Nursing students' attitudes towards mental illness: A multi-national comparison.

Accessible Summary What is known on the subject Health professionals, including nurses, are shown to have stigmatizing attitudes towards mental illness. For nursing students who are in their formative years of professional development, mental illness stigma can severely impact the care they provide. Little research has investigated multi-national comparisons of nursing students' attitudes towards mental illness. What this paper adds to existing knowledge This study shows that between countries, there were substantial differences amongst nursing students in stigmatizing attitudes towards mental illness. Cultural perspectives may explain some of these differences. What are the implications for practice Regardless of location, stigmatizing attitudes are present at varying levels. Each nation can take steps to reduce these by acknowledging the presence of stigmatizing attitudes amongst nurses, educating nurses regarding the negative impacts of stigma on patient outcomes, and decrease stigmatizing attitudes by facilitating opportunities for nurses (particularly student nurses) to have direct contact with people with lived experiences of mental illness. ABSTRACT: INTRODUCTION: Stigmatizing attitudes perpetuated by nursing professionals are a pervasive problem for people experiencing mental health issues. This global issue has detrimental consequences; inhibiting one's life chances and help-seeking behaviours. To date, few studies have compared nursing students' attitudes towards mental illness from a multi-national perspective. AIM: To compare undergraduate nursing students' attitudes towards mental illness across six countries: Australia, India, Jordan, Saudi Arabia, Taiwan and USA. METHOD: In a cross-sectional design, data were collected from undergraduate nursing students (N = 426) using the Social Distance Scale. A one-way analysis of variance was used to compare differences between countries. RESULTS: Nursing students' attitudes to mental illness differed between countries. Social Distance Scores were highest amongst nursing students from Jordan and Saudi Arabia. Students from Taiwan and India possessed moderate stigma scores. Social Distance Scores from the USA and Australia were lowest. DISCUSSION: Clear differences in stigmatizing attitudes emerged between countries; these are discussed in relation to possible cultural influences. IMPLICATIONS FOR PRACTICE: It is suggested that educating nurses, combined with direct contact with people with lived experiences of mental illness, can reduce stigmatizing attitudes regardless of country, location or educational institution.

Cold Water Immersion Directly and Mediated by Alleviated Pain to Promote Quality of Life in Indonesian with Gout Arthritis: A Community-based Randomized Controlled Trial.

Background: Gout arthritis is an autoinflammatory arthritis that generates chronic long-term pain. Pain impacts physical activities, joint mobility, stress, anxiety, depression, and quality of life. Cold-water immersion therapy reduces inflammation and pain associated with gout arthritis. However, cold-water immersion therapy has not been conducted among people worldwide with gout arthritis. Objective: To investigate the cold-water immersion intervention on pain, joint mobility, physical activity, stress, anxiety, depression, and quality of life among acute gout patients. Methods: A community-based randomized control trial design with two parallel-intervention groups: a cold-water immersion group (20-30°C 20 minutes/day for 4 weeks) and a control group. In total, 76 eligible participants in Tomohon City, Indonesia, were recruited using a multi-stage sampling method and were randomly assigned using block randomization. A generalized estimating equation model was used to analyze the results (coef. ß) and produce 95% confidence intervals (CIs). A path analysis was used to analyze mediating effects. Results: Significant pain alleviation (ß = -2.06; -2.42), improved joint mobility (ß = 1.20, 1.44), physical activity (ß = 2.05, .59), stress (ß = -1.25; -1.35), anxiety (ß = -.62; -1.37), and quality of life (ß = 5.34; 9.93) were detected after cold-water immersion at the second-week, and were maintained to the fourth-week time point, compared to pre-intervention and the control group. Depression (ß = -1.80) had decreased by the fourth week compared to the pre-test and control group. Cold-water immersion directly mediated alleviation of pain (ß = -.46, p ≤ .001) and to promote the quality of life (ß = .16, p = .01). Conclusions: Cold-water immersion decreased pain, stress, anxiety, and depression, and increased joint mobility, physical activity, and quality of life. It mediated alleviation of pain to increase the quality of life.

