Taiwan's Department of Health (DO... more Taiwan's Department of Health (DOH) promotes a standardized 2-year training program to raise the competence of newly certified nurses in the realms of patient care, nursing professionalism and communication skills as well as to ensure professional nurse training program quality. This study evaluated training program participants' self-perception of nursing competency. We used a cross-sectional approach and structured questionnaire to evaluate the nursing competency of 128 nurse trainees at a medical center. Questionnaires were filled out independently by participants and thus reflect participant self-assessments of questionnaire items. Descriptive and correlation analyses further explored data. Results showed: mean scores were 3.80 ± .60 for clinical technique; 3.78 ± .67 for administrative skill; and 3.21 ± .88 for educational and research skills . Nursing ability correlated significantly with age, seniority, nursing grade, and courses taken. The relationship between participant total score and program completion ratio formed a "V"-shaped distribution. The DOH training program was has a positive effect on nursing competency in nurse trainees. Results also provide valuable information and suggestions for revising the DOH's nurse training program in the future.
Spontaneous fracture is an issue of increasing concern in clinical care. However, this topic has ... more Spontaneous fracture is an issue of increasing concern in clinical care. However, this topic has received only limited attention in nursing research. Gaps in understanding related to spontaneous fractures may increase medical-legal risks faced by frontline care nurses, exacerbate nursing pressures, and serve as a disincentive to remain in the already understaffed nursing profession. This article reviews previous research on spontaneous fractures to determine the epidemiological causes of clinical spontaneous fracture and identify effective prevention strategies. We hope this paper may increase clinical practitioner and expert awareness of spontaneous fractures; help establish a screening mechanism to identify high risk spontaneous fracture patients; and help nurses develop and implement proactive prevention / treatment strategies to strengthen awareness of this topic among patients and their families.
Historically, positivism has been the dominant approach in the philosophy of science. In nursing,... more Historically, positivism has been the dominant approach in the philosophy of science. In nursing, most quantitative researchers tend to employ positivism as their epistemological underpinning, which could be why positivism has long been identified as the epistemology of quantitative research. It can be argued, however, that some of the procedures of qualitative research reflect the perspectives on which positivists insist. This article takes grounded theory and phenomenology as examples, in order to observe how positivism influences their methodologies, evidence obtained is then used to support the aruthors' arguments. The article, furthermore encourages beginning researchers to familiarize themselves with background knowledge of philosophy of social sciences, especially epistemologies and methodologies, in order to make clear the philosophical context in which their research is conducted.
The purpose of this article is to describe a nursing experience with a patient with schizophrenia... more The purpose of this article is to describe a nursing experience with a patient with schizophrenia who had antipsychotics-induced overweight. The authors assessed the patient's health condition and provided weight management to reduce her hallucinations as well as her body weight between May 1 and June 10, 2004. Three nursing problems had been identified as follows: disturbed sensory perception, imbalanced nutrition, and ineffective health maintenance. During the nursing process, the authors established a rapport relationship with the patient and her mother, educated them in skills for reducing hallucinations, and designed an individual body weight management program. After the interventions, the patient was able to positively face her illness, effectively use methods to reduce the impact of hallucinations, and successfully lose 5.5 kg. From this perspective, an individual body weight management program can be an effective intervention for nurses to care for this group of patients.
The purpose of this study is to describe fań, a culturally constructed expression of emotional an... more The purpose of this study is to describe fań, a culturally constructed expression of emotional and psychological discomfort, from the perspective of 34 suicidal patients in Taipei, Taiwan. An important finding from this ethnographic study is an idiom of emotional distress, fań, which is not expressed as related to a body part like in most previous research on expressions of psychological symptoms in Chinese cultures. This description will help health professionals better understand what fań means to Chinese patients and what methods they use to cope with it.
Sleep is a basic human need. A good night's sleep shapes our physical and mental health. Fema... more Sleep is a basic human need. A good night's sleep shapes our physical and mental health. Female nurses experience particularly complex sleep disturbance problems because of after working rotating shifts, as well as because of the effects of the female reproductive hormones. Both issues present a challenge to the understanding of female nurses' sleep. This paper summarizes the existing knowledge about sleep in women, including shift workers in relation to their reproductive status, and introduces practical sleep hygiene concepts and strategies for female nurses.
