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Aims and objectives To inquire into the reasons for family involvement in adult patients' surgical decision-making processes from the point of view of the patients' family. Background Making a patient the centre of medical decision-making is essential for respecting individual's autonomy. However, in a Chinese society, family members are often deeply involved in a patient's medical decision-making. Although family involvement has long been viewed as an aspect of the Chinese culture, empirical evidence of the reasons for family involvement in medical decision-making has been lacking. Design A qualitative study. Method In order to record and examine reasons for family involvement in adult patients' surgical decision-making, 12 different family members of 12 elective surgery patients were interviewed for collecting and analysing data. Results Three major reasons for family involvement emerged from the data analyses: (1) to share responsibility; (2) to ensure the correctness of medical information; and (3) to safeguard the patient's well-being. These findings also reveal that culture is not the only reason for family involvement. Conclusions Making decision to undergo a surgery is a tough and stressful process for a patient. Family may provide the patient with timely psychological support to assist the patient to communicate with his or her physician(s) and other medical personnel to ensure their rights. It is also found that due to the imbalanced doctor-patient power relationship, a patient may be unable, unwilling to, or even dare not, tell the whole truth about his or her illness or feelings to the medical personnel. Thus, a patient would expect his or her family to undertake such a mission during the informed consent and decision-making processes. Relevance to clinical practice The results of this study may provide medical professionals with relevant insights into family involvement in adult patients' surgical decision-making. [ABSTRACT FROM AUTHOR]

Background: The WHOQOL-BREF, a generic quality of life (QoL) instrument, has been widely used clinically and for research on older populations. However, its measurement equivalence/invariance (ME/I) has not been well examined for the elderly (≥ 65 years) across some different demographics.Methods: The data were derived from a cross-sectional study with a convenience sampling design in Taiwan. We enrolled 244 elderly participants: men = 143 (58.6%); educational level ≤ primary school = 121 (49.6%). The ME/I was examined using multiple group confirmatory factor analysis (MGCFA) across gender and educational level.Results: The fit indices were satisfactory for the configural models of gender and educational level (standardized root mean square residual [SRMR] = 0.0742 and 0.0770; root mean square error of approximation [RMSEA] = 0.0655 and 0.0686; comparative fit index [CFI] = 0.953). In addition, MGCFAs showed that ME/I was supported across gender (ΔSRMR = 0.001 to 0.019; ΔRMSEA = -0.003 to 0.001; ΔCFI = -0.003 to 0.000) and educational level (ΔSRMR = 0.002 to 0.006; ΔRMSEA = -0.002 to 0.004; ΔCFI = -0.007 to 0.000).Conclusion: The WHOQOL-BREF Taiwan version is appropriate for combined use and for comparisons in older people across gender and different educational levels. [ABSTRACT FROM AUTHOR]

This study investigated the relationships between types of activity and quality of life (QOL) for older men and women at different ages. Based on cross-sectional data that included 220 community-dwelling elderly persons aged 65 and older in southern Taiwan, the results showed that the participation rates in many activities declined with age for both genders. Social activity and solitary leisure activity were significantly associated with QOL for old-old men, but not for young-old men. Only social activity was significantly associated with QOL for young-old women, but there was no significant association between any activity and QOL for old-old women. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Nursing is the property of Taiwan Nurses Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Nursing is the property of Taiwan Nurses Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Functional decline is a common complication in hospitalized older adults, and decline in the ability to walk is often the first change in physical functioning in this population. Decline in walking ability leads to a loss of independence in the activities of daily living in older adults after discharge from the hospital., Purpose: To explore the factors associated with the recovery of walking ability in older adults after discharge from the hospital., Methods: This study used a longitudinal research design. Potential participants were recruited from a tertiary medical center in southern Taiwan. Patients were eligible for inclusion if they were at least 65 years old and were affected by a decline in walking ability at discharge. The data collected at discharge included: demographic information, Charlson Comorbidity Index, Modified Katz Index of Independence in Activities of Daily Living (walking item), Mini Nutritional Assessment, Mini-Mental State Examination, and ambulation during hospital stay. The follow-up data collected at three months after discharge included: Modified Katz Index of Independence in Activities of Daily Living (walking item), exercise habit, rehabilitation, and social support., Results: A total of 78 older adults were enrolled as participants. Three-quarters (75.64%) of the participants had regained their ability to walk at three months after discharge. Moreover, nutritional status, cognitive function, and exercise habit were significantly associated with the recovery of walking ability. The results of multiple logistic regression analysis showed having an exercise habit to be significantly associated with the recovery of walking ability at three months after discharge (OR = 10.212, p = .004)., Conclusions / Implications for Practice: In addition to treating the acute medical issues of older patients, healthcare professionals should screen and provide them with appropriate nutritional, cognitive, and physical care plans. Moreover, emphasizing the importance of an exercise habit in nursing discharge plans is also important. This effort may help older adults recover their walking ability and maintain their independence.

