explored the perspectives of Taiwan organ transplant health professionals on the challenging issues related to transplantation procedures in mainland China, including health professionalism as well as collaborative systems for information and communication technologies (ICTs). METHODS: A purposive sample including overseas transplant surgeons (OTS), registered nurses (RN), overseas transplant coordinating nurses (OTCN), and e-health ICTs experts (eh-ICTs) was obtained from two medical centers in Taipei. Subjects underwent face-to-face interviews with data subjected to content analysis. RESULTS: The 70 subjects included OTS (n = 20), RN (n = 25), OTCN (n = 15), and eh-ICTs (n = 10). Their ages ranged from 23 to 63 years old (mean, 33.7 years). The current challenges were identified: (a) lack of workable collaborative systems for continuous medical care between two parties due to different medical recording systems in particular (86%, n = 60; OTS, n = 19; RN, n = 21; OTCN, n = 10; eh-ICTs, n = 10); (b) lack of mutual trustworthy relationships between medical delivery systems (84%, n = 59; OTS, n = 17; RN, n = 22; OTCN, n = 10; eh-ICTs, n = 10); (c) lack of accreditation systems to judge possible conflicts related to medical diagnosis and treatment protocols (79%, n = 55; OTS, n = 19; RN, n = 19; OTCN, n = 7; eh-ICTs, n = 10); (d) Taiwanese hesitation regarding the quality of transplant procedures in mainland China (71%, n = 50; OTS, n = 18; RN, n = 17; OTCN, n = 8; eh-ICTs, n = 7); and (e) stress from concerns of Taiwan medical societies about the benefits of collaboration with mainland China (64%, n = 45; OTS, n = 13; RN, n = 18; OTCN, n = 8; eh-ICTs n = 6). CONCLUSION: This discussion is still ongoing. Trapped by the limited organ source and confronted by multiple challenges revealed in this project, Taiwan societies have suggested to initiate interdisciplinary communication avenues. Starting with less culturally confounded issues such as establishing a reliable ICTs system (ie, e-health documents) may be more appreciated by the two parties in the near future.

Caring for overseas liver transplant recipients: Taiwan primary family caregivers' experiences in mainland China.

INTRODUCTION: This study explores the motivations of overseas liver transplant recipient (OLTR) families of Taiwanese OLTR who undergo the procedure in mainland China. We report the waiting time to receive the transplant in mainland China as well as the rational and service. PATIENTS AND METHODS: This exploratory qualitative method reflects guided face-to-face, semistructured interviews with families members of OLTRs. Data were subjected to content analysis. RESULTS: We interviewed 19 OLTR family members (15 females and 4 males who were between 29 and 71 years of age; mean 55.1 years) regarding 19 patients who had (17 males and 2 females who were between 36 and 71 years of age, mean, 54.6 years). The OLTR underwent transplantation in three cities in mainland China: Tianjin, Shanghai, and Guangzhou. After arrival the average waiting time was 33.1 days. Subjects reported the following reasons to help patients undergo the procedure in mainland China: (1) it is difficult to have the procedure in Taiwan; (2) the desire to extend life; and ((3)) there is no domestic living donor. Seven reasons for serving as OLTR supportive family members were identified: (1) The role and obligation in the marital relationship; (2) a close bloodline relationship; (3) insufficient manpower; (4) an individual's availability; (5) evasion of responsibility by other family members; (6) compensation for inadequate caring efforts earlier in life; and (7) an unwillingness to disturb other relatives' lives. Finally, the following support for the OLTR was reported: providing company during medical treatment/doctor visits, food preparation, massage, daily assistance, medical care, and psychological support. CONCLUSIONS: Taiwanese OLTR family members' perspectives throughout the transplant process may provide better understanding of living experiences and concerns during the stages of overseas liver transplantation.

Job resumption status, hindering factors, and interpersonal relationship within post-heart transplant 1 to 4 years as perceived by heart transplant recipients in Taiwan: a between-method triangulation study.