A year has passed since a major earthquake and tsunami hit northeastern Honshu, Japan in March 20... more A year has passed since a major earthquake and tsunami hit northeastern Honshu, Japan in March 2011. Amidst mourning for the tens of thousands of victims, survivors have just begun the difficult and urgent tasks of rebuilding. Many survivors suffer from post-traumatic stress disorder (PTSD). PTSD causes chronic, long-term suffering for patients and their families and inevitably burdens social and medical care systems. This article tries to integrate PTSD evidence-based treatment experiences into a practical and detailed nursing intervention protocol for PTSD. We also elicit the function and effect of "family-centered care." We hope that nursing professionals apply family-centered care principles to PTSD treatment and care approaches in order to promote PTSD patient resilience. Nurses can thus enhance PTSD care efficacy and improve the opportunity for PTSD patients to overcome their symptoms and recover their life.
Worldviews on evidence-based nursing / Sigma Theta Tau International, Honor Society of Nursing, 2014
Metabolic syndrome (MetS) is primarily attributed to an unhealthy lifestyle, which is a modifiabl... more Metabolic syndrome (MetS) is primarily attributed to an unhealthy lifestyle, which is a modifiable risk factor. Researchers have been exploring various strategies, including lifestyle-modification programs (LMPs), to prevent the progression of MetS. However, the effectiveness of LMPs on metabolic risks and patient-reported outcomes (PROs) among adults with MetS remains inconclusive. To evaluate the effectiveness of LMPs on the metabolic risks and PROs among adults with MetS. A systematic review of randomized controlled trials published from January 1985 to June 2014 was conducted. The review extracted LMP interventions that included outcomes on the metabolic risks and PROs (quality of life and any other psychological health indicators). The quality of the included studies was assessed using the Cochrane Collaboration criteria. Among the five trials included, the most commonly applied intervention components were diet plans, supervised exercise, health education, individual counselin...
An extensive body of literature advocating a &amp... more An extensive body of literature advocating a "patient-centered" approach to medical care has emerged over the past three decades. This approach is now a mainstream trend in healthcare. Despite its popularity, there remains little consensus regarding the content or definition of patient-centered care. Various quantitative and qualitative research studies have extracted core meanings from "doctor-patient relationship" perspectives and investigated the relationships of these meanings with patient satisfaction, compliance with health promoting behavior, and health status. Mead and Bower's review of the conceptual and empirical literature represented the first attempt to develop a model of the doctor-patient relationship that considered the multiple aspects embraced by the "patient-centered" approach. However, any interpretation of the "patient-centered" concept that fails to consider the perspective of nursing is likely incomplete, as patient-centered care is the essence of nursing. This paper reviewed the concept of "patient-centered care", conducted a systematic review of randomized control trials to explore the effectiveness of patient-centered care, and integrated nursing-related studies that focused on patient-centered care. Our search covered articles published through the end of February 2011 in the Cochrane Controlled Trials Register, JBI, MEDLINE, CINAHL, Pubmed, ProQuest, PsycInfo, and CEPS, with 13 relevant articles identified. The majority of trials addressed by these studies demonstrated a positive "patient-centered care" effect on self-care knowledge and skills but a limited/insignificant effect on disease improvement. The reviewed studies used traditional definitions of "patient-centered care" that were inconsistent with the concepts defined by Mead and Bower. Heterogeneities exist between reviewed studies and the lack of related research in Taiwan. We thus integrated outcome indicators related to "patient-centered care". This study may be referenced by nursing research and clinical care professionals responsible to improve and integrate medical care quality.
Spontaneous fracture is an issue of increasing concern in clinical care. However, this topic has ... more Spontaneous fracture is an issue of increasing concern in clinical care. However, this topic has received only limited attention in nursing research. Gaps in understanding related to spontaneous fractures may increase medical-legal risks faced by frontline care nurses, exacerbate nursing pressures, and serve as a disincentive to remain in the already understaffed nursing profession. This article reviews previous research on spontaneous fractures to determine the epidemiological causes of clinical spontaneous fracture and identify effective prevention strategies. We hope this paper may increase clinical practitioner and expert awareness of spontaneous fractures; help establish a screening mechanism to identify high risk spontaneous fracture patients; and help nurses develop and implement proactive prevention / treatment strategies to strengthen awareness of this topic among patients and their families.
