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Aims: To examine the level of decision difficulties of long‐term‐care facility (LTCF) nurses when transferring residents to the emergency department (ED) and associated influencing factors. Design: A cross‐sectional nationwide study. Methods: The LTCFs were selected through random stratified sampling across the whole Taiwan during February 2018 to January 2019. LTCF nurses who met the selection criteria were invited to participate with two or three nurses selected from each LTCF. The Patient Transfer Decision Difficulty Scale (PTDDS) was used to measure the level of difficulty in making decisions related to the transfer of residents to the ED. Data were collected by mailing the questionnaires and asking the nurses to return the completed form in 2 weeks. Data were analysed using simple linear regression and multiple regression with stepwise methods. Results: In total, 618 valid questionnaires with an 85.32% response rate from 319 LTCFs were used for the data analysis. Decision difficulties that LTCF nurses experienced were moderate, the nursing personnel‐bed ratio, LTCF professional training and basic life support training were predictive factors of the level of difficulty experience (scores of PTDDS) for the LTCF nurse (F = 6.81, p <.001). Conclusions: Enhancing emergency training in LTCF can improve nurses' decision‐making ability to refer LTCF residents to emergency treatment. Impact: What problem did the study address? The study addressed the difficult decision LTCF nurses may experience when transferring a resident to the emergency department.What were the main findings? All LTCF nurses faced a moderate level of difficulty in decision‐making. 'Transfer timing' was most often considered in the decision‐making process when a resident was transferred to the ED.Where and on whom will the research have impact? Results of this study have considerable reference value for LTCF managers and nurses in the decision‐making ability and suitability of transferring residents for emergency treatment. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore perceptions of experience exacerbations of chronic obstructive pulmonary disease among chronic obstructive pulmonary disease patients with comorbid gastrooesophageal reflux disease by focusing on unravelling how patients differentiate and react to symptoms of chronic obstructive pulmonary disease and gastrooesophageal reflux disease. Background: While gastrooesophageal reflux disease has been suggested to be a risk factor for chronic obstructive pulmonary disease exacerbations, no study has explored perceptions of the symptoms leading up to severe exacerbation of chronic obstructive pulmonary disease events among chronic obstructive pulmonary disease patients with comorbid gastrooesophageal reflux disease. Design: Qualitative design. Methods: The analysis was performed in accordance with principles of Grounded Theory methodology. Data were collected via semi‐structured interviews from 12 chronic obstructive pulmonary disease patients with endoscopy‐diagnosed gastrooesophageal reflux disease who had experienced a chronic obstructive pulmonary disease exacerbation with hospitalisation. Appraisal and analysis using consolidated criteria for reporting qualitative research (COREQ) checklist were undertaken. Results: The core category of this study was the ineffective management of exacerbation symptoms, which was associated with perceived symptoms pre‐exacerbation which contained three overlapping categories of symptom presentation experienced, and chronic obstructive pulmonary disease‐related coping strategies, high anxiety and a sense of helplessness in disease management. Conclusions: Patients with severe chronic obstructive pulmonary disease with comorbid gastrooesophageal reflux disease presented with some distinctly different atypical symptoms yet used common respiratory symptom management strategies. Patients and practitioners alike need to be more aware of the possibility of other symptoms such as nonspecific symptoms being clues of exacerbation onset for a more effective intervention. Relevance to clinical practice: The medical community needs to educate patients to understand and manage not only chronic obstructive pulmonary disease but also gastrooesophageal reflux disease symptoms so that they are better able to identify the cause of their symptoms, treat them appropriately and seek out medical assistance when necessary. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how patients adapt to their changed body and life within the first year of receiving bariatric surgery. Background: Bariatric surgery is used to treat severely obese patients. Most studies investigating the postsurgery period are about weight loss related issues. However, few studies have investigated these patients' subjective live experiences within the first year after discharge. Design: A qualitative research using grounded theory method was applied. Methods: In‐depth interviews were conducted with 17 participants with a mean age of 34.5 years. The constant comparative method was used to analyse the interview data. Findings: The core concept of "living with my small stomach" indicates that postbariatric patients are confronted with multidimensional challenges over time in their live experiences. Post‐bariatric surgery patients felt "unexpected body discomforts" in the initial period after discharge. Qualitative analysis generated two different types of living processes—either in the "life modification" process or a "suffering" process. The associated categories and subcategories delineated the living process after discharge. In the life modification process, five categories were identified: "being forced to change meal habits," "bad feelings due to unsatisfied eating desires," "choosing food for quality rather than quantity," "persisting and confronting" and "getting support from family members." In the suffering process, three categories were identified: "health becoming worse due to loss of albumin," "suffering from bad health" and "emotional disturbances." Finally, most participants would engage in "valuing my changed body" by "doing the right things and maintaining my new life." Conclusions: How to modify one's life is the main concern of postbariatric patients. These patients need to either engage in the process of making life modifications or suffer from complications. Relevance to clinical practice: Patients need support and health education regarding living with their small stomach. In addition, we should be more sensitive about the need to detect malabsorption early. [ABSTRACT FROM AUTHOR]

