"To do or not to do", male nurses' experiences of providing intimate care to female patients in China, a constructivist grounded theory study.

BACKGROUND: Some studies suggest that female patients have more concerns about receiving intimate care from male than female nurses. Thus, providing intimate care to female patients is a challenging experience for male nurses. The purpose of this study was to explore Chinese male nurses' experiences and process of providing intimate clinical care to female patients. METHODS: A constructivist grounded theory approach was used to develop a theoretical understanding of male nurses' experiences. This study included participants from 3 hospitals in different locations in China. Twenty-five male nurses were recruited using purposive and theoretical sampling. Semi-structured interviews were conducted. Data analysis was completed using initial coding, focused coding, theoretical coding and memo writing to produce core concepts and categories, and theory development. RESULTS: Chinese male nurses' experiences of providing intimate care to female patients can be constructed as a three-stage process: (1) anticipation of the level of embarrassment, (2) deciding on the process: do it or not do it and (3) protecting both parties and dealing with embarrassment. Additionally, seven themes and associated categories were identified to represent the important factors in the process of male nurses providing intimate care to female patients in China. CONCLUSIONS: Chinese traditional culture may affect the embarrassment in Chinese male nurses providing intimate care to female patients. The embarrassing situation can be divided into three different stages, and male nurses have different main concerns in each stage. Hospital nursing administrators should consider the experiences and needs of male nurses in providing intimate care and provide them with psychological support, education and training.

Oncology nurses' experiences of providing emotional support for cancer patients: a qualitative study.

BACKGROUND: A high percentage of cancer patients may experience emotional distress. Oncology nurses are expected to play an important role in recognizing emotional distress and planning and delivering care that meets the individual needs of each patient. However, few studies have focused on the experiences of clinical nurses in such cases. This study adopted a qualitative research method to gain an in-depth understanding of the experience of nursing staff in caring for cancer patients with emotional distress. METHODS: A qualitative descriptive design and semi-structured interviews were used in this study. Twenty-one oncology nurses were interviewed, and the qualitative content analysis suggested by Graneheim & Lundman (2004) was used to interpret the data. RESULTS: Six themes were identified, as follows: (1) dictating the abnormality of emotion, (2) soothing and comforting patients, (3) a lack of psychology knowledge and communication skills, (4) negative impacts of a lack of time, (5) managing emotional labor, and (6) reflecting on the experiences. CONCLUSION: Hospital administrators should arrange pre-employment education and training as well as on-the-job education to help nurses in caring for cancer patients with emotional distress. They should also focus attention on the personal emotional states of nursing staff in a timely manner and provide psychological support and emotional counseling as necessary.

Exploring return to work for patients with head and neck cancer.

BACKGROUND: The number of survivors of head and neck cancer (HNC) has steadily increased due to major advances in cancer care. However, cancer survivors who experience job loss face different challenges regarding return to work (RTW). Relatively few studies have integrated the experience encountered by patients. OBJECTIVE: This mixed-methods study aimed to explore the experience and challenges of RTW in patients with HNC. METHODS: Data were collected with structured questionnaires (n = 120) and semi-structured face-to-face interviews (n = 12). RESULTS: Relationships were found between patient's physical status, perceived stress, and social support. Patients who continued work, or not, had significant differences in reported physical function and stress. Four themes emerged from the qualitative data, including the perceived meaning of work, challenges for RTW, preparing for RTW, and social support. After diagnosis and treatment, patients perceived the meaning of work, such as personal value, responsibility, and financial need. They faced many challenges to RTW, including declining physical strength, workload, schedule rearrangement, speech difficulty, and changed appearance. In order to RTW, they prepared extensively and needed support from family and friends. CONCLUSION: This study revealed the experiences and challenges of RTW patients with HNC. The results allowed us to identify patients' concerns and ways that healthcare providers could improve the RTW process. Future studies may develop tailored approaches for RTW in healthcare and government policies.

[The Health-Seeking Experience of Patients With Sjögren's Syndrome].

