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Background: Depression is one of the most severe mental disorders experienced by older adults worldwide. The prevalence of depression among older adults in nursing homes is three-time higher than in the community. Therefore, knowing the incident rates of depression and its related factors would help provide appropriate intervention and prevention programs in the future. Objectives: The study aimed to determine the prevalence of depression and compare the difference in depression status according to the sociodemographic characteristic of the older adults in the Indonesian nursing homes. Methods: A descriptive cross-sectional study design was used in this study, which involved 116 participants selected using convenience sampling from five different general nursing homes in Bandung City, Indonesia. The Short Form (SF) of the Geriatric Depression Scale (GDS) was used to evaluate depression among older adults in nursing homes. The t-test and one-way ANOVA were used for data analysis. Results: Of the total participants, 56.9% had depression, which 7.8% with mild depression, 37.1% with moderate depression, and 12% with severe depression. In addition, there were significant differences in depression according to age, gender, marital status, educational background, ethnicity, disease history, duration of stay, and the visitor frequency among the older adults in nursing homes (p

Transitioning to advanced practice, novice nurse practitioners need to take on new roles, learn new practice areas, and develop new skills. This process requires breaking old practices and work habits and facing new challenges.To explore the nature of nurse practitioners' work experiences during the first year of transition from registered nurse to nurse practitioner.This qualitative study was based on Husserl's phenomenological methodology. A purposive sample of 16 first-year nurse practitioners was recruited. Data were collected through in-depth interviews and analyzed by thematic content analysis. The approaches of LincolnGuba were applied to improve the validity of the study.Results showed that the first-year experience of transitioning from registered nurse to nurse practitioner fell into two overarching themes: challenge and adjustment. The challenge consists of five subthemes: "facing the expectation-reality gap," "managing others' expectations," "striving to acquire professional skills," "handling situational variability," and "bearing emotional burdens" subthemes. The adjustment includes five subthemes: "finding resources," "gaining experiences," "building relationships," "relieving stress," and "overcoming obstacles."Novice nurse practitioners face many challenges as they adjust to a new role during their first year on the job. New nurse practitioners develop coping strategies to help themselves adjust to their work. They also gradually gain new resources and experiences to help them stay positive in stressful situations and restore work-life balance. The challenges of transitioning from a registered nurse to a nurse practitioner cannot be overlooked. Novice nurse practitioners need appropriate support measures to adapt to advanced practice roles.

This study aimed to investigate psychological resilience and demoralisation and their predictors and mediators in prostate cancer survivors (PCSs).A cross-sectional research design was used. PCSs (N = 122; mean time since diagnosis = 54.79 months, range in 13 years and 2 months) were recruited using convenience sampling at the outpatient department of a hospital in Taiwan. Data collection was conducted using self-report structured questionnaires, including one for demographic and disease characteristics, the Expanded Prostate Cancer Index Composite, Cancer Survivors' Self-Efficacy Scale, Connor-Davidson Resilience Scale and the Demoralisation Scale.In PCSs, a lower most-recent level of prostate-specific antigen and higher cancer-specific self-efficacy were associated with better psychological resilience. Further, fewer hormonal, bowel and urinary symptoms and bother; higher cancer-specific self-efficacy; and better psychological resilience were associated with less demoralisation. Cancer-specific self-efficacy was a mediator for the relationship between urinary symptoms and bother and demoralisation, while psychological resilience mediated the relationship between cancer-specific self-efficacy and demoralisation.The results reveal that cancer-specific self-efficacy is a protective factor against demoralisation and increases psychological resilience in PCSs. Better psychological resilience and fewer physical symptoms and bother are associated with less demoralisation in PCSs.

BACKGROUND Rectal cancer patients who have undergone lower anterior resection with sphincter-saving surgery often experience loss of bowel control. We currently do not have suitable treatment regimens for such patients. OBJECTIVE The aim of this study was to explore the experiences of losing bowel control in patients who have undergone lower anterior resection with sphincter-saving surgery for rectal cancer in Taiwan. METHODS A descriptive phenomenological study design was adopted. Purposive sampling and one-on-one semistructured interviews were conducted for data collection. Narratives were analyzed using Colaizzi's method. RESULTS Data saturation was achieved after interviewing 12 patients (8 men, 4 women) whose average age was 61 years. Three themes and 11 subthemes emerged: physical problems (pain from broken perianal skin, insomnia, decreased physical strength, and body weight loss), adverse psychological reactions (worries, helplessness, and social isolation), and the use of coping strategies (avoidance of inappropriate foods to reduce bowel irritation and peristalsis, reduction of food intake, and use of antidiarrheal drugs and perianal skincare products). CONCLUSION The study supports the importance of having a good understanding of patient experiences by healthcare professionals to provide more effective healthcare. Furthermore, awareness of the cultural issue of social isolation was deemed important for providing individualized healthcare. IMPLICATIONS FOR PRACTICE Education, counseling, and psychological support can enhance patients' abilities to use coping strategies to overcome the physical and mental challenges of bowel symptoms. For example, appropriate diet-related education programs must be developed to reduce the trial-and-error learning process commonly adopted by patients to identify inappropriate foods.

Sarcopenia is a common and progressive skeletal muscle condition, often described as an intermediate stage in the development of frailty and disability in patients with diabetes. This can be improved through physical activity and exercise. This descriptive phenomenological study explored the exercise experiences of older adults with diabetes and sarcopenia. Individual interviews were conducted following semi-structured interview guidelines, and narratives were analyzed using Giorgi’s method. Data saturation was achieved after interviewing 14 purposively sampled older patients with diabetes and sarcopenia. The study identified three main themes: encountering difficulty during exercise, recognizing the advantages of exercise, and constructing a suitable exercise model. While older adults with diabetes and sarcopenia may encounter difficulty during exercise, they also experience positive feedback from exercise. Understanding the limitations of older adults, individualizing exercise models based on their exercise experiences, and providing appropriate interventions and necessary emotional support can effectively prevent diabetes and sarcopenia.

This research aims to explore the psychological processes of postpartum mothers during the admission of their newborns to the intensive care unit. It is hoped that the findings from this study will serve as a reference for clinical medical staff in providing individual and holistic patient care.Using grounded theory methodology, we collected data through semistructured, one-to-one in-depth interviews. When data saturation occurred, 12 participants were involved through the constant comparative analysis process.The psychological processes consisted of a core category and three main categories. The core category was "worrying about the baby and striving to fulfill maternal responsibilities." The three main categories were as follows: "impact on the maternal role," "recognition of the maternal identity," and "exhibition of maternal role." The entire process may be affected by intrinsic and extrinsic factors, such as breast milk supply, timing of skin-to-skin contact, seriousness of the newborn's health conditions, the support system, and the style of postpartum confinement care.It is recommended that the neonatal intensive care unit should adopt family-centered care, taking an initiative to empathize and care for the mother, assisting skin-to-skin contact for the mother and baby as soon as possible, maintaining established breastfeeding, providing the correct concept of postpartum care, and encouraging participation in support groups. These activities can reduce the impact of the situation on the maternal role and improve maternal identity recognition.

