Associations of professional quality of life and social support with health in clinical nurses.

AIM: To explore the associations of the professional quality of life and social support with health in nurses. BACKGROUND: Physical and mental health may be associated with absence from work among nurses. Few studies have explored the associations of professional quality of life and social support on the physical and mental health of nurses. METHODS: This was a cross-sectional study. In total, 294 nurses were recruited from a hospital in Southern Taiwan. A self-report questionnaire was used to collect data. RESULTS: Burnout, secondary traumatic stress and social support from relatives or friends were important factors of physical and mental health. Interactions between support from relatives or friends and secondary traumatic stress are important factors in physical health. CONCLUSION: Reducing burnout and secondary traumatic stress is important for physical and mental health of nurses. Increasing social support from relatives or friends may be useful to reduce the negative effects of secondary traumatic stress on the physical health of nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers could design interventions to reduce and prevent nurses from being influenced by burnout and secondary traumatic stress. Educating nurses to build effective social networks with relatives or friends and to seek support when experiencing secondary traumatic stress may also be needed.

[The Efficacy of Rooming-In in the Context the Physical and Mental Health of New Mothers].

The Breastfeeding-Friendly Policy promotes successful breastfeeding by encouraging postpartum rooming-in and other practices that have been shown to increase breastfeeding success. Puerperium is a key transition period in a woman's life during which she faces physical changes as well as changes in roles and tasks as she transitions into motherhood. During this transition period, postpartum women typically follow the rooming-in and breastfeeding practices that are recommended by the hospital. However, without suitable assistance, the physical and mental problems that often accompany childbirth may impact the postpartum health of the mother. This article reflects on the potential health problems that are encountered by postpartum women who adopt 24-hour rooming-in practices from the perspective of their health rights and proposes suggestions for improving these practices as a reference for related government and healthcare workers.

Alcohol consumption after the recognition of pregnancy and correlated factors among indigenous pregnant women in Taiwan.

To examine the rates and factors associated with alcohol consumption after the recognition of pregnancy among indigenous pregnant women, as well as the rates and factors associated with continuing alcohol consumption after the recognition of pregnancy among indigenous pregnant women who drank alcohol before the recognition of pregnancy in 10 hospitals in southern and eastern Taiwan. A total of 806 indigenous women who had just given birth in 10 hospitals in southern and eastern Taiwan were recruited. They were interviewed to collect their substance use information, demographic characteristics, psychological health status, history of physical abuse, and pregnancy history. The rates of alcohol consumption after the recognition of pregnancy in all indigenous pregnant women and the rates of continuing alcohol consumption after the recognition of pregnancy among those who drank alcohol before the recognition of pregnancy were calculated. The factors relating to alcohol consumption and continuing alcohol consumption after the recognition of pregnancy were examined using logistic regression analyses. The results of this study found that 26.6% of indigenous pregnant women drank alcohol at any stage after the recognition of pregnancy, and 52.5% of indigenous pregnant women who drank alcohol before the recognition of pregnancy persisted in drinking alcohol after the recognition of pregnancy. Multiple parities, smoking or chewing betel quid after the recognition of pregnancy, and a higher frequency of drinking alcohol before the recognition of pregnancy were significantly associated with alcohol consumption and continuing alcohol consumption after the recognition of pregnancy. Meanwhile, being single or divorced, and intimate partner violence after the recognition of pregnancy were significantly associated with alcohol consumption after the recognition of pregnancy. High prevalence rates of alcohol consumption and continuing alcohol consumption after the recognition of pregnancy were found among indigenous pregnant women in Taiwan. Early detection of alcohol consumption and effective intervention for alcohol consumption during pregnancy are needed.

The associations between menopausal syndrome and depression during pre-, peri-, and postmenopausal period among Taiwanese female aborigines.

