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Accessible Summary: What is known on the subject?: Individuals diagnosed with substance use disorders may perceive stigma and suffer from mental health problems.Perceived stigma is related to poor mental health among individuals diagnosed with substance use disorders.The social support deterioration deterrence model proposes that stressors (e.g. perceived stigma) negatively affect mental health via reduced perceived social support. To the best of the present authors' knowledge, the model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. What the paper adds to existing knowledge?: The paper used structural equation modelling to show that the social support deterioration deterrence model could explain the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders.Perceived support from family and perceived support from friends are mediators in the association between perceived stigma and depression among individuals diagnosed with substance use disorders. What are the implications for practice?: Psychosocial interventions to increase perceived support from family and friends would be helpful in addressing perceived stigma effects on mental health. Introduction: Although the relationship between perceived stigma and mental health outcomes is documented in the existing literature, very few studies have investigated the mechanism linking perceived stigma and mental health outcomes among individuals diagnosed with substance use disorders. To the best of the present authors' knowledge, the social support deterioration deterrence model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. Aim/Question: Guided by the social support deterioration deterrence model, the present study investigated the mediating role of perceived support from three types of social network members (i.e. significant others, family members, and friends) in the association between perceived stigma and depression in individuals diagnosed with substance use disorders. Method: The study employed a cross‐sectional survey design comprising 300 participants diagnosed with substance use disorders in Taiwan. Results: Results of a structural equation modelling analysis indicated that perceived stigma was significantly associated with depression. The relationship between perceived stigma and depression was partially mediated by perceived family support and perceived friend support. Discussion: Consistent with the prediction of the social support deterioration deterrence model, the negative effect of perceived stigma on depression for individuals diagnosed with substance use disorders is through the mediating effect of social support. Implications for practices: Based on the present study's results, psychosocial interventions to increase perceived support from family and friends would be helpful in addressing negative effects of perceived stigma on mental health among individuals diagnosed with substance use disorders. [ABSTRACT FROM AUTHOR]

Purpose During the survival period of breast cancer patients, an understanding of and ability to implement health knowledge may be important for survivors' physical and mental quality of life (QOL). This study aims to investigate the health literacy and predictors of QOL for survivors of breast cancer. Method: A cross‐sectional design was used, and convenience sampling was performed. Eighty‐six survivors with breast cancer were recruited from a general hospital in northern Taiwan from February to August 2017. Taiwan's health literacy scale and SF‐12 questionnaire were used for data collection. Results: The average health literacy score was 3.28. Education level and breast cancer stage were significant factors for the health literacy of survivors with breast cancer. Age, body mass index and health literacy were predictors of physical health‐related QOL. Health literacy also was a predictor of mental health‐related QOL. Conclusion: The results provide the factors associated health literacy as well as health‐related QOL. Nurses should understand the health literacy among survivors with breast cancer and improve health literacy to optimize their quality of life. SUMMARY STATEMENT: What is already known about this topic? Individuals with lower health literacy generally had fewer communications with medical personnel regarding their own risk of disease.Individuals with higher health literacy tend to have better social‐related QOL. What this paper adds? Survivors with early‐stage breast cancer tended to be younger (aged 60 years or less) had normal body mass index, continued working, had no other illnesses and better physical health.Survivors with normal body mass index who had not received chemotherapy had better mental health.Health literacy was the main predictor and accounted for 20% of the variance in physical health and for 18.8% of the variance in mental health. Implications of this paper: Nurses should understand the importance of health literacy, which is a key factor to improve QOL for survivors with breast cancer.Nurses should develop individualized care plans for survivors based on different levels of health literacy to improve the efficiency of the nurse–patient dialogue. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Suicide is a global mental health issue. Taking care of suicidal individuals is a substantial challenge. Most studies emphasize the suicidal individual. Few studies have emphasized the family caregivers of suicidal individuals., No study has explored the relationship between family caregivers' caring stress with suicidal attitudes and suicide care ability., What this paper adds to existing knowledge? The main results indicated that the older family caregivers tended to have a more negative attitude towards suicidal individuals. Female family caregivers' stress was higher than that of male family caregivers., A mild level of caring stress would help family caregivers have a more positive attitude towards suicidal individuals. Furthermore, a positive attitude would help family caregivers improve their caring ability., What are the implications for practice? Mental health nurses could help family caregivers, especially female family caregivers, reduce their holistic caring burden by looking for support resources and enhancing their coping strategies., Mental health nurses could help family caregivers promote positive attitudes towards suicidal relatives by understanding suicidal individuals' suffering., Abstract Introduction Suicide is a global mental health issue. Family caregivers play a key role in preventing suicide attempts. Aims The aim of this study was to examine the relationship among stress due to the family caregiver's role, suicidal attitude of the family caregiver and suicide care ability among family caregivers. Additionally, instruments of caring stress, attitudes towards suicidal relatives and caring abilities used in the study were tested to measure construct validity. Methods A cross-sectional correlational study was conducted with 164 family caregivers of people who are suicidal. The following three questionnaires were used: the Caring Stress Scale, the Suicidal Attitudes Scale and the Suicidal Caring Ability Scale. Structural equation modelling was performed using SPSS AMOS 19.0 to examine the path relationships among variables. Results Bivariate analyses showed that age was negatively correlated with suicidal attitude. In the final path model, caring stress had a positive effect on suicidal attitudes. Suicidal attitude and suicide care ability were highly positively correlated. Gender had a direct effect on caring stress, which indicated that female family caregivers experienced more stress from their role. Implications for practice: Mental health nurses could help family caregivers become aware of the emotional pain that suicidal people experience and then promote their positive attitudes towards their suicidal relatives. Furthermore, family caregivers could increase their ability to care for their suicidal relatives, which could reduce the numbers of suicides. [ABSTRACT FROM AUTHOR]

Aim: The purposes of this study were to describe the degree of knowledge and explore the factors associated with knowledge of infertility among women of childbearing age with breast cancer. Methods: In this cross‐sectional study, we recruited women of childbearing age with a diagnosis of breast cancer who had completed chemotherapy at a hospital in Taipei from 2015 through 2016. Face‐to‐face interviews were completed with 201 (62%) of 324 eligible women, asking about sociodemographic variables, disease and treatment characteristics, fertility intention, and infertility‐related knowledge. Results: The result showed one in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy. The mean score of infertility knowledge among participants was low, especially for general knowledge. Women with higher levels of education had better knowledge scores. Fertility intention score, especially for the domain of the pregnant risk, was negatively associated with infertility knowledge score. Conclusion: Women with breast cancer lacked knowledge about infertility and underestimated the possibility of infertility. We suggest future patient education on infertility after cancer treatment and about reproductive technology in oncologic practice before treatment begins. SUMMARY STATEMENT: What is known about this topic? Women with cancer diagnosed during the reproductive age are interested in a subsequent pregnancy.Less than half of childbearing‐age women with cancer have a comprehensive discussion about the potential impact of cancer therapy on fertility with the oncology physician.Reproductive‐age women with breast cancer have gaps in their knowledge of fertility planning as breast cancer survivors. What this paper adds? One in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy.Most women with breast cancer lack sufficient general and cancer‐specific knowledge about infertility.Factors associated with knowledge of infertility are fertility intention and education level. The implications of this paper: Results offer oncological nurses an understanding of fertility needs and infertility‐related knowledge in childbearing‐age women with breast cancer.Clinical nurses should continue to assess fertility willingness and knowledge of infertility in women with cancer both before and after cancer treatments.Comprehensive education about fertility and infertility in Taiwan is suggested. [ABSTRACT FROM AUTHOR]

