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BackgroundEvidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient’s perspective. ObjectiveThis study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. MethodsA 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. ResultsA total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. ConclusionsThe strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer.

A significant proportion of cesarean deliveries in Taiwan were without medical indications and/or on maternal request. The purpose of this study was to understand the decision-making process of choosing an elective cesarean delivery (ELCD) among primiparas in Taiwan. This qualitative exploratory study was guided by grounded theory. Data were collected through in-depth interviews with 20 primiparous women, 15 of whom chose ELCD. Verbatim transcriptions were analyzed using constant comparative analysis and methods of open, axial, and selective coding. The core category that describes the process of ELCD decision making among primiparas is 'controlling risks of childbirth and ensuring well-being.' The decision process can be divided into three phases: (1) Pre-decision: risk perception, including two subcategories, negative pre-existing ideas about normal spontaneous delivery (NSD) caused worry, and desire for ELCD as the solution; (2) In-decision: risk assessment. Women proactively collected information about NSD and cesarean delivery, and then weighed the personal risk between NSD and ELCD. Risk assessment focused on seven dimensions including safety, health, comfort, efficiency, feminine charms, time and economy; (3) Post-decision: marching onward fearlessly, including two subcategories, belief in ELCD and stress relief, and persuading stakeholders to agree and gaining the required resources for ELCD. At different phases of decision-making, women revealed different concerns, though the sequence of phases was not necessarily unidirectional. Health care providers should be aware of the decision phase and intervene at appropriate times. It is difficult to change a women's decision to have ELCD in the post-decision phase. Keywords Decision making * Primiparas * Elective cesarean delivery * Risk perception * Childbirth * Pregnancy, Introduction With advances in medical technology and changes in the social environment, cesarean delivery has gradually evolved from a life-saving operation to a common mode of delivery [1]. The rate [...]

Aim: To explore parents' perspective on hospital's care and management of the remains of stillborn babies. Background: Each year, 2.6 million of pregnancies end as stillbirth. Recent literature began to understand parents' traumatic experience in stillbirth and its profound impact on parents' mental health and psychosocial effect. But there is limited understanding on the actual care and management of the stillborn baby, nor is there an agreement on how hospitals should care for the stillborn baby to mitigate parents' profound loss. Design: A descriptive phenomenological approach was applied to conduct this study. Methods: A purposive sample of twenty couples (40 individuals) who had encountered how to care for the remains of their stillborn babies participated in the study. The data were collected through in‐depth interviews, which involved semi‐structured and open‐ended questions. The phenomenological methods of Giorgi were applied to analyse the data. The COREQ checklist was used preparing the manuscript. Results: Parents felt unprepared and lack of support when they had to handle their stillborn babies' remains. The research results revealed two major themes: (1) Handling stillborn babies remain ignorantly; (2) Pacifying the disturbed soul on both sides. Conclusions: It was found in the study that reflection and identification were the emerging themes, which can enable healthcare professionals to understand parents' concerns in a meaningful way, as they deal with the remains of stillborn babies. Moreover, it is hoped that hospital administration and health care personnel should consider stillborn parents' concerns and incorporate their needs into nursing assessment and treatment practices. Relevance to clinical practice: Given stillbirth's profound implication for parents' identity and psychosocial role, hospitals need to be more sensitive and proactive to parents' cultural and religious needs when they care for stillborn baby and handle its body. [ABSTRACT FROM AUTHOR]

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Objectives: Advance care planning (ACP) interventions are supposed to affect patients' autonomy and family health-care outcomes positively. However, the clinical benefits of ACP actualization and associated contextual factors merit questioning. Therefore, this study explores the critical contextual and procedural factors related to ACP decision-making based on the actual situation of older patients with cancer encountering end-of-life care in Taiwan., Methods: This retrospective qualitative secondary analysis used the Kipling method (5W1H) to explore further the critical contextual and procedural factors related to ACP decision-making processes. We applied thematic analysis and dual coding for 35 narratives, including 10 patients with cancer, 10 family caregivers, and 15 health-care staff, derived from a preliminary qualitative study regarding palliative care decision-making among patients with advanced cancer, their families, and health-care staff., Results: We identified 6 domains detailing the contextual factors for ACP decision-making: (1) WHO (decision makers); (2) WHAT (discussion content); (3) WHEN (care plan for which disease stage); (4) WHERE (patient's situational location); (5) WHY (reasons underpinning the decisions); and (6) HOW (the way to form the decisions)., Significance of Results: Using the Kipling method to elaborate the contextual factors for ACP decision-making among older patients with cancer strengthens the understanding of complicated end-of-life care decision-making procedure. This study also demonstrates the dynamic and cultural complexity and the various factors considered during end-of-life care and future ACP discussion.