AIM: The aim of the study was to evaluate the association between physiological menopausal symptoms and depression during the pre-, peri-, and postmenopausal period among female Taiwanese aborigines. METHODS: A total of 672 Taiwanese aboriginal women, aged 40-60 years, were recruited in the interviewing study and classified as pre-, peri-, and postmenopausal according to menstrual bleeding patterns in the previous 12 months. Then, the postmenopausal symptoms, depression, self-perceived health, family support, and associated demographic variables were assessed by questionnaire based on the results of interviewing by research assistants. RESULTS: The results revealed that perimenopausal statuses are associated with depression and women with a perimenopausal status had a higher prevalence of depression than those with a premenopausal status. A higher score on physiological postmenopausal symptoms was found to be significantly associated with depression. Furthermore, somatic symptoms were associated with depression for pre-, peri-, and postmenopausal statuses. Moreover, sexual dysfunction and vasomotor symptoms were associated with depression only in the premenopausal status and postmenopausal status, respectively. CONCLUSION: Depression should be routinely evaluated for female Taiwanese aborigines consulting with physicians for menopause symptoms, especially for somatic symptoms. Furthermore, attention should be provided to premenopausal women with sexual dysfunction and postmenopausal women with vasomotor symptoms for depression.

Relationships among smoking, drinking, betel quid chewing and pregnancy-related nausea and vomiting in Taiwanese aboriginal women.

A cross-sectional survey was conducted to investigate the associations among smoking, drinking, betel quid chewing and pregnancy-related nausea and vomiting (N/V) in Taiwanese aboriginal women. A total of 901 aboriginal women from 11 hospitals were recruited into this study. A structured questionnaire on demographic and obstetric information, smoking history, alcohol consumption, betel quid chewing habits, and N/V by checklist was used to collect data. The findings of this study indicated that the prevalence of N/V, maternal smoking, drinking, and betel quid chewing were 75.6% (n = 682), 22.8% (n = 201), 31.9% (n = 287), and 34.7% (n = 313) respectively. Multiple logistic regression with adjustment for age, body mass index and antiemetics use revealed significant relationships between smoking habits and N/V before confirmation of pregnancy and during pregnancy. In comparison with those who did not smoke, women smoking in excess of 10 cigarettes a day before pregnancy were 1.65 times more likely to develop N/V; and women smoking in excess of 10 cigarettes a day during pregnancy were 2.79 times more likely to develop N/V. Based on the findings of this study, smoking was associated, with a dose-response effect, with pregnancy-related N/V. Reducing the intake of cigarettes could decrease the risk of pregnancy-related N/V. Health care providers should help these women decrease their uncomfortable symptoms and improve their experiences of pregnancy and birth outcome during critical times.

[Moral distress and leadership in nursing].

While nursing staff learn the rules of ethical behavior in nursing education programs, they commonly experience confusion, frustration and stress in practice settings due to barriers to moral action faced in the work environment. "Moral distress" is a term used to describe the situation in which a decision-maker cannot carry out an ethical or moral action due to the presence of an obstacle. In this article, we described the meaning of and factors influencing moral distress in nursing work settings in relation to nursing leader management strategies. Goals of the article were to help nursing leaders appreciate their personal beliefs as well as to develop strategies to alleviate emotional distress and promote self-efficacy among nursing staff members. One favorable benefit is expected to be greater retention of nursing staff.

The effect of maternal betel quid exposure during pregnancy on adverse birth outcomes among aborigines in Taiwan.

In considering documented developmental toxicity and teratogenicity found in earlier research, maternal betel quid chewing may very well be linked to a higher risk of adverse birth outcomes. The aim of this study was to investigate the significance of betel quid chewing, together with the use of cigarettes or alcohol, either independently or combined, on birth-related outcomes. A total of 1264 aboriginal women who had just given birth in 10 hospitals in Southern and Eastern Taiwan were recruited. Information on their maternal and newborn characteristics was obtained from medical charts and by performing personal interviews using a validated questionnaire. Maternal areca nut chewing during pregnancy was found to be significantly associated with both birth weight loss (-89.54 g) and birth length reduction (-0.43 cm). A significantly lower male newborn rate (aOR=0.62) was observed among aboriginal women with a habit of betel quid chewing during pregnancy. The use of this substance conveyed a 2.40- and 3.67-fold independent risk of low birth weight and full-term low birth weight, respectively. An enhanced risk (aOR=3.26-5.99) of low birth weight was observed among women concomitantly using betel quid, cigarette and alcohol during gestation. Our findings suggest that betel quid chewing during pregnancy has a substantial effect on a number of birth outcomes, including sex ratio at birth, lower birth weight and reduced birth length.