Background Androgen deprivation therapy is the primary treatment for advanced cases of prostate cancer, but its adverse effects may decrease prostate cancer survivors' quality of life. Objective The aim of this study was to understand the self-care experiences of prostate cancer survivors before and while receiving androgen deprivation therapy. Methods A qualitative study design with inductive content analysis was used. Semistructured interviews were conducted with 13 prostate cancer survivors in Taiwan treated with androgen deprivation therapy. Data collection and analysis proceeded simultaneously until data saturation was reached. Results The survivors' self-care experiences were categorized into generic categories: physical impacts, psychosocial impacts, lack of supporting information, changing lifestyle habits, coping with physical symptoms, relieving stress, and acquiring disease-related knowledge. These generic categories were then organized into 2 main categories: impacts and adjustments. Conclusions This article describes the experiences of prostate cancer survivors in terms of the impacts of disease and its treatment and adjustments in self-care before and while receiving treatment. It was found that the information acquired by survivors and the adjustment strategies they used were not entirely appropriate or adequate. Implications for practice Healthcare providers should continually assess the self-care experiences of prostate cancer survivors receiving androgen deprivation therapy, provide them with appropriate information, and clarify their understanding. This will improve survivors' disease care-related knowledge, increase the success of their experience of self-care, alleviate their emotional distress, and strengthen their ability to adjust their self-care to cope with the impacts of the disease and its treatment.

This descriptive phenomenological study was conducted to explore the lived experiences of adolescents with cancer. Purposive sampling was used to recruit participants. In-depth, nonstructured interviews were conducted to collect data, and narratives were analyzed using Colaizzi’s seven-step method. Data saturation was achieved after interviewing 16 participants. The study was divided into three main themes and 16 subthemes: suffering (caused by symptoms, therapy, cancer recurrence, the feeling of being trapped in hospital, the burden of food therapy, delayed education, the absence of peer relationships, and limited activities), emotional reactions (fear, worry, sadness, anger, and loneliness), and rebalancing (strong family relationships, optimistic thinking, and healthy lifestyles). While adolescents with cancer experience changes in lifestyle, and physical, psychological, and social burden, they also have positive life experiences. Building appropriate learning systems, improving communication skill, and providing appropriate food therapy may alleviate the psychological burden experienced by young patients.

Aims To investigate a partnership intervention of the community-based and hospital-based home visit to improve patients' satisfaction. Methods A time series quasi-experimental quantitative design was used. The experimental group had “partnership intervention”, while the control group maintained routine home visits. Patient satisfaction was measured pre-intervention, six months and 12 months after the partnership intervention. Results Six and 12 months after partnership intervention, in the experimental group, items related to stabilizing disease conditions, improving daily living abilities, enhancing communication ability and providing relevant resources were significantly higher than pre-intervention. However, 12 months after the intervention, the influence of the intervention became weaken. Conclusions The partnership intervention can significantly improve patients' satisfaction with home visit service.

Aims and objectives To determine the individual and mutual predictors of the marital satisfaction of couples in which the husband experienced prostate cancer. Background Marital satisfaction of prostate cancer patients has been insufficiently studied in Asian countries as compared with Western countries. Design This study used a prospective and repeated-measures design. Methods Seventy Taiwanese couples in which the husband had prostate cancer completed measures at 6 and 12 months post-treatment. Assessments of physical symptoms, marital satisfaction, coping behaviour, and psychological distress were conducted. Multiple linear regression was used to analyse the data. Results The marital satisfaction of prostate cancer patients and that of their spouses were significantly correlated. At 6 months, spouses’ marital satisfaction, patients’ appraisal of prostate cancer as a threat, and patients’ serum prostate-specific antigen (PSA) levels were found to be the predictors of patients’ marital satisfaction. Furthermore, patients’ marital satisfaction and their spouses’ psychological distress were predictors of spouses’ marital satisfaction. At 12 months, spouses’ marital satisfaction and patients’ appraisal of prostate cancer as harm were predictors of patients’ marital satisfaction. Finally, spouses’ marital satisfaction (at 6 months) and appraisal of prostate cancer as a threat were predictors of spouses’ marital satisfaction. Conclusions At 6 months post-treatment, patients’ and spouses’ marital satisfaction will influence each other. However, at 12 months, patients’ marital satisfaction exerts an insignificant effect on spouses’ marital satisfaction. Moreover, patients’ serum PSA level or the negative appraisal of prostate cancer affects their marital satisfaction. Spouses’ marital satisfaction is affected by psychological distress and their negative appraisal of prostate cancer. Relevance to clinical practice The results can be used to develop interventions for prostate cancer couples. Such an intervention can be used to modify couples’ appraisal of prostate cancer by changing incorrect thinking or to ease the psychological distress to improve marital satisfaction. This article is protected by copyright. All rights reserved.

To understand the effectiveness of a couple-based psychosocial information package (PIP) and multimedia psychosocial intervention (MPI) on patients with prostate cancer and their partners.A random assignment and quasi-experimental design were used.From August 2015-March 2018, 103 newly diagnosed patients with prostate cancer and their partners were divided into a control group (CG) (N = 50), PIP group (N = 25) and MPI group (N = 28). The CG received usual care, the PIP group received information manuals and telephone counselling for 6-week and the MPI group received multimedia films and manuals and professional support for 6 weeks. The three groups were posttested 6, 10, 18 and 24 weeks after the pre-test. The outcome measurements included disease appraisals, emotion status, relationship satisfaction, health-related quality of life (HRQOL) and satisfaction with MPI.Partners in the MPI and PIP groups experienced significant improvements in positive and negative affect or mental HRQOL as compared with the CG. The effectiveness of MPI and PIP on negative affect, mental HRQOL, however, were not statistically significant in patients with prostate cancer. Nevertheless, patients were satisfied with the MPI.Nurses can provide different types of interventions for partners, depending on personal preferences and available resources.There is a lack of studies that focus on the effectiveness of couple-based psychosocial intervention on both the patients with prostate cancer and their partners in Asia. Partners in the multimedia psychosocial intervention group and psychosocial information package group experienced improvements in positive affect, negative affect or health-related quality of life as compared with the control group. Patients in both intervention groups experienced similar negative affect and health-related quality of life as compared with the control group. The couple-based psychosocial interventions can be provided by nurses based on partners' preferences and available resources.目的: 了解基于夫妇的心理社会信息包（PIP）和多媒体心理社会干预（MPI）对前列腺癌患者及其伴侣的治疗效果。 设计: 采用随机分配和准实验设计。 方法: 从2015年8月至2018年3月，将103位新诊断的前列腺癌患者及其伴侣分为对照组（CG）（N = 50）、PIP组（N = 25）和MPI组（N = 28）。对照组接受常规护理，PIP组接受为期6周的信息手册和电话咨询，MPI组接受为期6周的多媒体电影、手册以及专业支持。在预测试后的第6、10、18和24周对这三组进行后测试。结果测量包括疾病评估、情绪状态、关系满意度、健康相关生活质量（HRQOL）和MPI满意度。 结果/发现: 与对照组相比，MPI组和PIP组的伴侣在积极和负面影响或心理HRQOL方面都有显著改善。MPI组和PIP组队前列腺癌患者的负面情绪、精神生活质量的影响在统计学不显著。然而，患者对MPI很满意。 结论: 护士可以根据个人喜好和可用资源为伴侣提供不同类型的干预措施。 影响: 在亚洲，目前还缺乏对前列腺癌患者及其伴侣进行基于夫妇的心理社会干预效果的研究。与对照组相比，多媒体心理社会干预组和心理社会信息包组的伴侣在积极情感、消极情感或健康相关的生活质量方面有所改善。与对照组相比，两个干预组的患者经历相似的负面影响和与健康相关的生活质量。护士可以根据伴侣的喜好和可用资源提供基于夫妇的心理社会干预。.

