The experiences of public health nurses during the COVID-19 in Taiwan: A qualitative study.

AIM: The coronavirus disease 2019 (COVID-19) pandemic has had a substantial effect on frontline health care workers and caused public health nurses (PHNs) to come under various forms of pressure. PHNs face high-risk challenges in their work environment, and their professional commitment and adaptability are key concerns. The aim of this qualitative study was to describe the experiences of PHNs during the COVID-19 outbreak. METHODS/DESIGN: Twenty PHNs who worked during the COVID-19 outbreak were recruited from seven public health centres through posters. Data were collected through in-depth interviews that comprised semi-structured and open-ended questions; subsequently, the data were analysed through content analysis. RESULTS: Three themes emerged from the study findings, namely (1) the disorderliness of COVID-19 pandemic prevention work, (2) managing stress and fear, and (3) the establishment of a new normal. Because of the severity of the pandemic, the workload and stress associated with epidemic prevention policies continue to increase. PHNs may infect their family members and experience a sense of alienation and distance. They must also deal with irrationality and reactions in the people within their community. CONCLUSION: Health department directors and policymakers should provide the necessary support and assistance to frontline pandemic prevention workers to increase the efficiency of pandemic prevention efforts. PATIENT OR PUBLIC CONTRIBUTION: The participants agreed to participate in the qualitative study during the study period.

Associations between domestic violence and poor pregnancy outcomes in taiwanese women: a nested case-control study.

BACKGROUND AND AIMS: Domestic violence (DV) are one of the important risk factors for women's health outcomes. The aim of this study was explored the risk of DV association with the poor pregnancy outcomes (PPOs), including premature delivery, abortion, and stillbirth. METHODS: A nested case-control study was applied. Data from the Taiwan National Health Insurance Research Database were collected from 2000 to 2015. A total of 41,730 participants were included in this study, including 8,346 participants in the case group and 33,384 age- and index year-matched control group. Assessments of DA and PPOs were determined according to the International Classification of Diseases, 9th Revision. We conducted a conditional logistic regression analysis to estimate the effect of DV on PPOs. RESULTS: The mean age was 35.53 in the 41,730 female participants. The overall incidence rate of PPOs of the participants, who had experienced DV, was 84.05 per 100,000 person-years. which was significantly higher than that for the controls (18.19 per 100,000 person-years). The risk of PPOs was higher in the participants who had experienced DV than in the controls (adjusted odds ratio [AOR] = 3.31; 95% confidence interval [CI] [95% CI]: 2.83-3.86), including for premature delivery (AOR = 3.57; 95% CI: 3.05-4.17), abortion (AOR = 3.31; 95% CI: 2.83-3.86) and stillbirth (AOR = 2.98; 95% CI: 2.55-3.47). The results showed that the longer a participant has been suffering DV, the risk of PPOs was higher. CONCLUSIONS: Present results reaved the risk of PPOs associated with DV. Especially, the longer a woman has been experiencing DV, the risk of PPOs was higher, showed a dose-response effect.

Self-management experience of first-time diagnosed gestational diabetes mellitus: A focus group interview.

AIM: Gestational diabetes mellitus (GDM) has become the most common complication in women during pregnancy in Taiwan. Since several clinical trials have demonstrated benefits of aggressive treatment, which rely heavily on self-management. The present study was conducted to explore the self-management experience of women with first-time diagnosed GDM. DESIGN: A qualitative descriptive approach was applied to conduct this study. METHODS: Purposive sampling was used to recruit patients with first-time diagnosed GDM from the maternity outpatient clinics of medical centre in Taiwan. A total of three focus groups interviews with 22 women were conducted to collect the data. Content analysis was applied to analyse the data. RESULTS: Four themes were identified: (1) unexpectedly having a high-risk pregnancy, (2) different perceptions for self-management, (3) implementation predicament of self-management and (4) maternal duty to ensure the safety of mother and child.