Suicidal thoughts among elderly Taiwanese aboriginal women.

OBJECTIVES: The aims of this study were to investigate prevalence of suicidal thoughts among a population of elderly aboriginal women in Taiwan over a 1-month period and to examine the risk factors for suicidal thinking in terms of individual (self-perceived health, disability and financial difficulty), family (marital discord) and social (medical accessibility) aspects. The mediating effects of depression on the above risk factors were also investigated. Furthermore, we examined the buffer effect on suicidal ideation of emotional social support for dealing with marital discord. METHODS: One thousand three hundred and forty-seven elderly Taiwanese aboriginal women were enrolled. Suicide thoughts within the past month, demographic data, adverse life events, emotional social support and depressive state were assessed. The 1-month prevalence of suicide thoughts was calculated. The risks of suicide thought based on individual, family and community aspects were estimated. RESULTS: The 1-month prevalence of suicidal thoughts among the community-dwelling aboriginal elderly women was 17.8%. Those subjects with poorer self-perceived health, difficulty in accessing medical resources, or experiencing marital discord were at higher risk of having suicidal thoughts. After controlling for depression, the odds ratio of self-perceived health and marital discord remained statistically significant. The odds ratio of interaction of marital discord and emotional social support was 0.41. CONCLUSION: Suicidal thoughts are common among the community-dwelling aboriginal elderly women in Taiwan. Risk factors for suicidal thoughts comprise individual (depression and physical condition), family (marital discord) and community (medical resources) aspects. Better emotional social support can effectively buffer the effect of marital discord.

Effects of childhood physical abuse on depression, problem drinking and perceived poor health status in adolescents living in rural Taiwan.

AIMS: The aim of the present study was to investigate the magnitude and independence of the effects of childhood physical abuse on adolescent depression, problem drinking and perceived poor mental health in Taiwanese indigenous and non-indigenous adolescents living in rural areas controlling for individual and familial characteristics. METHODS: A sample of adolescents was randomly selected from junior high schools in the rural areas of southern Taiwan. The associations between childhood physical abuse and adolescent depression, problem drinking and perceived poor health status were examined on univariate and multivariate logistic regression. RESULTS: Of the 1684 adolescents who completed the questionnaires, 374 (22.2%) reported that they had experienced physical abuse in childhood. Controlling for individual and familial factors, childhood physical abuse significantly increased the risk of depression, problem drinking and perceived poor health status in the present sample of adolescents on multivariate logistic regression. CONCLUSION: History of childhood physical abuse should be elicited from adolescents in treatment for depression, alcohol abuse or physical discomfort of unknown etiology. This finding may be of clinical benefit in terms of the design and implementation of intervention.

Childhood physical and sexual abuse: prevalence and correlates among adolescents living in rural Taiwan.

OBJECTIVE: The aims of this cross-sectional survey study were to examine the prevalence and correlates of childhood physical and sexual abuse in adolescents living in the rural areas of Taiwan. METHOD: A sample of indigenous (n=756) and non-indigenous (n=928) adolescents was randomly selected from junior high schools in the rural areas of southern Taiwan. Structured questionnaires were used to collect data anonymously. The prevalence of childhood physical and sexual abuse was examined and their correlates were examined using univariate and multivariate logistic regression. RESULTS: A total of 374 (22.2%) adolescents reported experience of physical abuse and 42 (2.5%) reported sexual abuse in their childhood. Multivariate logistic regression analyses revealed that the adolescents who perceived poor family function, frequent family conflicts and whose parents drank habitually were more likely to experience physical abuse. The adolescents who were indigenous and perceived frequent family conflicts were more likely to experience childhood sexual abuse. Further analyses indicated that indigenous boys had a higher risk of being the victims of sexual abuse than non-indigenous boys, while no difference was found between indigenous and non-indigenous girls. CONCLUSION: The results remind clinical workers of the importance of taking abuse histories from adolescents on a routine basis, and this is especially important in the case of dysfunctional families. PRACTICE IMPLICATIONS: Adolescents who live in rural areas have less social and medical resources for early detection and intervention of physical and sexual abuse. Correlates of physical and sexual abuse identified in this study may be helpful for the design and implementation of preventive intervention.