Background This study aimed to discuss the reasons for kidney donation withdrawal and related factors among the potential donors of living kidney transplant. Methods This study was conducted in outpatient departments with purposive sampling. Potential donors received relevant examinations and completed questionnaires when they would donate their kidneys for living related kidney transplant. Researchers tracked the final decision of potential donors. The structured questionnaire included basic data, psychosocial adjustment to illness scale, and decisional conflict scale. Results A total of 53 potential donors participated in this study, 46 of whom completed the kidney donation surgery (86.6%). The factors related to the final decision of kidney donation or kidney donation withdrawal included self-ranking health condition, value clarity, feeling supported in decision making, and overall decisional conflict. Conclusion Organ transplant teams should conduct a complete physical and psychological assessment of potential donors, provide information and support, and assist potential donors to clarify their true values and willingness to undergo kidney donation. Thus, each potential donor can decide to donate in true accordance with their willingness.

This study aimed to explore the self-stigma of schizophrenia patients. Qualitative phenomenological approach, purposive sampling and unstructured one-on-one interviews were used. Narratives were analyzed using Colaizzi's method. Data saturation was reached after 15 had been interviewed. Three themes and six sub-themes were revealed: the origin of the self-stigma (experience of self-stigma from the outside and the inside), the suffering experience of self-stigma (alienation from others and negative inner feelings), and coping with the self-stigma (acceptance and change of mind). The study supports the importance to increase awareness of self-stigma and suggests effective measures to help patients deal with this challenge.

Purpose To explore the subjective interpersonal interaction experiences of patients with chronic schizophrenia. Design and methods Descriptive phenomenological, purposive sampling, in-depth one-to-one, and unstructured interviews were used. Colaizzi's method was used to analyze narratives. Findings Three themes and six subthemes were emerged: Feelings associated with interpersonal interactions (pleasant and unpleasant feelings experienced during interpersonal interactions); interpersonal interaction is a dynamic process (Positive and negative dynamic processes); selection of interaction targets (limitations in the selection of interaction targets and selection criteria for interaction targets). Practice implications Professionals should understand the interpersonal interactions experiences of patients with schizophrenia to help them have a better interpersonal relationship.

PURPOSE To evaluate the effectiveness on reducing anxiety of a diaphragmatic breathing relaxation (DBR) training program. DESIGN AND METHODS This experimental, pre-test–post-test randomized controlled trial with repeated measures collected data using the Beck Anxiety Inventory and biofeedback tests for skin conductivity, peripheral blood flow, heart rate, and breathing rate. FINDINGS The experimental group achieved significant reductions in Beck Anxiety Inventory scores (p < .05), peripheral temperature (p = .026), heart rate (p = .005), and breathing rate (p = .004) over the 8-week training period. The experimental group further achieved a significant reduction in breathing rate (p < .001). PRACTICE IMPLICATIONS The findings provide guidance for providing quality care that effectively reduces the anxiety level of care recipients in clinical and community settings.

Objective. To explore the relationship between body constitution (BC) types and weight change in patients with schizophrenia and who underwent second-generation antipsychotics (SGAs) treatment.Method. Body weight and waist circumference of eighty-five participants were measured for 6 consecutive weeks. Constitutions of Yin-Xu, Yang-Xu, and Stasis were assessed using the Body Constitution Questionnaire (BCQ).Results. Participants with body constitutions Yin-Xu (50.6%), Yang-Xu (49.4%), or Stasis (38.8%) exhibited worse physical condition and unhealthy daily habits, particularly in Stasis constitution. Moreover, Stasis constitution was significantly associated with several factors, including BMI, body weight, waist circumference, perception of stress, perception of health, staying up late, and less physical exercise. However, perception of stress showed significant difference in Yin-Xu, Yang-Xu, and Stasis. Generalized estimating equation (GEE) analysis revealed that significant time effects in body weight increase in the imbalanced BC types and gentleness BC type. SGAs induced weight gain in imbalanced BC type as well as gentleness BC type, especially treated with olanzapine.Conclusions. This is the first study to explore the longitudinal relationship between BC and weight gain in schizophrenia patients undergoing SGAs treatment. Health care providers should focus on weight gain problems in schizophrenia patients who underwent SGAs treatment.

Background: The number of patients with diabetes mellitus (DM) in Indonesia was reported to increase every year. Indonesia included into ranked sixth countries for diabetes (20-79 years) and ranked third as the deadliest diseases, (IDF, 2017; WHO, 2016). However, research about self-management experience for people with Type 2 DM is insufficient. Objectives: The purpose of this study was to explore the Self-management Experience of Patient with Type 2 DM in Sumbawa Besar, West Nusa Tenggara. Methods: Purposive sampling with one-on-one depth interview were used to obtain the participants experiences about self-management. six participants were selected randomly from 30 participants in community. Data saturation was achieved and analyzed by Colaizzi’s (1978) seven-step method. Results: Six themes emerged from study were: dietary adjustment, using medicine to decrease blood glucose, taking exercise, taking care of DM by oneself, social support and looking for information regarding DM were consider as important theme for DM population in Sumbawa Besar, West Nusa Tenggara. Conclusion: the result of this study showed that each patient with DM has ability to carry out self-management based on their belief, value and knowledge. Basic information about diabetes was the most important aspect before patients can perform self-management successfully.

