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To synthesize and evaluate the psychometric properties of self-report instruments that measure patient dignity.A psychometric systematic review.A comprehensive search of studies published from inception until February 17, 2022, was performed using PubMed, Embase, CINAHL, Web of Science, and Scopus.The methodological quality of the psychometric studies was evaluated following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.Eleven self-report instruments that evaluate dignity were identified. For most instruments, psychometric properties, including reliability, cross-cultural validity, responsiveness, and measurement error, had not been adequately examined. The Patient Dignity Inventory (PDI), the Jacelon's Attributed Dignity Scale (JADS), and the Inpatient Dignity Scale (IPDS) had acceptable content validity, structure validity, and internal consistency to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care.The PDI, the JADS, and the IPDS are recommended for future clinical practice and research to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care. Early identification of patients' dignity-related problems in nursing care can prevent negative health outcomes and help develop a timely intervention to promote patients' health and recovery.Given that the psychometric properties of the existing self-report dignity instruments have not been systematically assessed, the present review utilized comprehensive methods according to COSMIN to evaluate and determine the most appropriate measure for research and practice. The PDI, the JADS, and the IPDS demonstrated satisfactory psychometric properties and are, thus, recommended for clinical and research applications. Nursing professionals can employ these instruments to assess and promptly identify dignity issues among both young and older adults in hospitals and communities.

Frailty leads to multiple unfavourable outcomes in older adults. However, few studies have investigated correlations between frailty and its impacts on morbidity and mortality of elderly patients in intensive care units (ICUs) in Taiwan.To investigate the impact of frailty on the risk of hospital and 30-day mortality and functional outcomes of elderly Taiwanese ICU patients.A prospective observational study was conducted. Patients aged 65 years or older were recruited from three medical ICUs. We defined 'frailty' according to the Clinical Frailty Scale (CFS) higher than 4 within 1 month prior to admission. The primary outcomes were hospital and 30-day mortality. The secondary outcome was CFS changes at ICU admission, hospital discharge, and 30-day follow-up. Logistic/Cox regression was used to analyse the data.We recruited a total of 106 patients, 57 (54%) of whom were classified as frail. The overall mortality rate was 21%. Hospital mortality and mortality within 30 days after discharge were higher in the frail patients without a significant statistical difference (hospital mortality: 17.5% vs. 12.2%, p = .626; 30-day mortality: 26.3% vs. 14.3%, p = .200). The risk of 30-day mortality for frail patients was up to 2.84 times greater than that of non-frail patients in the Cox model (hazard ratio = 2.84, 95% confidence interval [0.96, 8.38]). Both non-frail and frail patients had a worse CFS score on admission, but the CFS score of surviving non-frail patients improved significantly over the medium term.Frailty tended to increase short-term ICU mortality risk and worsen functional outcomes in the elderly Taiwanese population. This information might guide critical medical decisions.Frailty could be included in the prognostic evaluation of either mortality risk or functional outcome. Prompt palliative care might be one last piece of holistic elder care.

To examine simulation-based education (SBE) strategies on situation awareness (SA) in nursing students including the strategies of SBE, the measurement tools of SA during SBE and the effectiveness of SBE on SA.SA has been reported as an effective way to identify and manage deteriorating patients. Researchers have suggested that SBE is more effective than other instructional modalities in improving SA. However, SA among nursing students and studies regarding the effectiveness of SBE on SA are limited.The Arksey and O'Malley scoping review framework was used to guide the review process and the PRISMA-ScR checklist was used to report on this scoping review.The databases searched were Medline, CINAHL, EMBASE, EBSCO and Google Scholar from December 2020 to November 2021. Thematic analysis was applied to identify the main findings in the literature.Nine eligible articles were included. Five major themes were identified: SBE situations used to teach SA to nursing students, SBE strategies to improve SA in nursing, effectiveness of SBE on SA in nursing, measurements of SA used during the SBE and experimental studies examining the effectiveness of SBE on SA.This review reveals that SBE may be useful to cultivate SA in nursing students. Future studies that use randomized clinical trials to test the effects of combining different simulation strategies on SA are suggested. Developing more reliable and valid SA global assessment queries and standardizing the query process of SA measurement is also recommended.