BACKGROUND: The multiple symptoms of Sjögren's syndrome lead patients affected by this disease to seek medical advice from different medical disciplines and specialists. Diagnoses are often made many years after initial onset, resulting in mental and physical exhaustion and misunderstandings. PURPOSE: This study was designed to explore the health-seeking experiences of patients with Sjögren's syndrome. METHODS: Qualitative research methods and purposive sampling were used. Fourteen patients with Sjögren's syndrome were interviewed by the first author, and the collected data were analyzed using content analysis. RESULTS: Four themes were revealed from the data, including: (1) distressing symptoms; (2) difficulty in diagnosis; (3) concerns about drug side effects; and (4) facing the disease. The participants initially sought medical attention when they began experiencing early onset symptoms that caused discomfort or annoyance. Their doctors' failure to provide proper diagnoses during the long health-seeking process caused a great deal of suffering to the participants. Although related medications should be taken for life, the participants reported taking lower-than-prescribed dosages out of fear of side-effects. The participants explored their process of coping with the disease, which began with denial and ended with acceptance. By learning from their health-seeking process, participants realized that they needed to take proper care of themselves, adapt to life with their disease, and control related symptoms. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: To facilitate the early diagnosis of Sjögren's syndrome, healthcare professionals should improve their awareness of this condition and refer patients with related symptoms to rheumatologists and immunologists. Effective early diagnosis and treatment can help these patients reduce the time and effort involved in unproductive doctor's visits, allowing them to better continue as productive members of society and to maintain a good quality of life.

Factors influencing the effects of the mindfulness-based interventions of patients with substance abuse: A qualitative systematic review and meta-synthesis.

Objective: This article aims to provide the experiences of mindfulness treatments from the perspectives of patients with a history of substance abuse. Data source: Peer-reviewed articles on 5 databases, namely, PubMed, PsychINFO, Medline, CINAHL and the Cochrane Library, between the year of 2000 and 2023. Study Inclusion and Exclusion Criteria: Studies were included if they were published in the English language and reported on qualitative studies that directly engaged patients with experiences of substance abuse and mindfulness treatments. Data extraction: After our initial search, 5355 studies were reviewed by title and abstract, consequently, 10 studies were included. Data synthesis: Meta-ethnography were used in this study. Data were obtained from the quotations from participants and text under the heading "results" or "findings" from the included 10 studies. Results: Effective mindfulness-based interventions (MBI) influence recovery from substance abuse. Four themes were identified as factors influencing the MBI treatment effect. They were (1) engaging in mindfulness: entry and retention, (2) perceived benefits of MBIs, (3) implementation of treatment group and (4) maintenance of treatment effect. Conclusion: This article examines the scientific literature to date and presents the evidence on the factors that influentially impact the effect of MBIs in patients with substance abuse. The findings of this study should be helpful in guiding clinical practice, policy, and future research focused on the treatment effect of MBIs for person with substance use.

[Changing Mindsets to Create a New Mental Health Nursing Care Landscape].