Background While most living kidney donors are satisfied with their decision and do not regret donating, few studies have been conducted on the determinants related to the effectiveness and regret of the decision. This study aims to explore the relationship between basic attributes, quality of life, positive affect, negative affect, effectiveness of decision-making, and regret in living kidney donors. Methods In this cross-sectional study, living kidney donors were recruited from urology and kidney transplant outpatient services. The structured questionnaire used to collect the data included the Positive and Negative Affect Schedule, Medical Outcomes Study 12-Item Short-Form Health Survey, Decision Conflict Scale, and Decision Regret Scale. Results The findings indicate that living donors with better health status, 24-hour creatinine clearance, physical health-related quality of life (HRQOL), and positive affect experienced greater feelings of effective decision-making. Moreover, women and donors with better physical HRQOL, positive affect, and decision effectiveness were less regretful about the decision of kidney donation. Conclusion Health status, physical HRQOL, and positive affect are related to decision validity and regret of living donors. Therefore, clinical care providers should regularly assess the mood and health of living kidney donors. Furthermore, activities promoting their health should be encouraged, especially for men.

AIMS AND OBJECTIVES To investigate a community-based and hospital-based home visit partnership intervention in improving caregivers' satisfaction with home service and reducing caregiver burden. BACKGROUND The community-oriented mental healthcare model prevails internationally. After patients return to the community, family caregivers are the patients' main support system and they also take the most of the burden of caring for patients. It is important to assist these caregivers by building good community healthcare models. DESIGN A longitudinal quasi-experimental quantitative design. METHODS The experimental group (n = 109) involved "partnership" intervention, and the control group (n = 101) maintained routine home visits. The results were measured before the intervention, 6 and 12 months after the partnership intervention. RESULTS Six months after the partnership intervention, the satisfaction of the experimental group was higher than the control group for several aspects of care. Although the care burden was reduced in the experimental group, there was no significant difference between the two groups. CONCLUSIONS This study confirms that the partnership intervention can significantly improve caregiver satisfaction with home services, without reducing the care burden. RELEVANCE TO CLINICAL PRACTICE The community-based and hospital-based mental health home visit service partnership programme could improve the main caregiver's satisfaction with the mental health home visit services, while the reduction in care burden may need government policies for the provision of more individual and comprehensive assistance.

Purpose Altered bowel function is a common consequence of anal sphincter-saving surgery in rectal cancer patients, and bowel symptoms influence patients' daily life and psychosocial status. Patients have inadequate professional support because care specialists fail do fully appreciate the impact of the patients' symptoms. In-depth exploration of the individual's experience is essential to improve the quality of patient care. The purpose of this study was to explore the lived experiences of post-operative rectal cancer patients with altered bowel function. Methods This Husserlian descriptive phenomenological study recruited 16 post-operative rectal cancer patients with altered bowel function. Data was collected through purposive sampling and one-on-one in-depth, semi-structured interviews. Narratives were analyzed thematically using Colaizzi's seven-step method. Results Three themes emerged, namely: “living in the restroom”, “never backward”, and “rebalancing on a new road”. “Living in the restroom” described how patients frequent the restroom due to post-operative physical changes. “Never backward” outlined that such changes disturbed their mood, interrupted their daily activities, and affected their family life. “Rebalancing on a new road” described the patients' coping strategies, which included spiritual reconstruction, a new excrement model, an adjusted lifestyle, and peer support. Conclusions Post-operative rectal cancer patients with altered bowel function frequent the restroom for prolonged periods, which disturbs their psychosocial status. However, they are forced to develop coping methods by themselves. Specialists can offer effective early post-operative interventions by thoroughly understanding each patient's symptomatic experience, symptom-related interferences, and primary concerns.

Purpose To explore the efficacy of community rehabilitation for facilitating daily function among patients with mental illness. Design and methods A quasi-experimental design was used. Two hundred and sixty-four participants completed a daily living function scale questionnaire and provided disease-related information. Findings Community rehabilitation was shown to be efficient in helping to stabilize mental illness and enhance daily function. Daily function had a significant and positive correlation with disease stability. Practice implications Community rehabilitation for patients with mental illness can effectively stabilize and prevent disability among those with mental illness.

We evaluated changes in psychosocial adjustment over time and its associated factors in prostate cancer patients. A total of 69 patients with prostate cancer were surveyed at pre-diagnosis, 1 month and 6 months post-treatment. The questionnaires distributed to the patients consisted of the Psychosocial Adjustment to Illness Scale and the UCLA Prostate Cancer Index. The generalized estimating equations were used to analyse the collected data. The results of adjustments to psychological distress, the domestic environment and the social environment worsened post-treatment. However, the adjustment to health-care orientation was worst at the time of pre-diagnosis and improved during post-treatment. Patients who perceived an unfavourable health status reported poor adjustment in psychological distress. Patients exhibiting poor urinary function poorly adjusted to the domestic environment. Patients with sexual dysfunction exhibited poor adjustment to the social environment. Patients with low education demonstrated poor adjustment to health-care orientation. Further studies should assess the psychosocial adjustment among prostate cancer patients and provide interventions following pre-diagnosis.

Novice psychiatric nurses experience heavy workloads, insufficient training and support in Taiwan. The aim of this study was to understand the working experiences of novice psychiatric nurses during their first year in a clinical setting. A qualitative phenomenological approach, using semi-structured face-to-face interviews was used. Narratives were analyzed using Colaizzi's seven-step method. Data saturation was reached after interviews were conducted with 15 nurses based on the purposive sampling. Four themes and eight sub-themes were identified: struggling (lacking a sense of security and competency), emulating (learning the process of interaction with clients and families, learning an appropriate role from nursing staff), prevailing (developing core competency, creating a therapeutic environment) and belonging (coping with the job, becoming a part of the psychiatric nursing staff). The findings from this study demonstrate that nurses are often inadequately prepared for psychiatric nursing. They have little understanding of mental illness, are unable to communicate appropriately with clients and struggle to cope with the conditions. Our study supports the importance for helping nurses to improve their essential knowledge and skills for coping with the job and providing good quality care, particularly in the first year.

Purpose The aim of the article is to explore the chronic sorrow experiences of the caregivers of clients with schizophrenia in Taiwan. Design and Methods Descriptive, phenomenological, and purposive sampling and one-to-one, in-depth, and unstructured interviews were used. Data saturation was achieved after interviewing 12 participants. Narratives were analyzed using Colaizzi's (1978) method. Findings Three themes and eight subthemes emerged, including encountering sorrow (disordered life, disintegrated self-esteem, little prospect for hope, and collapsed sense of security), talking with sorrow (cognitive change and transformation of action), and living with sorrow (living with defects and living with responsibilities). Practice Implications Advanced practice psychiatric nurses should take the emotional stability of caregivers into consideration. Caregivers should be encouraged and taught effective culture-oriented strategies for living with sorrow.