Background:Limited efficacy has been observed when using opioid to treat neuropathic pain. Lidocaine patches reduce neuropathic pain in post-herpetic neuralgia, but their benefits for cancer-related neuropathic pain remain unclear. This study aimed to demonstrate a useful treatment for cancer-related neuropathic pain. The primary endpoint was pain intensity evaluated by the numerical rating scale (NRS). The secondary endpoints were the pain relief score and the quality of analgesic treatment. Methods:We assessed the efficacy and safety of lidocaine transdermal patches in patients experiencing neuropathic cancer pain.Terminal cancer patients with opioid treatmentparticipated in the 3-day study. Results:The results showed a statistically significant difference in the median NRS over three days (Kruskal-Wallis test, PConclusions:In this study, the 5% lidocaine transdermal patch reduced the NRS pain intensity in neuropathic cancer patients with opioid treatment. The transdermal patch is generally useful and well-tolerated.

A massive demand for palliative care has developed in Vietnam because of the burden of cancer, with more than 70% of patients diagnosed in the terminal stage. Despite the recommended guidelines, palliative nursing in Vietnam has focused mainly on pain management and the treatment of complications. Research is needed to explore the reality of nursing practice and difficulties in palliative nursing. A cross-sectional study was conducted at 6 hospitals in 2 central cities of Vietnam by using the Palliative Care Difficulties Scale and the Palliative Care Self-Reported Practices Scale. All 143 registered nurses reported difficulties providing palliative care, with community coordination being the most difficult aspect and the alleviation of symptoms being the least difficult. The most common practice in palliative nursing was dyspnea management; the least common practice was patient- and family-centered care. The longer nurses had practiced, the less difficulty they experienced in palliative care. The improvement of nursing practice could help minimize the difficulties that nurses encounter when providing palliative care. Palliative nursing could be enhanced through training programs, especially for community coordination and patient- and family-centered care. Further longitudinal studies are recommended for multidimensional perspectives in palliative nursing.

Learning to handle cardiovascular emergencies is complex and can cause psychological stress for nursing students. Gamification using question cards as a learning aid is one of the creative educational strategies that can help students learn in a fun way. The design of cards with valid and reliable questions is essential in gamification; however, such cards are still lacking in cardiovascular emergency learning.To develop and validate cardiovascular emergency question cards for the future use of gamification for education regarding cardiovascular emergencies among undergraduate nursing students.The development process included two phases: designing the question cards and testing validity evidence. A table of specifications was used to select and assign questions based on three levels with six learning outcome categories. Five nurse experts assessed the evidence based on test content, including the relevance, clarity, and essentiality of the questions. Seven final-year nursing students evaluated the evidence based on the response process. After revision, 61 nursing students evaluated the internal consistency reliability of each level.In the design phase, ninety English question cards were categorized into three levels based on the learning outcomes expected in an undergraduate emergency nursing course. Most of the questions were multiple-choice questions, and some were short answer questions. The final item-content validity index = 1.00, the scale-content validity index/universal agreement = 1.00, and the content validity ratio = 1.00. Cronbach's α for internal structure was 0.81 for level I (n = 61), 0.92 for level II (n = 54), and 0.81 for level III (n = 46).The cardiovascular emergency question cards showed acceptable evidence based on the test content, response process, and internal structure. In the future, testing the feasibility of applying the question cards to gamification and assessing their learning effect on cardiovascular emergency knowledge retention will be necessary.

Little is known about the association between obstructive sleep apnea (OSA) and oral and oropharyngeal cancers (OOCs). This study aims to investigate the incidence and severity of OSA in patients with OOCs before and 6 months after free flap reconstruction (FFR), as well as identify the factors that affect the severity of OSA.A prospective cohort study was designed. We recruited patients aged ≥ 20 years who were newly diagnosed with OOC and underwent FFR surgery at a medical center. Demographic data, cancer characteristics, and objective full-night polysomnographic parameters were collected. The Spearman rank correlation coefficient or the Kruskal-Wallis test was used for analyses.In the 23 included patients, the incidence of OSA was 91.3% before surgery and 95.6% as of 6 months after surgery. The proportion of patients with moderate OSA (apnea-hypopnea index (AHI) 15-29) or severe OSA (AHI ≥ 30) had increased from 52.2% to 78.3%, and the AHI was significantly increased (23.3 ​± ​17.6 vs. 34.6 ​± ​19.3,Patients with OOCs had a high incidence of OSA before and after surgery. OOC survivors should undergo early OSA assessment and receive pre- and post-FFR OSA management to improve their quality of life.