Background: Low physical activity is common in systemic lupus erythematosus populations. Aim: To evaluate the effect of physical activity counselling on physical activity and the association between physical activity changes and changes in fatigue, quality of sleep, and quality of life in women with systemic lupus erythematosus. Methods: A randomized, controlled, single‐blind trial was conducted from March 2015 to August 2016. Seventy‐six women with systemic lupus erythematosus were randomly assigned to the intervention or control groups. The intervention group received three sessions of physical activity counselling at 1, 4, and 8 weeks and three telephone follow‐ups over 13 weeks. Outcome measures, which include daily steps, fatigue, quality of sleep, and the quality of life, were collected at baseline and 8 and 12 weeks. Results: The study showed that daily steps, quality of sleep, and vitality in the intervention group were significantly improved compared with those in the control group at weeks 8 and 12. Mental health was significantly improved only at week 8 in the counselling group. A positive correlation between physical activity changes and changes in vitality and mental health was observed. Conclusions: Physical activity counselling can improve physical activity. As physical activity increases, systemic lupus erythematosus women feel more energetic and happier. SUMMARY STATEMENT: What is already known about this topic? Patients with systemic lupus erythematosus (SLE) have inactive lifestyles, and few of them exercise regularly.Patients with SLE have poor aerobic fitness and muscle strength.Fatigue, poor sleep, and low quality of life are common in patients with SLE. What this paper adds? The five A's physical activity counselling model is feasible and can enhance SLE patients' physical activity levels.Vitality and mental health improvement are associated with an increase in physical activity. The implications of this paper: Health care professionals could provide physical activity counselling to SLE patients during every clinical visit.Health care professionals could encourage patients with SLE to use a pedometer as a monitor to record their daily steps. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an exploration of the effects of self-efficacy and different dimensions of self-management on quality of life among kidney transplant recipients. Background. Self-efficacy is an important factor influencing self-management. Patients with higher self-efficacy have better self-management and experience better quality of life. Self-efficacy influences the long-term medication-taking behaviour of kidney transplant recipients. Method. A longitudinal, correlational design was used. Data were collected during 2005–2006 with 150 adult kidney transplant recipients on self-efficacy, self-management and quality of life using a self-efficacy scale, self-management scale and the Medical Outcomes Scale SF-36 (Chinese), respectively. Relationships among variables were analysed by path analysis. Results. Participants with higher self-efficacy scored significantly higher on the problem-solving ( β = 0·51), patient–provider partnership ( β = 0·44) and self-care behaviour ( β = 0·55) dimensions of self-management. Self-efficacy directly influenced self-care behaviour and indirectly affected the mental health component of quality of life (total effect = 0·14). Problem-solving and partnership did not statistically significantly affect quality of life. Neither self-efficacy nor self-management had any effect on the physical health component of quality of life. Conclusion. Transplant care teams should incorporate strategies that enhance self-efficacy, as proposed by social cognitive theory, into their care programmes for kidney transplant recipients. Interventions to maintain and improve patients’ self-care behaviour should continue to be emphasized and facilitated. Support to enhance patients’ problem-solving skills and the partnership of patients with health professionals is needed. [ABSTRACT FROM AUTHOR]

Aim and objectives: The study aimed to investigate the associations of suicide risk, self‐efficacy and mental health help‐seeking among the lesbian, gay, bisexual and transgender (LGBT). Background: The LGBT individuals were found to have higher risk of suicide. However, mental health promotion and suicide prevention strategies were lacking in this population. Design: A cross‐sectional survey with two‐group comparison. Methods: The LGBT group was recruited through snowballing method, which was then age‐matched with the comparison group as the reference. The questionnaire contained demographics, self‐rated health, suicide risk assessment and help‐seeking indicators including formal (e.g. medical or psychiatric services) and informal (e.g. family or friends) help sought. Chi‐square tests, t‐tests, two‐way ANOVA and multivariable regression were performed to test the differences between two groups. The methods followed STROBE criteria. Results: The LGBT group had a significantly higher prevalence of lifetime/recent suicide ideation, prior suicide attempts and mental distress or depressive symptoms. Their self‐rated health and health‐related self‐efficacy were poorer than those of the comparison group and were associated with increased suicide risk levels. Among the 27.1% of LGBT who intended to seek help for depression, one in five visited psychiatric services. The LGBT were 2–4 times more likely than the comparison group to disclose their distress or seek informal help. However, psychiatric and medical service contacts were relatively low for suicide high‐risk individuals in the LGBT group. Conclusions: The LGBT individuals had a lower level of self‐efficacy and higher suicidal risks than the general public. Healthcare professionals and the public should be aware of their informal help‐seeking signals such as disclosure of suicide ideation to friends/relatives and connect them to proper mental health resources for further assessment. Relevance to clinical practice: The LGBT with suicide risks require early detection and proper referrals by first‐line nurses to promote suicide prevention in this population. [ABSTRACT FROM AUTHOR]

