Caring Difficulties and Coping Strategies for Pediatric Organ Transplant Recipients and Their Families During Dark Recovery Experiences in the Hospital: Perspective of Health Professionals in Taiwan.

BACKGROUND: This study explored caring difficulties and the reliable coping strategies for pediatric organ transplant recipients (POTR) and their families during their dark recovery experiences (DRE) in the hospital from the perspectives of Taiwan organ transplant health professionals (OTHP) in Taiwan. METHODS: A qualitative design was used with a purposive sample of OT surgeons (OTS) and nurses. Data were collected by face-to-face in-depth interviews and analyzed by content analysis. RESULTS: Fifty-five subjects (39 females, 16 males) participated in this project. They included 15 OTS and 40 nurses. The nurses included registered nurses (n = 27), nurse practitioners (n = 5), and assistant or head nurses (n = 8). Their ages ranged from 25 to 66 (M = 38.4) years old. Thirty-eight (69%) had a college education and 17 (31%) had a graduate education. Their OT careers ranged from between 3 to 40 (M = 23.8) years for OTS, and 0.5 to 15 (M = 4.10) years for the OT nursing group. Six types of coping strategies for caring difficulties were reported: (a) implementing humanistic care training programs, (b) developing clinical paths for complex multiple OT cases, (c) holding case conferences for successful and failed cases, (d) developing OT expert training programs for interdisciplinary team members, (e) integrating acute and long-term care teams for difficult OT cases and families, and (f) inviting assistance from social workers. CONCLUSIONS: This research identifies important care difficulties and provides coping strategies that help to empower OTHP to care for POTR and their families during DRE, including increasing the manpower of experienced OT staff, conducting systematic in-service training, building teamwork between OTHP, and establishing a good pediatric OTHP team with consensus and good communication channels so as to effectively deal with the difficulties faced when caring for the POTR, and further to effectively enhance the overall quality of clinical care of POTR.

Dilemma of applying telehealth for overseas organ transplantation: comparison on perspectives of health professionals and e-health information and communication technologists in Taiwan.

INTRODUCTION: Telehealth is one of the avenues of e-health; it is a voice, image, or document delivery system via the internet and aims to assist patients to prevent disease and to promote health, diagnosis, self-care, and treatment. The purpose of using telehealth for overseas organ transplantation (OOT) was debated. This study aimed to explore the dilemma in applying telehealth for OOT patients from the perspectives of health professionals and e-health information and communication technologists (eh-ICTs) in Taiwan. METHODS: An exploratory qualitative method was used, with a purposive sample of OT health professionals (OTHP) and eh-ICTs in Taiwan. Qualitative data were collected by face-to-face semistructured interviews, and were analyzed by content analysis. RESULTS: Fifty subjects including 10 OT surgeons (OTS), 30 registered nurses (RNs), and 10 eh-ICTs participated in this study. Five dilemmas were identified: (1) medical law violation (80%, n = 40 of 50; 100% OTS [n = 10 of 10], 67% RNs [n = 20 of 30], 100% eh-ICTs [n = 10 of 10]); (2) integrating telecommunication and medical systems for OOT (74%, n = 37 of 50; 90% OTS [n = 9 of 10], 73% RNs [n = 22 of 30], 60% eh-ICTs [n = 6 of 10]); (3) the inconsistent caring protocols among medical parties (68%, n = 34 of 50; 80% OTS [n = 8 of 10], 70% RNs [n = 21 of 30], 50% eh-ICTs [n = 5 of 10]); (4) the uncertainty in quality of care in overseas medical institutes (62%, n = 31 of 50; 80% OTS [n = 8 of 10], 60% RNs [n = 18 of 30], 50% eh-ICTs [n = 5 of 10]); and (5) the uncertainty in cost-effectiveness (36%, n = 18 of 50; 60% OTS [n = 6 of 10], 17% RNs [n = 5 of 30], 70% eh-ICTs [n = 7 of 10]). CONCLUSIONS: The use of telehealth for OOT is in its infancy. A systematic curriculum with advanced pilots targeted to develop telehealth for OOT will be needed for mutual communication between OTHPs and eh-ICTs in the near future.

Caring dilemmas and coping strategies for organ transplant recipients and their families: perspective of health professionals in Taiwan.

BACKGROUND: Organ transplant health professionals (OTHP) are challenged by more and more sophisticated caring dilemmas raised by organ transplant recipients (OTR) and their families. The purposes of this study were to explore caring dilemmas and the reliable coping strategies applied by OTHPs in Taiwan. METHODS: A qualitative design was used with a purposive sample of OT surgeons and nurses. Data were collected by face-to-face in-depth interviews and analyzed by content analysis. RESULTS: Sixty subjects (43 females, 17 male) participated in this project. They were 16 OT surgeons and 44 nurses, including RNs (n = 29), nurse practitioners (NP, n = 6), and assistant/head nurses (n = 9). Their ages ranged from 25 to 66 (mean = 38.2) years old. Their OT careers ranged from 3 to 40 (mean = 24.7) years for OT surgeons and 0.5 to 15 (years = 4.3) years for the nursing group. Five types of coping strategies for caring dilemmas were reported: (1) developing clinical paths for complex multiple-OT cases, (2) developing OT-expert training programs for interdisciplinary team members, (3) integrating acute and long-term care teams for difficult OT cases and families, (4) holding case conferences for successful and failed cases, and (5) implementing humanistic care training programs. CONCLUSIONS: The findings of this research provide important coping strategies that can help empower OTHPs to care for complex multiple-OT cases with humanitarian expressions. More discussion about cultivation of interdisciplinary OT experts programs, and integration of caring resources are needed in the near future.

