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Introduction The worldwide coronavirus disease 2019 pandemic re-emphasises the importance of videoconferencing in supporting interactions between nursing home residents and their family and friends. However, there is a scarcity of comparative studies on how modalities of conferencing programs impact health outcomes. The purpose of this study was to compare laptop-based with smartphone-based videoconferencing programs on nursing home residents’ perceptions of loneliness, depressive symptoms and social support. Methods This retrospective secondary analysis used data from two previous studies on the effectiveness of videoconferencing programs (laptop-based and smartphone-based) to improve outcomes of loneliness, depressive symptoms and social support (type and source) among nursing home residents. Generalised estimating equations compared differences from baseline measures with measures at 1 and 3 months between the two groups with and without adjusting for the effects of confounding variables. Results With the exception of age, there were no differences in demographics between participants in the laptop and smartphone groups. Neither changes from baseline in mean scores for loneliness nor depressive symptoms differed between groups. However, changes in mean scores from baseline between groups were significantly greater in the smartphone-based group compared with the laptop-based group for three types of social support: informational and appraisal at 1 and 3 months; and emotional at 3 months. Changes from baseline in mean scores for social support from friends (at 1 and 3 months) and other sources (at 3 months) were also significantly greater for the smartphone group compared with the laptop group. Discussion The two modalities of videoconferencing did not differ in effects on depressive symptoms or loneliness. However, smartphones had a greater effect on the type and source of social support compared with laptops. Whether the small screen of a smartphone reduces users’ anxiety and allows them to talk more on screen is worth studying.

This study aimed to understand the prevalence of Chinese medicine and other potentially inappropriate medications and to examine if there are relationships with emergency room visits, hospital admissions, and falls in a Chinese nursing home population. This cross-sectional descriptive study was a secondary analysis of data from 531 nursing home residents in Taiwan. Cox proportional hazard regression models were used in the analysis. Use of Chinese medicine in combination with Western medicine was observed in approximately 1% of residents. For every additional Chinese medicine used, the hazard ratio was 3.09 (p=.26) for emergency room visits and 3.22 (p=.21) for hospital admissions. For every additional nonsteroidal antiinflammatory agent used, the hazard ratio for falls was 5.42 (p=.006). Further studies with larger sample sizes are required to understand the appropriate time intervals required between administration of Chinese and Western medicine as well as to understand the drug-drug interactions.

Objectives:This study aimed to investigate the relationship between depression in older nursing home residents and family caregivers’ (FCGs) depressive status and reasons for involvement with residents.Design:This study employed a cross-sectional design.Setting:Eight nursing homes in northern Taiwan.Participants:A total of 139 older resident–FCG pairs were recruited.Measurements:Depression was measured with the Geriatric Depression Scale-Short Form for nursing home residents and the Center for Epidemiologic Studies Depression Scale-Short Form for family members. Depression and demographic data were collected with face-to-face interviews. The meaning ascribed to caregivers’ nursing home visits was calibrated using the Family Meaning of Nursing-Home Visits scale. Multiple logistic regression was used to understand the factors related to residents’ depressive symptoms.Results:Depressive symptoms were present in 58.3% of the nursing home residents (n = 81). Depressive status of family members (Chi-square = 1.46, p = 0.23) or family’s visiting frequency (Chi-square = 1.64, p = 0.44) did not differ between residents with or without depressive symptoms. Factors associated with an increased risk of residents having depressive symptoms were age, self-perceived health status, and having a caregiver motivated to visit to assuage their guilt.Conclusions:Visiting a family member to assuage their guilt was the only caregiver variable associated with depressive symptoms for nursing home residents. This finding suggests that developing interventions to improve personal relationships between nursing home residents and family members might facilitate the emotional support of caregivers and psychological support for older nursing home residents in Taiwan.

BACKGROUND Hip fractures are one of the most serious injuries affecting older adults. Evidence-based knowledge regarding the functional status of older persons after hip fracture can provide information critical for developing effective continuous-care and rehabilitation programs. PURPOSE This study was developed to examine the post-hospital-discharge outcome measures and predictors of functional status in older adults in Indonesia after hip fracture surgery. METHODS The functional status of 109 patients discharged from an orthopedic hospital in Indonesia after hip fracture surgery was evaluated in this prospective cohort study. Functional status was evaluated using measures of physical and independent activities of daily living (PADL and IADL, respectively) at 1, 3, and 6 months postdischarge. Predictors of changes in functional status, including age, length of hospital stay, comorbidity, prefracture walking ability, type of surgery, status of depression and nutrition, type of insurance, and residential status (urban vs. rural), were also examined. Data were analyzed using generalized estimating equations. RESULTS Significant improvements in PADL were found at 3 and 6 months, and significant improvements in IADL were found at 6 months. Predictors of poor outcomes found in this study included age, a dependent prefracture walking ability, depression, and having public health insurance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The findings of this study support the effectiveness of using presurgery assessments to identify individuals at a higher postdischarge risk of having poor PADL and IADL outcomes. Home nursing or subacute rehabilitation is recommended to improve and maintain functional status in older persons after hip fracture surgery. In addition, interventions and rehabilitation should take into consideration different recovery periods for PADL and IADL after hospital discharge after hip fracture surgery.