Effects of Spirituality, Knowledge, Attitudes, and Practices toward Anxiety Regarding COVID-19 among the General Population in INDONESIA: A Cross-Sectional Study.

BACKGROUND: Currently, the determinants of anxiety and its related factors in the general population affected by COVID-19 are poorly understood. We examined the effects of spirituality, knowledge, attitudes, and practices (KAP) on anxiety regarding COVID-19. METHODS: Online cross-sectional data (n = 1082) covered 17 provinces. The assessment included the Daily Spiritual Experiences Scale, the Depression, Anxiety, and Stress Scale, and the KAP-COVID-19 questionnaire. RESULTS: Multiple linear regression revealed that individuals who had low levels of spirituality had increased anxiety compared to those with higher levels of spirituality. Individuals had correct knowledge of early symptoms and supportive treatment (K3), and that individuals with chronic diseases and those who were obese or elderly were more likely to be severe cases (K4). However, participants who chose incorrect concerns about there being no need for children and young adults to take measures to prevent COVID-19 (K9) had significantly lower anxiety compared to those who responded with the correct choice. Participants who disagreed about whether society would win the battle against COVID-19 (A1) and successfully control it (A2) were associated with higher anxiety. Those with the practice of attending crowded places (P1) had significantly higher anxiety. CONCLUSIONS: Spirituality, knowledge, attitudes, and practice were significantly correlated with anxiety regarding COVID-19 in the general population.

[Exploration of the Association Between Workplace Bullying and Attitudes Toward Patient Safety in Female Nurses].

BACKGROUND: Workplace bullying is known to have a significant and detrimental effect on the physical and psychological outcomes of its victims. The reactions of victims to bullying may decrease clinical care outcomes and patient safety. PURPOSE: To explore the relationship between workplace bullying and the attitudes of female nurses toward the safety of their patients. METHODS: This cross-sectional survey study used convenience sampling. Participants included female nurses from a regional teaching hospital. The research tool was a three-part, structured questionnaire that included a basic personal information datasheet, negative behavior scale, and patient safety attitude scale. The researcher distributed 420 questionnaires and collected 329 valid samples (valid return rate: 78.3%). Data were analyzed using SPSS software version 22.0. RESULTS: The analysis found that 29.8% of the participants had suffered from various degrees of workplace bullying. The mean score for patient safety attitudes was 3.58 (standard deviation = 0.55). Workplace bullying and patient safety attitudes were negatively correlated (p < .1), and being a recipient of workplace bullying was identified as a significant predictor of attitudes toward patient safety. CONCLUSIONS: Based on the results, we suggest that supervisors should take the initiative to care for their nursing staffs and to provide them with training in conflict-oriented skills. Organization managers should set up relevant committee-notification mechanisms that construct the safe working environment necessary to reduce workplace bullying and to enhance the patient safety attitudes of nurses, which will indirectly improve the quality of patient care.

The effect of a researcher designated music intervention on hospitalised psychiatric patients with different levels of anxiety.

AIMS AND OBJECTIVES: The purpose of this study was to investigate the effects of a music intervention on hospitalised psychiatric patients with different levels of anxiety. BACKGROUND: In clinical practice, psychiatric inpatients and nurses routinely suffer from anxiety. A music intervention may possibly be useful, but knowledge as to how useful and how effective it is in patients with different levels of anxiety is limited. DESIGN: The study design was a three-group, repeated-measures experimental study. METHODS: Subjects were 22 psychiatric patients who were divided into three groups based on their level of anxiety. They listened to 20 minutes of music each day for 10 days and were assessed using the Beck Anxiety Inventory before and after the music intervention and at a one-week follow-up; an electroencephalogram and finger temperature were monitored before and during the music intervention. RESULTS: Anxiety levels of all three groups showed a significant difference (p = 0·0339) after the intervention. The difference alpha and beta electroencephalogram percentages for all three groups showed a significant difference (p = 0·04; p = 0·01). The finger temperature showed a non-significant difference (p = 0·41). CONCLUSIONS: A music intervention can effectively alleviate the anxiety of hospitalised psychiatric patients who suffer from all levels of anxiety. RELEVANCE TO CLINICAL PRACTICE: The study recommends a practice in alleviating anxiety. Effective lower-cost interventions to reduce anxiety in psychiatric inpatient settings would be of interest to nurses and benefit patients.