ObjectiveA common difficulty at the end of life (EOL) is to determine an appropriate service model, such as hospice share care (HSC), hospice inpatient care (HIC) and hospice home care (HHC). This study aimed to recommend the appropriate hospice delivery model based on the physical, psychosocial and spiritual needs of patients referred for hospice care.MethodsThis cohort study included patients who received only one kind of hospice delivery model between 2006 and 2020. Data were analysed with descriptive statistics, Fisher’s exact test, non-parametric analysis of variance, Kaplan-Meier curves and Cox proportional hazards model that determined the patients’ clinical characteristics for a hospice delivery model and overall survival.ResultsA total of 8874 hospice patients were recruited, of which 7076 (79.7%) were HSC patients, 918 (10.4%) were HIC patients and 880 (9.9%) were HHC patients. There were significant differences in the physical symptoms and demographic, psychosocial and spiritual factors among the three groups (pConclusionsThis study provides guidance regarding the appropriate hospice service model, based on individualised palliative needs, targeting improvement in EOL care.

PurposeLimited efficacy has been observed when using morphine to treat neuropathic pain. Lidocaine patches reduce neuropathic pain in post-herpetic neuralgia, but their benefits for cancer-related neuropathic pain remain unclear. This study aimed to demonstrate a useful treatment for cancer-related neuropathic pain. The primary endpoint was pain intensity evaluated by the visual analog scale (VAS). The secondary endpoints were the pain relief score and the quality of analgesic treatment. MethodsWe assessed the efficacy and safety of lidocaine patches in patients experiencing neuropathic cancer pain. Terminal cancer patients with opioid treatment resistance participated in the 3-day study. ResultsThe results showed a statistically significant difference in the median VAS over three days (Kruskal-Wallis test, P

Purpose To explore the experience of grief in bereaved Taiwanese family members whose loved ones died from cancer. Method A qualitative study was used in this interview-based investigation. A purposive sampling technique and maximum variability were used to obtain a comprehensive overview. A total of 16 Taiwanese adults whose beloved family member had died of cancer were recruited from a palliative care unit of a medical center in southern Taiwan. Interviews were transcribed verbatim and analyzed using thematic analysis. The data analysis and interpretation were critically evaluated and discussed until final agreement was achieved. Recruitment was terminated when the data were found to be saturated. Results Four “TEAR” themes reflecting the experience of grief in bereaved Taiwanese family were extracted from the transcript analyses: taboo topics, emotion hiding, asynchronous grief, and relational tension. The participants endured the mutual influence of the family atmosphere, which was akin to silently walking the grief journey and inconsistent with TEAR model of task-oriented mourning. Silent grieving dominated their lives, which is different from Western culture with a more explicit expression of grief. Conclusions Silent grief provides a new avenue for exploring grief among bereaved families, potentially impacting their ability to fully grieve through the expressed feelings proposed by William Worden's TEAR model of task-oriented mourning. Thus, this silent grieving should be acknowledged. The findings provide support for developing family-centered, culturally tailored bereavement care. Healthcare professionals play an important role in detecting changes in family dynamics that may interfere with support from family members.

Truth-telling is an important step toward reducing the cognitive gap between physicians and patients as well as reducing the psychological pressures applied to physicians by family members. There is a lack of research on the truth-telling experience and needs in the intensive care unit from the perspective of patient family members.This study is designed to explore the experiences and needs of families in the intensive care unit.A descriptive phenomenology method was used in this study. In-depth interviews were conducted with five participants who had family members assessed with acute physiology and chronic health evaluation II scores ≥ 20. Data were analyzed using Giorgi's phenomenological methods and Nvivo 11.Four experience themes were examined, including (1) nothing is clear, requires explanation; (2) helpless to find answers, need a nurse to resolve this issue; (3) professional conduct makes us feel helpless, longing for love from the medical team; (4) decisions are very difficult, hoping to get more help.The family members expressed that they were unable to understand the underlying causes of the progression in patient condition because the medical team only presented outcomes to the family and did not discuss related causes. Thus, it is recommended that medical teams learn to recognize the cognitive processes of patient family members and consider their emotions, including their needs and expectations, in order to provide individualized explanations based on a patient's status and progress.從加護病房家屬觀點探究重症病情告知的經驗.病情告知是減少醫病認知落差的重要步驟，且能減輕家屬心理壓力。現階段研究仍缺乏家屬對重症病情告知經驗及需求之探討。.瞭解重症家屬病情告知經驗及過程需求。.採描述現象學，立意取樣5位加護病房疾病嚴重度≥ 20分的病人家屬進行深度訪談。以Giorgi現象學分析法，利用Nvivo 11分析歸納資料。.整體經驗包含四大主題：（一）訊息聽了無法懂，希望疑問詳細解、（二）無助找尋為解答，期望護理來幫忙、（三）託付專業卻無奈，渴望醫療多些愛、（四）重重難關多牽絆，盼望見解來割斷。.病情告知著重傳遞結果，家屬無法理解病情變化原因。本研究建議醫療專業人員應體認家屬認知程度，並顧及其情緒反應，納入家屬需求及期待，以病人為中心提供個別化告知。.

