Comparisons for Effectiveness of Aromatherapy and Acupressure Massage on Quality of Life in Career Women: A Randomized Controlled Trial.

OBJECTIVES: This study was aimed to compare the effectiveness of aromatherapy and acupressure massage intervention strategies on the sleep quality and quality of life (QOL) in career women. DESIGN: The randomized controlled trial experimental design was used in the present study. One hundred and thirty-two career women (24-55 years) voluntarily participated in this study and they were randomly assigned to (1) placebo (distilled water), (2) lavender essential oil (Lavandula angustifolia), (3) blended essential oil (1:1:1 ratio of L. angustifolia, Salvia sclarea, and Origanum majorana), and (4) acupressure massage groups for a 4-week treatment. The Pittsburgh Sleep Quality Index and Short Form 36 Health Survey were used to evaluate the intervention effects at pre- and postintervention. RESULTS: After a 4-week treatment, all experimental groups (blended essential oil, lavender essential oil, and acupressure massage) showed significant improvements in sleep quality and QOL (p < 0.05). Significantly greater improvement in QOL was observed in the participants with blended essential oil treatment compared with those with lavender essential oil (p < 0.05), and a significantly greater improvement in sleep quality was observed in the acupressure massage and blended essential oil groups compared with the lavender essential oil group (p < 0.05). CONCLUSIONS: The blended essential oil exhibited greater dual benefits on improving both QOL and sleep quality compared with the interventions of lavender essential oil and acupressure massage in career women. These results suggest that aromatherapy and acupressure massage improve the sleep and QOL and may serve as the optimal means for career women to improve their sleep and QOL.

Influence of Religious Beliefs on the Health of Cancer Patients.

BACKGROUND: This study investigated the influence of religious beliefs on the health of cancer patients and identified the factors contributing to the influence. MATERIALS AND METHODS: A questionnaire survey was conducted using a convenient sampling method. A structured questionnaire was used to the samplings, and the data of 200 cancer patients were collected. RESULTS: The effects of religion on the health of cancer patients achieved an average score of 3.58. The top five effects are presented as follows: (a) Religion provides me with mental support and strength, (b) religion enables me to gain confidence in health recovery, (c) religion motivates me to cope with disease-related stress positively and optimistically, (d) religion helps me reduce anxiety, and (e) religion gives me courage to face uncertainties regarding disease progression. Moreover, among the demographic variables, gender, type of religion, and experience of religious miracles contributed to the significantly different effects of religion on patients. Specifically, the effect of religion on the health of patients who were female and Christian and had miracle experiences was significantly (< .01) higher than that on other patients. CONCLUSIONS: These results are helpful in understanding the influence of religious beliefs on the health of cancer patients and identified the factors contributing to the influence. The result can serve as a reference for nursing education and clinical nursing practice.

Effect of Relaxation With Guided Imagery on The Physical and Psychological Symptoms of Breast Cancer Patients Undergoing Chemotherapy.

BACKGROUND: Breast cancer patients frequently experience psychological distress during the chemotherapy period. OBJECTIVES: This study aimed to evaluate the effect of relaxation with guided imagery on patients with breast cancer. PATIENTS AND METHODS: A two-group, pretest-posttest, quasi-experimental design with a randomized controlled trial was conducted. Sixty-five breast cancer patients from one medical center in Taiwan were enrolled in the study. These patients were randomly assigned to the experimental group (n = 32) or to the control group (n = 33). Both groups received chemotherapy self-care education, but the experimental group also received relaxation with guided imagery training. The training on relaxation with guided imagery was conducted before chemotherapy, and the patients were supplied with a compact disc detailing the performance of relaxation with guided imagery for 20 minutes daily at home for 7 days after chemotherapy. RESULTS: The experimental group showed significant decreases in insomnia (-0.34 ± 0.83, P < 0.05), pain (-0.28 ± 0.58, P < 0.05), anxiety (-3.56 ± 2.94, P < 0.00), and depression (-2.38 ± 2.70, P < 0.00) between the pretest and the posttest. Comparing the two groups, statistically significant differences were found in the overall symptom distress (B = 0.11, P < 0.05), insomnia (B = 0.50, P <0.05), depression (B = 0.38, P < 0.05), and numbness in physical symptoms (B = 0.38, P < 0.05), as well as in anxiety (B = 3.08, P < 0.00) and depression (B = 1.86, P < 0.00) in psychological distress. One week of relaxation with guided imagery can significantly improve the overall symptoms of distress, insomnia, depression, physical symptoms, and anxiety, and can decrease psychological distress. CONCLUSIONS: Relaxation with guided imagery had a positive effect on mediating anxiety and depression in breast cancer patients.