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Aim: To understand the self‐care coping process among chronic heart failure patients. Background: Previous studies have been carried out to understand the experience and the challenges of living with chronic heart failure. However, the coping processes that patients use to overcome self‐care challenges are less understood. Design: A qualitative design with qualitative content analysis of data was employed. Methods: Purposive sampling was conducted to recruit inpatients with chronic heart failure between March 1, 2014–March 1, 2015, in a teaching hospital in Taiwan. Semi‐structured interviews (N = 27) were completed, and a content analysis was performed using an inductive method to explore the self‐care coping processes in patients with chronic heart failure. Results: The findings were categorised into three themes: (a) responding to chronic heart failure self‐care (dealing with negative emotions, accepting reality and struggling between a self‐care regime and self preference), (b) finding ways to live with chronic heart failure (enhancing understanding and knowledge about chronic heart failure, maintaining outer and inner self, engaging positively/negatively with others and relying on religious thoughts and seeking consolation) and (c) reinterpreting chronic heart failure and performing meaning‐oriented coping (re‐evaluating the meaning of life, assigning a new perspective for chronic heart failure and discovering a deeper meaning behind it). Conclusion: Self‐appearance concerns should be given more attention by healthcare professionals. Meaning‐oriented coping was found to be helpful to cope with the challenges of chronic heart failure. Thus, there is a need to develop interventions associated with meaning‐oriented coping to enhance coping strategies for chronic heart failure patients. Relevance to clinical practice: It is suggested for healthcare professionals to understand an individual's coping process and support people with chronic heart failure who struggle with self‐care coping. Furthermore, specific interventions including meaning‐oriented interventions might benefit people with chronic heart failure to cope more successfully. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the health needs of older Aboriginal people, using a multidimensional instrument. The gender differences related to their health needs were also addressed. Background Health status and life expectancy between Aborigines and non-Aborigines have been shown to differ. The investigation of the health needs of Aboriginal people is however scarce, particularly among the older adult population. There is a need to address unmet health needs and improve information on the health needs assessment of the older Aboriginal population. Design A cross-sectional design was used. Methods Aboriginal people aged 65 and over were randomly sampled to take part in the present study. A multidimensional instrument consisting of eight domains and three cross-domain categories was used to assess their health needs. Results A group of older Aboriginal people was recruited ( n = 90, mean age = 73·5). The top three identified needs were 'mental health and well-being', 'staying healthy' and 'social participation'. The female participants had statistically significant higher scores for the 'mental health and well-being', 'getting around' domains and in the 'risk of falls' than the male ones. A regression model demonstrated that the health need of 'looking after oneself' was associated with all cross-domain categories of health need, which are 'independence', 'risk of breakdown in care' and 'risk of falls'. Conclusions The present study has revealed major health needs among older Aboriginal people and found that older female Aborigines have more health needs than older male Aborigines. Further study to identify effective approaches to address these needs among this group is warranted. Relevance to clinical practice The findings can be used to identify effective approaches to addressing health needs among older Aboriginal people with a consideration of gender. Only then can resources be allocated and prioritised in a culturally sensitive and gender-specific manner nationally and globally. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate Taiwanese women's mental health trajectories from the third trimester of pregnancy to four weeks postpartum and the correlations of these trajectories with perceived social support and demographic characteristics. Background Previous studies have reported differences between prenatal and postpartum mental health status. Design A repeated design study was conducted in a medical hospital in Southern Taiwan. Methods One-hundred and ninety-four Taiwanese women completed the Chinese Health Questionnaire and Social Support Scale at the 36th prenatal week and first and fourth week postpartum. Results Three linear mental health trajectories for perinatal women were identified. Consistently poor perinatal mental health was reported by 16·0% of the participants. Less social support was associated with lower prenatal mental health scores. Younger age was a risk factor for consistently poor perinatal health. Vaginal delivery was associated with improved mental health after childbirth. Conclusions Mental health was worse in the third trimester of pregnancy than postpartum. Less social support was associated with lower prenatal mental health scores, and this association was similarly distributed between women with consistently poor and improved mental health after birth. Relevance to clinical practice Health care providers should assess women's mental health status and provide timely interventions during the perinatal period. Social support should be provided for pregnant women, especially younger women or those with lower perceived social support. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore sleep quality in infertile women and examine the factors that contribute to sleep disturbances during intrauterine insemination treatment. Background Sleep disturbance is an important factor of human health and well-being. Sleep disturbances tend to occur among infertile women during intrauterine insemination treatment. Although many studies have focused on the high percentage of somatic symptoms and psychological distress in infertile women associated with their treatment, few studies have investigated factors linked to their sleep disturbances. Design A cross-sectional study. Methods The study was conducted during the period of September 2010- January 2011 in a teaching hospital in Taiwan. Infertile women ( n = 117) who received assisted reproduction with intrauterine insemination treatment completed a questionnaire. Demographic data, somatic symptoms, psychological distress and perceived sleep quality were collected. Results More than one-third (35%) of the infertile women reported having sleep disturbances. Their nausea symptoms and psychological distress were risk factors that contributed to sleep disturbance. Conclusions The variables of nausea and psychological distress significantly explained 30% of the sleep disturbances in the infertile women. The evaluation of nausea symptoms and/or psychological distress among infertile women is an important area of future research; such research should aim to identify the best compromise between infertility treatment and sleep quality. Relevance to clinical practice Clinical obstetrics and gynaecology nurses should develop strategies to help infertile women reduce their nausea symptoms and psychological distress during intrauterine insemination treatment to promote healthy sleep. [ABSTRACT FROM AUTHOR]

Aim To develop a theory to guide the recovery process of a recent suicide attempt. Background Suicide is one of the 10 leading causes of death in many countries. Many nations have set targets to reduce the high incidence of suicide by aiming to prevent people from taking their own lives and also providing care to promote the healing of those who attempt suicide. Design A qualitative grounded theory approach was used. Methods Data were collected in 2011-2012 in a Taiwanese hospital until data saturation occurred. Twenty participants were interviewed, comprising patients who recovered from suicide attempts ( N = 14) and their caregivers ( N = 6). Data were analysed using open, axial, and selective coding and using the constant comparison technique. Findings A substantive theory was formulated to guide the recovery process of people who have recently attempted suicide. The core category that emerged from the data collected was 'Striving to accept the value of self-in-existence'. Other key categories linked to and embraced in this core category were: becoming flexible and open-minded, re-building a positive sense of self, and endeavouring to live a peaceful and contented life. Conclusion Nurses could use this theory as a theoretical framework to guide people who are recovering from a suicide attempt by affording them the opportunity to grow and heal, and facilitating the re-building a positive sense of self, acknowledging the uncertainties of life, and inspiring hope. [ABSTRACT FROM AUTHOR]

Aim. To evaluate the effectiveness of self-management intervention for people with diabetes mellitus. Background. Enhancing self-efficacy and improving health quality of life for persons with diabetes are ongoing challenges for health care providers. There currently is a need to develop and test the effects of a self-management programme. Design. A quasi-experimental design. Method. The study was carried out in the outpatient clinic of a municipal hospital in Taipei. Patients aged 30 and over with type 2 diabetes and an oral medication regimen were recruited. One hundred and forty-five participants completed the six-month post-treatment assessments (72 in the intervention group and 73 in the control group). Both control and intervention groups received a standard diabetic educational programme. The self-management intervention is to improve psychosocial skills or addressing attitudes and beliefs specific to diabetes or the regimen behaviours. The intervention group received the following additional interventions: (1) a diabetic booklet (2) DVD viewing (3) four counselling sessions (4) and a telephone follow-up. The main outcome measures were Short Form 12 for health-related quality of life, the Medical Outcomes Study Social Support scale and the Center for Epidemiology Studies Short Depression Scale. Results. The scores for social support were significantly increased in the intervention group at Time 2 and Time 3 (three and six months from commencement of the intervention) compared with those of the control group ( p < 0·01), whereas health-related quality of life and depression were not significantly different. Conclusions. The diabetic self-management intervention programme improved social support for participants, but future studies are needed. Replication of this study in various settings, with other populations, or with additional outcome measures may result in different findings. Relevance to clinical practice. Self-management programmes should be held regularly and evaluated in clinical practices, especially in developing countries. Providing practical screening tools and conducting psychological research on diabetes drive policy and health care system change. [ABSTRACT FROM AUTHOR]