Nursing is a distinct branch of science. Nursing research is not only key to developing professio... more Nursing is a distinct branch of science. Nursing research is not only key to developing professional knowledge and but also to promoting nursing as an independent discipline. This paper describes the development and outcomes of nursing research over the past 100 years and then explores the factors that have influenced the focus of nursing research in the past. Findings may be applied to future efforts to promote nursing research. The authors hope that nurses integrate the best research evidence, the best clinical judgment, and the expectations of patients in order to provide the best quality of nursing care through reflection and praxis in nursing research.
To investigate whether physical activity is a protective factor against metabolic syndrome in mid... more To investigate whether physical activity is a protective factor against metabolic syndrome in middle-aged and older women. Socio-demographic and lifestyle behaviour factors contribute to metabolic syndrome. To minimise the risk of metabolic syndrome, several global guidelines recommend increasing physical activity level. However, only limited research has investigated the relationship between physical activity levels and metabolic syndrome in middle-aged and older women after adjusting for socio-demographic and lifestyle behaviour factors. Cross-sectional design. A convenience sample of 326 middle-aged and older women was recruited. Metabolic syndrome was confirmed according to the National Cholesterol Education Program, Adult Treatment Panel III guidelines, and physical activity levels were measured by the International Physical Activity Questionnaire. The sample had a mean age of 60·9 years, and the prevalence of metabolic syndrome was 43·3%. Postmenopausal women and women with low socioeconomic status (low-education background, without personal income and currently unemployed) had a significantly higher risk of developing metabolic syndrome. After adjusting for significant socio-demographic and lifestyle behaviour factors, the women with moderate or high physical activity levels had a significantly lower (OR = 0·10; OR = 0·11, p < 0·001) risk of metabolic syndrome and a lower risk for each specific component of metabolic syndrome, including elevated fasting plasma glucose (OR = 0·29; OR = 0·26, p = 0·009), elevated blood pressure (OR = 0·18; OR = 0·32, p = 0·029), elevated triglycerides (OR = 0·41; OR = 0·15, p = 0·001), reduced high-density lipoprotein (OR = 0·28; OR = 0·27, p = 0·004) and central obesity (OR = 0·31; OR = 0·22, p = 0·027). After adjusting for socio-demographic and lifestyle behaviour factors, physical activity level was a significant protective factor against metabolic syndrome in middle-aged and older women. Higher physical activity levels (moderate or high physical activity level) reduced the risk of metabolic syndrome in middle-aged and older women. Appropriate strategies should be developed to encourage middle-aged and older women across different socio-demographic backgrounds to engage in moderate or high levels of physical activity to reduce the risk of metabolic syndrome.
In the ethnographic study on which this article is based, the authors investigate experiences aft... more In the ethnographic study on which this article is based, the authors investigate experiences after a suicide attempt from the perspective of patients and their family members in Taiwan. Thirty-four patients and 49 family members or colleagues participated in interviews from the point of patients' hospitalization to their return to the community. The postsuicide stigma suffered by patients and their families was based on such cultural themes as Suicide is bu-hsiao (non-filial piety), Suicide results in an inability to transmigrate the soul, and Suicide is inherited. Patients, family members, and colleagues cope with the stigma through explaining suicide as due to "bad luck" or "a kan-huo (hot energy) problem," or by insisting that it was "not a true suicide." These findings suggest that health professionals can move closer to patients and their families and suggest appropriate health care policy through understanding the patient's and the family's explanation of suicide experiences.
In this article we present the findings of a qualitative study exploring what suicide survivors i... more In this article we present the findings of a qualitative study exploring what suicide survivors in Taiwan experienced after a family member's suicide and how they adjusted to the perceived stigma. Fifteen suicide survivors participated in this study. We found that when a family member's suicide death occurred, survivors first kept a low profile when holding the funeral, and then tried to expel the dead person from their family. They also wished that their grief and painful, shameful feelings could be buried with the dead person. These findings suggest that health care professionals need to work more closely with suicide survivors through understanding the survivors' fear and pain from a sociocultural perspective, and to help them construct a new moral life.
