Impact of Mobile Apps in Conjunction With Percutaneous Endoscopic Gastrostomy on Patients' Complications, Quality of Life, and Health-Related Self-Care Behaviors: Randomized Clinical Trial.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is commonly chosen for long-term enteral nutrition support. However, common complications of PEG include wound infection, leakage, obstruction, bleeding, dislodgement, pneumonia, peritonitis, and more. The anticipation of these complications by both patients and their family caregivers underscores the essential requirement of ongoing technical guidance for the daily care of PEG and the adoption of preventative strategies. OBJECTIVE: This study aimed to establish and compare a health education program utilizing a tracking system for PEG using a mobile app (PEG app) and instant messaging software versus a paper-based health education program with instant messaging software. Their effectiveness in preventing complications, avoiding hospital readmissions, improving self-care practices, and enhancing quality of life outcomes was assessed. METHODS: A randomized controlled trial design was used, and the study sample consisted of patients from a medical center in central Taiwan who underwent thoracic surgery or gastroenterology procedures. Inclusion criteria were being a new case undergoing his or her first gastric tube insertion and having the ability to operate a smartphone. Exclusion criteria were cases requiring tube replacement or nasogastric tubes. A total of 74 participants were enrolled, with 37 participants in the experimental group and 37 participants in the control group. Data collection took place from hospitalization until 1 month after discharge. The experimental group received care using the gastric tube tracking system (PEG app) and the Line app that included phone, text, and photo capture capabilities, while the control group received routine nursing care and used the Line app. RESULTS: The experimental group demonstrated a significant reduction in the occurrence of complications compared with the control group (χ21=12.087, P=.001). Specifically, the occurrence of leakage events was significantly lower in the experimental group than in the control group (χ21=12.906, P=.001). However, the experimental group exhibited superior self-care ability compared with the control group (t72=2.203, P=.03). There was no significant difference in overall quality of life scores between the experimental and control groups (t72=1.603, P=.11). However, the experimental group showed better social aspects of quality of life than the control group (t72=2.164, P=.03). CONCLUSIONS: Integration of the PEG app with instant messaging can enhance self-care ability, improve social aspects of quality of life, and reduce complications. The study results suggest that the PEG app could be used as an adjunct tool to promote patients' self-directed management of their gastric tube at home, particularly for patients who have undergone their first PEG placement and are being discharged from the hospital. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2300071271; https://tinyurl.com/4vvy584e.

Re-figuration of suffering: Transitional phenomena of people living with schizophrenia in group analysis.

This study examined how people living with schizophrenia recognize their lived experiences in free-floating group discussions. Interpretative phenomenological and group analyses were employed to collect qualitative data from 14 patients. The identified superordinate theme was "re-figuration of suffering" including: "being treated as an object," "encountering the self through others," and "returning to the self." Participants shared their traumatizing stories of being alienated, discovered the realities of their lives and responsibilities through inward and outward observations, and progressed to a self-returning stage while regaining their appreciation of others and hope for the future. The contributions of psychiatric nursing practice were identified.

Calling nurses to care for burn victims after color-dust explosion.

BACKGROUND: Healthcare professionals follow codes of ethics, making them responsible for providing holistic care to all disaster victims. However, this often results in ethical dilemmas due to the need to provide rapid critical care while simultaneously attending to a complex spectrum of patient needs. These dilemmas can cause negative emotions to accumulate over time and impact physiological and psychological health, which can also threaten nurse-patient relationships. AIM: This study aimed to understand the experience of nurses who cared for burn victims of the color-dust explosion and the meaning of ethical relationships between nurse and patient. RESEARCH DESIGN: A qualitative descriptive study using a phenomenological approach. PARTICIPANTS AND RESEARCH CONTEXT: Clinical nurses who provided care to the patients of the Formosa color-dust explosion of 2015 were selected by purposive sampling (N = 12) from a medical center in Taiwan. Data were collected using individual in-depth semi-structured interviews. Audiotaped interviews were transcribed and analyzed using Colaizzi's method. ETHICAL CONSIDERATIONS: This study was approved by the institutional review board of the study hospital. All participants provided written informed consent. FINDINGS: Three main themes described the essence of the ethical dilemmas experienced by nurses who cared for the burn-injured patients: (1) the calling must be answered, (2) the calling provoked my feelings, and (3) the calling called out my strengths. CONCLUSIONS: Healthcare providers should recognize that nurses believed they had an ethical responsibility to care for color-dust explosion burn victims. Understanding the feelings of nurses during the care of patients and encouraging them to differentiate between the self and the other by fostering patient-nurse relationships based on intersubjectivity could help nurses increase self-care and improve patient caregiving.

