Exploring the challenges of taiwanese nurses in the COVID-19 post-pandemic era.

In the wake of the COVID-19 pandemic, the fluctuating nurse resignation rates highlighted an understudied area in healthcare: post-pandemic challenges in clinical settings. This study, conducted from May to November 2023, employed a qualitative inquiry using focus groups to delve into these challenges. Six focus group sessions, involving 33 nurse participants recruited through snowball sampling from various hospital settings were conducted to explore their clinical experiences during and after the pandemic. Thematic analysis revealed two primary themes: the 'Invisibility of Nurses' within the healthcare system and the 'Moral Duty of Nursing Practice'. These findings illuminate a tension between the overlooked role of nurses and their ethical obligations, underscoring a critical need for policy reassessment. The study advocates for systemic changes, particularly in the undervaluation of the nursing profession and the National Health Insurance system, to address the poor working environment and mitigate long-term nursing shortages. This research deepens understanding of post-pandemic nursing workforce challenges in Taiwan, highlighting the need for policy evolution to enhance recognition and support for the nursing industry. It is suggested to provide tangible compensation to acknowledge nurses' daily care and health education for patients. A healthier working environment can be enhanced by collaborative efforts between healthcare institutions and nurses.

Indigenous lands and health access: The influence of a sense of place on disparities in post-stroke recovery in Taiwan.

Despite many countries having policies and systems for universal healthcare coverage, health disparity persists, with significant variations in disease prevalence and life expectancy between different groups of people. This focused ethnography explored the post-stroke recovery of Indigenous and non-Indigenous populations in three geographical areas in Taiwan. Forty-eight observations and 24 interviews were carried out with 12 dyads of stroke survivors and family caregivers, revealing their varied experiences of healthcare. Findings indicate that repeatedly engaging in social activities in the same place increases stroke survivors' attachment to the environment, facilitating their reintegration into the community and improving wellbeing following stroke. The significance of 'place' in post-stroke life and healthcare access is particularly salient for Indigenous people's recovery. Indigenous people tend to employ cultural symbols, such as Indigenous languages and kinship ties, to define and interpret their surrounding environment and identity. Indigenous people residing within or close to their own native communities make better recoveries than those based in urban settings, who are attached to and yet located away from their native lands. A sense of place contributes to identity, while loss of it leads to invisibility and healthcare inaccessibility. To promote equitable healthcare access, future policymaking and care practices should address the environmental and cultural geography and structural barriers that impede the connection between minority groups and the mainstream community healthcare system. The study findings suggest extending welfare resources beyond Indigenous administrative regions and establishing partnerships between Indigenous organisations and the mainstream healthcare system. Leveraging Indigenous people's attachment to cultural symbols and increasing healthcare facilities staffed with Indigenous healthcare workers could help ease structural barriers, maintain identifiable Indigenous beneficiaries and increase entry points into the mainstream healthcare system.

Biographical continuation: recovery of stroke survivors and their family caregivers in Taiwan.

AIM: To explore the experiences pertaining to long-term care services from the perspectives of dyads of stroke survivors and their family caregivers in indigenous and non-indigenous communities. BACKGROUND: Stroke occurrence is a life-changing event associated with quality of life for stroke survivors and their families, especially those who provide primary support. Indigenous people are more likely to experience a stroke at a younger age and have a higher likelihood of hospitalisation and death due to health disparities. Few studies have investigated family dyads or indigenous populations to understand their experiences of coping with changed body-self and to contextualise their reintegration into communities post-stroke. METHODS: Ethnographic fieldwork over nine months in 2018-2019 with indigenous, urban-based, and non-indigenous populations, resulting in 48 observations and 24 interviews with 12 dyads in three geo-administrative communities. FINDINGS: The post-stroke recovery trajectory is illuminated, delineating the dyads' life transitions from biographical disruption to biographical continuation. The trajectory is shaped by seven states involving four mindsets and three status passages. The four mindsets are sense of loss and worry, sense of interdependence, sense of independence, and wellbeing state. The status passages identified in this study are acceptance, alteration, and identification. A community-based and family-centred long-term care system, aligning with medical healthcare and community resources, underpinned each dyad's biographical continuation by: (1) providing rehabilitation that afforded time and space for recovery adaptation; (2) acknowledging the individuality of family caregivers and helping to alleviate their multitasking; and (3) reintegrating stroke survivors into their communities. Key to determining the quality of recovery for the indigenous participants was their reintegration into their native community and regaining of identity. Therefore, integrating post-stroke care into various care contexts and incorporating indigenous-specific needs into policymaking can support dyads in adapting to their communities.

Trajectories of mobility difficulty and falls in community-dwelling adults aged 50 + in Taiwan from 2003 to 2015.

BACKGROUND: A decline in mobility leads to fall occurrence and poorer performance in instrumental activities of daily living, which are widely proved to be associated with older adults' health-related quality of life. To inform potential predicaments faced by older adults at different age levels, predictors of this mobility change and falls along with the ageing process need to be further evaluated. Therefore, this study examined the risk factors associated with the longitudinal course of mobility difficulty and falls among community-dwelling middle-aged and older adults in the Taiwanese community. METHODS: We evaluated data for the period between 2003 and 2015 from the Taiwan Longitudinal Study on Aging; the data cover 5267 community-based middle-aged and older adults with approximately 12 years of follow-up. In terms of mobility, the participants self-reported difficulties in mobility tasks (eg, ambulation) and whether they used a walking device. We employed linear mixed-effects regression models and cumulative logit models to examine whether personal characteristics are associated with mobility difficulty and falls. RESULTS: Mobility difficulty significantly increased over time for the participants aged ≥ 60 years. Perceived difficulties in standing, walking, squatting, and running became apparent from a younger age than limitations with hand function. The probability of repeated falls increased significantly with older age at 70 (p = .002), higher level of mobility difficulty (p < .0001), lower cognitive status (p = .001), living alone (p = .001), higher number of comorbid illnesses (p < .001), walking device use (p = .003), longer time in physical activities (p < .011), and elevated depressive symptoms (p = .006). Although walking aid use increased the probability of falls, individuals with mobility difficulty had a reduced probability of repeated falls when using a walking device (p = .02). CONCLUSION: Community-dwelling Taiwanese adults face an earlier mobility difficulty starting in 60 years old. Individuals with more leisure and physical activities in daily life were more likely to maintain mobility and walking safety. Long-term, regular, social, and physical activity could be a referral option for falls prevention program. The use of a walking device and safety precautions are warranted, particularly for individuals with walking difficulties.