Aims and objectives. To explore suicide predictors in rural outpatients with schizophrenia. Background. Suicide is a major cause of mortality in patients with schizophrenia. Evidence indicates that patients in rural areas are at high risk for inadequate health care services. However, information is limited on suicide risk in outpatients with schizophrenia in rural areas. Design. Cross-sectional survey. Methods. Data were collected on individuals enrolled in the 2007 Taiwan National Health Insurance program as diagnosed with schizophrenia, ≥18 years, and living in a rural county. Eligible individuals (n = 1655) were assessed by 12 community-based nurses at 12 public health centres. Participants' personal information was retrieved from National Health Insurance records using a personal data sheet, and treatment experiences were obtained by interviewing patients with a 10-item risk-assessment inventory. Data were collected over 18 months (2007-2008) and analysed by descriptive statistics and regression analyses. Results. Risk of suicide attempt in the previous year had four significant predictors: number of self-harm incidents during the previous year, violent incidents towards others during the previous year, number of follow-ups by mental health clinics and number of involuntary hospitalisations during the previous year (R(2) = 0·337, adjusted R(2) = 0·334, F = 133·19, p = 0·000). Conclusion. Health care providers should assess rural outpatients with schizophrenia for suicidal thoughts by asking simple questions to evaluate for a history of self-harm and violence and by comparing this information with health system data on follow-ups by mental health clinics and involuntary hospitalisations. Relevance to clinical practice. Community-based health providers may use these results to prioritise assessments when they have a high case load of patients with schizophrenia. Community-based nurses need to be trained to recognise these four predictors to increase their sensitivity to suicidality among patients with schizophrenia. Language: en

Objective This study discusses the intervening conditions of hospital-based home care (HBHC) for people with severe mental illness in Taiwan. Design and Sample Grounded theory of the Strauss and Corbin approach was used. Participants were selected from six hospitals in Central Taiwan, including 21 clients, 19 caregivers, and 25 professionals. Measures Semi-structured one-on-one interviews were used to collect data. Data analysis consisted of three stages: open, axial, and selective coding. Data analysis, data collection, and sampling were conducted through the constant comparative analysis process. Results Two categories were generated as positive and negative intervening conditions of HBHC services. Eight positive effects and nine negative effects were generated from the data. Conclusions Several positive and negative intervening conditions were found in this study to affect the delivery of HBHC. Government support and several limitations regarding HBHC services quality should be noticed and improved.

Accessible summary • Encouraging people with schizophrenia to live in the community is the current health-care policy, but community living is difficult for clients and their families. • Influencing factors in home care need to be identified so as to guide service delivery for community-dwelling clients with schizophrenia and their families. • Four categories and 12 subcategories of influencing factors were identified, which have positive and negative effects on nursing roles and the functions of public health nurses in the mental health home-visiting service in Taiwan. • The influencing factors were found to support the importance of home care services. Abstract The purpose of this study was to explore the influencing factors in the substantive theory of home care for people with schizophrenia in Taiwan. The grounded theory of Strauss and Corbin approach was used. Semi-structured one-to-one in-depth interviews were utilized to collect data. Constant comparative analysis continued during the open, axial and selective coding processes until data saturation occurred. Participants were selected using theoretical sampling, and the final sample in this study consisted of a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home-visiting services. The public health nurses and home health nurses both conducted a total of 16 (eight carers and eight clients) home visits. Four categories and 12 subcategories of influencing factors were identified; these factors have both positive and negative effects on nursing roles and the functions of public health nurses in the mental health home-visiting service in Taiwan. The influencing factors identified support the importance of home care services.

Aims and objectives. The aim of this study was to elucidate the experiences of first encountering death by nursing students during clinical practice. The objective is to assist nursing educational and clinical professionals to provide essential assistance for nursing students who encounter patient death. Background. Increasingly, deaths are occurring in hospitals. However, there has been little qualitative research in Taiwan on the experiences of nursing students who encounter patient death for the first time. Design. A descriptive qualitative method was employed to explore nursing students’ first experience with death during clinical practice in Taiwan. Methods. Purposive sampling, one-on-one, in-depth with semi-structured interviews were conducted to collect data. Participants were selected from an acute haematological ward in a major teaching hospital in Central Taiwan. Narratives were analysed using Colaizzi’s seven-step method. Results. Data saturation was achieved after interviewing 12 nursing students. The average age of the students was 20, and seven and half days was the average time spent attending dying patients. Three themes and eleven sub-themes were identified: Providing Care During the Dying Period (feelings of dread and terror, hardship of experiencing patient’s life fading away, devotion to patient care and self-affirmation); Facing the Moment of Patient Death (state of being scared or trapped, emotional breakdown); Adjustment after Patient Death (acceptance or avoidance, growth or escape). Conclusions. Findings demonstrate the importance of understanding such first experiences, and the results are beneficial to clinical instructors and nursing personnel in understanding the students’ pressure and difficulties experienced before, during and after the patients’ death. Relevance to clinical practice. Several recommendations have been made, including teaching and support not only in the period of dying, but at the moment of patient death and postmortality. Avoiding topics about death in local culture have been noted.

Aims and objectives. This paper analysed the scholarly discourse about the influence of Taiwanese culture on beliefs about expressing anxiety and engaging in physical activity from literature review. Background. The well-being of individuals with mental illness is promoted by the World Health Organization. Reducing barriers to treatment and care in community health-service systems requires cultural understanding. However, little is known about the influence of Taiwanese culture on physical activity programmes for people with anxiety disorders in Taiwan. Design. A discursive analysis of the literature. Method. Literature was used to examine the impact of Taiwanese culture on beliefs about anxiety and physical activity from historical, economic, social, political and geographical perspectives. Results. Taiwanese cultural beliefs about anxiety and physical activity can be summarised into six themes. Beliefs about anxiety are reflected in three themes: anxiety and shame, beliefs against direct communication and beliefs about anxiety and external forces. Beliefs about engaging in physical activity are reflected in three themes: beliefs about human action, the relationship between health and physical activity and priority of academic achievement. Conclusion. This paper exposes the hidden power of culture to influence Taiwanese beliefs about anxiety and physical activity. Three negative beliefs about anxiety influence the expression of anxiety symptoms and help-seeking behaviours. Two positive and one negative belief about physical activity significantly affect choice of activity type and level of participation in physical activity. Anxiety and physical activity have a dynamic relationship and both are deeply influenced by Taiwanese culture. Relevance to clinical practice. An awareness of cultural influences on beliefs about anxiety and physical activity is important when encouraging Taiwanese people with anxiety disorders to engage in physical activity. This awareness may help nurses understand better how their patients perceive anxiety and physical activity, leading to more appropriate physical activity programmes to improve both physical and psychological well-being.