Meaning of critical traumatic injury for a patient's body and self.

BACKGROUND: Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient's body and self. AIM: To understand the meaning of traumatic injury for body and self for patients receiving intensive care. RESEARCH DESIGN: A qualitative descriptive study using Giorgi's phenomenological approach. PARTICIPANTS AND RESEARCH CONTEXT: Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30-60 min. Audiotaped interviews were transcribed and analyzed. ETHICAL CONSIDERATIONS: This study was approved by the Institutional Review Board of the medical center. FINDINGS: The impact of the experience of traumatic injury on participants' body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. DISCUSSION AND CONCLUSION: The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient's body and self that facilitates ethical care and recovery from injury.

From self-compassion to compassionate action: reflecting on ending life of stillbirth care in nursing.

Nurses' distress in response to the professional experience of the neonatal loss and stillbirth care is poorly addressed in nursing practice; therefore, the purpose of this study is to explore nurses' experiences of labour of a stillborn baby. A qualitative approach with ten Registered Nurses from hospital birth units in northern Taiwan was used to investigate the stillbirth care experiences of nurses. Research data analysed by interpretative phenomenological analysis (IPA) were collected from eight digital recorded sessions of group dialogues, nurses' responses and feedbacks. Three main themes extracted from data include unfolding the suffering, engrossing in stillborn parents and demonstrating compassionate actions for the stillborn baby. Unfolding the suffering includes shame, guilt and disenfranchised grief. Engrossing in stillborn parents includes perceiving the mother's suppress sadness and empathising with the father's anger. Finally, demonstrating compassionate actions includes fulfilling the parents' needs to say goodbye to their stillborn baby and saying a personal goodbye to the dead baby. The finding of this study shows that the reflective group provided the space for nurses to unfold their suffering, share their emotion, and develop practical wisdom in caring for stillborn baby and the parents. The experience of nurse group conducting the reflecting dialogues could be a expository strategy to promote the nurse to provide the compassionate care actions.

[Subjectivity of the Body in Nursing Care].

Although it is the lived body that performs caring actions, we regularly neglect the subjectivity of our bodies. The aim of this paper was to explore the relation between the lived body and the world, emotions as a mediator between body and mind, and the embodiment of group dialogue. 'Embodiment of group' includes listening to the inner voice, listening from the context, and using the mind as a mirror in order to promote self-directed learning. Achieving understanding the subjectivity of the body may significantly improve the quality of nursing care and clinical teaching.

Psychometric Testing of Two Chinese-Version Scales on Attitudes Toward and Caregiving Behaviors for End-of-Life Patients and Families.

The study purpose was to examine the validities and reliabilities of the Chinese-versions Frommelt Attitudes Toward Care of the Dying Scale (Attitudes Scale) and Caregiving Behaviors Scale for End-of-Life Patients and Families (Behaviors Scale). The scales were tested in a convenience sample of 318 nurses with ≥6 months work experience at three hospitals. Cronbach's alphas of the Attitudes and Behaviors Scales were .90 and .96, respectively. Each scale had Kaiser-Meyer-Olkin index >.85 and Bartlett's test of sphericity >4000 ( p < .001). Attitudes Scale loaded on three factors: respecting and caring for dying patients and families, avoiding care of the dying, and involving patients and families in end-of-life care. The Behaviors Scale loaded on two factors: supporting dying patients and families, and helping families cope with grief. Factor loadings for both scales were ≥.49. Both Attitudes and Behaviors Scales are reliable and valid for evaluating nurses' attitudes and caregiving behaviors for the dying.

From vulnerability to passion in the end-of-life care: The lived experience of nurses.