The efficacy of music therapy for people with dementia: A meta-analysis of randomised controlled trials.

AIMS AND OBJECTIVES: To (1) perform a meta-analysis of randomised controlled trials pertaining to the efficacy of music therapy on disruptive behaviours, anxiety levels, depressive moods and cognitive functioning in people with dementia; and (2) clarify which interventions, therapists and participant characteristics exerted higher and more prominent effects. BACKGROUND: Present study was the first to perform a meta-analysis that included all the randomised controlled trials found in literature relating to music therapy for people with dementia over the past 15 years. DESIGN: A meta-analysis study design. METHODS: Quantitative studies were retrieved from PubMed, Medline, Cochrane Library Database, CINAHL, SCOPUS and PsycINFO. A meta-analysis was used to calculate the overall effect sizes of music therapy on outcome indicators. RESULTS: Music therapy significantly improved disruptive behaviours [Hedges' g = -0·66; 95% confidence interval (CI) = -0·44 to -0·88] and anxiety levels (Hedges' g = -0·51; 95% CI = -0·02 to -1·00) in people with dementia. Music therapy might affect depressive moods (Hedges' g = -0·39; 95% CI = 0·01 to -0·78), and cognitive functioning (Hedges' g = 0·19; 95% CI = 0·45 to -0·08). CONCLUSION: Music therapy exerted a moderately large effect on disruptive behaviours of people with dementia, a moderate effect on anxiety levels and depressive moods, and a small effect on cognitive functioning. RELEVANCE TO CLINICAL PRACTICE: Individual music therapy provided once a week to patients with cognitive functioning and manual guided in music intervention construction is suggested. Group music therapy is provided several times a week to reduce their disruptive behaviours, anxiety levels and depressive moods. Music therapy is a cost-effective, enjoyable, noninvasive therapy and could be useful for clinical nurses in creating an environment that is conducive to the well-being of patients with dementia.

The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study.

OBJECTIVE: The aims of this study were to determine the effectiveness of group music therapy for improving depression and delaying the deterioration of cognitive functions in elderly persons with dementia. METHOD: The study had a prospective, parallel-group design with permuted-block randomization. Older persons with dementia (N = 104) were randomly assigned to the experimental or control group. The experimental group received 12 sessions of group music therapy (two 30-min sessions per week for 6 weeks), and the control group received usual care. Data were collected 4 times: (1) 1 week before the intervention, (2) the 6th session of the intervention, (3) the 12th session of the intervention, and (4) 1 month after the final session. RESULTS: Group music therapy reduced depression in persons with dementia. Improvements in depression occurred immediately after music therapy and were apparent throughout the course of therapy. The cortisol level did not significantly decrease after the group music therapy. Cognitive function significantly improved slightly at the 6th session, the 12th session, and 1 month after the sessions ended; in particular, short-term recall function improved. The group music therapy intervention had the greatest impact in subjects with mild and moderate dementia. CONCLUSION: The group music intervention is a noninvasive and inexpensive therapy that appeared to reduce elders' depression. It also delayed the deterioration of cognitive functions, particularly short-term recall function. Group music therapy may be an appropriate intervention among elderly persons with mild and moderate dementia.

The effects of assertiveness training in patients with schizophrenia: a randomized, single-blind, controlled study.

