High-altitude hypoxia exposure inhibits erythrophagocytosis by inducing macrophage ferroptosis in the spleen.

High-altitude polycythemia (HAPC) affects individuals living at high altitudes, characterized by increased red blood cells (RBCs) production in response to hypoxic conditions. The exact mechanisms behind HAPC are not fully understood. We utilized a mouse model exposed to hypobaric hypoxia (HH), replicating the environmental conditions experienced at 6000 m above sea level, coupled with in vitro analysis of primary splenic macrophages under 1% O2 to investigate these mechanisms. Our findings indicate that HH significantly boosts erythropoiesis, leading to erythrocytosis and splenic changes, including initial contraction to splenomegaly over 14 days. A notable decrease in red pulp macrophages (RPMs) in the spleen, essential for RBCs processing, was observed, correlating with increased iron release and signs of ferroptosis. Prolonged exposure to hypoxia further exacerbated these effects, mirrored in human peripheral blood mononuclear cells. Single-cell sequencing showed a marked reduction in macrophage populations, affecting the spleen's ability to clear RBCs and contributing to splenomegaly. Our findings suggest splenic ferroptosis contributes to decreased RPMs, affecting erythrophagocytosis and potentially fostering continuous RBCs production in HAPC. These insights could guide the development of targeted therapies for HAPC, emphasizing the importance of splenic macrophages in disease pathology.

Temporal and spatial evolution and influencing factors of urban ecological total factor productivity in the Yellow River basin under strong sustainable development.

A growing consensus worldwide has indicated the need to protect the ecological environment and achieve sustainable development. Ensuring ecological protection and high-quality development of the Yellow River basin have become China's major national strategy. We reviewed extant literature, summarised government reports and guidance documents on the Yellow River basin, and proposed introducing a strong sustainable development theory into the study of total factor productivity (TFP). The spatial-temporal evolution and influencing factors of urban ecological TFP in the Yellow River basin are of great practical significance. We proposed a new ecological TFP indicator: the modified input-oriented Luenberger productivity indicator (MIL). Using panel data from 78 cities in the Yellow River basin during 2003-2019, we measured the urban ecological TFP. We adopted the geographic information system tool and kernel density estimation to analyse the temporal and spatial evolution of the indicator, as well as its spatial effects and influencing factors, using the global Moran's I index and dynamic spatial Durbin model (SDM). Our results show that, during the sample period, our indicator increased in cities in the region with an average annual growth rate of 0.627%, driven by technological progress. The average annual growth rate in urban areas showed a decreasing distribution of 'downstream-midstream-upstream'. Fiscal decentralisation (FD), industrial structure (IND), financial development (FIN), urbanisation level (URB) and research and development (RD) investment improved growth rates in this and the adjacent regions through direct and indirect effects. However, environmental regulation (ER), opening level (OPEN) of cities and population density (POP) were obstacles to TFP growth.

[Legal Risk Management in Nursing Practice: The Importance of Duty of Care].

The steady and continued rise in medical-related disputes and lawsuits is one indicator of the myriad risks and challenges faced in today's nursing practice. When nurses become defendants, the lengthy litigation process and pressures that ensue greatly impact their professional and personal lives. Nursing practice dispute categories marked by particularly high severity and frequency over the past ten years include: (1) Failure to operate according to standard procedures, (2) Insufficient nursing sensitivity and negligent care, (3) Failure to communicate and deal with issues promptly and appropriately, (4) Beyond the scope of nursing practice, and (5) Falsification or alteration of nursing records. In this paper, the important duties of care in four major nursing practices are first summarized based on the relevant legal risks. Next, based on this, risk management procedures are prioritized, evidence-oriented nursing routine standards are set, and systematic analysis and management are conducted. In addition, to strengthen the legal awareness of nurses, nursing staffs, supervisors, and institutions must all understand clearly the three types of civil and criminal legal liabilities and their respective administrative responsibilities. Nurses should proactively work to handle the related legal risks and avoid the unpleasant consequences of civil liability in the realms of compensation, criminal punishment for negligent injury and homicide, and administrative disciplinary action.

[Reflections on the Nursing Work Environment in Light of the Experience With COVID-19].