Elderly patients with end stage renal disease (ESRD) frequently suffer from frailty, multiple comorbidities, and complications that greatly increase the mortality rate for this population. The irreversibility and variability of ESRD directly affect quality of life, which highlights the importance of gaining an early understanding of the preferences and expectations of these patients with regard to end-of-life care. This article describes a nursing experience that used ethical analysis to help an elderly ESRD patient and the dilemma faced by his family as to whether to sustain or withdraw hemodialysis. This article examines the uncertain trajectories of this disease and how to use shared decision making with the patient and his/her family to make the best decisions. A comprehensive assessment was conducted to identify the major health-related problems, to elicit the dilemmas faced in making the decision to sustain or end hemodialysis, and to understand the pain and suffering of the patient. Symptom control and comfort were identified as the most important goals of the patient, followed by building trust and rapport with his family. An analysis of the pros and cons of treatment was conducted using the 4-box ethical analysis developed by Josen, Siegler, and Winslade. The shared decision-making process was applied to help the patient express his expectations for his end-of-life care. While the health professionals considered that pain and suffering may influence the patient's decision, the patient found his connection between himself and others, self-value, and meaning of life through family love and support. A needs-based, flexible approach was adopted that established a continuous-care plan that was designed to provide the best care for the patient under a variety of possible scenarios while involving the family, which created a family-centered decision-making process that improved the quality of life of the elderly ESRD patient.運用倫理分析於老年腎病末期病人終止血液透析之共享決策經驗.老年腎病末期病人苦於衰弱及多重共病與併發症導致高死亡率，疾病的不可逆性與病程進展軌跡起伏不定攸關生命末期生活品質，並突顯及早了解老年人對末期醫療想法與期待的重要。本文運用倫理分析協助一位老年腎病末期病人及其家屬，在面對不確定性的疾病軌跡及是否要終止透析治療之兩難過程中，透過醫療共享決策達成最佳可行的治療選擇。根據整體性評估分析，病人的主要健康相關問題有維持或終止血液透析與否之醫療決策兩難、瞭解痛與苦難。醫療照護團隊以症狀控制和舒適護理為優先，與病人及其家屬建立信任與親善關係，採Josen、Siegler與Winslade之倫理四面向（4-boxes）整體分析權衡利弊得失，幫助病人表達餘生期待，並考量影響決策背後之苦，引導病人察覺自我與他人關係之連結，從對家人的愛與支持中找回自我的價值與生命意義，並彈性依照不同病程階段，以「需求」為導向提供符合病人最大福祉之持續性照護計畫，達成以家庭為中心的醫療共享決策，提升老年末期腎病病人之整體生活品質。.

Objective Fear of cancer recurrence (FCR) is the most commonly reported problem and unmet need among breast cancer survivors. The aim of this qualitative study was to explore the experience of recurrence fears among Taiwanese breast cancer survivors. Methods Three focus groups were included in this study. A purposive sampling technique was used to recruit 11 recurrence-free women at least 20 years of age from southern Taiwan who were diagnosed with breast cancer within the previous 2 years. Data were analysed and interpreted using content analysis. Results Three themes reflecting the experience of FCR were extracted from the transcript analyses: "Trapped in insecurity," "Suffering in silence," and "Pretending as if nothing happened." Participants endured a complex set of circumstances akin to silently walking the survival tightrope. Breast cancer survivors were still insecure and suffering, rather than celebrating survival, after the completion of treatment. Fear of cancer recurrence silently dominated their lives. Conclusions An avoidance mindset and an unspoken FCR leave survivors insecure, resulting in a silent survival journey. These difficult thoughts and feelings that may impact the reconstruction of post-cancer life should be acknowledged. The development of appropriate survivorship care programs and emotional resilience regarding recurrence is needed for Taiwanese breast cancer survivors.