A cross-sectional survey of the symptom experience of kidney transplant recipients.

BACKGROUND: Previous studies have shown that being able to assess and improve kidney transplant recipients' experience of the common side effects of long-term post-operative immunosuppressive drug therapy can positively affect their treatment compliance, and thus, their quality of life. However, more needs to be learned about the factors affecting the symptom experience of kidney transplant patients in Taiwan. OBJECTIVE: The purpose of this study was to further our understanding of kidney transplant recipients' symptom experience in Taiwan in order to improve their symptom experience, drug and other therapies, and overall quality of life. METHODS: A cross-sectional study was conducted with purposive sampling of transplant recipients from a hospital in southern Taiwan. Data were collected from August 23, 2003 to June 30, 2004. One hundred subjects participated and self-reported using a structured questionnaire. The reliability (alpha) of social support and symptom experience was 0.96 and 0.78, respectively. RESULTS: The results indicated that there were significant differences in physical symptom experience by gender and herbal medicine use, and in psychosocial symptom experience by educational level and herbal medicine use. Women, on an average, had more severe physical symptoms than men. A higher level of social support and herbal medicine use was associated with less severe physical symptoms among men and women. These three factors explained 22.5% of the variance in physical symptom experience: gender (13.0%), value support (6.1%) and herbal medicine use (3.4%). The factor with the highest explanatory value for the variance in psychosocial symptom experience was herbal medicine (7.8%), its use being associated with slightly lower levels of psychosocial symptoms. CONCLUSIONS: A better understanding of kidney transplant patients' symptom experience can improve health professionals' symptom appraisal efforts, enabling them to provide better quality care, encourage greater patient compliance, and ultimately, improve the quality of life for kidney transplant recipients.

Intimate partner violence and minor psychiatric morbidity of aboriginal Taiwanese women.

OBJECTIVES: Experiences of abuse increase the risk of psychiatric morbidity in women. This study assesses the prevalence of intimate partner violence and minor psychiatric morbidity and analyzes their association among aboriginal women in Taiwan. METHODS: Using system random sampling, 840 aboriginal women between the ages of 18 and 50 years old were recruited from four townships with aboriginal communities in southern Taiwan. Trained primary care nurses interviewed the participants at home by structured questionnaire. RESULTS: One hundred twenty-six of 840 (15%) of the aboriginal women had experienced physical abuse perpetrated by an intimate partner (her husband or cohabitant) during their lifetime; 10.1% had experienced it during the past 12 months; 4.0% had experienced sexual abuse by the partner; and 6.3% had experienced physical abuse during childhood at the hands of one or both parents. Multiple logistic regression revealed that after adjusting for women's age, alcohol and drug use, religious activity and husband's employment status, the experience of abuse (including partner physical abuse, partner sexual abuse, and childhood physical abuse) was significantly associated with suicidal ideation and depression. CONCLUSIONS: Health care professionals need to provide adequate support and health education, develop interventions, and use referrals in primary care in the community in order to reduce and prevent domestic violence against aboriginal women in Taiwan.

Physical abuse against pregnant aborigines in Taiwan: prevalence and risk factors.

The purpose of this study was to estimate the prevalence of, and to investigate the risk factors for physical abuse against pregnant aborigines in Taiwan. A cross-sectional survey was conducted. Aboriginal women who had just given birth in hospitals were recruited from January to December 2003. The women were interviewed with a structured questionnaire about the physical abuse and substance use experiences. Participants were 1143 aboriginal women who had just given birth in hospitals. About 175/1143 of the women (15.3%) had ever experienced physical abuse from a husband or intimate partner, and 79/1143 of the women (6.9%) had experienced it during their recent pregnancy. Multiple logistic regression analysis revealed that the women who were more likely to have been physically abused during their pregnancy were: had fewer years of education, husbands who were unemployed, with a patriarchal family situation and had alcohol, cigarette and non-prescription drug use. Based on these results, we suggest that health care professionals provide adequate support and health education, develop interventions, and use referrals in concert with routine prenatal care in order to reduce and prevent the physical abuse of aboriginal women in Taiwan.