AIMS: In this study, we investigated the effects of group assertiveness training on assertiveness, social anxiety and satisfaction with interpersonal communication among patients with chronic schizophrenia. BACKGROUND: Only limited studies highlighted the effectiveness of group assertiveness training among inpatients with schizophrenia. Given the lack of group assertiveness training among patients with schizophrenia, further development of programmes focusing on facilitating assertiveness, self-confidence and social skills among inpatients with chronic schizophrenia is needed. DESIGN: This study used a prospective, randomized, single-blinded, parallel-group design. METHODS: This study employed a prospective, randomized, parallel-group design. Seventy-four patients were randomly assigned to experimental group receiving 12 sessions of assertiveness training, or a supportive control group. Data collection took place for the period of June 2009-July 2010. RESULTS: Among patients with chronic schizophrenia, assertiveness, levels of social anxiety and satisfaction with interpersonal communication significantly improved immediately after the intervention and at the 3-month follow-up in the intervention group. The results of a generalized estimating equation (GEE) indicated that: (1) assertiveness significantly improved from pre- to postintervention and was maintained until the follow-up; (2) anxiety regarding social interactions significantly decreased after assertiveness training; and (3) satisfaction with interpersonal communication slightly improved after the 12-session intervention and at the 3-month follow-up. CONCLUSION: Assertivenss training is a non-invasive and inexpensive therapy that appears to improve assertiveness, social anxiety and interpersonal communication among inpatients with chronic schizophrenia. These findings may provide a reference guide to clinical nurses for developing assertiveness-training protocols.

The effect of music therapy on hospitalized psychiatric patients' anxiety, finger temperature, and electroencephalography: a randomized clinical trial.

PURPOSE: This study aimed to explore the effectiveness of music therapy in reducing anxiety in hospitalized psychiatric patients. METHODOLOGY: The authors used a randomized clinical trial design and randomly allocated the 24 enrolled participants to the experimental or the control group. Patients in the experimental group received music therapy in a therapy room at a set time for 30 min each morning for 11 days. The authors administered the Beck Anxiety Inventory (BAI) and measured skin temperature and brain waves to determine anxiety level before, during, and after music therapy. RESULTS: Experimental group participants had lower scores on the BAI than control participants, after the music therapy (z = -2.0, p < .05) and at 1-week follow-up (z = -2.2, p < .05), indicating that they were experiencing significantly less anxiety. The mean BAI anxiety score fell in the experimental group from 23.9 (SD = 9.9) at baseline to 13.9 (SD = 8.8), after music therapy, and 12.7. (SD = 10.5) at follow-up. The experimental group demonstrated a significant elevation in the average alpha electroencephalographic (EEG) percentage (from 38.1% to 46.7%) and a reduction in the average beta EEG percentage (from 61.9% to 53.4%) after the music therapy. After adjusting for change in patient finger temperature on the first day, mean change in finger temperature did not differ significantly between the experimental and control groups. CONCLUSIONS: Music therapy can relieve anxiety in hospitalized psychiatric patients and help them achieve a state of relaxation.

Effectiveness of group music intervention against agitated behavior in elderly persons with dementia.

OBJECTIVES: This study explored the effectiveness of group music intervention against agitated behavior in elderly persons with dementia. METHODS: This was an experimental study using repeated measurements. Subjects were elderly persons who suffered from dementia and resided in nursing facilities. In total, 104 participants were recruited by permuted block randomization and of the 100 subjects who completed this study, 49 were in the experimental group and 51 were in the control group. The experimental group received a total of twelve 30-min group music intervention sessions, conducted twice a week for six consecutive weeks, while the control group participated in normal daily activities. In order to measure the effectiveness of the therapeutic sessions, assessments were conducted before the intervention, at the 6th and 12th group sessions, and at 1 month after cessation of the intervention. Longitudinal effects were analyzed by means of generalized estimating equations (GEEs). RESULTS: After the group music therapy intervention, the experimental group showed better performance at the 6th and 12th sessions, and at 1 month after cessation of the intervention based on reductions in agitated behavior in general, physically non-aggressive behavior, verbally non-aggressive behavior, and physically aggressive behavior, while a reduction in verbally aggressive behavior was shown only at the 6th session. CONCLUSIONS: Group music intervention alleviated agitated behavior in elderly persons with dementia. We suggest that nursing facilities for demented elderly persons incorporate group music intervention in routine activities in order to enhance emotional relaxation, create inter-personal interactions, and reduce future agitated behaviors.