Perception of change is a real and profound out come of the recently ended COVID-19 pandemic. The course of this pandemic was unpredictable and subject to change with no clear end in sight. Thus, "uncertainty" became the only certainty in daily life. The realities of the pandemic necessitated that changes and adjustments be made in our physical, psychological, and emotional states as well as life and work styles, which tested everyone's resilience. Change interpreted through Buddha Siddhartha's "Theory of Dependent Origination" is normal and to be expected. The Buddha believed all "conditioned dharmas" in the world (things that can be seen with form) were not created from nothing and could not exist alone. Instead, they must have been formed through a combination of various causal conditions and, once these conditions disappear, must return again to nothingness. Thus, "All dharmas arise due to conditions, and all dharmas cease due to conditions (Sina Buddhism, 2017)". Because of this, the Buddha believed all things and all phenomena to be impermanent and changing (Master Sheng Yen, 2002). According to the Buddha, change is normal and impermanence is permanent. As such, the practice of mental healthcare has not been passively changed by the epidemic, but has always been changing continuously and proactively. The process of treating and restoring to health in patients with mental illness is actually a long and arduous journey, and mental health nurses play a very important role throughout this long process of recovery. We abandon the traditional treatment and care model that only focuses on mental disorders and symptoms, and instead adopt the concept of holistic healthcare (Mandal et al., 2020), which focuses on patient physical, psychological, social and spiritual aspects, helping them achieve whole person wellness (Swanson et al., 2019). Each patient should be regarded as a unique individual not only in terms of their disease diagnosis, symptoms, physical and mental states, understanding, and communications but also in terms of their socioeconomic status, family support, and social resources. Because of this, nursing care plans should not be institutionalized or mechanistic, but rather allow flexibility to address each patient's current condition. Through comprehensive and integrated care and consultation and interdisciplinary teamwork, the psychiatric and mental health nurses work hard to ensure every patient and family member who receives care is satisfied in terms of their physical, psychological, social, and spiritual needs. Another aspect of change is the adoption by mental health nurses of a more active, more professional, larger pattern, and broader vision of their professional services. After all, mental patients may not necessarily fully understand their needs. As mental health professionals, we can develop our professional sensitivity. Moreover, while devoting ourselves to helping patients move towards holistic health and providing holistic care for patients, we should also try our best to detect and pay attention to whether current mental-health-related policies, medical system norms, or usual modes of operation may be ignoring patient needs or increasing the obstacles encountered in the rehabilitation process. In addition, we should try to seek strategies to change the situation, advocate for the health and well-being of patients, and improve the quality and effectiveness of overall mental healthcare. In this issue, four professors respectively discuss issues related to mental health policy, clinical practice, community rehabilitation and employment support, and the expansion of the professional role and service field of mental health nursing. These authors share how the field and functions of mental healthcare can change and evolve along a positive path forward. They not only provide direction and light but also show the results of their efforts.

Experiences of Participating in an Academic-Hospital Partnership Nursing Program: A Qualitative Study.

BACKGROUND: Although 5-year colleges account for 41.7% of all nursing graduates in Taiwan, most of these graduates go on to university and earn a bachelor's degree. In 2015, four universities received approval from the Ministry of Education of Taiwan and started to enroll students in the academic-hospital partnership nursing program to guide nursing graduates from 5-year colleges into the nursing workplace. The effects of this program have never been examined, especially from the perspective of the students. PURPOSE: The aim of this study was to explore the experiences of students currently participating in the academic-hospital partnership nursing program. METHODS: A qualitative approach was used in this study. Twelve students were invited to participate in a focus group that met for five sessions over 3 years to understand the motivations for and experiences of participating in the academic-hospital partnership nursing program. Data were analyzed using thematic analysis. RESULTS: Six themes were identified: (a) incentives for participating in the academic-hospital partnership nursing program, (b) worries about making the wrong decision, (c) worries about future adaptation, (d) facing the real workplace, (e) confusion about role perception and benefits, and (f) administrator support. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study enhance the general understanding of nursing student experiences and the changes over time in the academic-hospital partnership nursing programs. Moreover, the findings may be used to help teachers and nursing administrators at healthcare institutes better support the needs of students at each program stage. In addition, the findings may serve as a reference for the government in refining the design of these programs in the future.

Healthcare workers' experiences of caring for patients diagnosed with intellectual disability co-occurrent with psychiatric disorders.