Background: Neoadjuvant chemotherapy is commonly performed to reduce the size of tumors before partial mastectomy to improve the rate of breast-conservation. Few studies have been conducted to assess the neoadjuvant chemotherapy experience of women diagnosed with breast cancer and their responses to it., Purpose: To explore the experience of women diagnosed with breast cancer who received neoadjuvant chemotherapy and their responses to it., Methods: The grounded theory was adopted as the methodology. Participants were recruited using purposive sampling. The data were collected using semi-structured, in-depth interviews and analyzed using open, axial, and selective coding., Results: A total of 15 women newly diagnosed with breast cancer participated in this study, with information showing that the core category oscillated between the sizes of the tumor. The three categories included difficulty in coping with the physical response to chemotherapy, absence of role fulfillment, and uneasy emotions. The coping strategies used by the participants included: body and mind adjustment, hiding, family labor adjustment, and changing the pace of social life., Conclusions / Implications for Practice: The participants experienced tremendous physical and psychological stress during their neoadjuvant chemotherapy, in which tumor response assessment served as a critical time point. Medical professionals, in addition to noting changes in women's physiological response, must pay attention to their psychological burden and provide emotional support and treatment information as needed.

Breast cancer significantly threatens the life of women, while the adverse effects of cancer treatment degrade quality of life and psychological well-being. The quality of transitional care following the completion of treatment significantly affects the ability of breast cancer patients to transition successfully into survivorship. This paper introduces multiple theoretical perspectives and provides an overview of the tenets of each in order to identify the positions of breast cancer survivors and to highlight the factors and strategies that influence their transitional care. The theoretical perspectives that are introduced include the social-ecological model, transition theory, and the strengths perspective. In order to improve the holistic care of women with breast cancer, factors relevant to transition are categorized into the individual, interpersonal, organizational, community, and policy levels. Furthermore, empirical interventions, which are based on the respective advantages of the various levels of the social-ecological model, are proposed in order to conform to the sociocultural context and clinical practices. Healthcare providers should leverage the strengths and resources at each level to develop feasible strategies and to provide quality of care in order to assist breast cancer patients to transition successfully from treatment to survivorship and to holistically improve their subsequent quality of life and function.

Background: Chronic psychiatric patients tend to have cognitive and functional impairments. Participation in physical activity has been shown to improve their health and independence. Regular practice of Taijiquan may help improve mood and life stresses, promoting physical and mental health., Purpose: This research explores the effect of a 13-week Taijiquan learning program on the daily life experience of chronic psychiatric patients. The process and the essential meaning of the entire learning experiences are presented., Methods: Data were collected from a psychiatric daycare center at a Teaching Hospital in Taipei. The 6 patients who participated in this study included 3 with bipolar disorders and 3 with schizophrenia. Narrative inquiry and focus-group interviews were used for qualitative data collection and analysis., Results: The initial results of participant experiences were categorized into 3 themes: 1. Learning kung fu in the Taijiquan; 2. Releasing binding through the practice of Taijiquan; and 3. Pursuit of excellence through the learning of Taijiquan. The views of illness, body, and interpersonal interaction as well as the three stages of dilemma, transcendence / acclimation, and acquaintance for the psychiatric patients and their Taijiquan's learning world were described and the potential therapeutic effects on the body and daily life of these patients were explored., Conclusions / Implications for Practice: Learning Taijiquan is highly challenging for the novice, especially those with chronic psychiatric illnesses. However, after familiarization with the postural actions and key concepts of this exercise, Taijiquan facilitated body relaxation, heightened perception, and postural balance. Consequently, this exercise stabilized the mood, disease status, and capacity for handling interpersonal relationships of participants and consequently may enhance their long-term life quality and disease recovery status. Results of this study recommend strongly that Taijiquan be included as a therapeutic activity for psychiatric patients to improve their health, healing, and recovery.