PURPOSE: End-of-life (EOL) care is considered to be inherently difficult and vulnerable for patients and nurses. It also seems hard to develop passion for care during these problematic times. This study elucidates how EOL nurses interpret their care experience and how they transform their experience and mindset. METHODS: This study was conducted by organizing a reflective group based on the concept of group analysis for oncology and hospice nurses to share their experience. Thirteen registered nurses were enrolled from a medical center in northern Taiwan. Data drawn from the group dialogue was derived from six digitally recorded sessions and then analysed alone with the researcher's diaries and participants' feedback sheets. Interpretative Phenomenological Analysis (IPA) was used to analyze the data. RESULTS: The results showed that nurses who provide EOL care actually experience suffering by witnessing patients' suffering. However, the suffering authentically drives the nurses to encounter their own inner selves, to induce the shift of mindset, and then allow them to continuously provide and maintain the passion in EOL care. CONCLUSIONS: This study provides a new viewpoint for understanding of EOL nurses' experiences, indicating that this line of work may be recognized as a privilege. We recommend that the setting of a nurse reflective group is important and it may be considered in providing EOL care training for nurses. Hopefully the study results could shed lights for future policies regarding EOL care.

[Correspondence in Humanistic Care].

BACKGROUND: Intersubjectivity is a significant element of humanistic care. However, there is a lack of evidence related to the perceptions of nurses in clinical practice settings. PURPOSE: To explore the evidence of correspondence in clinical intersubjective caring activities. METHODS: The van Manen's thematic analysis approach was used to analyze the data, which was obtained from dialogues in small group learning settings. Six scenarios were identified to define the nature of correspondence in nursing care. RESULTS: In terms of reason, ethical relation, and activity, the following three items of correspondence in humanistic care were identified: coexistence through reconciling relationships with the other, cooperation through bringing out (unfolding) and not through putting in (imposition), co-transcendence from actions and reflections. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: By adopting openness in correspondence, nurses may promote coexistence through being open-minded to their opposite, promote cooperation with their opposite, and promote co-transcendence through pursuing authentic existence. The findings show that correspondence that is grounded in coexistence, cooperation, and co-transcendence promotes creativity and diversity in caring actions.

[Living With Tolerable Burden: Exploring the Ethical Self of Nurses Who Provide End-of-Life Care].

BACKGROUND: Providing end-of-life (EOL) care elicits complex emotions in nurses in the context of modern medicine. Nurses must not only watch their patients succumb to disease and death but also witness their suffering. PURPOSE: This qualitative study adopted the perspective of "the other", as proposed by Emmanuel Levinas, to understand the experience of nurses who provide EOL care and the possibilities of nurses build up their ethical selves within the context of modern medicine. METHODS: The study used interpretative phenomenology and group dialogue. Thirteen nurses who had EOL care experience were included. Data were drawn from the six transcripts of the group sessions, the researcher's diaries, and participants' feedback sheets. Interpretative phenomenological analysis was used to analyze the data. RESULTS: The findings showed that nurses not only execute medical procedures but are also capable of self-molding into ethical subjects. The categories of participant experiences included: (1) encountering the death; (2) encountering my inner self; and (3) greeting the death. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: EOL nursing does not require abstract or decontextualized knowledge, but rather requires more experiential knowledge. EOL care may inspire nurses to become ethical persons and to gain wisdom if they shift away from a self-centered perspective to receive "the other". This study illustrates that EOL care should not depend solely on ethical codes or principles but should also adopt the attitudes of "for the other".

[Narrative Pedagogy in Nursing Education: The Essence of Clinical Nursing Process Recording].

BACKGROUND: Clinical nursing process recording (CNPR) has been shown to be an effective tool for facilitating student-centered teaching and learning in nursing education. Yet, the essence and process of this tool have yet to be sufficiently explored and clarified. PURPOSE: To explore the essence of CNPR in the contexts of clinical teaching and learning. METHODS: Reflective analysis was used as the phenomenological approach to analyze the qualitative data, which were transcribed from the oral responses of the six participants who were attending the Clinical Nursing Education Forum. A total of five sessions of the Clinical Nursing Education Forums were conducted. The content of the Clinical Nursing Education Forums consisted of a series of 12 narrative writings of CNPR that were written by a senior student and read and commented on by the student's clinical instructor. RESULTS: Three groups of the essence and process of clinical teaching and learning were inductively identified as: (a) mobilizing autonomous, self-directed learning behavior from self-writing and re-storying; (b) establishing the student-instructor dialogical relationship from mutual localization; and (c) co-creating a learning environment in education and in clinical practice. CONCLUSIONS: When used as an interactive teaching and learning tool, CNPR promotes mutual understanding by re-locating the self in the coexisting roles of student nurse, instructor, and patient in a series of nursing care situations. This re-location facilitates students' self-directed learning, enhances the abilities of asking question, waiting for and accompany with the instructor; and promotes the self-care capabilities of patients.