WHAT IS KNOWN ON THE SUBJECT?: Intellectual disability (ID) involves problems with general mental abilities and affects intellectual functioning and adaptive functioning. People diagnosed with ID present higher levels of functional disability, which means they usually have difficulty or the inability to independently perform basic activities of daily living. Little to no attention has been paid to the issues of the mental health of people diagnosed with ID. Specifically, healthcare workers' experiences of caring for patients with IDPD have been neglected. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The findings increase our understanding and partially address the knowledge gap regarding the situations and circumstances faced by healthcare workers in caring for patients diagnosed with intellectual disability co-occurrent with psychiatric disorders (IDPD). In cases of insufficient staffing, healthcare workers may be forced to ignore the individualized needs of patients so as to facilitate management. Healthcare workers may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. They adapt by adjusting their expectations of their patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in-service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department responsible for the management of ID patient care institutions should be able to regularly monitor the overall staffing and quality of care in these institutions. ABSTRACT: Introduction When intellectual disability co-occurs diagnosed with psychiatric disorders (IDPD), the impact of the burden of illness on the affected individuals, their caregivers, their family and friends, and the services that provide for them is particularly high. The issues of the mental health of people diagnosed with ID have received little, if any, attention. One specific area of neglect is healthcare workers' experiences of caring for patients diagnosed with IDPD. Aim The aim of this study was to understand healthcare workers' experiences of caring for patients diagnosed with IDPD. Methods A qualitative descriptive research approach and semi-structured interviews were used in this study. We interviewed 15 participants who had experience in caring for patients diagnosed with a dual diagnosis of IDPD. Findings Four themes were found, as follows: (1) Negative impacts of insufficient staffing on the quality of care, (2) Constantly worrying about harmful incidents, (3) Discovering effective ways to provide individual patient care and (4) Adjusting expectations and attitudes towards patients. Participants' experiences revealed that they perceived the importance and effectiveness of providing individualized care for IDPD patients. However, when staffing is insufficient, they may be forced to ignore the individualized needs of patients so as to facilitate management. They may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. In addition, they adapt by adjusting their expectations of the patients. Discussion The findings from this research help to fill the knowledge gap in our understanding of healthcare workers' experiences of and their perspectives on caring for patients diagnosed with IDPD. Implications for Practice Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in-service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department overseeing the management of institutions providing ID patient care should be empowered to conduct regular monitoring of the overall staffing and quality of care in such institutions.

Students' Experiences of Studying in an Accelerated BSN Program in Taiwan.

INTRODUCTION: Today's global nursing shortage is having an adverse impact on health systems around the world and in Taiwan. Many universities in the United States have implemented accelerated BSN (ABSN) programs to create a shortcut for students who have bachelor's degrees in other fields to become nurses. Previous studies have revealed that students feel stress during the programs, especially in their first year. Students' first-year experiences in an ABSN program in the Taiwanese context are worthy of study. STUDY AIM: The purpose of the study was to understand nursing students' first-year experiences in an ABSN program in Taiwan. DESIGN: A qualitative research design was used in this study. SETTING AND PARTICIPATIONS: A total of 25 students from a university in central Taiwan participated in this study to share their first-year experiences of studying in an ABSN program. METHODS: Data were collected from 3 focus group interviews and students' written reflections and were analyzed by qualitative content analysis with the help of ATLAS.ti 7.0. FINDINGS: Five themes were identified: (1) pursuing a brighter future, (2) positively facing doubts (3) challenges of surviving, (4) changing their learning attitudes and methods, and (5) seeking support. CONCLUSIONS: The findings of this study may help nursing schools to provide the support students need and serve school administrators as a reference for refining such programs in the future.

Infection preventionists' challenges in psychiatric clinical settings.

BACKGROUND: Infection preventionists (IPs) play an important role in preventing health care-associated infections in a health care system. However, the limitations of the clinical setting and the unique characteristics of psychiatric patients could be barriers to effective infection prevention. The purpose of this study was to understand how IPs perceived their challenges and how these challenges negatively affect their infection prevention work in psychiatric clinical settings. METHODS: A descriptive, qualitative research approach was used in this study. Thirteen Taiwanese psychiatric IPs were interviewed in semistructured interviews. Data were transcribed and then analyzed by thematic analysis. RESULTS: This analysis identified 6 themes: (1) lack of preservice training in psychiatric infection control, (2) insufficient staffing in practice, (3) working within environmental limits, (4) patient noncompliance, (5) undervaluation of the importance of infection control by professionals, and (6) involvement of hospital administrators. CONCLUSIONS: The implementation of effective infection prevention in psychiatric clinical settings may be strongly related to the factors of sufficient training and IP staffing while relying on collaboration among patients and clinical professionals and on the full support of administrators.