The effects of a support group on dementia caregivers' burden and depression.

OBJECTIVE: The aim of the study is to investigate the effects of a support group on depression levels and burden among dementia caregivers in Taiwan. METHOD: An experimental, pre-intervention postintervention control group design was used in this study. The experimental group received intervention consisting of a 12-week support group for dementia caregivers. A total of 85 subjects were evaluated before intervention, after intervention, and at 1-month follow-up. RESULTS: (a) The depression level of participants in the experimental group was significantly decreased after the intervention and at 1-month follow-up. (b) There was no significant difference in caregiver's burden after the support group intervention and 1-month follow-up. DISCUSSION: The improvement in dementia caregivers' depression levels shows that the support group was effective for reducing caregivers' depression although not effective for relieving their burden of care.

Effects of a home-based walking program on perceived symptom and mood status in postoperative breast cancer women receiving adjuvant chemotherapy.

AIM: This paper is a report of a study analysing the effect of a home-based walking exercise program on symptoms and mood distress among breast cancer women receiving chemotherapy postoperatively. BACKGROUND: Treatment-related symptoms, mood distress and decline in physical activity have been identified as major complaints among cancer patients. Studies on the efficacy of home-based walking exercise for symptoms and mood did not fully describe the exercise prescriptions that could be safe and beneficial for women with breast cancer, especially these receiving adjuvant chemotherapy. METHOD: This is a prospective, randomized clinical trial. In 2008-2009, participants were recruited from the oncology outpatient clinic of a medical center in Taiwan, and were assigned to either the exercise group (n=19) or the control group (n=21). Women in the exercise group participated in a moderate-intensity home-based walking program for 12 weeks during their chemotherapy treatments. Symptoms, mood status and physical activity level were measured at baseline, 6- and 12-week follow-up. Data were analysed by two-way repeated-measures analysis of variance. RESULTS: Women in the exercise group reported significantly lower symptom severity scores and mood disturbance compared with those in the control group throughout the study period. CONCLUSION: Regular moderate-intensity exercise can play an important role in improving treatment-related symptoms and mood in women with breast cancer. A home-based walking exercise program can be easily incorporated into care for women with breast cancer undergoing chemotherapy.

Chinese version of the positive and negative suicide ideation: instrument development.

AIM: This paper is a report of a study conducted to develop a Chinese version of the Positive and Negative Suicide Ideation Inventory and evaluate its psychometric properties. BACKGROUND: Comprehensive assessment of suicidal behaviour in youths should incorporate both protective factors and risk factors. METHODS: We recruited 2341 middle- and high-school students for a longitudinal and prospective study, conducted between 2005 and 2007. To assess predictive validity, a convenience sample of 251 of the 2341 students was recruited 1 year later to follow-up on suicide attempts during the preceding 2 weeks. To evaluate construct validity, a small convenience sample of 94 adolescent inpatients and outpatients was used as a comparison group. Instruments used included the Children's Depression Inventory, the Self-Control Schedule, and the Cognitive Triad for Children. RESULTS: Cronbach's alpha coefficients for the Chinese version of the positive and negative suicide ideation-negative suicide ideation and the Chinese version of the positive and negative suicide ideation-positive ideation were 0.94 and 0.86 respectively. Satisfactory test-retest reliability was evident. Convergent and divergent validities were demonstrated by statistically significant correlations among subscales and the other instruments used. Construct validity was evidenced by statistically significantly different scores on the subscales among the contrasted groups. Subscale scores in the first-wave study statistically significantly predicted attempted suicide behaviour 1 year later, demonstrating evidence of predictive validity. Factor analysis showed a two-factor structure. CONCLUSION: The Chinese Version of the Positive and Negative Suicide Ideation Inventory may be a reliable and valid instrument to measure the severity of suicidal ideation in adolescents, subject to further research to test the generalizability of the present findings.