Widowhood, an unavoidable and stressful situation, has been associated with negative effects in elderly people during later life. This article reviews and summarizes the influences of widowhood on the health, daily life, and social life of elderly people. The influences of widowhood on elderly people may vary by gender, spousal relationship, and cohort background. In order to provide nursing care as early as possible, nurses must cooperate with professionals from social-welfare and / or community-support systems to identify high-risk widowed elderly. When nurses assess the influences of widowhood on elderly people, they should consider the interactions among gender, spousal relationship, and cohort background. Furthermore, nurses may apply various strategies based on the needs of elderly people to improve the health and quality of life of patients. Suggestions include providing appropriate nursing care, offering positive social support, adjusting daily-life routines, and arranging activity programs based on care-recipient interests and resources.

The elderly population is increasing rapidly in Taiwan. With the average life expectancy on the rise, the elderly have become major consumers of healthcare products and services. Factors that influence respect for autonomy, a core value of medical ethics, may be related to family, society, and the medical culture. Especially in patients who are already elderly, aging causes declines in physical, mental and societal capacities. Practicing a respect for patient autonomy is particularly challenging for healthcare professionals in Taiwan due the unique culture background of elderly Taiwanese patients. This article reviews and integrates the literature related to the issue of patient autonomy and elaborates on medical decision-making among elderly patients in Taiwan in the contexts of: the disadvantages faced by the elderly, the background of Chinese culture, and the current medical decision-making environment. A few suggestions are proposed to help preserve the medical-decision-making autonomy of elderly patients in Taiwan.

Constipation is a common problem afflicting the elderly. When elderly patients complain of constipation to their healthcare providers, they are typically prescribed laxatives rather than given a clinical examination to explore the specific causes. This approach not only does not resolve the long-term problem of constipation, but may also lead to further complications (e.g., constipation alternating with diarrhea, abdominal distention, poor appetite, and ileus). Effective management of constipation in the elderly should in many cases be tailored to the symptoms and conditions of individual patients rather than simply applying evidence-based treatment. There is a lack of consistency amongst specialists on how best to deal with the problem of constipation. The aim of this article was to explore evidence-based management approaches to constipation in the elderly. A definition of constipation is given and relevant causes are first given. Pharmacological and non-pharmacological treatment approaches are then introduced with regard to effective approaches to conducting physical examinations, assessing patient medical history, and performing laboratory tests. In addition, this article also developed a constipation protocol as a reference tool in the clinical management of constipation in the elderly. The authors hope results can help reduce the problem of constipation in the elderly population.