Holistic care for pediatric organ transplant recipients and their families during their dark postoperative recovery stage in the hospital.

INTRODUCTION: This study explored the difficulties in caring for pediatric organ transplant recipients (POTR) and their families during dark recovery experiences (DRE) in the hospital from the perspectives of Taiwan organ transplant health professionals (OTHP). METHODS: A qualitative design was used, with a purposive sample of OTHP including OT surgeons (OTS) and nursing groups. Data were collected by thorough face-to-face interviews and were analyzed using content analysis. RESULTS: Fifty-five subjects (39 female, 16 male) participated in this project. They included 15 OTS and 40 nurses. The nurses included registered nurses (n = 27), nurse practitioners (n = 5), and assistant or head nurses (n = 8). Their ages ranged from 25 to 66 (mean = 38.4) years old. Thirty-eight (69%) had college education, and 17 (31%) had graduate education. Their OT careers ranged from between 3 to 40 (mean = 23.8) years for OTS, and 0.5 to 15 (mean = 4.10) years for the OT nursing group. Five types of caring difficulties were reported: (1) threat of OT failure, (2) work overload, (3) insufficient collaboration within interdisciplinary teams due to incongruent surgical and nursing opinions, (4) poor communication between OTHP and POTR, and (5) lack of competent professional OT care. CONCLUSIONS: The following suggestions were made to help relieve the OTHPs' stress in providing holistic care for POTR and their families during DRE: (1) increasing the amount of experienced OT manpower and professional communication liaisons, (2) providing systematic on-the-job interdisciplinary case seminars and OT workshops, and (3) enhancing the POTR's mental health care and helping manage their distress of DRE.

Hindering factors and suggestions related to organ donation decisions: perspective of the Taiwan Ali-Shan Tsou aboriginal tribe.

BACKGROUNDS AND AIMS: Ali-San Tsou (AST) is one of leading aboriginal tribes in Taiwan with traditional godly beliefs related to life and death. Lacking related knowledge, health professionals (HPs) often failed to help them reach good dying or organ donation (OD). This study aimed to explore hindering factors and suggestions related to OD for good dying from Taiwan AST's own perspective. METHODS: An explorative qualitative design was employed using a purposive sample of the AST tribes from Taiwan. Data were collected with AST residents by face-to-face interviews and analyzed by content analysis. RESULTS: Thirty AST residents (16 females and 14 males) with ages ranging from 28 to 78 (mean, 54.5) years completed interviews. Of them, 85% reported various diseases. In this study 73% were Catholics and Christians, 17% held traditional godly believes, and 10% had no religious affiliation. Eight hindering factors were reported: (1) limited information about organs and OD; (2) no qualified organs for donation; (3) worry about lack of forgiveness by ancestors; (4) tribe elders who might not accept concept of OD; (5) intact bodies were required at home during spirit-companion rituals; (6) earth burial with intact bodies was preferred; (7) bodies due to accidental and bad death were impermissible for OD; and (8) worry about possession by the donor's spirit. Seven suggestions were also reported for HPs to enhance AST's OD decisions: (1) starting with friendship and a caring relationship; (2) providing spiritual support from reverent religions; (3) stressing good deeds and honoring tribe folks by OD; (4) avoiding accidental/bad death; (5) providing relevant modern medical knowledge of human organs and OD; (6) introducing OD as part of a good-dying care plan; and (7) demonstrating a respectful discussion mindset about OD. CONCLUSIONS: Eight hindering factors and 7 types of suggestions for enhancing AST aboriginal people's OD decisions were first explored in this project. In the future, HPs are encouraged to invite AST to share the concepts of OT and try to clarify the related concerns with respect for their cultural contexts. With mutual respect, the efforts of sharing and integrating OD into good-dying care would be more possible.

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.

Factors contributing to poor sleep quality as perceived by heart transplant recipients in Taiwan.

BACKGROUND: The aims of this project were to explore the factors contributing to poor sleep quality at 1 to 3 years after heart transplantation (post-HT), and to explore economic problems and social support for HT recipients (HTRs). METHODS: This study used a cross-sectional retrospective triangulation approach combining qualitative and quantitative research method designs. Quantitative data included data from the visual analog scale and the Taiwanese version of the World Health Organization Quality of Life questionnaire. Qualitative data were derived from questions that explored physiological, psychological, and economic factors contributing to poor sleep quality postprocedure for HTRs. RESULTS: Sixty-four subjects (81% male, 19% female) participated in this research. Their ages ranged from 20 to 70 (M = 46.88 ± 12.12) years old. Their post-HT timeframe ranged from 1 to 4.10 years; 33% received preoperative extracorporeal membrane oxygenation support. Sleeping disturbances were reported by 72.7% of subjects after HT. Poor sleeping quality at 2 to 3 years post-HT (P = .028) was a complaint, and was worse than at 1 to 2 years post-HT (P = .008). Six physiological (62.5%) and 3 psychological (37.5%) contributing factors were further identified in qualitative interviews. Physiological factors were the major causes affecting their sleep quality 2 to 3 years after HT, whereas psychological factors arose from various family roles, responsibilities, and economic-related pressures. CONCLUSIONS: Medical teams should find the causes that lead to sleep disturbances and use the findings to improve HTR sleep quality. When the family financial status is affected, these teams should offer assistance and suggestions for patients who are unable to work due to post-HT physical decline. Establishing and providing good family support systems or patient support groups may allow patients to obtain physical, psychological, and spiritual comfort.

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.

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.

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.