Surviving a life-threatening crisis: Taiwan's nurse leaders' reflections and difficulties fighting the SARS epidemic.

AIM: This study explored Taiwan's nurse leaders' reflections and experiences of the difficulties they encountered and survival strategies they employed fighting the severe acute respiratory syndrome epidemic and the background context framing these phenomena. BACKGROUND: On several continents in 2002-2003, the highly infectious severe acute respiratory syndrome overwhelmed health care systems and health professionals who had to provide care in situations involving high personal risk and stress, some becoming infected and dying. Nurse leaders in Taiwan had to develop new strategies and support systems for nursing care. DESIGN: A two-step within-method qualitative triangulation research design. METHODS: Focus group in-depth interviews held with 70 nurse leaders from four Northern Taiwan hospitals involved in the severe acute respiratory syndrome epidemic. Participants then completed an open ended questionnaire. Content analysis was undertaken with data and stages and themes generated. Data were then analysed using Hobfall's concepts of conservation of resources to further discuss participants' reactions and actions in the severe acute respiratory syndrome crisis. RESULTS: Participants worked under incredible stress to lead the profession through a period of crisis. Five stages arose in the participants' involvement against severe acute respiratory syndrome over 12 weeks: facing shock and chaos; searching for reliable sources to clarify myths; developing and adjusting nursing care; supporting nurses and their clients; and rewarding nurses. CONCLUSION: Nurse leaders become important executors of intervention in this health disaster, requiring emotional intelligence to manage their internal conflicts and interpersonal relationships effectively. They developed sociopolitical and analytical abilities and crucial requirements for planning and implementing strategies in areas where none previously existed. Building support systems was an important resource for managing conflicts between familial and professional roles. Relevance to clinical practice. Findings will assist nurse leaders to prepare themselves and the profession to better deal with disaster management in similar infectious outbreaks in the future.

Prevalence and impact on quality of life of lower urinary tract symptoms among a sample of employed women in Taipei: a questionnaire survey.

BACKGROUND: Previous studies about the prevalence and impact of lower urinary tract symptoms (LUTS) were focused on urinary incontinence or overactive bladder in the general population. Little research has been focused on the role that the workplace has in employed women's experiences with LUTS or the impact of LUTS on their health-related quality of life (HRQL). OBJECTIVES: To estimate the prevalence of LUTS among employed female nurses in Taipei and to compare the HRQL for nurses with and without LUTS. DESIGN: This study was a cross-sectional, questionnaire survey. SETTINGS: Three medical centers and five regional hospitals in Taipei were selected randomly. PARTICIPANTS: In the selected hospitals, 1065 female nurses were selected randomly. Data analyses were based on 907 usable surveys. All participants were native Taiwanese; most of the female nurses were 26-35 years of age (mean=31.02, SD=6.32), had normal body mass index, and had never given birth. Most nurses' bladder habits were poor or very poor and their personal habits of fluid consumption at work were inadequate. METHODS: Data were collected using the Taiwan Nurse Bladder Survey and the Short Form 36 Taiwan version. Chi-square tests were used to compare the prevalence rates of different LUTS for nurses in different age groups. Student's t-tests were conducted to compare the mean scores of HRQL for nurses with and without LUTS. RESULTS: Based on 907 usable surveys, 590 (65.0%) experienced at least one type of LUTS. The prevalence for different LUTS ranged from 8.0% to 46.5%. Nurses who reported LUTS also reported lower HRQL, more so on physical health than mental health, than nurses who did not report LUTS. CONCLUSIONS: Although most of the nurses in this study were young (< or =35 years) and nulliparous, LUTS were common among this group. The high prevalence rate of LUTS leads to concerns about nurses' possible dysfunctional voiding patterns and possible effects of working environment and poor bladder and personal habits on LUTS. Study results showed a possible negative impact of LUTS on nurses' physical health. Designing a continence-related education program for this group is essential for delivering information about LUTS prevention and management.