Interdisciplinary understanding is crucial for readers today. This article integrates the ideas of four care-aesthetics-column writers in order to illustrate and discuss nursing art and aesthetic care experiences in a cross-disciplinary conversation. This article reflects critically on the art, culture, and nature of nursing in the five themes of: 1) the shape of nursing knowledge, "science" or "art"?; 2) the caring arts: passively regulative or consciously creative labor?; 3) busy hospital workers: a landscape of persons and objects or the creators of the scenery?; 4) nursing skills, arts, and the Tao; and 5) art liberation: is the nursing profession in need of a revolution or fundamental reform? This article utilizes diverse and occasionally contradictory points of view together with practical examples in order to encourage readers to interlink their disparate professional nursing skills and draw aesthetic knowledge from multiple sources and experiences.

Background: Caring consciousness and care action are core nursing values. The concept of internal temporal flow offers the potential to provide patients a richer and more meaningful life and better care. The family care phenomenon of psychiatric patients merits re-exploration., Purpose: This study identifies and describes relationships and issues within and between caring consciousness, care actions, and internal temporal flow by describing and interpreting the family care phenomenon of psychiatric patients. This study targets the care-recipient as a primary subject and highlights the orientation of co-existing and co-presenting caring-temporal flow for family and professional care applications and references., Methods: This study conducts secondary data analysis using hermeneutic phenomenology inquiry. Research work was completed using multi-perspectives and multi-methods of data collection, including participant observation, individual in-depth and focus group interviews with psychiatric patients and their family members regarding their feelings, and thoughts and experiences of psychiatric family care., Results: Data analysis results are divided into two parts: (1) the intersection of caregiver's and care receiver's caring-temporal flow and (2) The trajectory and construction of psychiatric patients' self-care temporal flow. Multiple appearances of the caring-temporal flow were formed when caregivers and care receivers engaged in different time and diverse care patterns., Conclusion: Fluctuation and competition among psychiatric patients' and their family members' control and transfer in terms of their lived temporality were influenced by mutual maturity as well as the demand and offering of caring consciousness and care action. The psychiatric patient as a primary subject should return and take control over his or her own mainstream lived temporality, which is the core essence of care.

People with mental illness suffer from their disorder as well as from social stigma. This paper explores the bio-psycho-social reasons that underlie human stigma and proposes potential anti-stigmatization strategies. Furthermore, this paper presents a multi-component, multi-level intervention genetic psychiatry protocol addressing stigma prevention. Significant levels of social stigma still pervade Taiwanese culture, and a potential crisis of genetic psychiatry exists in cases where mental illness is identified. Promoting humanistic, ethical, and caring attitudes and enhancing genetic nursing education at both the community level and amongst health professional are central to ensuring the rights and quality of life of the mentally ill in Taiwan society.

Background: Schizophrenia negatively affects both patients and their families. What are the effects of this incurable, potentially hereditary disease on daily life? Related research shows that schizophrenics tend to experience 'uncertainty' in daily life. Discussions on 'uncertainty' experienced in daily life in the context of concerns regarding hereditary illness remain scarce in Taiwan., Purpose: This research was designed to gather important data on schizophrenic patients and their family members related to their uncertainties about disease heredity., Methods: Participants were recruited from the psychiatric unit and outpatient services department at two hospitals in Hsinchu County. Research subjects included a total of six schizophrenics and six family members., Results: The three topics deduced from data analysis included: 1. marriage / family difficulties rooted in feelings of suffering and torture related to the psychosis and uncertainties regarding disease heredity; 2. evolution from doubt to trust as patients gradual accept choices and make decisions related to disease heredity; and 3. dealing with disease heredity again after having made a successful transition (i.e. persistence to maintain family ties)., Conclusions / Implications for Practice: Both patients and family members experienced worry and fear due to uncertainty about the hereditary condition of the disease. Some experienced emotional responses such as anxiety and helplessness. Research results are expected to help nursing personnel understand the multiple effects and impacts of uncertainty toward illness heredity experienced by the patients and their families in order to provide better consultation and medical care quality under differing circumstances depending on the individual characteristics of patients and their families.