The mental health of military personnel varies as a result of different cultural, political, and ... more The mental health of military personnel varies as a result of different cultural, political, and administrative factors. The purpose of this study was to evaluate the psychological morbidity and quality of life of military personnel in Taiwan. This cross-sectional study utilized the World Health Organization Quality of Life Instrument, brief version, Taiwan version, the General Health Questionnaire-12, Chinese version, and the Visual Analog Scale (VAS) in several military units. More than half of the subjects (55.3%) identified themselves as mentally unhealthy on the General Health Questionnaire-12, Chinese version; however, a higher percentage of officers perceived themselves as healthy (57.4%) than did noncommissioned officers (38.5%) or enlisted men (42.2%). Officers also had higher total quality of life (QOL) scores (83.98) than did enlisted men (79.67). Scores on the VAS also varied: officers: 72.5; noncommissioned officers: 67.7; and enlisted men: 66.3. The VAS and QOL were positively correlated with perceived mental health among these military personnel. Our subjects had higher rates of perceiving themselves as mentally unhealthy compared to the general population. Those of higher rank perceived themselves as having better mental health and QOL. Improving mental health could result in a better QOL in the military. The VAS may be a useful tool for the rapid screening of self-reported mental health, which may be suitable in cases of stressful missions, such as in disaster rescue; however, more studies are needed to determine the optimal cut-off point of this measurement tool.
This study presents the findings of a qualitative study exploring the experiences of undergraduat... more This study presents the findings of a qualitative study exploring the experiences of undergraduate nursing students imagining the possibility of their own death during a workshop on life-and-death issues. Didactic instruction in end-of-life care is a critical element of nursing education and for most health professions training in general. Properly implementing this often-overlooked educational process requires providing students with opportunities to reflect on death and dying along with guidance during nursing practice in coping with emotional reactions to caring for dying patients. An interpretive descriptive design was adopted. Data were gathered from the text of 20 students' reflective journals and workshop evaluations and researchers' field notes on observations during the workshop at a Taiwan university in August 2007. Students experienced a process of dying, death and rebirth. Students not only expressed emotional responses that included surprise, reluctance to let go and gratitude but also realised the importance of cherishing the present, committing to the nursing profession and valuing their own lives. Students can learn their fear of death and possible emotional reactions towards dying patients through self-reflection during a workshop on life-and-death issues. The foundation for facilitating students' self-awareness is a safe environment for them to gain experiential knowledge of the dying process and end-of-life care. Experiential education not only helps students grow personally but also increases their motivation to learn. Students' ability to recognise and manage their own emotional reactions towards death and dying patients should be included as part of end-of-life education. A workshop on life-and-death issues can help students discover that they are not alone and that they can support each other and learn how to manage their own emotions.
Taiwan's Department of Health (DO... more Taiwan's Department of Health (DOH) promotes a standardized 2-year training program to raise the competence of newly certified nurses in the realms of patient care, nursing professionalism and communication skills as well as to ensure professional nurse training program quality. This study evaluated training program participants' self-perception of nursing competency. We used a cross-sectional approach and structured questionnaire to evaluate the nursing competency of 128 nurse trainees at a medical center. Questionnaires were filled out independently by participants and thus reflect participant self-assessments of questionnaire items. Descriptive and correlation analyses further explored data. Results showed: mean scores were 3.80 ± .60 for clinical technique; 3.78 ± .67 for administrative skill; and 3.21 ± .88 for educational and research skills . Nursing ability correlated significantly with age, seniority, nursing grade, and courses taken. The relationship between participant total score and program completion ratio formed a "V"-shaped distribution. The DOH training program was has a positive effect on nursing competency in nurse trainees. Results also provide valuable information and suggestions for revising the DOH's nurse training program in the future.
Spontaneous fracture is an issue of increasing concern in clinical care. However, this topic has ... more Spontaneous fracture is an issue of increasing concern in clinical care. However, this topic has received only limited attention in nursing research. Gaps in understanding related to spontaneous fractures may increase medical-legal risks faced by frontline care nurses, exacerbate nursing pressures, and serve as a disincentive to remain in the already understaffed nursing profession. This article reviews previous research on spontaneous fractures to determine the epidemiological causes of clinical spontaneous fracture and identify effective prevention strategies. We hope this paper may increase clinical practitioner and expert awareness of spontaneous fractures; help establish a screening mechanism to identify high risk spontaneous fracture patients; and help nurses develop and implement proactive prevention / treatment strategies to strengthen awareness of this topic among patients and their families.
Historically, positivism has been the dominant approach in the philosophy of science. In nursing,... more Historically, positivism has been the dominant approach in the philosophy of science. In nursing, most quantitative researchers tend to employ positivism as their epistemological underpinning, which could be why positivism has long been identified as the epistemology of quantitative research. It can be argued, however, that some of the procedures of qualitative research reflect the perspectives on which positivists insist. This article takes grounded theory and phenomenology as examples, in order to observe how positivism influences their methodologies, evidence obtained is then used to support the aruthors' arguments. The article, furthermore encourages beginning researchers to familiarize themselves with background knowledge of philosophy of social sciences, especially epistemologies and methodologies, in order to make clear the philosophical context in which their research is conducted.