Background Family caregivers play an important role for patients admitted to the intensive care unit (ICU), and delirium is a common clinical syndrome. Little is known about the experiences of family caregivers when a relative is a patient with delirium, especially for caregivers in Asian cultures. Aims and objective To understand the experience of family caregivers with a family member as a patient with delirium in the ICU in Taiwan. Design A descriptive qualitative study with in-depth face-to-face semi-structured interviews. Methods Interviews were conducted with 20 family caregivers of 20 patients with delirium in the ICU of a hospital in northern Taiwan. Results The core theme describing the phenomenon of family caregivers of a patient with delirium was "Sailing in a sea of perplexity," which described family caregivers' uncertainty of navigating the ICU and providing support for a relative. Three subthemes described the core theme: (a) perplexity of the ICU environment, (b) perplexity of making decisions, and (c) perplexity of Chinese cultural constraints. Conclusion "Sailing in a sea of perplexity" underscores how uncertainty among family caregivers of patients with delirium in ICUs can lead to feelings of fear and anxiety. Therefore, nursing professionals should not only focus on patient care but also be sensitive to caregivers' feelings of uncertainty and their cultural beliefs. Relevance to clinical practice Unfamiliarity and lack of knowledge about intensive care and patient treatments were a source of family caregivers' perplexity. To reduce uncertainty, we recommend increased communication between staff and caregivers. Hospitals can also provide information on their websites, including treatment of delirium and visitation hours. Information access could be enhanced by developing a smartphone app linked to a QR code that families can scan to obtain information, which would be useful during restricted visitation.

Purpose The purpose of this study was to explore what motivates family members to visit a relative with dementia who has been transferred to a nursing home in Taiwan. Design and methods Data were collected for this qualitative descriptive study using audiotaped, semi-structured, in-depth, face-to-face interviews. A total of 20 family members of elderly nursing home residents participated in the study. Nursing home residents were from four nursing homes in Taiwan and had been diagnosed with probable or possible dementia by a psychiatrist or neurologist. Transcribed audiotaped interviews were analyzed using thematic analysis. Findings Most family members were the children of the residents (n =17, 85%). The theme describing the core motivation for family members' visits to nursing home residents was "to maintain the unforgotten family affection." This motivation comprised four relevant categories: hoping to slow degeneration, providing a congruous environment, honoring filial and karmic duty, and ensuring the quality of care. Conclusions Motivations for Taiwanese family members' visits to nursing home residents with dementia were similar to those in Western cultures. However, "hoping to slow degeneration" and "providing a congruous environment" were unique categories. Clinical relevance Nurses and policymakers could use these findings to design interventions that might increase holistic care for both family members and nursing home residents with dementia. Providing programming focused on family members' unique priorities could address swallowing difficulties, management of dementia symptoms, nutritional needs, and selection of residents' roommates. These programs could improve the quality of family members' visits as well as the quality of staff-family relationships.

BACKGROUND Smart care and remote health technology have been developed to facilitate family caregiving at home for older persons with physical or cognitive impairment. However, smart technologies have made only modest contributions to supporting caregivers, and their effectiveness is supported by little empirical evidence. OBJECTIVE The purpose of this preliminary study was to understand family caregivers’ experiences of receiving a smart technology-assisted (STA) home-nursing care program to provide a knowledge base for future modifications. METHODS Participants included seven persons with dementia recruited from neurological clinics and six persons discharged after hip-fracture surgery from surgical wards of a medical center, along with their 13 family caregivers. Data were collected and analyzed using a mixed-methods approach. RESULTS Our STA home-nursing care program increased family caregivers’ knowledge of older care receivers’ situation and condition, informed health care providers about care receivers’ condition, helped home care nurses provide timely interventions, balanced care receivers’ exercise and safety, motivated older persons to exercise, helped family caregivers balance work and care-giving, and provided guidance for caregiving activities. Family caregivers suggested that the STA home-nursing care program be modified by prompt feedback with more specific information analyzing care-receiver activity, increased variety of wearable devices (smart clothing), and improving the stability of and decreasing interference with electronic transmission and devices. CONCLUSIONS The STA home-nursing care program was beneficial to family caregivers and their care receivers. However, we suggest that future studies use larger samples, randomized controlled trials, and longer follow-ups to explore how this STA home-nursing care program is experienced. CLINICALTRIAL

Aims and objectives To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. Background Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. Design Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. Methods Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. Results Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. Conclusions The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. Relevance to clinical practice Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults between facilities such as nursing homes and hospitals.

Background Smartphones can optimize the opportunities for interactions between nursing home residents and their families. However, the effectiveness of smartphone-based videoconferencing programs in enhancing emotional status and quality of life has not been explored. The purpose of this study was to evaluate of the effect of a smartphone-based videoconferencing program on nursing home residents’ feelings of loneliness, depressive symptoms and quality of life. Methods This study used a quasi-experimental research design. Older residents from seven nursing homes in Taiwan participated in this study. Nursing homes (NH) were randomly selected as sites for either the intervention group (5 NH) or the control group (2 NH); NH residents who met the inclusion criteria were invited to participate. The intervention group was comprised of 32 participants; the control group was comprised of 30 participants. The intervention group interacted with their family members once a week for 6 months using a smartphone and a “LINE” application (app). Data were collected with self-report instruments: subjective feelings of loneliness, using the University of California Los Angeles Loneliness Scale; depressive symptoms, using the Geriatric Depression Scale; and quality of life using the SF-36. Data were collected at four time points (baseline, and at 1-month, 3-months and 6-months from baseline). Data were analysed using the generalized estimating equation approach. Results After the intervention, as compared to those in the control group, participants in interventional group had significant decreases in baseline loneliness scores at 1 months (β = − 3.41, p p p p = 0.01), vitality (β = 13.11, p p = 0.01) at 6 months. However, changes in mean depression scores did not significantly differ between groups. Conclusions Smartphone-based videoconferencing effectively improved residents’ feelings of loneliness, and physiological health, vitality and pain, but not depressive symptoms. Future investigations might evaluate the effectiveness of other media-based technologies in nursing homes as well as their effectiveness within and between different age cohorts.