Development and preliminary testing of an instrument to measure healthiness of lifestyle among breast cancer survivors.

Monitoring lifestyle to maintain health is an important issue for breast cancer survivors. No multidimensional instrument has previously been available specifically for assessing overall healthiness of lifestyle among breast cancer survivors. This study aims (i) to establish the Healthy Lifestyle Instrument for Breast Cancer Survivors (HLI-BCS) and (ii) to examine the reliability and validity of the established scale. A quantitative cross-sectional design was used. This project was conducted in four phases. In phase I, using the Health-Promoting Lifestyle Profile as the core concept, we created 50 preliminary measurement items. In phase II, we invited 10 breast cancer survivors and five professional experts to conduct a content validity assessment. In phases III and IV, a total of 220 breast cancer survivors were enrolled to assess the construct validity and the internal consistency and reliability. The final HLI-BCS contains 20 items across five domains: dietary habits, environment and physiology, health responsibility and stress management, social and interpersonal relations and spiritual growth. Through the information presented in the HLI-BCS, breast cancer survivors can assess their lifestyles on multiple dimensions and subsequently adjust their lifestyles to enhance their recovery and quality of life.

[Preparing Taiwan nurses for professional practice: a discussion of current international trends].

Taiwan is currently considering revising the minimum educational requirements for becoming a licensed registered nurse (RN). This article analyzes this issue from an international perspective within the framework of Taiwan's experience. Suggestions regarding possible approaches are given.

Effects of Hatha yoga on stress in middle-aged women.

BACKGROUND: Stress is considered a crucial trigger for physical and mental illness. Stress reduction is a known long-term benefit of regular Hatha yoga practice. The efficacy of a single-session Hatha yoga class on stress reduction is not currently known. PURPOSE: This study investigated the comparative effectiveness of a single 90-minute Hatha yoga class and an 8-week, 90-minute-class-per-week course. METHODS: We used a quasiexperimental design and recruited 63 female community residents in New Taipei City aged 40-60 years. Participants were randomly divided into an experimental group (n = 30) and a control group (n = 33). The experimental group received the 8-week Hatha yoga course. The control group received no intervention. The Perceived Stress Scale (PSS) and heart rate variability (HRV) assessed stress reduction effectiveness. Chi-square, independent t test, paired t test, and generalized estimating equations were used for data analysis. RESULTS: After a single 90-minute class of Hatha yoga, experimental group PSS scores were significantly less than those of the control group (p = .001). Although experimental group HRV (low-frequency norm and high-frequency norm) had improved, these changes were not statistically significant (p = .059). PSS scores for the single 90-minute class and 8-week course did not significantly differ (p = .157) and HRV of statistics is significant (p = .005). Generalized estimating equations analyzed changes in the effectiveness over time of stress reduction (HRV and PSS) after the Hatha yoga intervention. Results showed the postintervention HRV and PSS of the experimental group decreased significantly (p < .001) more than the control group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Our findings support the position that regular, long-term practice of Hatha yoga provides clear and significant health benefits. Participation in a single 90-minute Hatha yoga class can significantly reduce perceived stress. Doing Hatha yoga regularly can reduce perceived stress even more significantly.

Healthy lifestyle changes during the period before and after cancer diagnosis among breast cancer survivors.

AIMS: The purpose of the present study was to investigate healthy lifestyle changes during the period before and after breast cancer diagnosis in Taiwan. MATERIALS AND METHOD: Lifestyle changes during the period before and after cancer diagnosis were assessed by convenience sampling with a structured questionnaire for breast cancer survivors. RESULTS: A total of 235 breast cancer survivors completed the healthy lifestyle scale. The mean values before and after breast cancer diagnosis of the participants were 3.27 and 3.73. The final five dimensions for the period before breast cancer diagnosis were: had not experienced stress; had exercised; had maintained sleep quality; had maintained body weight; and had maintained relationships. The final five dimensions for the period after breast cancer diagnosis were: sleep quality; had not experienced stress; relationship; had exercised; and had maintained body weight. A paired-t test was applied to examine the differences before and after cancer diagnosis, revealing that the total average scores of the participants on the healthy lifestyle scale clearly differed statistically (t= -17.20, p<0.01); and the nine dimensions before and after testing also demonstrate a marked statistical difference (p<0.01). CONCLUSIONS: These findings are helpful in understanding the healthy lifestyle changes during the period before and after cancer diagnosis among breast cancer survivors. It is expected that these results can offer references of self-care for this group of patients.