INTRODUCTION: This project examined heart transplant (HT) recipients' perspectives of (a) the changes in their working competence (WC), status for job resumption and related factors at 1- to 2-year, 2- to 3-year, and 3- to 4-year stages; and (b) impacts of HT on interpersonal relationships (IPR). METHOD: We used a between-method triangulation (including qualitative and quantitative data) design. Quantitative data were collected using the Vertical Visual Analogue Scale and Taiwan's version of the World Health Organization Health-Related Quality-of-Life (HRQoL) questionnaire. Six qualitative semistructured questions were further applied to explore social and environmental domains. RESULTS: The Fifty subjects (86% males and 14% females) had an age range from 20 to 70 years old (mean, 47.68 years). Their post-HT time ranged from 1 to 4.1 years with 42%, 42%, and 16% at 1- to 2-, 2- to 3-, or 3- to 4-years post-HT, respectively. Within 6 months, 10% of administration or restaurant staff, and police resumed their jobs. At 6 to 12 months, 8% of administration, quality control, and design and planning staff resumed their jobs. At 12 months, 14% of educators, insurance personnel, managers, informatics engineers, and ironworkers resumed their jobs. Hindering factors to returning to work included (a) physical (ie, lack of energy, second heart attack, recurrence of rejection, physical discomforts of dizziness, memory lapses/lack of concentration or bone pain from osteoporosis); (b) psychological (ie, lack of confidence, worries about discrimination, being different, maladaptation); and (c) environmental (inadequate job opportunities due to poor socioeconomic conditions). Additionally, 34% reported worse IPR after HT due to diet limitations, slower pacing, less contacts with friends, and changes in personality. Reflections on both the meaning and value of life caused 10% to report better IPR with a better personality and positive mindset. By the end of the first postoperative year, the mean score of HRQoL in the preoperative extracorporeal membrane oxygenation (ECMO) group was similar to the non-preoperative ECMO group; the mean scores of WC and physical functions for the preoperative ECMO group were even higher than the non-preoperative ECMO group. Meanwhile, the mean scores of HRQoL and WC were higher in the Clinical Trail Plan (CTP) group than non-CTP groups across the three stages. As such, the use of preoperative ECMO and CTP groups are suggested to be both clinically and significantly associated with HTs recovery in heath status, positive HRQoL, and job resumption in the society. Finally, HRQoL and related domains of physical, psychological, social, and environmental health were stable at 12 months post-HT, with no significant change between 1- to 2-, 2- to 3-, and 3- to 4-years post-HT.

Perceived health-related quality of life in heart transplant recipients with vs without preoperative ECMO in Taiwan: between-method triangulation study.

OBJECTIVE: To compare changes in overall health-related quality of life (HRQoL), working competence, and physical functions in heart transplant (HTx) recipients with vs without preoperative extracorporeal membrane oxygenation (ECMO) at 3 crucial stages post-HTx: 1 and 6 months and 1 year. PATIENTS AND METHODS: This between-method triangulation study included qualitative and quantitative data for patients recruited from a medical center with 2200 beds. Quantitative data were obtained using a vertical visual analog scale and the Taiwan version of the World Health Organization Quality of Life Questionnaire. Six semistructured qualitative questions were added to further explore factors that influence changes in Social domains of HRQoL between the 4 groups across recovery stages. RESULTS: The 50 patients (86% men and 14% women) ranged in age from 20 to 70 years (mean age, 47.68 years). Time post-HTx ranged from 1 year to 4 years and 1 month, and 16% had received preoperative ECMO therapy. Mean (SD) HRQoL, working competence, and physical functions improved from 54.76 (24.44), 31.8 (26.53), and 80.00 (33.67), respectively, at 1 month post-HTx (r=.48) to 65.76 (20.24), 50.90 (25.23), and 96.80 (11.05) at 6 months (r=.52) and 74.40 (13.65), 64.30 (21.48), and 98.8 (7.80) at 12 months (r=.44), with moderately significant differences. Compared with the non-ECMO group, the preoperative ECMO group perceived lower (stage 1), similar (stage 2), and higher (stage 3) working competence. Thirty-two percent of recipients resumed stable jobs across the 3 stages (10%, 8%, and 14%, respectively), and reported higher working competence and physical functions compared with other patients (68%) (P<.001). Recipients with stable marriages (P=.046), higher educational achievement level (P=.004), and stable jobs (P=.001) reported greater overall HRQoL across the 3 stages. CONCLUSION: Heart transplant recipients reported higher overall HRQoL, working competence, and physical functions across the 3 recovery stages during 12 months post-HTX. Three major influencing factors identified included stable marriage, higher educational achievement level, and stable job status.