Aim Elderly nursing home residents are often malnourished or at risk of malnutrition. Family members often visit residents during mealtimes, which might be an ideal opportunity for interventions targeted at improving the nutritional status of older residents. Therefore, this study aimed to explore motivations behind family member visits with nursing home residents during mealtime in Taiwan. Methods This phenomenological study was conducted with family members of residents from four nursing homes in Taiwan. Participants were purposively sampled. Data were collected with individual face-to-face interviews from 18 family members. Data from transcribed audio-recorded interviews were analyzed using the approach of van Manen. Results Analysis of the interview data identified the essence of motivations underlying family members' visits to nursing home residents during mealtimes, which we termed "tailoring homely meals." This referred to providing food tailored to residents' needs, providing a comforting family atmosphere, assisting residents during mealtime, and monitoring food consumption. Conclusions The motivations of family members to visit during mealtime could guide healthcare professionals working with East Asian populations in developing interventions to reduce the possibility of malnutrition, while also improving their quality of life. We recommend providing the following for nursing home residents: a nutritious and balanced diet, supporting their independence and ability to feed themselves, and encouraging involvement of family members during mealtimes.

BACKGROUND Nursing home residents' repeated transfers to hospital are costly and can lead to in-hospital complications and high mortality for frail residents. However, no research has examined the trajectory of residents' symptoms over their nursing home residency and its relationship to hospital transfer. AIM The purpose of this retrospective chart-review study was to examine associations between nursing home residents' characteristics, including length of residency, and repeated hospital transfers as well as the trajectory of transfers during residency. DESIGN For this retrospective study, we reviewed 583 residents' charts in 6 randomly selected nursing homes from northern Taiwan. Data were analyzed by descriptive statistics, chi-squared tests, and 1-way analysis of variance. RESULTS About half of nursing home residents who had been transferred to hospital (n = 320) were transferred more than twice during their residency (50.97%). Residents who had been transferred 1, 2, 3, or ≥4 times differed significantly in length of residency (F = 3.85, P = .01), physical status (F = 2.65, P = .05), medical history of pneumonia (χ2 = 13.03, P = .01), and fractures (χ2 = 8.52, P = .04). Residents with different numbers of transfers differed significantly in their reasons for transfer, that is, falls (χ2 = 13.01, P = .01) and tube problems (χ2 = 8.87, P = .03). Among 705 total transfers, fever was the top reason for transfer, and transfer prevalence increased with nursing home residency. CONCLUSION To decrease the chance of residents' hospital transfer, nursing home staff should be educated about recognizing and managing fever symptoms, infection-control programs such as influenza vaccination should be initiated, and fall-prevention/education programs should be started when residents first relocate to nursing homes.

Objective The purpose of this study was to develop an instrument for assessing triggers of suicidal ideation among older outpatients and determine its psychometrics. Method Participants were recruited from older outpatients of two hospitals in northern Taiwan. The 34-item Triggers of Suicidal Ideation Inventory (TSII) was developed, and its items were validated by experts in two runs of Delphi technique survey. Pre-testing this TSII in 200 older outpatients resulted in a 12-item TSII, with three items not considered triggers but suggesting the need for further psychiatric assessment. The 9-item TSII was examined by criterion validity, construct validity, internal consistency reliability, and test–retest reliability. Results Factor analysis of the final version of TSII yielded a three-factor solution, accounting for 68.75% of the variance. Participants with depressive tendency tended to have higher TSII scores than participants with no depressive tendency (t = 8.62, p

Background Living donor liver transplantation may put the donor at risk of physical and psychological impacts. Recovery of physical and psychological function as well as quality of life (QOL) in living liver donors warrants investigation. Objectives This study aims to examine the recovery of liver function, emotional status, and QOL in living liver donors through a comparison with the general population and reference values. Methods This descriptive, comparative study included 97 living liver donors who underwent surgery from 2008 to 2012 and were divided into 4 groups according to their postoperative period (1 year [n = 31], 2 years [n = 31], 3 years [n = 21], and 4 years above [n = 14]). Data were collected retrospectively in a medical center in northern Taiwan. Results The mean aspartate aminotransferase level was 20.2–32.1 U/L, the mean alanine aminotransferase level was 14.7–33.5 U/L, and the mean total bilirubin level was 10.8–15.5 μmol/L among the 4 groups. Among donors of the 4 groups, 23.8%–51.6% and 0%–29% were defined as having a mild level of anxiety and depression, respectively. Donors in the 1- and 2-year groups had poorer QOL in the physical function, role physical, vitality, and mental health domains than did the general population of Taiwan (P Conclusions Liver function was at normal levels in all 4 groups. The emotional and psychological function of living liver donors should be monitored and health-related QOL should be promoted during the first and second year after liver donation.