Schizophrenia is a severe illness with little hope of recovery and requires long-term care. The purpose of this study was to explore the experiences of carers who live with someone with long-term schizophrenia, within the cultural context of Taiwan. The study was conducted in a community setting in central Taiwan. A qualitative phenomenological approach was used to explore the experiences of carers. Purposive sampling was used by selecting the carers who were close relatives of the clients, had lived with the clients for at least 1 year and bore most of the responsibilities. Semi-structured face-to-face interviews were conducted to collect the data and narratives were analysed using Colaizzi's (1978) seven-step method. Data saturation was achieved after interviewing 10 carers. Three themes and eight sub-themes were identified: burdens of caring (helping clients' illness, lack of professional support and family conflicts), emotional burdens (sadness, worry and fear) and strategies of coping (cognitive and religious coping strategies). Our study supported the importance for nurses to understand the cultural aspects of mental illness, particularly the widespread cultural beliefs and patterns of help seeking behaviours, in order to provide culturally sensitive health care.

Objectives: There is a dearth of evidence on the care that families provide to their relatives after they have been discharged from hospital following an attempted suicide. The aim of this study was to explore ex-patients' and family caregivers' perceptions of the care provided at home following hospital discharge. Design and Sample: A qualitative approach using Grounded Theory was adopted. Suicidal ex-patients (n=15) and family caregivers (n=15) were contacted in the south of Taiwan. Measures: Data were collected through interviews and the data were analyzed using open, axial, and selective coding. Results: A substantive theory was developed from the findings. However, for the purpose of this paper, the section of the paradigm model named the action/interaction strategies is presented and discussed. Three categories emerged in the action/interaction section relating to the family care of relatives who had been suicidal. They were: (1) "guarding the person day and night," which helped to ensure that their relatives felt safe; (2) "maintaining the activities of daily living," which promoted their physical health and recovery; and (3) "creating a nurturing environment," which facilitated their mental and emotional healing. Conclusions: Public health nurses could use the findings of this study as a theoretical map when providing health information to family caregivers during home visits. Language: en

Aim and objectives. The purpose of this study is to generate a substantive theory of hospital-based home care for people with severe mental illness in Taiwan. Background. Despite the documented advantages of hospital-based home care services, there is a lack of information and understanding regarding the practices, functions and limitations. Currently, there is no model for how those services are to be provided and what factors will affect these services. Design. The grounded theory method of Strauss and Corbin (Basics of Qualitative Research: Grounded Theory Procedures and Techniques, SAGE Publications, 1990) was used to develop a substantive theory through a paradigm model, including causal conditions, context, intervening conditions, action/interaction strategies and consequences. Methods. This study was conducted in six different hospital areas in Central Taiwan in 2007–2008. Data were collected using semi-structured face-to-face interviews. Constant comparative analysis continued during the open, axial and selective coding process until data saturation occurred. Participants were selected by theoretical sampling. When theoretical saturation was achieved, 21 clients with mental illness, 19 carers and 25 professionals were interviewed. Results. A substantive theory of hospital-based home care for people with severe mental illness in Taiwan was developed. The core category was the process of hospital-based home care in helping people with severe mental illness, with 15 categories and 33 sub-categories of the substantive theory. Conclusion. The substantive theory is the first to emerge from hospital-based home care services in Taiwan. Results showed those services had several effective functions for helping people with severe mental illness and their families. Relevance to clinical practice. The recommendations based on the findings of this research can be used as a guide to improve the delivery of hospital-based home care services to community-dwelling people with severe mental illness and their carers.

Aims and objectives. The study aimed to understand the nursing roles and functions of public health nurses and home health nurses in Taiwan and the factors that affect nursing roles and functions of nurses that provide community mental health home visiting services. Background. Although community nurses provide more psychiatric home visiting services than other psychiatric professionals, little research on their roles and functions has been conducted. Design. Nursing roles and functions were developed through use of grounded theory method of Strauss and Corbin. Methods. Data were collected using semi-structured face-to-face in-depth interviews and unstructured non-participant observations. The constant comparative analysis continued during the open, axial and selective coding process until data saturation occurred. Participants were selected using theoretical sampling. Final sample size in this study comprised a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home visiting. Public health nurses conducted a total of 16 (eight carers and eight clients) services and home health nurses conducted 16 (eight carers and eight clients) services. Results. Fourteen nursing roles were identified. These roles included assessor, supporter, educator, consultant, counselor, negotiator, harmoniser, collaborator, advocate, placement coordinator, resource provider, care provider, case manager and case finder. Moreover, several factors that affect nursing roles and functions in the community mental health home visiting service in Taiwan were also identified. Conclusion. This is the first study to identify the role of public health and home health nurses caring for people with schizophrenia in the community in Taiwan. Relevance to clinical practice. The recommendations based on the findings of this research can be used as a guide to improve the delivery of psychiatric home visiting services to community-dwelling clients with schizophrenia and their carers.

To evaluate the effectiveness on reducing anxiety of a diaphragmatic breathing relaxation (DBR) training program.This experimental, pre-test-post-test randomized controlled trial with repeated measures collected data using the Beck Anxiety Inventory and biofeedback tests for skin conductivity, peripheral blood flow, heart rate, and breathing rate.The experimental group achieved significant reductions in Beck Anxiety Inventory scores (p.05), peripheral temperature (p = .026), heart rate (p = .005), and breathing rate (p = .004) over the 8-week training period. The experimental group further achieved a significant reduction in breathing rate (p.001).The findings provide guidance for providing quality care that effectively reduces the anxiety level of care recipients in clinical and community settings.

We evaluated changes in psychosocial adjustment over time and its associated factors in prostate cancer patients. A total of 69 patients with prostate cancer were surveyed at pre-diagnosis, 1 month and 6 months post-treatment. The questionnaires distributed to the patients consisted of the Psychosocial Adjustment to Illness Scale and the UCLA Prostate Cancer Index. The generalized estimating equations were used to analyse the collected data. The results of adjustments to psychological distress, the domestic environment and the social environment worsened post-treatment. However, the adjustment to health-care orientation was worst at the time of pre-diagnosis and improved during post-treatment. Patients who perceived an unfavourable health status reported poor adjustment in psychological distress. Patients exhibiting poor urinary function poorly adjusted to the domestic environment. Patients with sexual dysfunction exhibited poor adjustment to the social environment. Patients with low education demonstrated poor adjustment to health-care orientation. Further studies should assess the psychosocial adjustment among prostate cancer patients and provide interventions following pre-diagnosis.

