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Aim: To explore the life experiences of women with interstitial cystitis. Design: A qualitative phenomenological study. Methods: Fifteen women with interstitial cystitis were recruited from a regional hospital in Taiwan using purposive sampling. Data were collected via one‐on‐one semistructured interviews and analysed using the Colaizzi's method. Rigorous testing was conducted to identify the themes and subthemes. Results: Four major themes were identified: torment, restriction, acceptance and empowerment. These themes reflect the life experiences of women with interstitial cystitis. They endured unrelenting physical and psychological distress and loneliness, experienced obstacles and limitations in daily living because of their symptoms, accepted reality and considered their symptoms as a part of everyday life and developed coping skills for the disease. Conclusion: Medical care, psychological support and emotional venting are crucial for women with interstitial cystitis. Despite living a life full of frustrations and suffering caused by the unpredictable and unrelenting nature of interstitial cystitis, through external support and intrinsic positive cognitive reconstruction, women with interstitial cystitis gradually accepted that they were ill. They adapted to their situation, developed a suitable lifestyle and pace and ultimately achieved stable coexistence with the disease. Implications for the Profession and Patient Care: Although women with interstitial cystitis are affected by an incurable disease, through adequate assistance and reconstruction of perception, they can develop coping skills and stably coexist with their disease. There is a delicate dynamic balance between their lives and disease. Impact: This study may help clinicians to understand patients' life experiences and provide suitable care. This may improve the quality of care provided to women with interstitial cystitis and help them adapt to their disease, thereby improving their life satisfaction. Reporting Method: This study was reported according to the COREQ checklist. Patient or Public Contribution: Women with interstitial cystitis contributed to the study data. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate psychological resilience and demoralisation and their predictors and mediators in prostate cancer survivors (PCSs). Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: 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. [ABSTRACT FROM AUTHOR]

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 patients with prostate cancer 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 made. Multiple linear regression was used to analyse the data. Results The marital satisfaction of patients with prostate cancer 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 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 prostate-specific antigen 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 ( R2 = 0·337, adjusted R2 = 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background/purpose: Physical activity has benefits for reducing levels of anxiety. However, factors that affect physical activity participation for individuals with anxiety disorders have not been well studied. Here, we aimed to clarify the roles of state and trait anxiety in physical activity participation by examining relationships among seven major study variables in Taiwanese adults with anxiety disorders.Methods: A multi-site, cross-sectional explanatory design was used. Data were collected using one interview and five self-administered questionnaires. The sample included 144 Taiwanese adults diagnosed with anxiety disorders.Results: State and trait anxiety were significantly correlated with most of the study variables. Physical activity participation by subjects with anxiety disorders was significantly correlated with state anxiety, benefits of activity, self-efficacy for activity, and social support for activity. When age, sex, and education were controlled in the analysis, state anxiety was associated significantly and negatively with physical activity, benefits of activity, and self-efficacy for activity, and was correlated positively with barriers to activity. Trait anxiety was found to be correlated significantly and negatively with benefits of activity and self-efficacy for activity, and correlated positively with barriers to activity.Conclusion: State anxiety demonstrated greater power than trait anxiety in its relationship with physical activity. These findings suggest that clinical mental health professionals should consider state anxiety when encouraging Taiwanese adults with anxiety disorders to engage in physical activity. [ABSTRACT FROM AUTHOR]

The purpose of the study is to explore changes in resilience and physical and psychological distress and their related factors over time in women with endometrial cancer. This study adopted a repeated measures design using purposive sampling and was conducted in a hospital in Taiwan. Data were collected before surgery, 2 weeks after surgery, and 3 months after surgery. The measured variables consisted of demographic and disease characteristics, social support, resilience, and physical and psychological distress. A total of 48 women participated in the study, of whom 42 (mean age = 54.2 years old) completed all of the questionnaires. The results showed that resilience and physical distress in women with endometrial cancer was not statistically significantly changed over time. Rather, their psychological distress was significantly alleviated 2 weeks and 3 months after surgery as compared to before surgery. Women with less social support showed a lower level of resilience. In addition, those with a lower level of resilience experienced greater psychological distress. Compared with those who received only surgical treatment, women who had undergone surgery combined with chemotherapy and radiotherapy had more physical distress. Clinical medical staff should conduct continuing assessments of the resilience, physical distress, and psychological distress of women with endometrial cancer. Interventions related to resilience-enhancing and self-care should be implemented to avoid worsening or to improve women's resilience and distress.