Labor issues related to the nursing profession have been gaining prominence in Taiwan as well as overseas. In 2016, the United Nations highlighted the importance of societies investing sufficient funds in their professional nurses to support and promote public health, gender equality, and economic growth. Good-quality care requires that nurses have good physical and mental health, while creating and maintaining a friendly nursing work environment rely on cooperation among the government, labor unions, and hospitals. Over the past decade, the Taiwan government has increasingly promoted relevant regulations and established a friendly platform to allow nursing staffs to identify problems and report labor rights violations. In addition, nurses have formed unions to defend and advocate for their professional rights. After the outbreak of COVID-19 in late 2019, the Department of Nursing and Health Care of the Ministry of Health and Welfare actively proposed policies related to creating and maintaining good nursing work environments. The Taiwan Nursing and Medical Industries Union took a supervisory role in this process, providing feedback on policies from the perspective of Taiwan's professional nurses and arguing for the reasonable and fair subsidization of epidemic prevention facilities, implementation of mask and protective equipment, nursing labor rights, and social respect for the nursing profession. Much work still needs to be done to improve the domestic working environment for nursing staffs, including improving and expanding education, normalizing and effectively utilizing nursing staff feedback and whistleblowing information, promoting information transparency, and implementing better policies. We hope that a friendlier nursing work environment will attract many more outstanding young persons to pursue a career in nursing.

[Exploring the Stress, Psychological Distress, and Stress-relief Strategies of Taiwan Nursing Staffs Facing the Global Outbreak of COVID-19].

BACKGROUND: The global outbreak of coronavirus disease (COVID-19) began in December 2019. The high levels of stress experienced by nurses during this pandemic may have immediate and long-term effects on their mental health. PURPOSE: To explore the stress and psychological problems of nurses during this pandemic and to identify strategies used by these nurses to relieve stress. METHODS: A cross-sectional online survey was conducted that included a basic information datasheet, stress of nursing staff during COVID-19 outbreak scale, psychological distress scale, and stress relief methods survey form. Convenience sampling was used and a total of 469 practicing nurses participated in this study. RESULTS: Most of the participants expressed concerns about living problems (72.7%). On the stress questionnaire, the facets of "burden of taking care of patients" and "worries about social isolation" earned the first and second highest scores, respectively. In terms of items, "worrying about infecting family members and friends" and "worrying about being separated from family after being infected" earned the two highest scores (2.35 ± 0.79 and 2.17 ± 0.92, respectively). Scores for psychological distress averaged 5.49 ± 3.83, with stress anxiety (1.32 ± 0.84) earning the highest mean subscale score followed by distress and irritability (1.17 ± 0.92) and depression (1.12 ± 0.94). Nearly two-thirds (61.8%) of the participants earned psychological and emotional distress scores within the 'normal' range, and 3.4% earned scores indicating severe distress. "Receiving education and training" was the most common method used by the participants to relieve stress (2.27 ± 0.51). CONCLUSIONS: The following six strategies are proposed based on the above findings: (1) Caring: provide psychological assessment and care; (2) Supporting: create a friendly team atmosphere and provide support; (3) Inquiring: recruit volunteers with relevant experience; (4) Informing: provide timely, open, and transparent epidemic-prevention information; (5) Equipping: provide complete and appropriate epidemic-prevention education and training; (6) Assisting: establish a strategy for family support and caring to reduce the stress and worries of nurses.

[Infection Control: The Roles and Functions of Nurses Working at the International Medical Center].

Travelers are known to convey infectious diseases across international borders. After its experience with SARS, Taiwan established a comprehensive mechanism at its border to prevent the entry of infectious diseases. However, people with chronic infectious diseases, carriers with no symptoms, and those likely to be infected are not easy to identify during border screenings. Therefore, Taiwan must implement internal disease-containment measures in addition to stopping infectious disease at its borders. With increasing numbers of patients coming to Taiwan for medical examinations, medical aesthetic treatments, and medical treatments and care, the risk of acute, chronic, and contagious diseases originating from non-residents must be considered and addressed. This article was developed to discuss the role and importance of nurses in preventing transnational infectious diseases from the perspective of international medical care. In addition to showing rich nursing experience, sensitivity, and conducting the management and communication of international cases, it is also necessary to make good use of information tools for remote screening care. Taking the period of the COVID-19 outbreak as an example, several procedures have been conducted. First, online detailed history of infectious diseases and nursing evaluations are conducted before admission. Second, preparation and movement notifications are given before admission. Third, online health education and follow-up care as well as cross-unit communication and coordination are implemented. International medical nurses directly affect the quality and effectiveness of international medical treatment. As Taiwan builds up its brand as an international medical caring destination, nursing professionals should help further this trend and announce to the world: Taiwan can help! Nursing can help!

[A Challenge for Home-Based Hospice Care: Good Death at Home].