[The Positionality of Caring Action: Small Group Dialogue in a Course on Nursing Ethics].

BACKGROUND: The content of nursing-ethics education has typically focused on the external standards of caring behavior and neglected the relationship between the ethical attitudes and internal experiences of caregivers. PURPOSE: To explore the embodied experience in order to define the positionality of caring action, which is necessary to enrich the content of nursing ethics through small-group-learning-based dialogue. METHODS: The researcher, as a participant observer, teaches a course on nursing ethics. Reflective analysis was used to analyze the data from the process of small group learning, a reflective group of faculty members, and 30 reflective journals submitted by 10 students. RESULTS: The results identified three items that were related to the positionality of caring action: the attitudes of belief, including the choice to belief and deep understanding; articulating the value system, including exploring affectivity and positionality; and cultivating the self through self-dialogues and dialogues with others. CONCLUSIONS: The attitudes of belief promote trust in interpersonal relationships. Articulating the value system deepens the meaning of caring. Cultivating the self may facilitate the ethical self.

The Transformation Process in Nurses Caring for Dying Patients.

BACKGROUND: Despite the recent increase in attention to end-of-life hospice care, little empirical evidence regarding the process of emotional or mental transformation in caregivers is available. PURPOSE: This study explores the transformative process that occurs in nurses because of the spiritual suffering and conflict associated with after caring for dying patients. METHODS: A phenomenological approach was used to investigate eight nurses (27-40 years old) working in the hospice ward of a medical center in Taipei. Data were collected through open-ended questions using semistructured interviews and were analyzed reflectively. RESULTS: A three-stage transformation in the emotional processes of participants was observed. In the first stage, the participants experienced acute emotional suffering because of facing the death of their patients, potentially exacerbated by their own memories of losing family members. In the second stage, the participants adopted coping strategies to improve self-care. These strategies included attempting to soothe patients, helping patients face or deal with unfulfilled business, and participating in funeral or memorial services. In the third stage, the participants learned to provide better care through emancipatory reflection and a reassertion of responsibilities toward the self, patients, and patient families. After the third stage, the initial emotional impact morphed into a medium for self-strengthening, and participants became more adept at detecting patient needs and at providing care to complete the transformational process fully. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Emotional suffering was the primary factor that induced participants to transform their personal and professional selves. Adequate emotional self-management, dialogue with other nurses, and personal reflection are crucial actions that nurses may use to cultivate personal growth, implement ethical practice, interact with other nurses, and engage in personal reflection. Strategies such as caring for patients, implementing reflective nursing practices, focusing on patient needs, and utilizing past experiences enable nurses to develop a heightened sense of responsibility and awareness, thus empowering them to take better care of themselves and their patients.

[Self-Reflection From Group Dialogue: The Lived Experience of Psychiatric/Mental Health Nurses].

BACKGROUND: Self-reflection is an essential element of reflective practice for group facilitators. However, this element typically exists largely at the personal level and is not addressed in group dialogues of nurses. PURPOSE: The purpose of this study was to explore the self-reflection of psychiatric nurses in a supervision group. METHODS: A phenomenological approach was used to investigate the dialogues across 12 sessions in terms of discussion content and the reflective journals of the psychiatric nurse participants. RESULTS: The findings showed that two forms of self-reflection included: Embodied self-reflection derived from the physical sensibility and discursive self-reflection derived from the group dialogues. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The embodied and discursive self-reflections promote self-awareness in nurses. The embodiment and initiation in the group facilitates the process of self-becoming through the group dialogue, which promotes self-examination and self-direction in healthcare professionals.

[The Mechanism of Free-Floating Discussion in a Psychiatric/Mental Health Nursing Supervisory Group].

BACKGROUND: Although the free-floating discussion format is widely used in group therapy, the application of this format in the context of supervisory groups has yet to be clarified. PURPOSE: The purpose of this study was to explore the mechanisms involved in facilitating and learning the free-floating discussion format in a supervisory group. METHODS: A phenomenological approach was used to investigate the group content and personal feedback of a psychiatric-nurse supervisory group. The group held on 12 sessions. Each session was conducted once weekly and lasting 150 minutes. RESULTS: The findings identified the functions of free-floating discussions in the context of supervisory groups as: embodied interaction and initiation by handling. Embodied interaction included: reflection on the experience of the other, sense of body, and present action. Initiation by handling included: facilitating the self-narrative, following the lead of the group, and reflecting in accordance with the group. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The role of the facilitator is to parallel process rather than to lead in order to produce practical wisdom. Free-floating discussion and self-evidence from initiation by handling has the potential to promote spontaneity, creativity, and self-confidence in clinical practice and to promote deep learning.