To explore the experiences of nursing home nurses when they transfer residents from nursing homes to the emergency department in Taiwan.The transfer of residents between nursing homes and emergency departments challenges continuity of care. Understanding nursing home nurses' experiences during these transfers may help to improve residents' continuity of care. However, few empirical data are available on these nurses' transfer experiences worldwide, and none could be found in Asian countries.Qualitative descriptive study.Data were collected from August 2012-June 2013 in audiotaped, individual, in-depth interviews with 25 nurses at five nursing homes in Taiwan. Interview transcripts were analysed by constant comparative analysis.Analysis of interview transcripts revealed that the core theme of nursing home nurses' transfer experience was discontinuity in nursing home to emergency department transitions. This core theme comprised three themes: discontinuity in family involvement, discontinuity in medical resources and expectations, and discontinuity in nurses' professional role.Nursing home nurses need a working environment that is better connected to residents' family members and more immediate and/or easier access to acute care for residents. Communication between nurses and residents' family could be improved by using text messages or social media by mobile phones, which are widely used in Taiwan and worldwide. To improve access to acute care, we suggest developing a real-time telehealth transfer system tailored to the medical culture and policies of each country. This system should facilitate communication among nursing home staff, family members and hospital staff.Our findings on nurses' experiences during transfer of nursing home residents to the emergency department can be used to design more effective transfer policies such as telemedicine systems in Taiwan and other Asian countries or in those with large populations of Chinese immigrants.

The McGill Pain Questionnaire (MPQ) pain quality descriptors have been analyzed to characterize the sensory, affective, and evaluative domains of pain, but have not been differentiated by pain location.To examine MPQ pain quality descriptors by pain location in outpatients with lung or prostate cancer.Cross sectional.Eleven oncology clinics or patients' homes.264 adult outpatients (80% male; mean age 62.2 ± 10.0 years, 85% White).Subjects completed a 100 mm visual analogue scale of pain intensity and MPQ clinic or home visit, marking sites where they had pain on a body outline and circling from 78 verbal descriptors those that described their pain. A researcher noted next to the descriptor spontaneous comments about sites feeling like a selected word and queried the subjects about any other words to obtain the site(s).Pain quality descriptors were assigned to all 7 pain locations marked by ≥ 20% of 198 lung or 66 prostate cancer patients. Four pain locations were marked with pain quality descriptors significanlty (p.05) more frequently for lung cancer (53% chest-aching, burning; 58% back-aching, stabbing; 48% head-aching, sharp; and 19% arms-aching, stabbing) than for prostate cancer, which had significantly more frequent pain locations in the abdomen (64%-aching, burning) and lower back/buttocks (55%-aching, burning).This type of pain characterization is innovative and has the potential to help implement targeted treatments for patients with cancer and other chronic pain conditions.

Videoconferencing with family members benefits nursing home residents by decreasing their depression and loneliness. Nevertheless, the rate of participation in videoconferencing by family members is low. The purpose of this study was to explore attitudes toward and factors related to videoconferencing by family visitors to nursing home residents in Taiwan.For this cross-sectional study, data were collected from 231 family members of residents at 16 medium to large (70 beds) nursing homes in Taiwan. Data were collected on participants' and residents' demographic and clinical characteristics, acceptance of and attitudes toward using videoconferencing as a form of nursing home visit, and reasons for/roles during visits to nursing home residents. Factors related to the use of videoconferencing were analyzed by logistic regression.Family members' acceptance rate of videoconferencing use was low (7.8%). The findings also showed that videoconference use was predicted by hiring a private caregiver (odds ratio=6.90), the role during/reason for family visits being to maintain residents' emotional status (odds ratio=5.46), and the frequency of in-person visits to the nursing home.We recommend encouraging family use of videoconferencing by available equipment such as smartphones or tablet programs that can address residents' emotional issues in a timely fashion. We also suggest developing more interactive content for videoconferencing, such as a family-oriented picture program to help broaden topics of conversation.

This chapter reviews current mental health needs in Taiwan, and provides a summary of the history of Telemedicine and Telemental health services. In addition, Taiwan has a growing elderly population, and there is an increasing number of elderly living in nursing homes, which is considered a highly stressful event associated with depression and loneliness. To outline the implementation of telemental health in Taiwan, the authors of this chapter highlight a case of providing videoconferencing-based services to geriatric populations residing in nursing homes. Acceptance of the use of technology, the intervention’s efficacy in reducing loneliness and improving depression symptoms, and the challenges facing its scaling up are reviewed. The chapter goes on to provide recommendation for widespread application of TMH services.

Context Communication conflicts are inevitable in nursing homes. Understanding communication conflicts experienced by practising nurses could provide insights to guide the development of sound communication education programmes. Objectives The purpose of this study was to explore the experiences of nurses in nursing homes of communication conflict in encounters with nursing home residents and their families in Taiwan. Methods Data were collected from April 2010 to December 2011 through audiotaped, individual, in-depth interviews with 26 nurses at five nursing homes in Taiwan. Data were analysed according to van Manen's interpretive phenomenological method. Results Data analysis revealed that nurses' experiences of communication conflicts during encounters with nursing home residents and their families could be categorised under three themes: differences in perspectives of nursing home services; differences in views of nurturing health, and mediation between family members and others. Conclusions The findings of this study can be considered by clinical educators and policymakers when designing communication education programmes for nurses and other clinicians. These programmes should include ways to increase nurses' independent thinking in settings in which power differences exist, as well as their cultural sensitivity as embodied in Leininger's culture care theory. These programmes should also include education in telephone communication and alternative methods of communication (e.g. videoconferencing).