Dark-recovery experiences, coping strategies, and needs of adult heart transplant recipients in Taiwan.

AIMS: The aim of this project was to identify the dark-recovery experiences (DRE) that adult heart transplant recipients (AHTRs) perceived as causing the most suffering after heart transplantation (HT). In artition, we sought to explore the stage-specific difficulties, coping strategies, and helpers for transplant recipients DRE in Taiwan. METHODS: A qualitative design was employed using a sample group of patients with DRE. Retrospective data collected by face-to-face in-depth interviews were subjected to content analysis. RESULTS: A total of 20 AHTRs (16 men, 4 women) participated in this research. Their ages ranged from 32-70 years (mean, 46.95 years). Their post-HT timeframe ranged from 3 months-2.10 years. The subjects reported DRE the across preoperative intensive care unit (ICU), postoperative floor unit, and even after the hospital discharge stages. Four major difficulties during DRE were reported: (1) becoming a burden for families (all stages); (2) unfamiliar with medical protocols, environment, and policy (ICU stage); (3) mental and physical discomforts caused by the invasive examinations and unstable health condition (post-ICU to postdischarge stages); and (4) sense of uncertainty about health progression and quality of life in the future (post-ICU to postdischarge stages). Four coping strategies were used for DRE: (1) asking religious support (all stages); (2) changing mindsets and taking positive attitudes to live with difficulties (ICU to postdischarge stages); (3) setting goals for health maintenance and recovery (post-ICU to postdischarge stages); and (4) planning to look for an appropriate job in the future (postdischarge stages). Families and religious persons were cited as helpers (all stages), as well as health professionals (ICU to postdischarge stages), other AHTRs (post-ICU to postdischarge stages), and the social welfare systems (postdischarge stages). CONCLUSION: DRE, coping strategies, and related helpers in Taiwan were systematically explored in this project. With this information, the transplantation team will be empowered to provide better care for AHTRs during their most vulnerable time.

Ethical issues of organ transplantation in Chinese community: perspectives of health professionals, legal professionals, and religious experts in Taiwan and mainland china.

OBJECTIVE: This study aimed to compare the perspectives of leading ethical issues related to organ transplantation as perceived by health professionals (HP), legal professionals (LP), and religious experts (RE) from Taiwan (TW) and Mainland China (MC). MATERIALS AND METHODS: A purposive sample including TW's organ transplant health professionals (OTHP), LP, and RE and MC's HP was obtained in this qualitative research. Data were analyzed by content analysis. RESULTS: A total of 127 subjects participated in this project (n = 119 in TW, 8 in MC). They were HP (n = 92), RE (n = 25 TW), and LP (n = 10 TW). Seven ethical dilemmas were reported: (1) difficulties in touching the hearts of the public (HP 100%, LP 100%, RE 100%); (2) challenges in helping donors and their families (HP 96%, RE 80%, LP 50%); (3) competence and availability of HP (HP 93%, RE 72%, LP 50%); (4) questionable social farewell (HP 92%, RE 20%, LP 100%); (5) questionable legitimacy of prisoners' motivations (LP 90%, RE 64%, HP 60%); (6) worry about public discrimination (LP 90%, HP 50%, RE 20%); and (7) challenges to families in taking care of the recipients (HP 87%, LP 70%, RE 52%). CONCLUSIONS: To provide holistic care, HP need to invite RE to provide spiritual support for the donors of cadaveric organs, recipients, and their families. Reliable LP can help them to complete the sophisticated legal procedures. With help from this triangulated collaborative team, the value of organ transplantation will be appreciated by the public.