Racial ethnic minorities are one of the fastest growing populations in Taiwan. In recent years, there has been an increase in literature addressing the efficacy of home blood-pressure (BP) management that uses telemedicine interventions in general healthcare and community settings. However, no study or systematic literature review has yet assessed the effectiveness of using telemedicine HTN interventions in Taiwan's indigenous, new-immigrant, and other minority populations.The purpose of the present paper is to review the current literature on the use of telemedicine interventions to assist HTN management among racial ethnic minorities.A comprehensive literature search was conducted for full-text articles that were published between January 2000 and December 2015 using the following databases: PubMed, WEB of Science, CINAHL (Cumulative Index to NursingAllied Health Literature), PsycINFO, Science Direct, ProQuest, Medline, Cochrane Library, National Dissertations and Theses, and airiti Library. The search used the following key search terms both alone and in combination: hypertension, blood pressure, management, telemedicine, telehealth, ehealth, and digital health. The studies were thoroughly assessed under the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 6 articles met the criteria for using keywords related to racial ethnic minority populations and were used in the present review.Findings of this systematic review show that telemedicine interventions significantly improve HTN management. The intervention that combined home telemonitoring with culturally competent nurse counseling calls was identified as the best intervention for reducing BP. As the current literature on this topic is limited to African-Americans, more research is necessary to validate our findings.Future studies should target racial ethnic minorities in Taiwan in order to better understand how to provide culturally appropriate, telemedicine-based HTN management to Taiwan's minority populations. Further studies with a long-term follow-up plan, randomized controlled trials, and larger sample sizes are required to support these results.探討應用遠距醫療協助少數族群高血壓管控之成效—系統性文獻回顧.台灣少數族群是高血壓人數快速成長的族群之一。近年來，健康照護單位運用遠距醫療（telemedicine）作為居家血壓監控已逐漸盛行，但大多數集中在主流族群，鮮少關注少數族群，如：原住民族與移民族裔，以及缺乏系統性文獻回顧探討遠距醫療之成效。.本文透過系統性文獻回顧，探討應用遠距醫療協助成年少數族群高血壓管控之成效。.利用國內外相關資料庫包括：PubMed、Web of Science、CINAHL（Cumulative Index to NursingAllied Health Literature）、PsycINFO、Science Direct、ProQuest、MEDLINE、Cochrane Library、airiti Library華藝線上圖書館等資料庫，針對2000年1月至2015年12月之間發表的全文文章進行廣泛性文獻查證。單獨或合併使用關鍵字：高血壓（hypertension）、血壓（blood pressure）、管控（management）、遠距醫療（telemedicine）、電子健康（telehealth）、e化健康（ehealth）、以及數位化健康（digital health）進行檢索，選出研究族群為少數族群的文獻。以Preferred Reporting Items for Systematic reviews and Meta-Analyses （PRISMA）建議步驟評定文獻品質，最後篩選出六篇納入分析。.本系統性文獻回顧結果發現，以遠距醫療為基礎的護理措施，能顯著改善少數族群血壓，尤以合併居家遠距監控和具文化能力（culturally competent）護理師諮詢電話的整合性介入方式更具成效，且多種成效指標應同時進行測量。但目前文獻多侷限於非裔美國人之研究，結果是否可適用於台灣少數族群，還需待更多研究進行探討。.未來宜針對台灣少數族群，進一步發展具文化適切性遠距醫療血壓管理，並嚴謹地以長期追蹤研究設計、盲化、大規模的隨機控制試驗，驗證並更新此實證結果。.