Clinical nursing instructors' perceived challenges in clinical teaching.

AIM: The purpose of this qualitative study was to explore the challenges in clinical teaching that are encountered by clinical instructors and to foster the relevant training. METHODS: Focus group methodology was used. The participants were 54 clinical nursing instructors who were recruited from middle Taiwan and participated in one of five focus groups of 2-3 h each. The data transcripts were analyzed by using qualitative content analysis. RESULTS: Five challenges emerged: (i) teaching outside one's area of expertise; (ii) building cooperative relationships with the clinical staff; (iii) the unit's use of students as nursing staff; (iv) inappropriate clinical practices by the clinical staff; and (v) clinical staff members' negative comments toward the students. These challenges revealed clinical nursing instructors' difficulties in balancing clinical teaching quality and their relationships with the clinical staff members. CONCLUSION: The identified challenges reflect the need to support clinical instructors and assist them to prepare for their role through training programs or policy changes.

[Using the Cognitive Behavioral Therapy to Improve the Mental Health of Women With Breast Cancer].

Previous studies have shown that patients with breast cancer may suffer from symptoms of psychological distress, such as: depression, anxiety, insomnia, and chronic fatigue. Nurses are expected to offer physical and mental support to these patients. Cognitive behavior therapy (CBT) is commonly used in psychiatry as well as in the treatment of patients with breast cancer. CBT is believed to reduce mental distress in patients by changing their negative cognitive schema. The present article discusses the mental problems of patients with breast cancer and introduces the effects of using CBT on patients with breast cancer. Successful examples of training clinical nurses to apply CBT to the patients are introduced in order to facilitate the design of effective CBT training programs for nurses that improve professional knowledge and skills in dealing with the mental health problems of these patients and further enhance the quality of nursing care.

There is nothing wrong with being a nurse: The experiences of male nursing students in Taiwan.

AIM: Male nurses are reported to experience role strain. Fear of gender stereotyping can be stressful and frustrating for male nursing students, which could make them feel isolated and excluded. The aim of this qualitative study was to investigate how male nursing students in Taiwan perceive the barriers to their experience as nursing students and how they manage these barriers in their study environment and social life. METHODS: A qualitative research approach was used in this study. Data were collected during 2014 from 24 male nursing students from three nursing educational institutes in Taiwan who participated in order to share their experiences by using a semistructured interview. All the interviews were recorded, transcribed verbatim, and analyzed by thematic analysis. RESULTS: The main theme that described the experiences of the male nursing students in Taiwan was: "There is nothing wrong with being a male nurse." Contrary to other studies, role strain for the participants was minimal. The students experienced some barriers because of being a male nursing student, both at school and in their social life. Most of these students tended to manage the barriers by developing positive thinking and coping strategies. CONCLUSION: Nursing educators are encouraged to use the findings from this study to provide appropriate support for male nursing students.

Experiences of caring for a sibling with schizophrenia in a Chinese context: A neglected issue.

Adult clients with schizophrenia are primarily cared for by their ageing parents. When the parents become ill or die, siblings are considered to be responsible for taking over the caregiving role. However, little is known about caregiving for a sibling with schizophrenia, and no studies have explored this phenomenon in an Asian context. The aim of the present descriptive, qualitative study was to understand the experiences of being the primary caregiver of a sibling with schizophrenia. Data were collected from 10 siblings of currently-hospitalized patients diagnosed with schizophrenia using semistructured, in-depth interviews. Recorded interviews were transcribed and analysed by qualitative content analysis. This analysis identified four themes: (i) stepping forward to become caregiver; (ii) challenges of caregiving; (iii) need for support; and (iv) worries about future care. Our findings suggest that mental health-care professionals should involve all family members, including siblings, in the care plan for the person with schizophrenia, and provide appropriate psychoeducation for all family members to reduce not only the tension and stress of current caregiving, but also anxieties about future care.