Psychopathology of aboriginal and non-aboriginal adolescents living in the mountainous region of southern Taiwan.

The aim of this study was to examine the hypothesis that Taiwanese aboriginal adolescents feature more severe psychopathology than non-aboriginal adolescents who live in the same mountainous region of southern Taiwan, and to test the hypothesis by controlling other individual and environ-mental factors. In this study, a total of 251 aboriginal and 79 non-aboriginal Taiwanese adolescents were enrolled. Their psychopathology was measured by the Symptom Checklist-90-Revised Scale; demographic and family characteristics, and their affinity with their peer group and with their school were also assessed. The results of the multiple regression analysis revealed that aboriginal adolescents feature more severe psychopathology than non-aboriginal adolescents, and indicated that females and adolescents perceiving higher levels of family conflict and lower family support were more likely to experience more severe psychopathology than those perceiving the contrary. Those who devise strategies to improve the mental health of adolescents living in impoverished regions must take into consideration their ethnicity, gender, and family context when devising such treatment strategies.

Harmful alcohol use among Aboriginal people in southern Taiwan: the prevalence, correlates, and adverse drinking effects.

This cross-sectional study aims to examine the prevalence and correlates of harmful alcohol use among aboriginal people in southern Taiwan and to examine the associations between harmful alcohol use and adverse drinking effects. Four hundred forty-nine aboriginal adults were recruited from two townships in southern Taiwan to complete the questionnaires. Among the aborigines, 59.7% scored an 8 or above on the Alcohol Use Disorders Identification Test, including 26.7% who were found to be hazardous drinkers (AUDIT level II), 18.5% who were harmful drinkers (level III), and 14.5% who were with likely dependence (level IV). Male aborigines who participated less in religious activities, had stressful life events, were cigarette smokers, or were betel quid chewers were more likely to have harmful alcohol use. Harmful alcohol use was also associated with an inability to work and with arguments with other people. Our study suggests that aboriginal people in southern Taiwan experience alcohol-related risks at rates as high as other worldwide populations for which AUDIT results are available. Individuals with AUDIT scores at levels II and III are generally candidates for brief interventions delivered in generalist health settings. Individuals with AUDIT scores at level IV should be referred for an addiction specialty evaluation and possible treatment as well as lower-risk individuals (those with AUDIT levels II-III) if they have concurrent physical or psychiatric disorders.

Nurses' attitudes toward clients with substance use problems.

PURPOSE: This study aimed to examine factors associated with nurses' attitudes toward clients with substance use problems. DESIGN AND METHODS: A cross-sectional design was used, and 489 nurses working in two medical centers in Taiwan participated in this study. FINDINGS: Age, total nursing experience, work unit, personal experience, experience of taking care of clients with substance use problems, substance use education in school, and continuing education were significantly associated with nurses' attitudes. Hierarchical regression revealed that continuing education predicted nurses' overall attitudes. However, the model explained a low variance. PRACTICE IMPLICATIONS: Education-focused training alone may not be adequate. Nursing workforce development needs to incorporate multiple strategies, including clinical supervision, when designing substance use education for clinical nurses in order to generate better improvements on attitudes.

Changes in quality of life among prostate cancer patients after surgery.