Experiences of Middle-Aged and Older Taiwanese Adults With Chronic Insomnia: A Descriptive Qualitative Study.

The purpose of the current study was to describe the experiences of middle-aged and older adults with chronic insomnia. A descriptive qualitative study design was used, and semi-structured interviews were conducted with 17 participants from two primary clinic health centers in northern Taiwan. Mean age of participants was 64.3 years, most (58.8%) participants were middle aged (aged 40 to 64 years), and mean duration of insomnia was 5.6 years. Three themes emerged: Imperfection of Lived Experience, Dilemma of Whether to Take a Hypnotic, and Seeking Help from Alternative Therapy. Participants believed chronic insomnia contributed to an accumulation of anxiety and negative emotions, resulting in psychological burden. For participants with insomnia, because of their negative impressions of hypnotics, they usually sought alternative therapies to improve sleep. Health care providers should endeavor to understand the needs of individuals with insomnia and provide them with sleep hygiene knowledge and assistance in safe sleep practices. [Journal of Gerontological Nursing, 48(11), 21-28.].

The association between obstructive sleep apnea and the risk of poor delivery events in women: A population-based nested case-control study.

PURPOSE: To investigate the risk of poor delivery events (PDEs; premature delivery, abortion, and stillbirth) in female subjects with obstructive sleep apnea (OSA). METHODS: The study identified 8346 female subjects with PDEs as cases between January 1, 2000 and December 31, 2015 from the Longitudinal Health Insurance Database 2005 in Taiwan. A total of 33,384 controls were also identified based on frequency matching for age and year of index date. Diagnoses of OSA and PDEs were determined according to the International Classification of Diseases, 9th Revision. The risk of PDEs in female subjects with OSA was estimated with conditional logistic regression analyses. FINDINGS: The mean age of the 41,730 female subjects was 35.53 years. The overall incidence rate of PDEs was 506.22 per 100,000 person-years for subjects with OSA, which was significantly higher than that for the controls (501.95 per 100,000 person-years). The risk of PDEs was higher in subjects with OSA than in controls (adjusted odds ratio [AOR] = 1.19; 95% confidence interval [CI] [95% CI]: 1.08-1.43), including for premature delivery (AOR = 1.20; 95% CI: 1.16-1.50), and abortion (AOR = 1.19; 95% CI: 1.09-1.47). OSA showed no relation to stillbirth (AOR = 1.04; 95% CI: 0.99-1.31). The findings indicate that the longer a subject has been experiencing OSA, the higher the probability of PDEs. CONCLUSIONS: The risk of PDEs associated with OSA was found in this study. In particular, the longer a subject has OSA, the higher the likelihood of PDEs, exhibiting a dose-response effect. CLINICAL RELEVANCE: To effectively promote maternal health in clinical practice, health providers need to recognize OSA as a risk factor associated with negative pregnancy outcomes. Furthermore, OSA symptoms should be assessed and managed in all pregnant women to enable more comprehensive maternal care.

Care and management of stillborn babies from the parents' perspective: A phenomenological study.

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.

Effectiveness of a Nurse-Led Web-Based Health Management in Preventing Women With Gestational Diabetes From Developing Metabolic Syndrome.