Assault experiences: Lessons learned from mental health nurses in Taiwan.

Mental health nurse are frequently subjected to patients' violent and aggressive behaviour. These assault experiences have given rise to mental health nurses' physical and psychological trauma, and negatively impact the quality of patient care. The purpose of the present qualitative study was to understand mental health nurses' experiences of being assaulted, the influences on their patient care, and their perspectives of the effectiveness of in-service, violence-prevention education. Ten mental health nurses from two different inpatient mental health facilities were interviewed using a semistructured interview guide. Thematic analysis of interview data found six themes: (i) violence is unpredictable; (ii) violence is normal; (iii) lasting psychological trauma; (iv) limited support from peers and the administrator; (v) violence prevention requires team cooperation; and (vi) doubting the effectiveness of in-service education on violence prevention. Psychiatric ward administrators should assess nurses' learning and skill needs to determine whether these needs are met by existing in-service training programmes. A culture of safety should also be promoted by building a warm and supportive ward climate for both staff and patients, which would include team cooperation and support for colleagues who suffer a violent incident.

Working in a danger zone: A qualitative study of Taiwanese nurses' work experiences in a negative pressure isolation ward.

BACKGROUND: Hospital nurses are frontline health care workers in controlling the spread of infectious diseases. It is not known if nurses working in negative pressure isolation wards (NPIWs) are better prepared than before to safely care for patients with common infectious diseases. METHODS: For this qualitative descriptive study, 10 nurses were interviewed in depth about their experiences caring for patients in an NPIW. Tape recordings were transcribed verbatim and analyzed by qualitative content analysis. RESULTS: The following 5 themes were identified: (1) complexity of patient care, (2) dissatisfaction with the quantity and quality of protective equipment, (3) shortage of nursing staff, (4) continued worries about being infected, and (5) sensitivity to self-protection. Our participants' anxiety and uncertainty about being infected in the NPIW were increased by the complexity of patients' health problems and organizational factors. To protect themselves against infection before and during patient care, participants also developed sensitivity to, concepts about, and strategies to improve self-protection. CONCLUSIONS: NPIW administrators should pay more attention to nurses' concerns about improving the NPIW working environment, supply good quality protective equipment, and provide appropriate psychologic support and ongoing education to ensure that nurses feel safe while working. This ongoing education should refresh and update nurses' knowledge about disease transmission, therefore decreasing unnecessary anxiety based on misunderstandings about becoming infected.

The influence of personality traits and social support on male nursing student life stress: a cross-sectional research design.

BACKGROUND: Understanding how male nursing students alleviate life stress during their academic career is conducive to their development as successful nursing professionals. PURPOSE: This study was designed to understand the personality traits, social support, and life stresses of male nursing students. The respective influences of personality traits and social support on life stress were also explored. METHODS: The study used a cross-sectional research design. A college in central Taiwan was targeted as the site for data collection. A total of 158 questionnaires were dispatched, with 145 valid copies returned (valid response rate = 91.7%). Structured questionnaires were designed to collect data on participant demographics, personality traits, social support, and life stress. Statistical methods such as descriptive statistics, one-way analysis of variance, and multiple regression analysis were applied to data analysis. RESULTS: Major findings of this study revealed that (a) in general, the personality traits, social support, and life stress of male nursing students scored in the medium to high range. Participants reported encountering more stress from learning and life goals than from interpersonal stress. (b) Male nursing student demographic variables (e.g., parent [father and mother considered separately] education level) and the personality traits of conscientiousness and family support, respectively, were found to impact significantly on participant life stress perceptions. And (c) the only significant predictors of life stress were support from family and education level of participant fathers and mothers, accounting for about 23.7% of variability. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It is suggested that nursing students in each year of their academic career should be exposed to courses geared to reduce the life stress perceptions (especially in the areas of learning and career development) of male nursing students. Increased family support is an effective way to decrease male nursing student life stress. This study could be a reference for the design and application of strategies to reduce the perceived life stress of male nursing students.