Background No data-based evidence is available regarding the best time for nursing home nurses to obtain residents' signatures on advance directives, especially for do-not-resuscitate directives, the most common type of advance directive. This information is needed to enhance the low prevalence of advance directives in Asian countries. Objectives The purposes of this study were to understand (1) the timing between nursing home admission and signing a do-not-resuscitate directive, (2) the factors related to having a do-not-resuscitate directive, and (3) the association between having a do-not-resuscitate directive and nursing home residents' mortality in Taiwan. Design Retrospective, longitudinal design. Setting Six nursing homes in Taiwan. Participants Nursing home residents ( N =563). Methods Data were collected by retrospective chart review with 1-year follow-up. Factors related to having a do-not-resuscitate directive were analyzed by multiple logistic regression, while associations between signing a do-not-resuscitate directive (resuscitation preference) and mortality were examined by Cox proportional hazard regression models. Results The mean interval between nursing home admission and signing a do-not-resuscitate directive was 840.65days (2.30 years), which was longer than the time from admission to first transfer to hospital (742.4days). Having a do-not-resuscitate directive was related to whether the resident had a nasogastric tube (odds=2.57) and the number of transfers to hospital (odds=1.18). Among the 563 residents, 55 (9.77%) had died at the 1-year follow-up. Having a do-not-resuscitate directive was associated with a greater risk of death (unadjusted hazard ratio, 2.03; 95% confidence interval, 1.10–3.98; p =0.02), but this risk did not persist after adjusting for age (hazard ratio, 1.89; 95% confidence interval, 0.99–3.59; p =0.05). Conclusion Early research recommendations to sign an advance directive, particularly a do-not-resuscitate order, on nursing home admission may not be the best time for Chinese nursing home residents. Our results suggest that the best time to sign a do-not-resuscitate directive is as early as possible and no later than 2 years (742days) after admission if residents had not already done so. Residents on nasogastric tube feeding should be particularly targeted for discussions about do-not-resuscitate directives.

The purpose of this study was to develop an instrument for assessing triggers of suicidal ideation among older outpatients and determine its psychometrics.Participants were recruited from older outpatients of two hospitals in northern Taiwan. The 34-item Triggers of Suicidal Ideation Inventory (TSII) was developed, and its items were validated by experts in two runs of Delphi technique survey. Pre-testing this TSII in 200 older outpatients resulted in a 12-item TSII, with three items not considered triggers but suggesting the need for further psychiatric assessment. The 9-item TSII was examined by criterion validity, construct validity, internal consistency reliability, and test-retest reliability.Factor analysis of the final version of TSII yielded a three-factor solution, accounting for 68.75% of the variance. Participants with depressive tendency tended to have higher TSII scores than participants with no depressive tendency (t = 8.62, p 0.01), indicating good construct validity. TSII scores were significantly and positively correlated with Beck Scale for Suicide Ideation (r = 0.45, p 0.01) and UCLA Loneliness (r = 0.55, p 0.01) scores, indicating satisfactory criterion validity. The TSII had Cronbach's α and intraclass correlation coefficient of 0.70 and 0.99, respectively, indicating acceptable internal consistency reliability and excellent test-retest reliability. Receiver operating characteristic analysis revealed an area under the curve of 0.82, indicating excellent ability to detect triggers of suicidal ideation. With a cutoff point of 2, the sensitivity and specificity were 0.76 and 0.69, respectively.The TSII can be completed in 5 min, is perceived as easy to complete, and yielded highly acceptable parameters of validity and reliability. Copyright © 2016 John WileySons, Ltd.

Aims and objectives. The purpose of this study was to develop and test a Family Meaning of Nursing-Home Visits Scale that can be used to assess and document family members’ rationale for visiting nursing home residents. Background. Understanding the meaning ascribed by families for visiting nursing home residents is necessary to develop intervention programmes that facilitate the quality of families’ nursing home visits. No valid and reliable instrument is available in Taiwan or elsewhere to accurately document the meaning of family visits to nursing home residents. Design. A cross-sectional design was used to collect survey data from family members of nursing home residents as the quantitative component of a mixed-methods study. Items were developed based on qualitative data from our previous research and that of others. This initial pool of items was used to develop and validate the scale. Methods. The validity of the scale was confirmed by exploratory factor analysis and criterion-related validity testing. Internal consistency reliability was assessed by Cronbach’s alphas. Results. Factor analysis yielded a six-factor final solution (32 items), accounting for 66·76% of the variance. For criterion-related validity, ‘responsibility for care quality’ was negatively correlated with satisfaction with nursing home caregiving (r = −0·23, p