Effectiveness of a nosocomial infection control training in improving knowledge in patient-hired attendants and outsourced workers in Taiwan.

Nosocomial infection represents an important indicator of healthcare quality and patient safety. Based on the experience gained during the outbreak of Severe Acute Respiratory Syndrome (SARS) in Taiwan in 2003, we gained greater awareness of the potential threat from patient-hired attendants and outsourced workers as bacteria carriers and transmitters. This study built a training model and evaluated training effectiveness in terms of improved knowledge. The training model included nosocomial infection control guidelines, a training CD, training program, evaluation form, and descriptive procedures for conducting training and evaluation. The training course for this study was conducted in 17 hospitals in Taiwan, with a total of 1,467 participants attending 27 seminars and 1,265 effective samples (return rate = 86.2%). Results of the study showed a statistical difference of < .001 before and after the training course on participant understanding of nosocomial infection control. Advantages of applying this training model include knowledge enhancement and reduced implementation time, manpower input and budget outlay. In addition to greater flexibility, the model can also positively influence clinical practice, improve patient safety and reduce hospital nosocomial infection rates. This program is worth promoting in hospitals and other healthcare institutions.

Determinants of suicidal ideation in Taiwanese urban adolescents.

BACKGROUND/PURPOSE: The primary purpose of this study was to examine the determinants of adolescent suicidal ideation in Taiwanese urban adolescents. METHODS: A descriptive and correlational study design was used. A sample of 2341 adolescents aged from 12 to 18 years in middle and high school was recruited for this study. Data were collected between January 2005 and July 2007. Instruments used included the Children's Depression Inventory, the Cognitive Triad for Children, the Positive and Negative Suicide Ideation, the Life Event Checklist, and the revised Daily Hassle Scale. RESULTS: Approximately 51% of the adolescents were identified as belonging to the high-risk group and needed further assessment for at-risk suicidal ideation. Specifically, 51.6% and 50.7% of the adolescents in middle and high schools, respectively, were identified as belonging to the high-risk groups. Results revealed that type of school, depressive symptoms, cognitive triad, and daily hassles significantly predicted adolescent suicidal ideation. Middle school students were likely to report a greater amount of suicidal ideation. Students with higher levels of depressive symptoms, negative cognitive triad and daily hassles tended to have more suicidal thoughts. The best predictor was the negative cognitive triad (beta = -0.43, p < 0.001) followed by depressive symptoms (beta = 0.35, p < 0.001). CONCLUSION: Results from this study have important implications for identifying high-risk suicidal adolescent groups and for furthering suicide prevention work.

Dying and caring on the edge: Taiwan's surviving nurses' reflections on taking care of patients with severe acute respiratory syndrome.

In 2003, Taiwan's nurses were terrified by severe acute respiratory syndrome (SARS), and four of them sacrificed their life in the course of their work with SARS patients. This study attempted to identify the stage-specific difficulties encountered by Taiwan's surviving frontline nurses during the anti-SARS process. A two-step within-method qualitative triangulation research design was used to obtain the in-depth and confidential thoughts of 200 participants during the precaring, tangible caring, and postcaring stages. Six major types of stage-specific difficulties with and threats to the quality of care of SARS patients were identified according to each specific stage of the caring process. Four themes were further explored; these are discussed to provide a background context in obtaining better understanding of the multifaceted needs of nurses during this crisis. Consequently, a conceptual framework was developed to depict this complex phenomenon.