Concerns regarding organ donation from prisoners with death penalties: perspectives of health professionals in Taiwan and Mainland China.

OBJECTIVE: This study aimed to compare the dilemmas of using organs from prisoners with death penalties (PDP) from the perspectives of organ transplant health professionals (OTHP) from Taiwan (TW) and Mainland China (MC). MATERIALS AND METHODS: A purposive sample including TW's OTHP (including transplant surgeons, nurses, researchers, social workers, and medical religious and legal experts), and MC's OTHP (including surgeons and nurses) was obtained in this qualitative research. TW's subjects received face-to-face interviews, and MC's subjects received telephone interviews due to limited communication opportunities. Data were analyzed by content analysis. RESULTS: A total of 105 subjects participated in this project (TW n = 99, MC n = 6). They were surgeons (n = 18: TW n = 14, MC n = 4), registered nurses (n = 42: TW n = 40, MC n = 2), OT coordinating nurses (n = 10 TW), OT researchers (n = 5 TW), social workers (n = 10 TW), medical religious experts (n = 15 TW), and medical legal experts (n = 5 TW). The following 8 ethical dilemmas were reported: (1) questionable legitimacy of PDP motivation (TW 100%, MC 100%); (2) recipients' worries about public discrimination (TW 89%, MC 50%); (3) difficulties in approaching PDP (TW 100%); (4) hesitation of HP and volunteers in helping PDP (TW 37%); (5) questionable social contribution of PDP as donor sources (TW 32%); (6) complex legal details of PDP issues (TW 26%); (7) potential threat from PDP families (TW 23%); and (8) difficulties in helping PDP families cope with post-organ donation syndrome (TW 11%). CONCLUSIONS: Five suggestions were developed in managing these challenges: (1) TW OTHP may empower their basic social science knowledge and empirical competence; (2) TW government may form a task force wherein OTHP leaders are encouraged to foster interdisciplinary collaborations with the public within short-, mid-, and long-term time frames; (3) TW and MC may establish evidence-based center(s) to provide systematic literature reviews for clinical guidance, policy making, and educational resources; (4) TW and MC may try to improve the quality of PDP organ harvesting and donation practice in jails/health institutes; and (5) TW and MC may develop reliable communication systems to share experiences of quality care for PDP, and to evaluate the appraisals both pro and con from multidisciplinary societies and the public, if available.

Comparison of the psychospiritual needs of Chinese heart transplant recipients at pre- and postoperative stages.

PURPOSE: This project sought to compare Chinese heart transplant (HT) recipients' psychospiritual needs during the preoperative (PS) and the postoperative predischarge stage (PDS). METHODS: Thirty HT recipients from two leading medical centers in Taiwan were recruited for this research. Data collected by face-to-face interview were analyzed by content analysis. RESULTS: The patients' ages ranged from 23 to 45 years (mean [M] +/- standard deviation [SD] = 28.5 +/- 4.1); 90% were married. The subjects' cardiac disease history ranged from 4.2 to 12.3 years (M +/- SD = 8.2 +/- 2.3). The waiting time list for HT ranged from 1.2 to 6.4 years (M +/- SD = 3.1 +/- 2.6). The subjects had the following six psychospiritual concerns: death (PS), unfulfilled family responsibilities (PS and PDS), unaccomplished personal life goals (PS and PDS), poor body image (PDS), loss of significant others' support and love (PDS), and discrimination by others (PDS). The following seven needs of help were reported: comforting the fear of failure in heart transplantation (PS and PDS), meeting unfulfilled family responsibilities (PS and PDS), accomplishing personal life goal (PS and PDS), religious support (PS and PDS), establishing confidence in body image (PDS), establishing positive relationship with significant others (PS and PDS), and preparation for dying with dignity when necessary (PS and PDS). CONCLUSION: The in-depth investigation on Chinese HT recipients' psychospiritual needs was first compared in PDS and PS. More distress and needs were found in PDS than PS. These findings were attributed by the dilemma of pursuing prospective future versus taking the risk of loss of life, valuing families' and health professionals' support system, and expecting grief and dying with dignity. Health professionals are encouraged to understand and provide stage-specific support to help them meet psycho-spiritual needs.