BACKGROUND: Quality of life (QoL) often is impacted after radical prostatectomy (RP) procedures. Although patients' QoL scores gradually improve after RP, changes in the QoL score over time after different RP procedures must be examined. OBJECTIVE: The aim of this study was to compare the changes in QoL over time of prostate cancer patients who were treated with open RP (ORP) or laparoscopic RP (LRP) procedures. METHODS: A longitudinal study design was used. A convenient sample of 67 prostate cancer patients was recruited after RP (ORP = 34, LRP = 33). QoL scores were assessed at 1, 3, and 6 months after RP using the University of California, Los Angeles, Prostate Cancer Index (UCLA-PCI). RESULTS: With respect to the PCI mean score between the ORP and LRP groups, there were significant differences in overall PCI and urinary function at time 1 (1 month after RP). However, a mixed-design analysis of covariance on the overall PCI of the 2 groups over time indicated that, after controlling for nerve sparing, there were significant differences in the main effects for group and time, but no interaction effect. CONCLUSION: Results indicated that all patients' QoL scores improved over time. Laparoscopic RP patients' overall scores were better than ORP patients' scores, but this may be due to unmeasured preoperative differences in this nonrandom sample, and thus, these findings cannot be attributed to treatment differences alone. IMPLICATIONS FOR PRACTICE: Patients' QoL after either RP surgery is likely to drop but is regained by 6 months. This information should be given to patients undergoing RP who are deciding between various RP procedures.

Association between psychosomatic symptoms and work stress among Taiwan police officers.

The aim of the study was to explore the association between the severity of psychosomatic symptoms and perceived work stress among male police officers in southern Taiwan. By stratified random sampling, a total of 698 male police officers were recruited into this study (the response rate was 73.4%; 512 of 698). A structured self-administered questionnaire on demographic and working characteristics, the severity of psychosomatic symptoms, perceived work stress, and social support was used to collect data anonymously. The results of multiple regression analysis revealed that (1) the police officers who perceived high-work stress reported more severe psychosomatic symptoms than those who perceived low-work stress; and (2) perceived social support had a moderating effect on the association between severity of psychosomatic symptoms and perceived work stress. Perceived work stress is an indicator of psychosomatic symptoms in police officers. Strategies for reducing psychosomatic symptoms of police officers include police administrators taking into account the level of work stress as well as more attention being paid to the resources of social support.

The symptom experience of neobladder recipients: characteristics and related factors.

BACKGROUND: Neobladder implantation has become the preferred means of handling urinary diversion following a cystectomy. However, this surgical procedure frequently results in side effects and complications for the patient. PURPOSE: The purpose of this study was to examine neobladder recipient symptom experience, characteristics, and related factors. METHODS: Using a cross-sectional design, 53 patients who underwent a radical cystectomy and received a neobladder were recruited from a medical center in southern Taiwan. Data were collected from March 2004 to July 2005 by telephone interview using structured questionnaires. RESULTS: The five most frequent symptoms for both genders included decreased sexual function, urinary incontinence, sleep disturbance, anxiety, and fatigue. We found significantly higher scores for women in sleep disturbance (p = .03), anxiety (p = .05), fatigue (p = .05), and decreased appetite (p = .01) variables. Length of hospital stay correlated positively and complete continence duration correlated negatively with symptom experience. Two factors, gender and duration until complete continence, together explained 72.0% of symptom experience variance (42.7% and 29.3% of variance, respectively). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A better understanding of the symptom experience of neobladder recipients and its related factors can improve the symptom appraisal efforts of physicians, enabling them to provide better quality postsurgical and discharge care and ultimately increase neobladder recipient quality of life.

Poor sleep quality and alcohol use problems among elderly Taiwanese aboriginal women.

BACKGROUND: Little is known about sleep quality and alcohol use problems in the elderly minority population. This study aimed to identify a one-month prevalence of poor sleep quality and alcohol use problems among elderly Taiwanese aboriginal women and to examine the association between them. METHODS: A cross-sectional survey with stratified random sampling was conducted in eight aboriginal communities in Taiwan. The 1261 elderly aboriginal women (response rate 84%) completed all assessments. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), while the CAGE questionnaire was used to evaluate alcohol use problems. RESULTS: Of the study participants, 20.54% and 25.59% had poor sleep quality and alcohol use problems, respectively. Controlling for confounding factors, alcohol use problems were a risk factor for poor sleep quality (AOR = 1.44, p = 0.0433). Alcohol use problems were associated with three components of PSQI: sleep disturbances, subjective sleep quality, and daytime dysfunction. CONCLUSIONS: The elderly Taiwanese aboriginal women with problematic alcohol drinking experienced poorer sleep quality. Development of a program to reduce alcohol use problems might improve sleep quality among elderly Taiwanese aboriginal women.