The inner door: toward an understanding of suicidal patients.

AIMS AND OBJECTIVES: To describe the suicide care dilemmas that psychiatric nurses experience and how they respond to suicidal patients. Background. Psychiatric nurses play a major role in helping patients after suicide attempts. Little is known, however, about the ways nurses resolve their suicide care dilemmas. DESIGN: Focused ethnography was used to describe the meanings and patterns of actions of psychiatric nurses in a medical centre in Taipei, Taiwan. METHODS: Fieldwork included two years of participant observation and individual interviews with 18 psychiatric nurses. Data from transcripts of observation field notes and interviews were transcribed verbatim and analysed. RESULTS: An important factor, the inner door (an invisible door inside the nurse's mind), determined the nurse's ability to understand the inner worlds of suicidal patients and the nurse himself or herself. In the absence of such understanding, nurses felt discouraged, labelled the patients and even restrained them, thus closing their inner doors. On the other hand, the nurses' willingness to reflect on their own experiences and receive the patients' teaching helped them understand the defensive patients and nurses themselves, thus opening the inner doors and enabling them to treat patients as their family or friends. CONCLUSIONS: The opening and closing of the inner door is a dynamic process. Nurses need to understand the essential meaning of a suicide experience to develop the insight to open the door and keep it open. RELEVANCE TO CLINICAL PRACTICE: The concept of an inner door helps nurses better understand why they distance themselves from patients when they encounter clinical dilemmas and offers a way to resolve their inner conflicts through self-reflection and appreciation of the patient's experiences.

Evaluation of assertiveness training for psychiatric patients.

AIM AND OBJECTIVES: To investigate the effectiveness of assertiveness training programmes on psychiatric patients' assertiveness, self-esteem and social anxiety. BACKGROUND: Assertiveness training programmes are designed to improve an individual's assertive beliefs and behaviours, which can help the individual change how they view themselves and establish self-confidence and social anxiety. It is useful for patients with depression, depressive phase of bipolar disorder, anxiety disorder or adjustment disorder. DESIGN: Experimental. METHOD: There were 68 subjects (28, experimental group; 40, diagnosis-matched comparison group). Subjects in experimental groups participated in experimenter-designed assertiveness training twice a week (two hours each) for four weeks. The comparison groups participated the usual activities. Data were collected in the two groups at the same time: before, after and one month after training programme. Efficacy was measured by assertiveness, self-esteem and social anxiety inventories. A generalised estimating equation was used for analysis. RESULTS: After training, subjects had a significant increase in assertiveness immediately after the assertiveness training programme and one-month follow-up. There was a significant decrease in social anxiety after training, but the improvement was not significant after one month. Self-esteem did not increase significantly after training. CONCLUSION: With our sample of patients with mixed diagnoses, assertiveness seemed to be improved after assertiveness training. RELEVANCE TO CLINICAL PRACTICE: Patients would benefit more from the assertiveness training programme for the change in how they view themselves, improve their assertiveness, properly express their individual moods and thoughts and further establish self-confidence. The assertiveness training protocol could be provided as a reference guide to clinical nurses.

[The relationship between qualitative research and positivism].

Historically, positivism has been the dominant approach in the philosophy of science. In nursing, most quantitative researchers tend to employ positivism as their epistemological underpinning, which could be why positivism has long been identified as the epistemology of quantitative research. It can be argued, however, that some of the procedures of qualitative research reflect the perspectives on which positivists insist. This article takes grounded theory and phenomenology as examples, in order to observe how positivism influences their methodologies, evidence obtained is then used to support the aruthors' arguments. The article, furthermore encourages beginning researchers to familiarize themselves with background knowledge of philosophy of social sciences, especially epistemologies and methodologies, in order to make clear the philosophical context in which their research is conducted.