The purpose of this article is to describe a nursing experience with a patient with schizophrenia... more The purpose of this article is to describe a nursing experience with a patient with schizophrenia who had antipsychotics-induced overweight. The authors assessed the patient's health condition and provided weight management to reduce her hallucinations as well as her body weight between May 1 and June 10, 2004. Three nursing problems had been identified as follows: disturbed sensory perception, imbalanced nutrition, and ineffective health maintenance. During the nursing process, the authors established a rapport relationship with the patient and her mother, educated them in skills for reducing hallucinations, and designed an individual body weight management program. After the interventions, the patient was able to positively face her illness, effectively use methods to reduce the impact of hallucinations, and successfully lose 5.5 kg. From this perspective, an individual body weight management program can be an effective intervention for nurses to care for this group of patients.
The purpose of this study is to describe fań, a culturally constructed expression of emotional an... more The purpose of this study is to describe fań, a culturally constructed expression of emotional and psychological discomfort, from the perspective of 34 suicidal patients in Taipei, Taiwan. An important finding from this ethnographic study is an idiom of emotional distress, fań, which is not expressed as related to a body part like in most previous research on expressions of psychological symptoms in Chinese cultures. This description will help health professionals better understand what fań means to Chinese patients and what methods they use to cope with it.
Sleep is a basic human need. A good night's sleep shapes our physical and mental health. Fema... more Sleep is a basic human need. A good night's sleep shapes our physical and mental health. Female nurses experience particularly complex sleep disturbance problems because of after working rotating shifts, as well as because of the effects of the female reproductive hormones. Both issues present a challenge to the understanding of female nurses' sleep. This paper summarizes the existing knowledge about sleep in women, including shift workers in relation to their reproductive status, and introduces practical sleep hygiene concepts and strategies for female nurses.
A year has passed since a major earthquake and tsunami hit northeastern Honshu, Japan in March 20... more A year has passed since a major earthquake and tsunami hit northeastern Honshu, Japan in March 2011. Amidst mourning for the tens of thousands of victims, survivors have just begun the difficult and urgent tasks of rebuilding. Many survivors suffer from post-traumatic stress disorder (PTSD). PTSD causes chronic, long-term suffering for patients and their families and inevitably burdens social and medical care systems. This article tries to integrate PTSD evidence-based treatment experiences into a practical and detailed nursing intervention protocol for PTSD. We also elicit the function and effect of "family-centered care." We hope that nursing professionals apply family-centered care principles to PTSD treatment and care approaches in order to promote PTSD patient resilience. Nurses can thus enhance PTSD care efficacy and improve the opportunity for PTSD patients to overcome their symptoms and recover their life.
Worldviews on evidence-based nursing / Sigma Theta Tau International, Honor Society of Nursing, 2014
Metabolic syndrome (MetS) is primarily attributed to an unhealthy lifestyle, which is a modifiabl... more Metabolic syndrome (MetS) is primarily attributed to an unhealthy lifestyle, which is a modifiable risk factor. Researchers have been exploring various strategies, including lifestyle-modification programs (LMPs), to prevent the progression of MetS. However, the effectiveness of LMPs on metabolic risks and patient-reported outcomes (PROs) among adults with MetS remains inconclusive. To evaluate the effectiveness of LMPs on the metabolic risks and PROs among adults with MetS. A systematic review of randomized controlled trials published from January 1985 to June 2014 was conducted. The review extracted LMP interventions that included outcomes on the metabolic risks and PROs (quality of life and any other psychological health indicators). The quality of the included studies was assessed using the Cochrane Collaboration criteria. Among the five trials included, the most commonly applied intervention components were diet plans, supervised exercise, health education, individual counselin...