The article reports on the experience of the author in successfully using nursing interventions to relieve the back pain of a patient who received percutaneous coronary intervention (PCI) for acute myocardial infarction. Nursing interventions were administered over three days, from September 5-7, 2008. After PCI, the patient suffered from back pain, insomnia and anxiety due to prolonged immobility and restricted positioning. The author used nursing interventions, such as position changing, massage and in situ limb movements to relieve symptoms, and instructed family members to participate in caregiving. Back pain and quality of sleep significantly improved, which greatly relieved the patient's anxiety and improved sleep quality. This article suggests specific nursing intervention techniques to relieve back pain induced by prolonged immobility / restricted positioning.

This article reviewed and summarized the findings of previously published studies on the leisure activities of community elders over 55 years of age. A total of 17 related articles, published before 2008, were identified in the search of electronic databases, which included the Chinese Periodical Table of Contents Index Image System, CEPS, Medline and Ageline. Leisure activities measurements used in this study consisted of recoding activities either categorically or by frequency. The majority of research indicated that elderly engage in primarily static activities and that participation in leisure activities had positive effects on cognitive and psychological health. However, inconsistencies in results were found due to differences in measurement tools and sample populations used among studies, making it difficult to conduct a valid comparison of specific features of elderly leisure activities. Most current leisure activity studies utilize cross-sectional research methodologies with restricted topics, which result in limited applicability of research results. In conclusion, we suggest that future studies should develop instruments to assess leisure activities that correspond to local conditions identified through qualitative research. With such, researchers can study different age groups by applying relevant ageing theories to construct empirical data related to current elderly leisure activities.

"Respect for autonomy", the primary principle of bioethics, is the basis of the process of informed consent. It is the responsibility of medical professionals to provide information when patients are involved in medical situations and decision making. However, many factors can potentially interfere with patient willingness to participate in decision making processes. This article organizes and discusses present knowledge on such factors. A thorough literature review was conducted to identify factors in terms of three aspects: interaction between health professionals and patients, family involvement, and patient characteristics. Patient involvement in medical decision making is a very complex issue. During the medical decision making process, health professionals must be aware of the social-cultural context of patients in order to create an environment in which patients feel comfortable to make decisions freely.

The number of elderly patients in hospitals rises as a country's population ages. In Taiwan, roughly 27% of hospitalized patients are elderly. Previous studies have reported that 30% to 60% of hospitalized elderly patient experienced functional decline following discharge. This article reviews references on the predictors of functional decline in hospitalized elderly. Six predictors are summarized, including, senility, daily activity disturbance (activity of daily living, preadmission disability in instrument activity of daily life), cognitive impairment, diseases (diagnosis, depression, incontinence), and hospitalization (length of hospital stay, prior hospital utilization, and demographic characteristics [e.g., high body mass, low income, institutional resident]). Nursing interventions that have been shown to help moderate functional decline in elderly patients include the multidiscipline care model, creating an elder-friendly environment, and facilitating exercise programs. As healthcare costs are so high, the need to decrease negative outcomes in personal health is a pressing issue. Thus, identifying hospitalized elderly at risk and providing intervention to prevent disabilities is an important mission of healthcare providers.

Postmodernism is a philosophical and social movement which stresses that ideas are temporary, research data should be considered only in context, reality is transcendent, grand theories are invalid, problems are deconstructed, and findings should have practical value. Manifestations of the postmodern paradigm are reflected in the epistemological shifts of nursing science and knowledge development in the professional community of nurses in Western countries. This article explores the context within which this movement emerged, delineates how it has deconstructed "language" and "subject" to frame a new paradigm and outlines related implications on nursing knowledge development. Both challenges and opportunities face the nursing profession as it evolves into a postmodern paradigm.

Holistic nursing, which emphasizes the care of the physical, psychological, social, and spiritual aspects of the person, is always the core of nursing practice. The goal of nursing care is not only to fulfill needs in relation to each of these dimensions but also to restore the harmony of the patient's life. Among the members of a health care team, it is nurses who spend the most time with the patients. It is therefore they who are in the best position to provide spiritual care. Usually, however, the spiritual needs of the patient are neglected by nurses. Part of the reason for this is that the majority of clinical nurses have not had enough training and practical guidance to conduct spiritual care. On the basis of a literature review, this paper suggests a model involving the relationships with the self, others, higher beings, and nature, to assist nurses in assessing spiritual needs and delivering spiritual care.