To explore suicide predictors in rural outpatients with schizophrenia. Background. Suicide is a major cause of mortality in patients with schizophrenia. Evidence indicates that patients in rural areas are at high risk for inadequate health care services. However, information is limited on suicide risk in outpatients with schizophrenia in rural areas.Cross-sectional survey.Data were collected on individuals enrolled in the 2007 Taiwan National Health Insurance program as diagnosed with schizophrenia, ≥ 18 years, and living in a rural county. Eligible individuals (n=1655) were assessed by 12 community-based nurses at 12 public health centres. Participants' personal information was retrieved from National Health Insurance records using a personal data sheet, and treatment experiences were obtained by interviewing patients with a 10-item risk-assessment inventory. Data were collected over 18 months (2007-2008) and analysed by descriptive statistics and regression analyses.Risk of suicide attempt in the previous year had four significant predictors: number of self-harm incidents during the previous year, violent incidents towards others during the previous year, number of follow-ups by mental health clinics and number of involuntary hospitalisations during the previous year (R(2) = 0.337, adjusted R(2) = 0.334, F=133.19, p=0.000).Health care providers should assess rural outpatients with schizophrenia for suicidal thoughts by asking simple questions to evaluate for a history of self-harm and violence and by comparing this information with health system data on follow-ups by mental health clinics and involuntary hospitalisations.Community-based health providers may use these results to prioritise assessments when they have a high case load of patients with schizophrenia. Community-based nurses need to be trained to recognise these four predictors to increase their sensitivity to suicidality among patients with schizophrenia.

This study was designed to investigate the learning outcomes of a suicide education programme for second-year student nurses in Taiwan.Research demonstrates that nurses' attitudes impact on the care provided to suicidal patients. However, evidence is sparse on promoting positive caring attitudes in nurses towards suicidal patients.A quasi-experiment.The total sample group (n = 174) comprised second-year student nurses. Some (n = 95) were randomly allocated to an experimental group who attended a four-hour suicidal education programme and others (n = 79) comprised a control group who did not attend the programme. All participants were given a questionnaire before and after the programme in 2008. The questionnaire contained 30 items and was divided into five categories. They were (1) the acceptability of suicidal behaviours, (2) morality and mental illness, (3) professional role and care, (4) communication and attention and (5) beliefs.Results demonstrated that the experimental group had higher scores on all five categories of the questionnaire than the control group did. Participants in the experimental group held more positive attitudes towards the acceptance of suicidal behaviours and were non-judgmental in their morality. Further, they showed more positive attitudes towards the provision of professional care and believed that people who attempt suicide are communicating their psychic pain. Moreover, participants in the experimental group held more positive beliefs about people who attempt suicide than the control group did.This suicide education programme raised student nurses' awareness about the phenomenon of suicide and promoted positive caring attitudes towards people who attempt suicide and hence their nursing care.A four-hour suicide education programme can promote positive caring attitudes towards people who attempt suicide and may have an affirmative influence on the nursing care provided to suicidal patients.

The aim of this study was to elucidate the experiences of first encountering death by nursing students during clinical practice. The objective is to assist nursing educational and clinical professionals to provide essential assistance for nursing students who encounter patient death.Increasingly, deaths are occurring in hospitals. However, there has been little qualitative research in Taiwan on the experiences of nursing students who encounter patient death for the first time.A descriptive qualitative method was employed to explore nursing students' first experience with death during clinical practice in Taiwan.Purposive sampling, one-on-one, in-depth with semi-structured interviews were conducted to collect data. Participants were selected from an acute haematological ward in a major teaching hospital in Central Taiwan. Narratives were analysed using Colaizzi's seven-step method.Data saturation was achieved after interviewing 12 nursing students. The average age of the students was 20, and seven and half days was the average time spent attending dying patients. Three themes and eleven sub-themes were identified: Providing Care During the Dying Period (feelings of dread and terror, hardship of experiencing patient's life fading away, devotion to patient care and self-affirmation); Facing the Moment of Patient Death (state of being scared or trapped, emotional breakdown); Adjustment after Patient Death (acceptance or avoidance, growth or escape).Findings demonstrate the importance of understanding such first experiences, and the results are beneficial to clinical instructors and nursing personnel in understanding the students' pressure and difficulties experienced before, during and after the patients' death.Several recommendations have been made, including teaching and support not only in the period of dying, but at the moment of patient death and postmortality. Avoiding topics about death in local culture have been noted.

Aims and objectives. The aim of this study is to generate a theory of meaning of care-giving for parents of mentally ill children in Taiwan. Background. Studies indicate that the meaning of care-giving plays an important role in the psychological adjustment of care-givers to care-giving. With a positive meaning of care-giving, care-givers can accept their roles and adapt to them more readily. Design. The research employs the qualitative method of grounded theory, the inquiry is based on symbolic interactionism. Methods. Twenty parental care-givers of children with schizophrenia were recruited at a private hospital in central Taiwan. Semi-structured interviews were conducted. A comparative method was used to analyse the text and field notes. Results. Responsibility (zeren) emerges as the core category or concept. Responsibility expresses broadly the behavioural principles that are culturally prescribed and centred on familial ethics and values. Related concepts and principles that influence caregiver actions and affections include a return of karma, challenges from local gods and fate. By maintaining their culturally prescribed interpretations of care-giving, parents hope to give care indefinitely without complaints. Conclusions. The findings clearly suggest that the meaning of care-giving is determined through a process of internal debate that is shaped by culturally specific concepts. The paper attempts to explain some of these culturally specific determinants and explanations of care-giving behaviour. Relevance to clinical practice. The theory contributes knowledge about the meaning of care-giving for parents of mentally ill children in Taiwan. It should be useful reference for mental health professionals, who provide counselling services to ethnically Taiwanese care-givers.

Aims and objectives. The purposes of this study were to understand the functions of hospital-based home care for people with severe mental illness in Taiwan, and the factors that affect functions of professionals who provide hospital-based home care. Background. Hospital-based home care is a service which provides those people with serious mental illnesses who are in crisis and who are candidates for admission to hospital. Home care has been shown to have several advantages over inpatient treatment. However, there is a lack of knowledge about the functions of hospital-based home care for people with severe mental illness in Taiwan. Design. This qualitative study was based on the grounded theory method of Strauss and Corbin. Methods. The study was conducted in six different hospital areas in central Taiwan in 2007–2008. Data were collected using semi-structured face-to-face interviews. Constant comparative analysis continued during the open, axial and selective coding processes until data saturation occurred. Participants were selected by theoretical sampling. When theoretical saturation was achieved, 21 clients with mental illness, 19 carers and 25 professionals were interviewed. Results. Several functions were found when these professionals provided hospital-based home care services for people with severe mental illness in Taiwan, including stabilising the clients illness, supplying emergency care services, improving life-coping abilities, employment and welfare assistance, emotional support for both clients and carers, assistance with future and long-term arrangements and assistance with communication between carers and clients. Conclusion. Hospital-based home care provides several important services for helping clients and their families to live in the community. Relevance to clinical practice. The recommendations based on the findings of this study can be used as a guide to improve the delivery of hospital-based home care services to community-dwelling clients with severe mental illness and their carers.