An extensive body of literature advocating a &amp... more An extensive body of literature advocating a "patient-centered" approach to medical care has emerged over the past three decades. This approach is now a mainstream trend in healthcare. Despite its popularity, there remains little consensus regarding the content or definition of patient-centered care. Various quantitative and qualitative research studies have extracted core meanings from "doctor-patient relationship" perspectives and investigated the relationships of these meanings with patient satisfaction, compliance with health promoting behavior, and health status. Mead and Bower's review of the conceptual and empirical literature represented the first attempt to develop a model of the doctor-patient relationship that considered the multiple aspects embraced by the "patient-centered" approach. However, any interpretation of the "patient-centered" concept that fails to consider the perspective of nursing is likely incomplete, as patient-centered care is the essence of nursing. This paper reviewed the concept of "patient-centered care", conducted a systematic review of randomized control trials to explore the effectiveness of patient-centered care, and integrated nursing-related studies that focused on patient-centered care. Our search covered articles published through the end of February 2011 in the Cochrane Controlled Trials Register, JBI, MEDLINE, CINAHL, Pubmed, ProQuest, PsycInfo, and CEPS, with 13 relevant articles identified. The majority of trials addressed by these studies demonstrated a positive "patient-centered care" effect on self-care knowledge and skills but a limited/insignificant effect on disease improvement. The reviewed studies used traditional definitions of "patient-centered care" that were inconsistent with the concepts defined by Mead and Bower. Heterogeneities exist between reviewed studies and the lack of related research in Taiwan. We thus integrated outcome indicators related to "patient-centered care". This study may be referenced by nursing research and clinical care professionals responsible to improve and integrate medical care quality.
Spontaneous fracture is an issue of increasing concern in clinical care. However, this topic has ... more Spontaneous fracture is an issue of increasing concern in clinical care. However, this topic has received only limited attention in nursing research. Gaps in understanding related to spontaneous fractures may increase medical-legal risks faced by frontline care nurses, exacerbate nursing pressures, and serve as a disincentive to remain in the already understaffed nursing profession. This article reviews previous research on spontaneous fractures to determine the epidemiological causes of clinical spontaneous fracture and identify effective prevention strategies. We hope this paper may increase clinical practitioner and expert awareness of spontaneous fractures; help establish a screening mechanism to identify high risk spontaneous fracture patients; and help nurses develop and implement proactive prevention / treatment strategies to strengthen awareness of this topic among patients and their families.
Nursing is a distinct branch of science. Nursing research is not only key to developing professio... more Nursing is a distinct branch of science. Nursing research is not only key to developing professional knowledge and but also to promoting nursing as an independent discipline. This paper describes the development and outcomes of nursing research over the past 100 years and then explores the factors that have influenced the focus of nursing research in the past. Findings may be applied to future efforts to promote nursing research. The authors hope that nurses integrate the best research evidence, the best clinical judgment, and the expectations of patients in order to provide the best quality of nursing care through reflection and praxis in nursing research.
To investigate whether physical activity is a protective factor against metabolic syndrome in mid... more To investigate whether physical activity is a protective factor against metabolic syndrome in middle-aged and older women. Socio-demographic and lifestyle behaviour factors contribute to metabolic syndrome. To minimise the risk of metabolic syndrome, several global guidelines recommend increasing physical activity level. However, only limited research has investigated the relationship between physical activity levels and metabolic syndrome in middle-aged and older women after adjusting for socio-demographic and lifestyle behaviour factors. Cross-sectional design. A convenience sample of 326 middle-aged and older women was recruited. Metabolic syndrome was confirmed according to the National Cholesterol Education Program, Adult Treatment Panel III guidelines, and physical activity levels were measured by the International Physical Activity Questionnaire. The sample had a mean age of 60·9 years, and the prevalence of metabolic syndrome was 43·3%. Postmenopausal women and women with low socioeconomic status (low-education background, without personal income and currently unemployed) had a significantly higher risk of developing metabolic syndrome. After adjusting for significant socio-demographic and lifestyle behaviour factors, the women with moderate or high physical activity levels had a significantly lower (OR = 0·10; OR = 0·11, p < 0·001) risk of metabolic syndrome and a lower risk for each specific component of metabolic syndrome, including elevated fasting plasma glucose (OR = 0·29; OR = 0·26, p = 0·009), elevated blood pressure (OR = 0·18; OR = 0·32, p = 0·029), elevated triglycerides (OR = 0·41; OR = 0·15, p = 0·001), reduced high-density lipoprotein (OR = 0·28; OR = 0·27, p = 0·004) and central obesity (OR = 0·31; OR = 0·22, p = 0·027). After adjusting for socio-demographic and lifestyle behaviour factors, physical activity level was a significant protective factor against metabolic syndrome in middle-aged and older women. Higher physical activity levels (moderate or high physical activity level) reduced the risk of metabolic syndrome in middle-aged and older women. Appropriate strategies should be developed to encourage middle-aged and older women across different socio-demographic backgrounds to engage in moderate or high levels of physical activity to reduce the risk of metabolic syndrome.