Aim: This study was designed to investigate the learning outcomes of a suicide education programme for second-year student nurses in Taiwan., Background: 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., Design: A quasi-experiment., Method: 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: 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., Conclusion: 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., Relevance to Clinical Practice: 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., (© 2011 Blackwell Publishing Ltd.)

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.

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 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 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.

Aims and Objectives: The purpose of this study is to understand the experiences of psychiatric nursing students during their first encounters with psychiatric patients in a clinical setting. The objective is to assist educational professionals in mental health to improve teaching strategies., Background: In clinical settings, student psychiatric nurses have to face complex problems and situations that can result in distress. Sometimes the student nurse will be uncertain of their own ability and this is reflected in a sense of fear on the part of some nurses. However, little research has been conducted into the first clinical experiences of such nursing students in Taiwan., Design: A qualitative phenomenological study was devised to explore what psychiatric nursing students perceived during their first experiences of clinical practice and narratives were analysed using Colaizzi's seven-step method., Method: A phenomenological approach and purposive sampling were used in the study. Face-to-face interviews were conducted to collect the data and during the process of data analysis we established epochs (bracketing) and focused on the reality of the student nurses' experience to keep the data objective., Results: Four themes were identified: breaking the stigma of mental illness, developing a trusting relationship with the patient, gaining professional knowledge and skills and the process of student growth., Conclusion: The findings from this study demonstrate that it is important to understand the perceptions of students during their first experiences of psychiatric nursing in a clinical setting and highlight the importance of educational programs., Relevance to Clinical Practice: By understanding the emotional process that psychiatric nursing students may go through during their clinical practice, educators can be better able to design suitable training courses in the future.

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: To understand the experiences of primary caregivers who are bringing up school-aged children with attention-deficit hyperactivity disorder. The research findings will help address the problems related to caring for school-aged children with attention-deficit hyperactivity disorder., Background: In Taiwan, the rate of school-aged children diagnosed with attention-deficit hyperactivity disorder ranges from 7.9-11.7%. This study is the first, which tries to understand the experiences of primary caregivers who are bringing up school-aged children with attention-deficit hyperactivity disorder in Taiwan., Design: The study used a qualitative phenomenological approach to explore the experiences of caregivers raising school-aged children with attention-deficit hyperactivity disorder., Methods: Purposive sampling and in-depth, face-to-face interviews were used to collect data. The unstructured interview guide allowed the major caregivers to express their experiences of raising school-aged children with attention-deficit hyperactivity disorder. When data saturation was reached, the sample size comprised 12 major caregivers. Narratives were analysed according to Colaizzi's seven-step method., Results: Three themes and seven sub-themes emerged from this study: the burdens of caring (parenting burdens, emotional burdens and family conflicts), the lack of adequate support systems (lack of support from professionals, spouses and other family members) and the mechanisms of coping (cognitive coping strategies and social coping strategies). Furthermore, several other factors that affected the caregivers of children with attention-deficit hyperactivity disorder are also revealed in the study., Conclusion: The findings of the study demonstrate the importance of understanding the experiences of primary caregivers, bringing up school-aged children with attention-deficit hyperactivity disorder. Improving professional services in family care should be a major concern for all healthcare professionals., Relevance to Clinical Practice: The recommendations that have been made based on the findings of this research can be used as a guide to improve the delivery of caring by people who have school-aged children with attention-deficit hyperactivity disorder and by the wider family.

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.

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.