Taiwan is expected to become a "super-aged" nation in 2065. Modern medical advancements, while extending the average human lifespan, has led to higher incidence of patient suffering and greater medical expenses due to chronic disease and terminal illnesses. As the concept and services of hospice and palliative care have become increasingly accepted by the public, the issue of final care for a good death has become a priority concern for both patients and their families. Experiencing a good death at home is a common last wish for terminal patients. However, guidelines for good death at home are still unavailable in Taiwan. The promotion of this concept thus remains a challenge with many limitations. This article aims to explore: (1) the importance of hospice care; (2) the selection of a proper location for good death; (3) the requirements for nursing education in the care of dying patients; and (4) the challenges and strategies of a good death at home, including "the family dimension-connections with the family members" and "the education dimension-promotion of home-based dying in nursing education". The goal is to help terminal patients experience a good death at home, to assist family members embrace the good death of their loved ones, and, eventually, to facilitate peaceful and successful home-based dying for both the patient and their family members.

[Mutual Support Beyond Suffering and Mortality-Spiritual Care for Families of Terminal Cancer Patients].

With the progression of cancer and the approach of death in terminal cancer patients, the suffering of the family members of patients increases drastically, often leading into a difficult spiritual journey. The needs for spiritual care in this population generally consist of: 1. Empathy: Bearing the psychological stress due to the sharing of physical pain with the patients; 2. Powerlessness: Regretting not having the power to turn the tide; 3. Loneliness: Becoming exhausted due to facing heavy physical workloads alone; 4. Break down: Feeling hopeless in the face of the myriad challenges of care; 5. Despair: Feeling perplexed by the prospects of a desperate future; 6. Sorrow: Feeling bitter due to the realization that the disease is incurable and to being reluctant to acknowledge the parting. The spiritual needs of family members may be met by evaluating the needs for and resistance to spiritual care, followed by the use of religious and non-religious companions and the application of listening and empathy approaches in order to elicit positive thoughts and the values of love, forgiveness, and reconciliation. In strengthening their personal beliefs, family members may find connectedness with god, humanity, and objects; may see hope in life; and may find the meaning of suffering in order to further seek and find inner peace, accomplish themselves, and eventually achieve spiritual sublimation.

Building a bridge for nursing education and clinical care in Taiwan--using action research and Confucian tradition to close the gap.

BACKGROUND: Nursing workplaces in Taiwan are unable to retain talent. An examination of this problem has revealed that the causes of this phenomenon are that nursing education fails to cultivate the skills that meet workplace requirements and that there are gap between nursing education and clinical practice. OBJECTIVES: This paper is an action research that aims is to design educational programs that can close the gap between nursing education and clinical practice in Taiwan. DESIGN: In this action research project, 4 action cycles were used to design educational programs including concept mapping and focused discussion strategies. SETTINGS: Participants were invited to join the research in three teaching hospitals and one university. PARTICIPANTS: Two groups of participants, student nurses (SN) and nursing staff personnel (NS), were sampled and invited to participate in the research. METHODS: Participant observation, focus groups, and qualitative interviews were used to collect data. Qualitative data were not only profiled by content analysis, but they were also compared continuously between the two groups as well as between the 4 cycles. RESULTS: The qualitative data collected for the 135 participants were analysed. The themes of an effective nursing program were summarized. CONCLUSIONS: Many fundamental values of traditional Chinese education have gradually faded due to the Westernization of education. In this study, we discovered that Western educational models may play a critical role in improving traditionally taught nursing education programs.

"Does one size fit all?" Exploring the cultural applicability of NANDA nursing diagnoses to Chinese nursing practice.

East Asia has historically unique concepts of health and well-being and thus is an appropriate setting for exploring the multicultural applicability of the North American Nursing Diagnosis Association's Nursing Diagnoses (NANDA ND) system. This study aimed to explore how NANDA ND affect the growth and quality of professional nursing from the perspective of Taiwanese nurses. Grounded theory was employed in this interview-based investigation of 53 Taiwan-licensed nursing professionals at various hospitals in Taiwan. Data were analyzed using constant comparative analysis until theoretical saturation was reached. The core concept, Struggling with (the NANDA ND notion that) One Size Fits All, emerged after ongoing analysis of the effects of NANDA ND on good nursing, patient welfare, and professional development. The preliminary theoretical framework developed from this study provides evidence that NANDA ND may be incompatible with the cultural beliefs of the traditional Chinese health care setting in Taiwan, which emphasize holistic harmony and balance.

Bioethics education for practicing nurses in Taiwan: Confucian-Western clash.

To understand the gaps between current bioethics education and the requirements of practicing nurses, a semistructured questionnaire was used to invite the directors of nursing departments at all 82 teaching hospitals in Taiwan to participate in this survey. The response rate was 64.6%. Through content analysis we obtained information about previous bioethical training, required themes and content, recommended teaching strategies, and difficulties with education and its application. The results suggest that Taiwanese nursing personnel need to be instilled with both self-cultivation of morality and mental cultivation to acquire nursing virtues and the right attitudes toward bioethical issues. Good communication skills to prevent damage to the harmonious relationships between patients, their families and medical team members, policies that support the provision of systematic formal knowledge of ethics, small group training, and clarification of values were also shown to be important in bioethics education.