BACKGROUND: Women with gestational diabetes mellitus (GDM) are more likely to develop metabolic syndrome (MS). However, the effectiveness of web-based health management in preventing women at high risk of GDM from developing MS has rarely been studied. PURPOSE: The aim of this study was to evaluate the longitudinal effects of nurse-led web-based health management on maternal anthropometric, metabolic measures, and neonatal outcomes. METHODS: A randomized controlled trial was conducted from February 2017 to February 2018, in accordance with the Consolidated Standards of Reporting Trials guidelines. Data were collected from 112 pregnant women at high risk of GDM who had been screened from 984 potential participants in northern Taiwan. Participants were randomly assigned to the intervention group (n = 56) or the control group (n = 56). The intervention group received a 6-month nurse-led, web-based health management program as well as consultations conducted via the LINE mobile app. Anthropometric and metabolic measures were assessed at baseline (Time 0, prior to 28 weeks of gestation), Time 1 (36-40 weeks of gestation), and Time 2 (6-12 weeks of postpartum). Maternal and neonatal outcomes were assessed at delivery. Clinical trial was registered. RESULTS: Analysis using the general estimating equation models found that anthropometric and metabolic measures were significantly better in the intervention group than the control group and varied with time. At Time 1, the levels of diastolic pressure (ß = -4.981, p = .025) and triglyceride (TG; ß = -33.69, p = .020) were significantly lower in the intervention group than the control group, and at Time 2, the incidence of MS in the intervention group was lower than that in the control group (χ2 = 6.022, p = .014). The number of newborns with low birth weight in the intervention group was lower than that in the control group (χ2 = 6.729, p = .012). CONCLUSION/IMPLICATIONS FOR PRACTICE: This nurse-led, web-based health management was shown to be effective in improving MS outcomes and may play an important role and show feasible clinical value in changing the current pregnancy care model.

Risk of alcohol use disorders in patients with insomnia: A population-based retrospective cohort study.

BACKGROUND: The aim of this study was to explore the risk of alcohol use disorders (AUDs) in patients with insomnia. METHODS: This was a population-based retrospective cohort study based on data from 2000 to 2013. Data from the Taiwan National Health Insurance Research Database were employed for this study. A total of 8076 patients with insomnia were identified as the study group. The control group comprised 16,152 age- and sex-matched patients. We conducted a Cox proportional hazard regression analysis to estimate the effects of insomnia on the risk of AUDs. RESULTS: The overall incidence of AUDs was 753.71 per 100,000 person-years for patients with insomnia, which was significantly higher than the incidence for those in the control group (377.73 per 100,000 person-years). Overall, patients with insomnia had a higher risk of AUDs than did those in the control group (adjusted hazard ratio [HR] = 1.75, 95% confidence interval [CI] = 1.42-2.10). We also observed a significantly higher risk of AUDs in patients with both insomnia and depression (adjusted HR = 5.85; 95% CI = 3.13-8.88) than in those without these conditions. CONCLUSIONS: The risk of AUDs in patients with insomnia was found to be significantly higher than that in individuals in the control group; the risk was particularly pronounced among those with insomnia and depression. These conditions thus exhibited a joint effect on AUDs risk.

Self-management Experience of Middle-aged and Older Adults With Type 2 Diabetes: A Qualitative Study.

PURPOSE: Diabetes mellitus has been either the fourth or fifth leading cause of death among Taiwanese adults during 1995-2015. Older adults with diabetes are at higher risk of developing diabetic macro-vascular and micro-vascular complications. The purpose of this study explored the self-management experiences of middle-aged and older adults with diabetes through a focus group. METHODS: Purposive sampling was used to recruit patients with diabetes from the metabolic outpatient clinics of medical centers and regional hospitals in Taiwan. Two focus groups, comprising a total of 23 participants, were employed to collect data, and group discussions were held a total of four times in an education room that was distant from clinical areas. RESULTS: Three themes were generated from analysis of the collected data: (1) "listening to the voice of the body and observing physical changes," (2) "re-recognizing diabetes and challenges," and (3) "self-management implementation dilemmas." This study provided new insights into the experiences of middle-aged and older adults in Taiwan regarding their self-management of diabetes. CONCLUSION: Healthcare teams should be involved in the self-management education of patients with diabetes as early as possible to reduce patients' anxiety and to develop more patient-centered, culture-sensitive clinical skills. In addition to monitoring patients' self-management, healthcare professor should pay more attention to patients' successful adaptation to and coexistence with the disease.

Developing a Web-Based Comic for Newly Diagnosed Women With Breast Cancer: An Action Research Approach.