Use of complementary and alternative medicine among breast cancer survivors in Taiwan.

AIMS: The purpose of this study was to investigate complementary and alternative medicine use among breast cancer survivors in Taiwan. MATERIALS AND METHODS: This study employed a descriptive research design approach to detail the CAM use among the target population. Convenience sampling was used along with a structured questionnaire. RESULTS: A total of 230 breast cancer survivors completed the use CAM scale. Prayer, reading books, taking antioxidants, eating various grains, and maintaining a vegetarian diet proved to be the five most frequently used CAM practices among patients in our study. More than 50.0% of the participants reported praying occasionally. More than 40.0% of participants read books occasionally, and 38.7% stated that they occasionally take antioxidants. CONCLUSIONS: These results provide more insight into CAM use for nurses who care for breast cancer patients.

Relationships between cause of cancer and breast cancer-related factors in breast cancer survivors.

AIMS: The purposes of this study were to (1) to identify the causes of cancer in breast cancer survivors in Taiwan; and (2) to investigate the influence of demographic characteristics and breast cancer-related factors on the cause of cancer. MATERIALS AND METHOD: This study details the related investigative results on survivors with breast cancer using a descriptive and correlational design. A convenience sampling approach was employed. A structured questionnaire was used to assess the participants. RESULTS: A total of 230 breast cancer survivors completed the questionnaire. Low-scoring cause of cancer participants were older adults (OR = 2.49, p<0.05) who were already of menopausal status (OR = 2.28, p < 0.05). Around 72% of participants agreed high responsibility. Our breast cancer survivors felt stress had caused their breast cancer. CONCLUSIONS: These findings are helpful in understanding the relationship between cause of cancer and related factors in breast cancer survivors.

[Clinical nursing education].

Nursing is a clinical profession influenced by social and environmental change. Facing the continuing evolution of the medical practice environment, nursing educators should take into account both current issues and future trends. As nursing clinical education undergoes radical reform, it must address both current and future healthcare demands. Relevant articles in the literature indicate that students continue to face significant difficulties applying classroom knowledge to clinical practice. This article describes the meanings, purposes, elements and models of nursing clinical education as well as relevant factors of influence. We also offer suggestions for meeting future societal demands.

Breast cancer survivors' efforts to renew and preserve their health in Taiwan.

AIMS: This study was designed to describe the personal life experiences of breast cancer survivors regarding their efforts to recover and preserve their health in Taiwan. METHOD: The study utilized a qualitative research method, wherein purposive sampling, one-on-one, face-to-face, in-depth semi-structured interviews were conducted. The data were then analyzed using content analysis. Data were saturated after interviewing 15 cancer survivors. RESULTS: Three common themes emerged: introspection on the cause of the cancer, realization of a harmonized lifestyle, and reflecting on the strong will to survive. CONCLUSIONS: These findings are helpful in understanding the relationship between breast cancer survival and individual efforts to restore and preserve health.

Motivations and reasons for women attending a breast self-examination training program: A qualitative study.

BACKGROUND: Breast cancer is a major threat to Taiwanese women's health. Despite the controversy surrounding the effectiveness of breast self-examination (BSE) in reducing mortality, BSE is still advocated by some health departments. The aim of the study is to provide information about how women decide to practice BSE and their experiences through the training process. Sixty-six women aged 27-50 were recruited. METHODS: A descriptive study was conducted using small group and individual in-depth interviews to collect data, and using thematic analysis and constant comparison techniques for data analysis. RESULTS: It was found that a sense of self-security became an important motivator for entering BSE training. The satisfaction in obtaining a sense of self-security emerged as the central theme. Furthermore, a ladder motivation model was developed to explain the participants' motivations for entering BSE training. The patterns of motivation include opportunity taking, clarifying confusion, maintaining health, and illness monitoring, which were connected with the risk perception for breast cancer. CONCLUSIONS: We recognize that the way women decide to attend BSE training is influenced by personal and social factors. Understanding the different risk assessments women rely on in making their health decisions is essential. This study will assist researchers and health professionals to gain a better understanding of alternative ways to deal with breast health, and not to be limited by the recommendations of the health authorities.

An exploration of quality of life and related factors among female flight attendants.