Efficacy of guided imagery with theta music for advanced cancer patients with dyspnea: a pilot study.

BACKGROUND: Dyspnea is a frequent and devastating symptom among advanced cancer patients for which improved and low-cost palliative techniques are needed. METHODS: A one-group repeated measures research design investigated the efficacy of guided imagery (GI) with theta music (M) on dyspnea in advanced cancer patients. The intervention consisted of four periods: (a) pretest; (b) intervention with peaceful non-M; (c) intervention with 10 min of GI with M (GI/M), with the first and last 3 min being M only (i.e., the middle 4 min was GI/M); and (d) posttest. Dyspnea outcome was measured with the Modified Borg Scale (MBS) for self-reported evaluation of dyspneic symptoms. Physiological parameters measured were pulse oxygen saturation (SpO(2)), end-tidal CO( 2) (EtCO(2)), heart rate (HR), and respiratory rate (RR). Posttest qualitative data were obtained via interview for subjective patient experience. RESULTS: Participants included 53 patients, 33% with lung cancer. GI/M produced a significant decrease in MBS scores; 90% of the subjects gave positive qualitative reviews of GI/M. SpO(2) did not change significantly over time. GI/M significantly increased EtCO(2), decreased RR, and decreased HR. DISCUSSION: This study demonstrates that GI/M is a useful intervention for palliative care of patients with dyspnea. M alone was demonstrated to be effective, while soothing non-M was not effective. GI/M was more effective than M alone. GI/M should be considered low-cost end-of-life palliative care for dyspnea.

[The application of hospice palliative care on discharge planning for the terminal cancer patient].

Whole person, family-centered, continued care, and multidisciplinary approach were four core values of hospice palliative care applied in this paper to assist in the difficult processes of discharging terminal cancer patients from the hospital and providing continued care until their peaceful death. Reasons underlying difficulties with discharges identified during hospitalizations between July 5th to 25th 2007 include: 1. 'whole person' aspects, including lack of confidence with the discharge on the part of the patient and his / her families due to inadequate symptoms control and loneliness due to lack of caregiver understanding and support; 2. 'family-centered' aspects, including failure to designate a key decision maker, differences of opinions, and overwhelming caregiver burdens; 3. 'continuity of care' aspects, including lack of appropriate and continuing palliative care and 4. 'multidisciplinary approach' aspects, including factitious relationships among patient, family members, and healthcare providers due to lack of trust. Furthermore, the healthcare team mapped out individual and continued care plans as follows: 1. 'whole person' aspects should focus on symptom control, enhancing comfort, and encouraging emotional expression; 2. 'family-centered' care aspects should identify the key person and significant others, decrease caregiver burdens, provide essential assistance and conduct family conferences; 3. 'continuity care' aspects should include consulting hospice home care and bereavement care professionals; 4. 'multidisciplinary approach' aspects should address comprehensive care so that team members learn from and reflect on their experiences. Ultimately, patients were successfully discharged from the hospital and peacefully passed away one week afterward. The writer hopes this nursing experience will provide a valuable reference for clinical practice to develop a family-centered approach to palliative care based on the four core values of hospice palliative care and the multidisciplinary discharge plan for terminal cancer patients.

[A nursing experience of holistic care on total suffering of a patient with terminal illness].

The purpose of this article was to describe a nursing experience using holistic care to relieve total suffering resulting from complex interactions amongst physical, psychological, social and spiritual aspects in a patient with terminal illness. Each aspect of problems was identified by means of direct participant care, observation, empathetic communication and holistic assessment. Such included: (1) physical aspect: distress caused by pain, nausea, vomiting and poor intake, infection and hypercalcaemia; (2) psychosocial aspect: caregiver's overwhelming burdens and financial concerns; (3) spiritual aspect: yearn for being with a higher-being and receiving unconditional love, pursuit of the meaning of suffering, proceed to the next stage to develop a unique care plan and nursing intervention program. Nursing goals were set up based on the patient's "life expectancy" represented by the hope for a painless and peaceful death. The author helped to provide unique, holistic and continued care for the purpose of humanity. The main nursing interventions included active control of symptoms, encouraging the expression of emotional distress, caring and emotional resonance with caregiver's overwhelming burdens, reconciling with a higher being through art therapy, pursuit of the meaning of suffering and sharing the darkness. This nursing experience of holistic care may be shared with other healthcare professionals and has been recorded as a positive response to the following quote from Dame Cicely Saunders: "The way care is given can reach the most hidden places and give space for unexpected development."