BACKGROUND: Personal narratives have been seen as a useful way of communicating about cancer treatment options and providing recovery information. Many printed versions of such material are available, including comics that explore the individual memories of patients who have gone through cancer treatment. These studies have been used to orientate patients, patients' relatives, and physicians. However, only a few Web-based comics have been specifically designed for patients with breast cancer and used as aids to decision making. OBJECTIVE: We aimed to describe the developmental process of creating an animated comic as a Web-based surgery decision-making tool; the comic was aimed at illustrating the feelings, thoughts, and meanings when a patient suffers from breast cancer. This was done by recounting the symptoms, diagnostic process, treatments, and treatment effects of such women from the diagnosis stage onward. METHODS: Using cycles of planning, action, evaluation, and reflection, which involved collaborative work, action research was conducted to develop a Web-based animated comic. The stages of action research consisted of (1) semistructured and in-depth interviews to collect experiences of women with breast cancer; (2) construction of an animated comic by editors, graphics designers, dubbers, and information technology engineers; (3) redrawing of pictures of the comic after gathering feedback from a breast surgeon; and (4) evaluation of the Web-based animated comic using 6 patient focus groups. RESULTS: The comic was produced and showcased on the website "The Network of Making-decision Aids for Breast Cancer Surgery"; the comic was accompanied by soft music and audio explanations. The comic functions as a personal statement that describes experiencing breast cancer. The animated comic consists of 8 chapters, based on the 8 themes deducted from the findings obtained during the analysis of relevant interviews. The 8 chapters include (1) the appearance of a lump; (2) confirmation by medical diagnosis; (3) the uncertainty of waiting (4) fear of life-threatening disease; (5) choosing life over despair; (6) being brave and deciding to undergo treatment; (7) choosing the type of surgery; and (8) being reborn. CONCLUSIONS: Using action research, this study illustrated that the comic that sheds light on issues of feelings, emotions, and thoughts that are present when a woman is diagnosed with breast cancer and provides a communication medium to explain the steps in the process. Meanwhile, it implies that hope will be able to overcome the challenges that will be faced. Within the Web-based decision aid for patients with breast cancer, the animated comic acts as an information resource and is aimed at patients' understanding of impacts of emotions arising when suffering from breast cancer. It is potentially applicable as a therapeutic tool that facilitates self-reflection and self-healing among newly diagnosed patients with breast cancer.

The Experiences of Fathers Whose Spouses Are Hospitalized for Pregnancy Termination Due to Fetal Chromosome Abnormality in Taiwan.

BACKGROUND: Hospitals, where most births and terminations of pregnancy take place in modern society, tend to focus on addressing the perinatal loss experiences of mothers rather than fathers. Healthcare providers often overlook the loss experiences of fathers when pregnancy has been terminated because of chromosome abnormality. Little literature exists on the perceptions of these losses from the point of view of fathers in Taiwan. PURPOSE: The aims of this study were to explore and reveal the essence and structure of the experiences of Taiwanese fathers whose spouses are hospitalized for pregnancy termination due to fetal chromosome abnormality. METHODS: A descriptive phenomenological approach was applied to collect data. In-depth interviews using individualized, semistructured, open-ended questions were conducted with 20 fathers whose spouses were hospitalized for termination of pregnancy due to fetal chromosomal abnormalities. Data were analyzed according to Giorgi's methods. RESULTS: The participants described their experiences as distressing and involving painful decisions. Four themes emerged: (a) "a dismayed father: the unexpected process of terminating pregnancy," (b) "a hidden source of grief: neglected care," (c) "a stressful decision: difficulty handling the deceased offspring," and (d) "a regretful father: inadequate treatment of the baby's remains." CONCLUSIONS: Health professionals must better understand the experiences of fathers, learn to be sensitive and empathetic, and keep communication lines open to create and maintain a more compassionate and caring environment. Health professionals should provide the opportunity for fathers to discuss the decisions that they face, treat the deceased infant with dignity, and acknowledge the grief of both parents as qualitatively equal. Both mother and father should receive appropriate care while the mother is in the hospital for a pregnancy termination.