Aims and objectives. The purpose of this study was to explore the lived experiences of brokered brides who have attempted suicide in Taiwan. Background. There has been a significant rise in number of brokered brides since the 1970s in Western world and since the 1990s in several Asian countries. However, there is a great lack of research on brokered brides' suicide around the world. Design. A descriptive phenomenological study was used to explore the lived experiences of brokered brides who have attempted suicide. Methods. Purposive sampling, one-on-one, in-depth with semi-structural interviews were conducted to collect data. Narratives were analysed by Colaizzi's (1978) seven-step method. Results. Data saturation was achieved after interviewing 12 brokered brides. The study group was comprised of females whose average age was 33. Three themes and the sub-themes were: being a chrysalis (loss of support, loneliness, suffering abused experience, loss of self-esteem), death of a chrysalis (loss of hope and seeking salvation) and birth of a chrysalis (regaining hope and sense of self-worth). Conclusions. These brokered brides suffered from numerous pressures and difficulties in life. Their hopelessness led to suicidal behaviours as a way to get out of trouble. Hence, the need to provide brokered brides with substantial assistance and support in their lives is an issue that cannot be neglected. The results of this study could be used as a reference to provide professionals and the public with a deeper understanding of suicide in this vulnerable group, and provide more appropriate help and care. Relevance to clinical practice. The suffering may be alleviated by giving brokered brides a reliable support system that they so obviously need. Several recommendations have been made, including amendments in terms of policy, society and the services offered by healthcare professionals. Language: en

PURPOSE. To evaluate the reliability and construct validity of the Meaning in Caregiving Scale (MICS) by confirmatory factor analysis and to explore whether the MICS meets the goodness-of-fit criteria for the 3-factor model. DESIGN AND METHODS. Four hundred and eighty subjects in Taiwan were recruited. The hypothesized confirmatory factor analysis model specifies the items to measure the reordering priority, relationship fidelity, and transcendent belief as indicators of latent factors. FINDINGS. The data show that the hypothesized 3-factor model does not fit the data well and indicate that the 3 factors might share a high-order common factor. Cross-cultural issues may account for this shortcoming. PRACTICE IMPLICATIONS. This scale offers better understanding around caregivers for psychiatric patients and the issues they face.

AIM: This paper is a report of a study to explore family carers' and suicidal ex-patients' perceptions of the home environment and the provision of care in the home. BACKGROUND: Worldwide, in 2000 approximately one million people died from suicide, which is among the three leading causes of death among those aged 15-44 years. Internationally, epidemiological trends show that there has been a rapid increase in suicide rates in many countries, including Taiwan. Families have an important role in caring for a member who is at risk of suicide. METHODS: Using a grounded theory approach, data were collected in 2006-2007 in two Taiwanese hospitals. Interviews were conducted with suicidal patients who had just been discharged (n = 15) and family members (n = 15). Data were analysed using open, axial and selective coding. FINDINGS: For the purpose of a larger study a substantive theory was formulated, which families could use to guide them in the care of a member who is at risk of suicide. Here we report the findings related to the 'context' and 'intervening conditions' of the grounded theory. Two categories emerged in the 'context' element, namely 'the family environment' and 'the Chinese culture'. One category surfaced in the 'intervening condition' namely, 'The provision of care in the home'. This category included three sub-categories: support systems; coping mechanisms and helping skills. CONCLUSION: Family carers experienced difficulties when caring for a member who had previously attempted suicide. Before patients are discharged from hospital, nurses should educate families on the preventive and caring approaches that they could use in their homes. Language: en

Aims and objectives. The purpose of this study was to understand the coping experiences of carers living with a schizophrenic family member. Our research may be a valuable reference for mental health professionals seeking to improve the quality of care for people with schizophrenia and their carers. Design. We employed a qualitative descriptive phenomenological research methodology to understand the coping experiences of carers living with a schizophrenic family member. Methods. Purposive sampling and in-depth, face-to-face interviews were used to collect data. When data saturation was reached, the sample size comprised 10 carers (five men and five women). The interview focused on the carer's coping experience. During the process of data collection and data analyis we established epoches (bracketing) and returned to the reality of the carers’ experience to keep the data objective. Narratives were analysed according to Colaizzi's seven steps method. Results. The two most commonly used coping mechanisms that emerged from this study were psychological coping strategies (cognitive, behavioural and emotional) and social coping strategies (religious, social and professional support). Furthermore, three factors were found in the study, including low social status, traditional help-seeking behaviours and feelings of shame. Conclusion. Findings from this study demonstrate the importance of understanding the coping experiences of carers who have a family member with schizophrenia. Further research is needed to identify more important detailed factors that affect the coping strategies of carers. Relevance to clinical practice. Community mental health care professionals need to improve the quality of care for helping carers living with a family member who has schizophrenia. It is important to develop effective coping intervention strategies that help carers cope with the stress and strain of caring for a family member with schizophrenia.

Aim and objectives. The aim was to develop a practice theory that can be used to guide the direction of community nursing practice to help clients with schizophrenia and those who care for them. Design. Substantive grounded theory was developed through use of grounded theory method of Strauss and Corbin. Methods. Two groups of participants in Taiwan were selected using theoretical sampling: one group consisted of community mental health nurses and the other group was clients with schizophrenia and those who cared for them. The number of participants in each group was determined by theoretical saturation. Semi-structured one-to-one in-depth interviews and unstructured non-participant observation were utilized for data collection. Data analysis involved three stages: open, axial and selective coding. During the process of coding and analysis, both inductive and deductive thinking were utilized and the constant comparative analysis process continued until data saturation occurred. To establish trustworthiness, the four criteria of credibility, transferability, dependability and confirmability were followed along with field trial, audit trial, member check and peer debriefing for reliability and validity. Results. A substantive grounded theory, the role of community mental health nurses caring for people with schizophrenia in Taiwan, was developed through utilization of grounded theory method of Strauss and Corbin. Conclusion. In this paper, results and discussion focus on causal conditions, context, intervening conditions, consequences and phenomenon. Relevance to clinical practice. The theory is the first to contribute knowledge about the field of mental health home visiting services in Taiwan to provide guidance for the delivery of quality care to assist people in the community with schizophrenia and their carers.

On the basis of the human rights of patients with psychoses, community psychiatric mental health continuous nursing care holds the core value of "cherishing life, caring for the whole person", and integrates hospital and community medical resources, in order to improve patients' quality of life in the community. This article elaborates on the core value of continuous care in community psychiatric mental health nursing, and on its current state and future prospects, as a source of reference for further development in education and practice.