Background: Early detection and appropriate treatment interventions for depressive symptoms in the elderly are important issues for healthcare systems. However, few studies to date have focused on understanding self-care strategies to manage depressive symptoms among elderly people worldwide. The purpose of this study was to explore self-care management strategies and risk factors for depressive symptoms among elderly outpatients in Taiwan.Methods: A convenience sample of elderly persons (≥65 years old; N = 1054) was recruited from outpatient clinics of two hospitals in northern Taiwan.Results: In our sample, the prevalence of depressive tendency was 16.3%. The majority of participants (70.1%) managed depressive symptoms with self-care strategies. The strategy most often used to relieve depressive symptoms was “take a walk.” The main information source for self-care strategies was self-learning. Depressive tendency in this sample was shown by logistic regression analysis to be significantly predicted by gender, marital status, perceived income adequacy, perceived health condition, stroke, and cancer.Conclusion: Elderly people need to be made more aware of strategies to self-manage depressive symptoms. Healthcare providers can decrease/prevent the first risk factor for depressive symptoms (poor perceived health status) by improving elders’ perceived health and promoting their actual health. The second risk factor (poor perceived income adequacy) can be decreased/prevented by carefully assessing patients’ financial situation during clinic visits and providing suitable referral for further assistance.

tsai h.-h. & tsai y.-f. (2012) Family members’ perceived meaning of visiting nursing home residents in Taiwan. Journal of Advanced Nursing 68(2), 302–311. Abstract Aim. The purpose of this article is to report the findings of a study to explore perceived family meaning of visiting older nursing home residents in Taiwan. Background. Family involvement in the care of institutionalized elders benefits residents, family and staff. Families have traditionally been involved through in-person visits. One factor influencing family visits is motivation, which is a vague concept, creating a need to better understand the meaning families ascribe to visiting nursing home residents. Understanding this meaning is necessary to develop intervention programmes that facilitate the quality of families’ nursing-home visits. However, little is known about the meaning of family visits to nursing home residents in Asian countries. Methods. Data were collected April 2009–2010 in audiotaped, individual, in-depth interviews with 15 family members of residents at four nursing homes in Taiwan. These family members included five women and 10 men, predominantly residents’ children and spouses. Results. The meaning of family visits to nursing home residents was captured by five major themes: hoping for recovery, honouring filial/karmic responsibility, insuring care quality, maintaining family relationships and making up for guilt. Conclusions. The findings of this study can be considered by nurses and policy makers when designing interventions and allocating resources to improve the quality of family visits with nursing home residents. These interventions can be tailored to family members’ perceived meanings for visiting, e.g. those hoping for residents’ recovery may benefit from health-promotion programmes, and those honouring filial/karmic responsibility might be helped by education on different ways to show filial respect.

Aim. This study explored the experiences of older Taiwanese nursing home residents in using videoconferencing to communicate with family members. Background. Enhancing communication between long-term care residents and their family is important. Interactions between residents and their family members can be increased through high-tech videoconferencing programmes. Design. A qualitative, observational research design was used to gain a deeper understanding of the videoconference experiences of older nursing home residents in Taiwan. Methods. In-depth interviews were used to gather information from 34 older residents at 10 nursing homes in northern Taiwan. Participants were asked to describe their three-month experience using videoconference communication with their family in the nursing home. Participants (18 women, 16 men) had an average age of 75·38 (SD 10·19, range 60–95). Verbatim transcripts of audiotaped interviews were analysed by content analysis and Atlas.ti software. Results. Participants experiences using videoconference communication with family members were captured by four themes: enriched life, second-best option for visiting, life adjustments and true picture of family life. Relevance to clinical practice. Our findings may enhance policy makers’ and healthcare providers’ understanding of older nursing home residents’ experience with videoconferencing to communicate with distant family members, thus guiding development and evaluation of nursing home videoconference services to improve older people’s lives in nursing homes.

Title. Self-worth therapy for depressive symptoms in older nursing home residents. Aim. The aim of this study is to report the effects of self-worth therapy on depressive symptoms of older nursing home residents. Background. Depression in older people has become a serious healthcare issue worldwide. Pharmacological and non-pharmacological therapies have been shown to have inconsistent effects, and drug treatment can have important side-effects. Method. A quasi-experimental design was used. Older people were sampled by convenience from residents of a nursing home in northern Taiwan between 2005 and 2006. To be included in the study participants had to: (i) have no severe cognitive deficits; (ii) test positive for depressive status and (iii) take the same anti-depressant medication in the previous 3 months and throughout the study. Participants in the experimental group (n = 31) received 30 minutes of one-to-one self-worth therapy on 1 day a week for 4 weeks. Control group participants (n = 32) received no therapy, but were individually visited by the same research assistant, who chatted with them for 30 minutes on 1 day/week for 4 weeks. Depressive status, cognitive status and functional status were measured at baseline, immediately after the intervention and 2 months later. Data were analysed by mean, standard deviations, t-test, chi-squared test and univariate anova. Findings. Self-worth therapy immediately decreased depressive symptoms relative to baseline, but not relative to control treatment. However, 2 months later, depressive symptoms were statistically significantly reduced relative to control. Conclusion. Self-worth therapy is an easily-administered, effective, non-pharmacological treatment with potential for decreasing depressive symptoms in older nursing home residents.