Seeing or not seeing: Taiwan's parents' experiences during stillbirth.

BACKGROUND: The findings of most quantitative studies and the clinical guidelines for encouraging or discouraging parents to see their stillborn babies remain diverse depending on country and culture of residence. There is still a lack of research comprehensively exploring the situational or cultural meanings of parents' decisions to face their stillborn infants. OBJECTIVES: Understanding the essence and structure of decision-making and seeing phenomena that parents go through during stillbirth of their child adds to the body of nursing knowledge and provides insight into how to care for this group of clients. DESIGN: A descriptive phenomenological approach with multi-setting, multistage, and paired design was used. SETTING: The study was conducted in maternity units in Taoyuan, Taiwan. PARTICIPANTS: A purposive sample of 12 couples (total=24 subjects) who experienced stillbirth deliveries following a diagnosis of fetal death participated in this study. METHODS: The participants' observations and in-depth interviews were recorded and analyzed according to Giorgi's methods. RESULTS: Most parents expressed a sense of deep upset, of never anticipating seeing their deceased babies while some had no fear of how their babies' bodies would look. Two constituted patterns with five themes each emerged from the study: 1.(a) "Deciding to see the stillborn baby" shows the seeing event as an experience of "believing", (b) "avoiding regret", (c)"an opportunity to say farewell", (d) "a chance for imprinting the stillborn infant in one's memory", and (e) "shock of seeing". 2.(a) "Deciding not to see the stillborn baby" demonstrates the meaning of not seeing is "cutting the attachment to the stillborn baby," (b) "preventing memory imprinting," (c) "avoiding guilt and suffering", (d) "pretending event closure", and (e) "the act of following a cultural taboo". CONCLUSIONS: Participants experienced acts of seeing and not seeing throughout their denial or facing of ongoing bereavement, which was influenced by their personal beliefs, readiness for the event, and social values. Health professionals need to understand the powerful interpretation of the "visual" meaning of the stillbirth experience and learn to be sensitive, empathetic and keep communication lines open in order to create and maintain a compassionate and caring environment.

Women of advanced maternal age undergoing amniocentesis: a period of uncertainty.

AIMS: To generate a descriptive model for understanding patterns and interpretations concerning women's experiences of amniocentesis in Taiwan. BACKGROUND: In light of scientific technology and social change, it would be important to recognise the complexity of a woman's situation and the meaning of her in-depth experience while undergoing amniocentesis. Earlier studies on the experience of these women often relied on quantitative data obtained from questionnaires at only one point in time; however, the changes in older pregnant women, known to be at increased risk for foetal chromosomal abnormalities, from the time of pregnancy until test results of their amniocentesis has not been clearly understood. DESIGN: A grounded theory approach was applied. METHODS: Data were collected through in-depth interviews and participant observation. Sampling and major coding continued from 2002-2003 until theoretical saturation occurred; 20 women (> or =35 years of age) participated in this study; data were analysed using constant comparative and content analysis. RESULTS: A prevailing sense of uncertainty was the core category for describing and guiding the process of this study with five main stages identified: (1) ambivalence toward pregnancy; (2) decision to undergo amniocentesis; (3) concerns regarding maternal and foetal safety during procedure; (4) anxiety while awaiting results and (5) thoughts about a lifetime maternal commitment. CONCLUSIONS: Identification and appreciation for emerging themes enables nurses to address women's concerns in a meaningful way as they undergo amniocentesis. Also, it is hoped that understanding key themes allows nurses to facilitate constructive interactions between women, physicians and other members of the obstetric team. RELEVANCE TO CLINICAL PRACTICE: Women in Taiwan undergoing amniocentesis had concerns about safety and dealt with cultural taboos of pregnancy in advanced age; health education should include coping strategies and decision making in dealing with these issues. To facilitate constructive interactions between clients and health care teams, the ethical guidance of informed consent and respecting the women's autonomy should be emphasised.