BACKGROUND: Quality of life is currently an important issue in the medical industry. Many studies have found that shift work affects health and life quality. However, data on quality of life related to female flight attendants are lacking. PURPOSE: The purpose of this study was to explore quality of life and related factors such as demographic data, work status, fatigue, sleep quality, and family function as they relate to female flight attendants working on international routes. METHOD: The study used a cross-sectional research design. A purposive sample of 207 participants was recruited from the Aviation Medical Center. The questionnaire distributed to participants incorporated the Multidimensional Assessment of Fatigue, the Chinese version of the Pittsburgh Sleep Quality Index, the Family Apgar Index, and the Taiwanese version of the WHOQOL-BREF. RESULTS: The mean score for holistic quality of life among participants was 54.49 (SD = 6.48), which ranks at a high-intermediate level. The physical health domain earned the highest mean score and the psychological domain earned the lowest. Results of hierarchical multiple regression analysis using the enter method showed that eight predictors, including religion, drug use, employment status, job stress, job passion, fatigue, sleep quality, and family function, explained 34.2% of variance in holistic quality of life. After controlling for demographics, analysis showed that three variables--fatigue, sleep quality, and family function--accounted for 21.3% of variance in holistic quality of life. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Healthcare providers should consider fatigue, sleep quality, and family function factors when planning related health promotion and disease prevention programs for female flight attendants in the future.

Development of a new prototype for an educational partnership in nursing.

The purpose of this 2-year study was to evaluate a new educational partnership for a nurse-managed community center in Taiwan. This project provided care to senior residents in an apartment complex and was integrated into a nursing educational program in Taiwan. In collaboration with these organizations, an educational partnership model was developed and evaluated. Three goals were accomplished: to provide health care to elderly residents, practical learning experience for nursing students, and practical experience for nursing faculty. The findings indicated that teachers, students, and residents in the apartment complex presented a high level of satisfaction with this model. The model created a vivid, practical, community-based resource and applied the principles of service-learning into practical nursing education in Taiwan. The model not only facilitated the empowerment of involved organizations, but also served as a reference for developing other community center-based nursing educational partnerships.

The development of a competency-based group health teaching performance examination model for BSN graduates.

Under the current nursing education system in Taiwan, a fair and objective evaluation of group health teaching competency has been lacking for a long time. Therefore, the purpose of this study was to establish a competency-based group health teaching performance examination model for baccalaureate graduates. Action research was the main research methodology used in this study. The research consisted of two phases. In the first phase, a development committee was established. Based on routine discussions, literature reviews and realistic cases, a draft examination model with quasi-clinical situation model content and procedure was developed. Examination Facility Preparations, Simulated Scenarios and Client Recruitments, Examination Result Evaluation (evaluated by teachers) and Learning Guidelines were also prepared. This draft was reviewed twice for expert opinion, a pilot test was done and both the draft and pilot testing were reviewed again before the draft was finalized. The second phase involved refining the examination model by actually practicing the completed draft examination model in a simulated group-teaching setting in order to examine the model's reliability and validity. Fifteen people were involved in this experiment: three nursing personnel each having at least two years' clinical and teaching experience; three nursing students who did not have actual clinical experience and had not taken the course of teaching principles; three senior teachers; and six virtual patients. The responses from the nursing personnel, nursing students, teachers, and virtual patients who participated in the testing were gathered and integrated to refine the model. The model has content, expert and discriminative validity. The reliability of the model was proven by the high consistency in administration and scoring of the model by clinical examiners. This examination model is not only applicable for the proof of students' credit point exemption, but also as an alternative option for examining nursing personnel in traditional nursing education and practice.

An investigation into competence in TCM of BSN graduates from technological universities in Taiwan.

The purpose of this study was to determine what competences in Traditional Chinese Medicine (TCM) should be possessed by Bachelor of Science in Nursing (BSN) graduates from technological universities in Taiwan. There were two phases in this study: focus groups and expert panel discussion. First, we held four focus groups, and interviewed 31 participants, including consumers, nursing staff and clinical nursing faculty. The interview tapes were transcribed verbatim, were proofed for accuracy and the content was analyzed. The results were then discussed by four academic experts in a panel discussion. Results indicated that the TCM competences of BSN graduates from technological universities should include the following: (1) to understand the basic concepts of TCM, including Yin/Yang, the Five Evolutive Phases, holistic view, the Five Viscera and Six Bowels, Meridians, etiology, and concepts of therapy and health preservation; (2) to recognize the cold and hot nature of food; (3) to illustrate the common dietetic care for immune enhancement in the four seasons, and the foods that help postnatal and postoperative physical regeneration; (4) to illustrate the properties, indications, and administration of common Chinese medicines, including: Ginseng, Lycium, Astragalus, Angelica sinensis (danggui), Chrysanthemum, Pinellia, Zizyphi fructus; (5) to describe the properties, indications, adverse effects, and administration of Siwutang and Shenghuatang; (6) to describe basic principles of administering both Chinese medicine and Western medicine; (7) to describe the indications and cautions of the following techniques: acupuncture, scraping therapy, and cupping; (8) to implement acupressure as a measure for promoting comfort under the following conditions: pain, vomiting, insomnia, palpitations; and (9) to demonstrate an open mind and cautious attitude to respect consumers using TCM. Results of the study can serve as a reference for nurse educators when training BSN graduates from technological universities in TCM competences.