Title. Perceptions of filial piety among Taiwanese university students. Aim. This paper is a report of a study to explore the perceptions of filial piety among university students in Taiwan. Background. Young Asians have been more influenced than their parents by recent social and economic developments, creating an intergenerational gap in attitudes towards filial piety. This gap directly influences expectations about ways of caring for ageing parents and intergenerational well-being. Resolving these differences depends on intergenerational communication. Methods. Data were collected in four audiotaped focus group interviews with 40 students (37 females, three males, average age = 21·3 years) at two universities in northern Taiwan during 2006. Transcripts were analysed by thematic analysis. Findings. Taiwanese university students are likely to practise filial duty differently from their parents, but this does not mean they are less filial. Five major themes indicated that participants viewed filial piety as following cultural traditions, reciprocating parents’ love and care, loving parents from the heart, achieving intergenerational well-being, but practising filial piety would depend on future circumstances. Conclusion. The findings reflect a shift from their parents’ views, particularly the filial practice of living with one’s older parents. These young adults loved and respected their parents, but would consider alternative living situations for them, depending on future circumstances. As considering an alternative to culturally traditional filial practice may have an impact on intergenerational well-being, we suggest that nurses could act as a bridge to facilitate communication between the two generations.

Aim. This study explored the lived experiences of older nursing home residents in Taiwan. Background. With more long-term care institutions in Taiwan, older people are more often placed in nursing homes than in the past. Increased understanding of their lived experience is essential to assess residents’ needs and determine the effectiveness of nursing interventions. Design. A qualitative design was used to gain a deeper understanding of the lived experiences of older nursing home residents in Taiwan. Methods. Focus groups, followed by in-depth interviews, were used to gather information from 33 older residents at eight nursing homes in northern Taiwan. Participants were asked to describe what was important to them and what impressed them most in their daily lives in the nursing home. Participants (24 females and nine males) were on an average 75·3 years old. Verbatim transcripts of audiotaped focus groups and interviews were analysed by thematic analysis via ATLAS.ti software. Results. The core theme of older residents’ nursing home experience was ‘a temporary home to nurture health’. This core theme was reflected in participants’ descriptions of their overall life in the nursing home as a temporary experience to nurture their health. Their everyday experience was characterised by four subthemes: highly structured lifestyle, restricted activities, safety concerns and social interactions. Relevance to clinical practice. Our findings may enhance policy makers’ and healthcare providers’ understanding of the lived experience of older nursing home residents, thus guiding the evaluation and development of nursing home services to improve residents’ lives. For example, residents with the same characteristics could be placed in the same room or same floor, thus increasing their interactions with other residents. Residents’ interactions with family members could also be developed using the Internet or mobile telephones.

Aim. To explore problem-solving experiences among older people living alone in eastern Taiwan. Background. Elders living alone in Taiwan have a low participation rate in government social support programmes. Providing sufficient care for this population of elders requires knowing not only their problems, but also how and when they seek help solve their problems. Design. Qualitative research was used to gain a deeper understanding of the problem-solving experiences of older people living alone. Methods. Elders living alone (n = 9) were recruited from a remote area of Taiwan. Data were gathered in audiotaped, semi-structured interviews and analysed by content analysis. Results. Participants used both internal and external resources to solve problems through an appraisal process. Their internal resources included self-perception of health status, preventive coping strategies, flexible coping ability and being resigned to one's situation. Their external resources included both human and environmental resources. Based on their lived experience, participants appraised the usefulness of both internal and external resources before deciding whether to seek help from external resources. Conclusion. In Chinese society, maintaining a balance between internal and external resources is an important mechanism for elders in solving problems. Relevance to clinical practice. Our findings may enhance policy makers’ and healthcare providers’ understanding of the problem-solving experiences of elders who live alone in Taiwan. In practical terms, these findings can be used to improve the elderly people's use of support systems in their community.

Background Depression in the elderly has become a serious health care issue worldwide. However, no studies have determined the prevalence and risk factors for depressive symptoms among a representative sample of community-dwelling elders in Taiwan. Objectives To determine the prevalence and risk factors for depressive symptoms among community-dwelling elders in Taiwan. Methods Stratified random sampling was used to recruit a representative sample of 1200 elderly participants from northern, middle, southern, and eastern regions of Taiwan. Results The prevalence of depressive symptoms was 27.5%. Logistic regression analysis demonstrated that having a respiratory disease, poor cognitive function, poor social support network, dissatisfaction with living situation, perception of poor health status, and perceived income inadequacy were significant predictors of depressive symptoms in this sample. Conclusions The risk factors for depression identified in this study need to be considered when assessing the health of elderly persons. In addition, interventions to reduce depressive symptoms in elders should include strategies to change some of these modifiable risk factors. Copyright © 2005 John Wiley & Sons, Ltd.

Background Elderly depression has gradually become a severe issue in the health care system. No studies have focused on evaluating the effects of light therapy on the elderly with depression in a subtropical climate area. Objectives To evaluate the effects of light therapy on hospitalized, depressed elders living in a subtropical climate area. Methods Experimental design was used. For the experimental group, patients sat in front of a light box, receiving 5000 lux in the morning. The light therapy course was administered for 50 minutes per day and lasted for 5 days. The control group did not receive any treatment. Results Depressive symptoms were significantly reduced in the experimental group at post-test but no significant decline was found in the control group. Conclusions Based upon the results of this study, light therapy could be used to decrease depressive symptoms in the elderly. Copyright © 2004 John Wiley & Sons, Ltd.