Aims and objectives This study aimed to evaluate the longitudinal effects of a personal counselling intervention for perimenopausal women in northern Taiwan. Background Women face a variety of physical changes during menopause. Counselling intervention could enrich individual health education for menopausal women. Design Quasi-experimental design. Methods The study used one-on-one personal health counselling with a 'menopausal health passport' for perimenopausal women. The Perceived Perimenopausal Disturbances scale, the Practice of Health Behavior scale and the Perceived Uncertainty scale were used to measure the intervention effects. Results were estimated by a Generalized Estimating Equation procedure at one and a half months, three months and six months post intervention. In addition, data regarding perceived health changes were collected qualitatively through interviews in the experimental group at the sixth month. Results A total of 34 women were included in the experimental group, while 33 were in the control group. Interaction effect results showed that personal health counselling significantly increased the practice of health behaviours at one and a half months and extended to three months post intervention. Additionally, content categories, including 'relief of symptoms', 'establishment of health behaviors', 'interaction with others' and 'consideration from others' were identified in quantitative analysis. Conclusions The results suggest that perimenopausal personal health counselling can effectively improve healthy behaviours. This study can also serve as a future reference for effective perimenopausal counselling. Relevance to clinical practice It is crucial to set up personal health counselling for perimenopausal women in clinics and develop information technology systems to support menopausal women in the technological era. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine the psychometric properties of the Menopausal Symptoms Distress Affecting Sleep Quality Scale. Background. Sleep disturbances are an extensive and common problem among menopausal women. However, no unique and specific scale has yet been developed to detect the inductive symptoms distresses that cause poor sleep quality for menopausal women. Design. A cross-sectional design. Methods. The Menopausal Symptoms Distress Affecting Sleep Quality Scale was based on in-depth interviews with menopausal women and literature review. Convenience sampling was employed. One hundred and fifty three women participated in this study. Exploratory factor analysis, concurrent validity and contrasting group validity were used to examine the validity of the Menopausal Symptoms Distress Affecting Sleep Quality Scale. Cronbach's a was conducted to test the reliability. The accuracy of the scale was analysed with the receiver operating characteristic from MED CALC version 10.4.8.0 software. The scale's sensitivity, specificity, positive and negative predictive value were analysed to locate the best cut-off point. Results. One factor was generated by Exploratory factor analysis, and this factor explained 49-07% of total variance. In addition, the Menopausal Symptoms Distress Affecting Sleep Quality Scale had significant positive correlations with the Greene Climacteric Scale and the self-evaluation of menopausal symptoms scale. Cronbach's a of the Menopausal Symptoms Distress Affecting Sleep Quality Scale was 0-89. Moreover, the diagnostic accuracy probability of the scale's receiver operating characteristic curve was 0-85. The best cut-off point was three with a sensitivity of 76% and a specificity of 87%. Conclusions. The Menopausal Symptoms Distress Affecting Sleep Quality Scale had good reliability and validity, as well as refined indicators for assessing the tool's accuracy. Relevance to clinical Practice. The Menopausal Symptoms Distress Affecting Sleep Quality Scale is easy to use, can quickly detect the sleep conditions of menopausal women who suffer from menopausal symptom distress, and provide efficient nursing interventions to relieve menopausal symptom distresses, and then improve sleep quality. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop a descriptive theory for the weight loss experiences of obese perimenopausal women with metabolic syndrome. Background Obesity and metabolic syndrome both pose a threat to the health of perimenopausal women; therefore, understanding perimenopausal women's subjective feelings and experiences is beneficial to establishing effective prevention strategies. However, studies have rarely explored these relevant experiences. Design A qualitative study using the grounded theory method to establish a descriptive theory. Methods Eighteen obese perimenopausal women with metabolic syndrome aged 45-60 years participated in comprehensive interviews. Results 'Crossing the gaps to making life modifications' was the core category, and 'the awareness of weight gain and health alarm' was the antecedent condition. In the weight loss experience, the following three interaction categories were identified: (1) 'experiencing bad feelings,' (2) 'encountering obstacles' and (3) 'making efforts to transition to a new life.' Some women adhered to new life habits through perceiving social support and by using self-incentives. Finally, women enjoyed and mastered self-monitoring of their health in their new life, and practiced new changes as part of their life. However, some participants felt that making changes to their life was too time-consuming. Therefore, these women chose to live with their abnormal health without making changes. Conclusions Obese perimenopausal women with metabolic syndrome experienced various gaps in their weight loss process. Although they struggled with many obstacles, these women were able to learn from their experiences and face their health challenges. Relevance to clinical practice These findings can guide healthcare professionals to provide appropriate interventions to understand the hidden health problems of this particular group of women. Healthcare professionals should develop a set of plans by which women receive a complete weight loss program and support from professionals and family. [ABSTRACT FROM AUTHOR]