Background: Dyspnea is a frequent and devastating symptom among advanced cancer patients for which improved and low-cost palliative techniques are needed.Methods: A one-group repeated measures research design investigated the efficacy of guided imagery (GI) with theta music (θM) on dyspnea in advanced cancer patients. The intervention consisted of four periods: (a) pretest; (b) intervention with peaceful non-θM; (c) intervention with 10 min of GI with θM (GI/θM), with the first and last 3 min being θM only (i.e., the middle 4 min was GI/θM); and (d) posttest. Dyspnea outcome was measured with the Modified Borg Scale (MBS) for self-reported evaluation of dyspneic symptoms. Physiological parameters measured were pulse oxygen saturation (SpO2), end-tidal CO2(EtCO2), heart rate (HR), and respiratory rate (RR). Posttest qualitative data were obtained via interview for subjective patient experience.Results: Participants included 53 patients, 33% with lung cancer. GI/θM produced a significant decrease in MBS scores; 90% of the subjects gave positive qualitative reviews of GI/θM. SpO2did not change significantly over time. GI/θM significantly increased EtCO2, decreased RR, and decreased HR.Discussion: This study demonstrates that GI/θM is a useful intervention for palliative care of patients with dyspnea. θM alone was demonstrated to be effective, while soothing non-θM was not effective. GI/θM was more effective than θM alone. GI/θM should be considered low-cost end-of-life palliative care for dyspnea.

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

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

The aim of hospice palliative education care is to train nurses in hospice philosophy, terminal care skills, nursing care competencies, and professional reliability. Student nurses, staff nurses, and advanced practice nurses must be taught through a proper sequence, from novice to expert. Working together with patients and their families, nurses can educate and care for the physical, social and spiritual needs of terminally ill patients. Currently, problems faced in hospice palliative care education include: 1. The lack of a systematic plan focusing on hospice palliative care and terminal care in nursing schools; 2. The absence of comfort care, communications, ethics, and other relevant issues in extant education and training; 3. The limited number of institutes that currently provide in-service training; 4. The shortage of teachers proficient in both hospice care knowledge and practice; and 5. The current overdependence on traditional nursing education models, which hinders student nurse originality and delays staff nurse growth. Faced with the present issues, self-reflection, localization, and multiple teaching strategies should be the critical developmental directions of hospice palliative education. In order to improve terminal care quality, it is also important to integrate practice, education, and research in order to train more hospice palliative nurses.

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

Advance Care Planning (ACP) is a national social movement. The purpose of this study is to evaluate the effectiveness of the life educational program and to make recommendations related to its delivery. The subjects were 252 students between the ages of 7 and 13 from one elementary school in southern Taiwan. The objective of this education program is to introduce life-cycle concepts that would help the student learn coping skills for the painful events. The program lasted 40 min and was conducted as follows: (1) A brief introduction and rapport building (10 min); (2) Presentation of a Flash video which introduced the concept of the life-cycle experience (10 min); (3) An open discussion session (20 min). Discussion outlines consisted of: a) natural life processes b) dealing with grief and loss and c) healthy attitudes toward life-and-death. The results showed that the video could become a catalyst for student discussion of life-and-death issues. Some findings Among the students who had relatives or friends who suffered from severe illnesses or had passed away; that 91% felt that they had no one to discuss their feelings with, and that 76% thought their loved one who died suffered in pain. 23% of all students had experienced the death of a pet and the grief they felt was in proportion to the pain their pet had endured while dying. The results of this study provided insights into the students9 feeling and needs related to life and death issues and also pointed out that ACP9s promotion should early evolve within the daily school experience.

With the action research method, the senior physicians and nurses became involved with the community: they interviewed 32 seniors, ages 50 to 80, through a focus group to understand their needs and suggestions regarding issues related to terminal medical decisions. The following five points regarding the presentation are summarized: (1) be easy to understand, not boring; (2) be realistic and accurate; (3) clearly guide the thinking of the important issues; (4) narrative; (5) present with actual images. The physicians and nurses further worked with the IT professionals. After five panel meetings and three times modified according to the experts and audiences9 suggestions, a 10-min video that combines flash design and real images was created. Total 291 valid questionnaires were collected in a university, a church and a nursing home; the participants included elementary school students as well as 80+ years old seniors. A discussion about the terminal medical decision was guided after each play of the video. 97.6% expressed interest in the issue related to terminal medical decision and the willingness of sharing and discussing it with their families. 98.3% indicated that when they or their illness reached the final stage, they wanted no more CPR and wished to receive hospice care. The results show the effect to use audio-visual media to guide the public to understand what is actually happening in terminal emergency treatment, to think about their own terminal medical decisions and to stand up and defend their own medical autonomies.