[Saying goodbye to the newborn: the unease and actions of nursing professionals in handling stillbirth care].

BACKGROUND: Facing the death of newborns is an inescapable part of the professional responsibilities of delivery room nurses. The meaning of the inner conflict of these nurses and their nursing experience in handling newborn death is poorly addressed in nursing practice. PURPOSE: This research explores the stillbirth care experiences of delivery room nurses. METHODS: A qualitative approach was used to investigate the stillbirth-care experiences of nurse participants. RESULTS: The results elicited the experiences of participants with inner conflict and their resulting action caring. Main themes extracted from data include: feeling unease about being unable to provide effective treatment and the need to say goodbye to the deceased newborn. The former includes the subthemes of: guilt about doing nothing and feeling conflicted about ending a life. The latter includes: caring about and empathizing with the mother and accompanying the mother as she says goodbye to her baby. Additionally, the theme of saying a personal goodbye to the newborn baby includes praying for the baby and respecting baby's body. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings of this study enhance the nursing practice knowledge of stillbirth nursing in the delivery room.

A study on the relationship between age and inpatient falls in Taiwan.

Falls are the most frequently reported adverse hospital events. How to prevent inpatients from falling has become an important issue of patient safety in hospitals. The purpose of this study was to investigate the correlation between age and inpatient falls. A retrospective study design was used. This study, which extracted information from fall-related incident reports, enrolled patients who had fallen during hospitalization in Taiwan. Of the 221 falls evaluated, 63.8% had occurred under companion care, 98.2% of patients had fallen once and most fall-related injuries were minor (46.6%). Falls occurred most frequently when patients were going to the toilet, walking and being moved. There were significant correlations with age groups and fall-related factors (P = 0.000; P < 0.05), the presence/absence of a companion (P = 0.022, P < 0.05), the situation of falls (P = 0.000; P < 0.05), and fall-related injuries (P = 0.000, P < 0.05). Preventive interventions related to falls should vary for different age groups.

[The practical wisdom gained in the provision of end-of-life care].

BACKGROUND: The suffering experienced by nurses while providing end-of-life care to patients influences the lived experience of these nurses. The perspectives of "for the other" and "practical wisdom" may be used to elicit the experience of nurses in caring for dying patients and to help illustrate the ethical contents and meanings of end-of-life care. PURPOSE: This study describes the experiences of nurses who have provided end-of life care in hospital settings. METHODS: In-depth interviews were used to explore the respective experiences of 7 nurses. Data were analyzed using interpretative phenomenological analysis (IPA). RESULTS: The findings show that practicing and engaging in end-of-life care provide nurses the opportunity to acquire practical care wisdom in three categories, including (1) the emotional difficulties of patient care; (2) the limitations of the self; and (3) learning to adjust to the needs and pace of the patient. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: End-of-life care is an opportunity for both dying patients and nurses to transform and grow spiritually. Dealing with the emotional difficulties of end-of-life care, recognizing their self-limitations in care, and adjusting their care provision to meet the needs and pace of their patients help increase the awareness of nurses to the ethical responsibility they have toward patients. These findings give nurses new perspectives on caring for others.

[The physical activity and life healing in psychiatric patients: taijiguan as an example].

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.

[Between the self and the other: the ethical attitude of providing care to others].

BACKGROUND: The need to face others is an inescapable part of the professional responsibilities of nurses. The meaning of "facing the other" is poorly addressed in nursing practice. PURPOSE: The purpose of this study was to explore the ethical attitudes of nurses related to facing others. METHODS: A qualitative approach was used to investigate the living experience of psychiatric nurses in the supervision group in terms of improved ability to handle therapeutic groups. RESULTS: The process of facing the other was for the other, by the other, and then for oneself. The presence of for the other, the sensibility from by the other, and the self-examination of for oneself were discussed in detail. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The process of for the other, by the other, and then for oneself constructed the significance of learning from the patients. The group with that used the free-floating discussion format was found to promote the ethical attitude of psychiatric nurses and may be applied in clinical practice.