In the ethnographic study on which this article is based, the authors investigate experiences aft... more In the ethnographic study on which this article is based, the authors investigate experiences after a suicide attempt from the perspective of patients and their family members in Taiwan. Thirty-four patients and 49 family members or colleagues participated in interviews from the point of patients' hospitalization to their return to the community. The postsuicide stigma suffered by patients and their families was based on such cultural themes as Suicide is bu-hsiao (non-filial piety), Suicide results in an inability to transmigrate the soul, and Suicide is inherited. Patients, family members, and colleagues cope with the stigma through explaining suicide as due to "bad luck" or "a kan-huo (hot energy) problem," or by insisting that it was "not a true suicide." These findings suggest that health professionals can move closer to patients and their families and suggest appropriate health care policy through understanding the patient's and the family's explanation of suicide experiences.
In this article we present the findings of a qualitative study exploring what suicide survivors i... more In this article we present the findings of a qualitative study exploring what suicide survivors in Taiwan experienced after a family member's suicide and how they adjusted to the perceived stigma. Fifteen suicide survivors participated in this study. We found that when a family member's suicide death occurred, survivors first kept a low profile when holding the funeral, and then tried to expel the dead person from their family. They also wished that their grief and painful, shameful feelings could be buried with the dead person. These findings suggest that health care professionals need to work more closely with suicide survivors through understanding the survivors' fear and pain from a sociocultural perspective, and to help them construct a new moral life.
The mental health of military personnel varies as a result of different cultural, political, and ... more The mental health of military personnel varies as a result of different cultural, political, and administrative factors. The purpose of this study was to evaluate the psychological morbidity and quality of life of military personnel in Taiwan. This cross-sectional study utilized the World Health Organization Quality of Life Instrument, brief version, Taiwan version, the General Health Questionnaire-12, Chinese version, and the Visual Analog Scale (VAS) in several military units. More than half of the subjects (55.3%) identified themselves as mentally unhealthy on the General Health Questionnaire-12, Chinese version; however, a higher percentage of officers perceived themselves as healthy (57.4%) than did noncommissioned officers (38.5%) or enlisted men (42.2%). Officers also had higher total quality of life (QOL) scores (83.98) than did enlisted men (79.67). Scores on the VAS also varied: officers: 72.5; noncommissioned officers: 67.7; and enlisted men: 66.3. The VAS and QOL were positively correlated with perceived mental health among these military personnel. Our subjects had higher rates of perceiving themselves as mentally unhealthy compared to the general population. Those of higher rank perceived themselves as having better mental health and QOL. Improving mental health could result in a better QOL in the military. The VAS may be a useful tool for the rapid screening of self-reported mental health, which may be suitable in cases of stressful missions, such as in disaster rescue; however, more studies are needed to determine the optimal cut-off point of this measurement tool.
This study presents the findings of a qualitative study exploring the experiences of undergraduat... more This study presents the findings of a qualitative study exploring the experiences of undergraduate nursing students imagining the possibility of their own death during a workshop on life-and-death issues. Didactic instruction in end-of-life care is a critical element of nursing education and for most health professions training in general. Properly implementing this often-overlooked educational process requires providing students with opportunities to reflect on death and dying along with guidance during nursing practice in coping with emotional reactions to caring for dying patients. An interpretive descriptive design was adopted. Data were gathered from the text of 20 students' reflective journals and workshop evaluations and researchers' field notes on observations during the workshop at a Taiwan university in August 2007. Students experienced a process of dying, death and rebirth. Students not only expressed emotional responses that included surprise, reluctance to let go and gratitude but also realised the importance of cherishing the present, committing to the nursing profession and valuing their own lives. Students can learn their fear of death and possible emotional reactions towards dying patients through self-reflection during a workshop on life-and-death issues. The foundation for facilitating students' self-awareness is a safe environment for them to gain experiential knowledge of the dying process and end-of-life care. Experiential education not only helps students grow personally but also increases their motivation to learn. Students' ability to recognise and manage their own emotional reactions towards death and dying patients should be included as part of end-of-life education. A workshop on life-and-death issues can help students discover that they are not alone and that they can support each other and learn how to manage their own emotions.
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Papers by Wen-chii Tzeng