Aim and objectives To generate a descriptive theoretical framework about the experiences of women who discontinued hormone replacement therapy. Background Some menopausal women would depend on hormone replacement therapy for relieving their menopausal symptoms. However, most of them feared of hormone replacement therapy's side effects and tried to discontinue hormone replacement therapy immediately. How did these women self-manage their discomforts without using dependent medicine - hormone replacement therapy? There are few studies conducted on this issue. Design A grounded theory research was applied. Methods Nineteen Taiwanese women discontinuing hormone replacement therapy for three months, aged 45 to 67 years, participated in face-to-face audio-taped interviews. Data collection, and coding of interviews, and data analysis occurred simultaneously. All conversations were audio-recorded and then transcribed as verbatim text. The constant comparative method was used to analyse the interview data. Results 'Relieving my discomforts safely' was the core theme for describing and guiding the process of discontinuing hormone replacement therapy. 'Immediately discontinuing hormone replacement therapy - it would hurt my body' was identified as the antecedent condition. Analyses showed five dimensions to the women's relieving my discomforts safely: (1) symptoms bothered me again, (2) negative emotions, (3) learning to let it go, (4) trying to use nonhormone replacement therapy or products and (5) choosing safely therapies as first priority. Finally, some women would choose their suitable nonhormone replacement therapy way, and some women would reuse hormone replacement therapy cautiously. Conclusions 'Relieving my discomforts safely' was the first-priority consideration for the menopausal women discontinuing hormone replacement therapy. It is the challenge to establish the health programme or management for helping these women felt safety and security to relieve their menopausal symptoms by using hormone replacement therapy or nonhormone replacement therapy. Relevance to clinical practice Healthcare providers need to empower women the rights of decision-making of using hormone replacement therapy and assist them in monitoring their health status to reduce their fear and uncertainty. [ABSTRACT FROM AUTHOR]

Aims and objectives To generate a descriptive theoretical framework for experiences among obstructive sleep apnoea (OSA) patients undergoing continuous positive airway pressure ( CPAP) therapy. Background Insufficient information is available about subjective experiences among OSA patients undergoing CPAP therapy. This study aims to address that lack of insight into patients' feelings. Design A qualitative study using the grounded theory method to establish a descriptive theory. Methods Twenty-two Taiwanese OSA patients undergoing CPAP therapy participated in comprehensive interviews. Results The patients, aged 37-68 years, participated in wide-ranging interviews. 'Living with CPAP' was the core theme describing the life experiences of OSA patients undergoing CPAP. Health warnings were identified as the antecedent condition, with subcategories including the following: severe snoring, choking and feelings of a terrible death during sleep, day and night sleepiness, easy tiredness, decreased memory, poor sleep, dry mouth, dry throat, headache, high blood pressure, poor blood sugar level control and falling asleep while driving. Analyses indicated seven subcategories of OSA patients with CPAP: (1) seeking medical information, (2) difficulties with CPAP, (3) trial and error for the 'right' CPAP, (4) long scheduled waiting times, (5) wondering, (6) high expectations, and (7) getting back good health. Conclusions The results will assist healthcare providers with references for OSA health care based on patients' subjective perspectives. Relevance to clinical practice After interpreting and analysing results, suggestions include the following: (1) provide medical resource education for outpatients and inpatients to access self-care knowledge regarding OSA; (2) institute professional personnel for providing OSA health education in sleep clinics or sleep centres; (3) develop hospital standards for sleep examination processes to shorten waiting times; (4) establish case management for pursuing OSA patients receiving CPAP; (5) arrange regular forums for patients to share their experiences; and (6) provide community health education to promote awareness of snoring issues. [ABSTRACT FROM AUTHOR]

Aim. To extend nursing knowledge of distress experienced by family caregivers of children with rare genetic disorders, by exploring the perspectives of caregivers of children with Russell-Silver Syndrome in Taiwan. Background. Caring for a child with a rare genetic disorder often has profound effects on families, especially when diagnosis and treatment is complex or not yet well developed, such as that in Russell-Silver Syndrome (or Silver-Russell syndrome). This disorder causes dwarfism and developmental difficulties, requiring long-term care planning. Previous research has focused mostly on medical care, but little is known about families' perspectives of caring difficulties, the help they need and nursing care required. Design. An exploratory qualitative approach was used to inform this study. Methods. Family caregivers, whose children were undergoing medical care in a leading Taiwan medical centre, were invited to participate in face-to-face, in-depth interviews. Data were analysed by content analysis. Results. Fifteen caregivers including 11 mothers, two fathers and two grandmothers participated. Five major themes and 13 sub-themes of care-giving distress were identified: endless psychological worries; the lengthy process to confirm a medical diagnosis; adjustment efforts in modifying family roles; dilemmas in deciding between Western or Chinese traditional medicine; and negative responses to society's concerns. Their primary sources of support were spouses, parents and health professionals, accordingly. Conclusion. Complex physio-psycho-social and decision-making distress in caring for children with a rare genetic disorder were systematically revealed from the perspectives of ethnic-Chinese family caregivers. Relevance to clinical practice. Long-term care plans for children with a rare genetic disorder such as Russell-Silver Syndrome need to focus on positive dynamic family interactions, life-stage development and family caregiver support. Research on care-giving in rare genetic disorders is also warranted across cultures and countries to develop a substantial knowledge basis for nursing practice. [ABSTRACT FROM AUTHOR]