The anal sphincter-preserving operation (ASP) has represented a significant improvement in surgical procedure for lower rectal cancer patients in recent years. Discussion has continued, however, on how to manage the reduced fecal function after such surgery. This case report describes how to help a patient with lower rectal cancer after ASP to overcome the problems due to changes in fecal function. Process recording was used to document the nursing process from Jan. 18 to Feb. 1, 2007. Data collected from interview, observation, and medical records, show that the patient revealed four vital nursing problems: fecal function disorder, impaired skin integrity, inappropriate regulation of diet, and powerlessness. After practicing pelvic floor exercises, adjusting her fecal behavior and modifying her food intake, the patient regained control of her fecal function and improved her quality of life.

In the past, Abdominal Perineal Resection (APR) with a permanent end-sigmoid colostomy was the major operating procedure for lower rectal cancer. Colostomy seriously affects patients' physical and psychological functions. Recently, the development of surgical devices and pre-operation adjuvant treatment combined with chemoradiotherapy have made an anal sphincter-preserving (ASP) operation possible. With these new treatment procedures, both the survival and recurrence rates are improved, as is patients' quality of life. The complications associated with ASP, however, are different from those associated with APR. There is only limited discussion of these issues in the literature on the subject. This paper synthesizes the information in the literature with the authors' personal clinical experiences. We propose several nursing interventions that could be applied by clinical nurses to assist ASP patients in coping with post-operative complications.

The Peripherally Inserted Central Catheter (PICC) is still in its infancy in Taiwan. It has many advantages, including safety, simplicity, and few complications during the insertion process. It is suitable for patients who need long-term parenteral administration of medication or chemotherapy. However, the duration of PICC implantation is around six months, or even up to one year. As a result, it is very important to educate patients to take care of themselves throughout the implantation period in order to prevent complications. This report describes the experience of nursing a forty-four-year old male patient who suffered from acute lymphocytic leukemia and received a PICC implantation while undergoing chemotherapy treatment. As a PICC case manager, the author utilized self-efficacy theory and devoted herself to nursing care, interviews and phone calls to collect valuable information. During the process of PICC implantation, the author analyzed the characteristics of this case and assisted the patient and his primary care giver in choosing a suitable catheter and self-care techniques to achieve minimal complications during implantation. It is hoped that, by sharing in her experience, nursing staff may enhance their ability to assist patients with PICC and to help them to maintain their quality of life.

Numerous reports have shown that there is a close relationship between elderly malnutrition and elderly mortality and morbidity. On the other hand, the aging process leads to declines in physical, psychosocial and spiritual functions, which directly or indirectly limit the quantity and quality of the intake of nutrients by the elderly. As a result, malnutrition is commonly observed in geriatric nursing practices. There is therefore an urgent need for a simple, economical but precise tool for the assessment of nutritional status, to help health practitioners to identify potential cases of malnutrition early on so that intervention can be undertaken as early as possible and the quality of geriatric nursing care can be raised. In this article, two clinical methods, the Mini Nutritional Assessment (MNA) and the Bioelectrical Impedance Analysis (BIA), are introduced. They are valuable tools in the assessment of elderly nutritional status.

As people grow older, they have to face the reality of attenuated physical and mental abilities, a lesser role in society, and many other issues associated with ageing. Appropriately arranged leisure activity can assist the elderly to reevaluate their life priorities and rebuild their self-confidence and self-respect. This article discusses what leisure activities mean to the elderly. By defining what constitutes leisure activity, and with reference to the literature on ageing theories and to the current situation regarding the elderly and their leisure activities in Taiwan, suggestions are made to promote leisure activities suitable to the elderly in Taiwan.