A journey of restoring self-confidence: the life experiences of women recipients of augmentation mammaplasty.

The purpose of this qualitative research study was to explore the preoperative through postoperative phase experience of women who had undergone augmentation mammaplasty. Nine women undergoing augmentation mammaplasty were selected by purposive sampling and interviewed using semi- structured, open-ended interview guidelines. Researchers used Symbolic interactionism to frame their overall perspective and analyzed data with the content analysis method. Rigors of data analysis were adopted credibility, transferability, dependability and confirmability proposed by Guba and Lincoln. The main theme of living experience of women who received augmentation mammaplasty could be summarized as "a journey to restore self-confidence". The categories identified within this journey included: (1) the invisible standards of breast beauty; (2) Taking courageous action to make changes; (3) conflicts between the natural and artificial. The above findings provided initial qualitative data from Taiwanese women's perspective. By better understanding their experience, nurses can become increasingly sensitive to patients' psychosocial adjustment and provide prudential nursing care.

[Prospective developments in nursing education from the perspective of current dilemmas].

Nursing education has evolved from the apprentice system into today's formal doctoral programs. However, has the elevated status of nursing education necessarily led to qualitative improvements? This paper focuses on the crisis and myths related to the nursing education paradigm, the evolution and ongoing reform of nursing education, as well as its future prospects.

Being reborn: the recovery process of postpartum depression in Taiwanese women.

AIM: This paper reports a qualitative study describing the process of recovery from postpartum depression in Taiwanese women. METHODS: We carried out a study using grounded theory with a purposive sample of 23 postnatally depressed women in 2001-2002. The Beck Depression Inventory was used to screen for severe depression. Women with scores higher than 16 at 6 weeks after childbirth were categorized as having postpartum depression. Only two out of the 23 mothers were being treated for depression at the time. The data were analysed by constant comparative method. FINDINGS: 'Being reborn' was the core concept that emerged from the data on the mothers' experience of going through postnatal depression, which was a process of descent into near-death insanity and eventual rebirth. Such postnatally depressed mothers often underwent four stages of coping with the loss of self or loss of former identity and attachment to their new lives as mothers. The four stages were: (1) shattered role identity, (2) feeling trapped and breaking down, (3) struggling for self-integrity and (4) regaining vitality. CONCLUSION: The experience of postpartum depression should be examined within the social and cultural contexts in which it occurs. These Taiwanese data can be used to develop culturally-sensitive health care. The nursing role is primarily that of reflective listening to help the women adjust to the process of being reborn--an internal process of painful growth represented by motherhood and striving to protect the real self in order to maintain emotional health while negotiating a developmental transition. Preventive interventions might include providing guidance for parenting, counselling of individual mothers, and facilitating the development of support groups.

Development of a Web-based childbirth education program for vaginal birth after C-section (VBAC) mothers.

The purpose of this study was to develop a web-based childbirth educational program for VBAC (vaginal birth after C-section) mothers. It contained two phases. In the first phase, analysis, design, development, implementation and evaluation (ADDIE) based on theoretical frameworks were used to establish the program. The second phase (implementation and evaluation) included: expert approval, posting on the Website of National Taipei College of Nursing, program registration through the Internet, implementing the educational program, and testing the results of the curriculum. Ten mothers who had experienced C-section previously and were currently pregnant for over 32 weeks participated in this program. The quantitative data was analyzed by descriptive statistics and pair-t test. Colaizzi's phenomenological method was used for the qualitative data. The first phase established the program goals, course content, teaching methods, and a 90- minute educational program. The outcomes of the second phase: the tests before and after the curriculum were significantly different in VBAC knowledge (p < .01) and attitude (p < .05), participants evaluated the program to be "thorough". This VBAC educational program can be offered to nursing staff as a means to promote VBAC.