The purpose of this cross-sectional study was to understand the prevalence and risk factors for depressive symptoms among nursing home residents’ family caregivers in Taiwan. Family caregivers (n = 191) of nursing home residents were recruited by stratified random sampling from 16 nursing homes throughout Taiwan. Data were collected from caregivers in face-to-face interviews on depressive status (using the Center for Epidemiologic Studies Depression Scale; CES-D), on meaning ascribed to visiting nursing home residents (using the Family Meaning of Nursing-Home Visits scale), and on demographic data. Factors related to depressive symptoms were analyzed by multiple logistic regression. The prevalence of depressive status among family caregivers was 29.8 % as determined by the CES-D cutoff score of ≥10. The non-depressed group (CES-D

BackgroundA 3-month videoconference interaction program with family members has been shown to decrease depression and loneliness in nursing home residents. However, little is known about the long-term effects on residents’ depressive symptoms, social support, and loneliness. ObjectiveThe purpose of this longitudinal quasi-experimental study was to evaluate the long-term effectiveness of a videoconference intervention in improving nursing home residents’ social support, loneliness, and depressive status over 1 year. MethodsWe purposively sampled 16 nursing homes in various areas of Taiwan. Elderly residents (N = 90) of these nursing homes meeting our inclusion criteria were divided into an experimental (n = 40) and a comparison (n = 50) group. The experimental group received at least 5 minutes/week for 3 months of videoconference interaction with their family members in addition to usual family visits, and the comparison group received regular family visits only. Data were collected in face-to face interviews on social support, loneliness, and depressive status using the Social Support Behaviors Scale, University of California Los Angeles Loneliness Scale, and Geriatric Depression Scale, respectively, at four times (baseline, 3 months, 6 months, and 12 months after baseline). Data were analyzed using the generalized estimating equation approach. ResultsAfter the videoconferencing program, participants in the experimental group had significantly lower mean change in instrumental social support scores at 6 months (–0.42, P = .03) and 12 months (–0.41, P = .03), and higher mean change in emotional social support at 3 (0.74, P < .001) and 12 months (0.61, P = .02), and in appraisal support at 3 months (0.74, P = .001) after adjusting for confounding variables. Participants in the experimental group also had significantly lower mean loneliness and depressive status scores at 3 months (–5.40, P < .001; –2.64, P < .001, respectively), 6 months (–6.47, P < .001; –4.33, P < .001), and 12 months (–6.27, P = .001; –4.40, P < .001) compared with baseline than those in the comparison group. ConclusionOur videoconference program had a long-term effect in alleviating depressive symptoms and loneliness for elderly residents in nursing homes. This intervention also improved long-term emotional social support and short-term appraisal support, and decreased residents’ instrumental social support. However, this intervention had no effect on informational social support.

The purpose of this quasi-experimental study was to evaluate the effectiveness of a videoconference intervention program in improving nursing home residents' social support, loneliness, and depressive status.Fourteen nursing homes were selected from various areas of Taiwan by purposive sampling. Elderly residents (N = 57) of these nursing homes, who met our inclusion criteria were divided into experimental (n = 24) and control (n = 33) groups. The experimental group received five min/week of videoconference interaction with their family members for three months, and the control group received regular care only. Data were collected through face-to face interviews on social support, loneliness, and depressive status using the Social Supportive Behavior Scale, University of California Los Angeles Loneliness Scale, and Geriatric Depression Scale, respectively, at three points (baseline, one week, and three months after baseline). Data were analyzed using the generalized estimating equation approach.Subjects in the experimental group had significantly higher mean emotional and appraisal social support scores at one week and three months after baseline than those in the control group. Subjects in the experimental group also had lower mean loneliness scores at one week and three months after baseline than those in the control group, and lower mean depressive status scores at three months after baseline.Our videoconference program alleviated depressive symptoms and loneliness in elderly residents in nursing homes. Our findings suggest that this program could be used for residents of long-term care institutions, particularly those with better ability to perform activities of daily living.

This study explored the experiences of older Taiwanese nursing home residents in using videoconferencing to communicate with family members.Enhancing communication between long-term care residents and their family is important. Interactions between residents and their family members can be increased through high-tech videoconferencing programmes.A qualitative, observational research design was used to gain a deeper understanding of the videoconference experiences of older nursing home residents in Taiwan.In-depth interviews were used to gather information from 34 older residents at 10 nursing homes in northern Taiwan. Participants were asked to describe their three-month experience using videoconference communication with their family in the nursing home. Participants (18 women, 16 men) had an average age of 75.38 (SD 10.19, range 60-95). Verbatim transcripts of audiotaped interviews were analysed by content analysis and Atlas.ti software.Participants experiences using videoconference communication with family members were captured by four themes: enriched life, second-best option for visiting, life adjustments and true picture of family life.Our findings may enhance policy makers' and healthcare providers' understanding of older nursing home residents' experience with videoconferencing to communicate with distant family members, thus guiding development and evaluation of nursing home videoconference services to improve older people's lives in nursing homes.

The purpose of this study was to explore pain prevalence, experiences, and self-care management strategies among elderly residents of nursing homes in Taiwan. Stratified random sampling was used to recruit participants (n=150). In these elderly nursing home residents, pain prevalence was 65.3% and the average number of pain sites was 3.24 (SD=2.59). The mean pain intensity was 3.86 (SD=1.90) and pain interference was 4.30 (SD=2.28). "Aching" was the word most commonly used (77.6%) to describe pain. Most participants (54.21%) took prescribed medications for dealing with pain; doctors were the main information source for this self-care strategy. Although participants reported severe bouts of pain, they used limited self-care pain management strategies. Since health care providers play an important role in helping the elderly to manage pain, the authors recommend training nursing home staff to perform regular pain assessments and providing current knowledge about pain assessment and management strategies.