Empirical validation of a teaching course on spiritual care in Taiwan.

UNLABELLED: AIM(S) OF STUDY: The aims of this study were threefold: (a) to develop the first spiritual care program for master of science in nursing degree students (MSNDS) in Taiwan, since most of these students are or will be nursing leaders in clinical practice, education, administration, or research; (b) to facilitate the MSNDS in applying the contents of this program to care of their clients; and (c) to understand the MSNDS' appraisals of the usefulness of the program in helping them provide spiritual care in clinical settings. BACKGROUND: The World Health Organization (WHO) (1998) proclaimed that health needs should include spiritual well-being in addition to physical, mental, and social domains. Nevertheless, many dominant medical educational systems have not yet encompassed spiritual care as part of their comprehensive or core curricula. DESIGN/METHODS: The methodological triangulation research design used in this project included various strategies of developing a novice course entitled 'Spirituality in Nursing Practice' which was given to the subjects over 18 weeks from September 1998 to February 1999. The course included classroom lectures, field trips, clinical implications, and presentation-appraisal. A convenience sample of 22 female MSNDS who were or had the potential to be nursing leaders from two schools of nursing in northern Taiwan was obtained. RESULTS: Four types of help were identified: (a) help in clarifying the theoretical concepts of spiritual care (100%); (b) help in providing a culturally bonded spiritual care plan (100%); (c) help in self-disclosure of the nurse's personal value systems and spiritual needs (91%); and (d) help in clarifying the symbolic meaning and the impact of religious rituals (86%). The explicit spiritual care plans and an empirical example of spiritual care were provided. CONCLUSIONS: This study presented the first spiritual care program for MSNDS in Taiwan. All subjects considered the course helpful in providing spiritual care for their clients in various clinical settings. The concept of spirituality is arousing great interest in the world, and this is evident in the spiritual care courses appearing in nursing curricula for nursing leaders in Taiwan.

[The decision-making process of pregnant women with positive reaction to maternal serum screening for Down's syndrome when facing amniocentesis].

The purpose of this study was to explore the decision-making process of pregnant women with positive reaction to maternal serum screening for Down's syndrome when facing amniocentesis. Seventeen pregnant women consented to participation in this study. The data were collected through semi-structured interviews and analyzed using the grounded theory method. The findings revealed that there were four decision-making patterns. Each pattern could be grouped into three stages: post-acknowledgement transition, decision-making transition, and after-decision transition. Most participants had psychological reactions, which included shock, fear, nervousness, worry, sadness, and stress. Their concerns during the decision-making transition stage were: confirmation of health, normality, and safety of the fetus, fear of abortion due to amniocentesis, clarification of relations between amniocentesis and maternal serum screening, opinions from physicians and family members, and fear of artificial abortion for unhealthy fetus. Concerns during the after-decision transition stage were: information relating to amniocentesis, the management of an abnormal fetus, the place for amniocentesis, preparation before amniocentesis, and inadequate time for making a decision. Coping strategies were developed to deal with their concerns.

The dilemma of "to-be or not-to-be": needs and expectations of the Taiwanese cadaveric organ donor families during the pre-donation transition.

There has been little study of the Chinese cadaveric donor family's decisions to donate organs within the Chinese cultural framework. A convenience sample of 25 cadaveric donor family members (12 men, 13 women) who gave their consent to donation at National Taiwan University Hospital agreed to participate in this study and completed in-depth interviews. Data were analyzed by a three-steps within-method qualitative triangulation method. The factors influencing the donor family's decisions to donate organs, the needs of donor families, and their expectations of health care providers during the pre-donation transition--the critical period of time between signing a donation and consent to organ harvesting--were examined. The background context and a conceptual framework were further developed to discuss and depict this phenomenon. This project aims to broaden the horizon on organ donation and contribute to the understanding of some of the psychodynamic issues in the Chinese family in Taiwan.