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[[alternative]]Experiences of Healthcare Seeking among Foreign Residents in Taiwan: A Quantitative and Qualitative Study
No full text[[abstract]]Background: In the twenty-first century, immigration is a very common phenomenon, which influences not only political and economic systems but also has a significant impact on medical care. Number of people who are leaving their country of origin and moving to new destinations is increasing year by year. Literature shows that those populations are having different experiences to seeking help when sick than local ones. Purpose: The current study includes four purposes: (1) to explore the status of healthcare seeking behavior for foreign residents in Taiwan; (2) to identify factors which affect foreign residents’ healthcare seeking behavior in Taiwan; (3) to identify factors that influence satisfaction and its relations with healthcare seeking behavior choices (4) to understand foreign residents’ experiences seeking health care in Taiwan. Methods: This study used a mixed-method design by combining quantitative and qualitative approaches. The quantitative was conducted as the first component. A total of 436 participants were recruited through a convenience sampling. Secondly, to understand foreigners’ experiences, the researcher conducted in-depth, semi-structured interviews. Participants were recruited through a purposive sampling, and the sample size comprised 20 foreigners. Result: For the quantitative part, 436 participants were surveyed. Approximately half of the participants rated their health status as good (50.7%), and the majority did not report any chronic diseases (69.3%). A total of 423 participants (97%) reported taking any action while feeling unwell with prelevance of consulting Western medicine physician (75.4%), taking over-the-counter medication (62.3%) or consulting a traditional Chinese medicine physician (37.3%). Similar patterns were seeing for the future preferences. The logistic regression analysis examining healthcare seeking choices and individual characteristics revealed a significant association for specific predisposing, enabling, and need factors. Additionally, one-way ANOVA results indicated statistically significant differences among the compared groups (H = 0.88, p = 0.02), emphasizing the importance of integrative healthcare. Furthermore, the chi-square analysis supported the assumption that there is a significant association between predisposing, enabling, and need factors and satisfaction levels. For the qualitative part, twenty participants were interviewed. The qualitative analysis revealed six major themes: major health issues; integrative healthcare seeking; factors influencing decision-making healthcare seeking; enablers of healthcare seeking; barriers of healthcare seeking; and satisfaction of healthcare seeking experience. Overall, as the result of the two sections, the study provided a conceptual framework, emphasizing the importance of immigrant-related factors and integrative healthcare. Conclusion: Understanding foreign residents’ healthcare seeking behavior is significant for healthcare providers to provide culturally appropriate care and policymakers to prepare adequate health policies
[[alternative]]Pain management experiences in cancer patients and development of pain management self-efficacy scale.
No full text[[abstract]]本研究旨在了解癌症病人疼痛處理經驗及建構癌症疼痛處理自我效能量表，並測試量表信度與效度。首先以Bandura理論為基礎建構半結構式訪談指引進行質性訪談後採用內容分析法，共得五個主題包括尋找另類輔助療法、應用各種非藥物輔助技巧、變通非藥物輔助技巧、運用方法轉移注意力、尋求幫忙使用非藥物輔助技巧。將上述質性訪談所得之發現發展成疼痛處理非藥物策略之題項，藥物策略之題項則是參考梁(2008)所發展之鴉片類藥物使用自我效能量表，統合非藥物與藥物策略題項後初步建構出37題癌症疼痛處理自我效能之題項，後續邀請13位專家進行二次匿名德菲法檢視，刪除語意重複或語意模糊之處剩33題題項。後續經過專家效度與題項分析後，再刪除4題題項，最後癌症疼痛處理自我效能量表共得29題題項，後續於北部某醫學中心收集30位癌痛病人進行量表前驅測試，結果顯示量表有良好的再測信度（r = .81, p < 0.00）與內在一致性信度(Cronbach’s α .74)。接著收集167位癌痛病患進行正式研究，先以探索性因素分析共萃取9個因素共同解釋71.20%之變異量，之後運用驗證性因素分析，扣除不佳題項後剩下7個因素共24題，結果顯示24題之RMSEA為0.038、GFI為0.80、AGFI為0.84、PGFI為0.65，具可接受的適配度，將7因素重新命名「使用輔助技巧」、「獲得幫助」、「處理止痛藥副作用」、「與醫護人員溝通疼痛與止痛藥使用」、「改變止痛藥的使用」、「與家人溝通疼痛與止痛藥使用」、「克服對疼痛及止痛藥相關擔憂」，量表之題項確定後，再進行量表信、效度分析，其已知團體法與匯聚效度均達統顯著差異，區辨效度僅次量表「改變止痛藥使用」與病人之現在疼痛程度呈現顯著負相關(r= -.208，p< 0.007)， 信度方面，此24題「癌症疼痛處理自我效能量表」之Cronbach’s α 值為0.79，顯示此量表具有良好信度與效度，此量表未來可作為評估癌痛病人在處理疼痛上之自我能力認知情形，以了解病人在處理癌症疼痛的自信程度，並針對得分較低的題項加強照護指導，以增進病人疼痛控制的自信心。[[abstract]]The purposes of the Study herein was to master the experience in the pains that cancer patients deal with, build a self-efficacy scale of cancer pain management, along with tests on reliability and validity. First of all, Bandura Theory is the developmental base of an interview guide in semi-structural form for qualitative interview, followed by content analysis method, where a total of five topics were included, alternative aided treatment, diversified applied non-pharmacological aiding technologies, adapted non-pharmacological technologies, leverage methods to divert attention, seeking non-pharmacology solutions for aiding technologies. I developed questions of non-pharmacological strategies of pain treatments based on the findings from aforementioned interviews, while pharmacological strategies were referenced to the Opioid Use Self-Efficacy Scale developed by Liang (2008). Thereafter, I incorporated non-pharmacological and pharmacological questions and built another 37 questions regarding to Self-Efficacy Scale on Cancer Pain Management in a preliminary stage. Continuously, I invited 13 experts to conduct anonymous Delphi reviews twice, among of which, I deleted questions hiding redundant or ambiguous semantics where 33 of them were left. With continuous analysis made on the validation and questions by experts, I deleted another 4 questions and finally 29 questions were left in this Scale. Subsequent pilot test was conducted with 30 patients with pains caused by cancer at a medical center in northern Taiwan, with a result indicating good re-test confidence (r = .81, p < 0.00) and internal consistency confidence (Cronbach’s α, .74). Next, I collected data from 167 patients with pains caused by cancer to launch a formal study. Firstly, there were 9 factors extracted by exploratory factor analysis where a common interpretation of variance, 71.20%, was made, followed by confirmatory factory analysis resulting in deletion of questions with insignificance and 7 factors remained, totaled to be 24 questions, where RMSEA constituted showed 0.038, GFI as 0.80, AGFI as 0.84 and PGFI as 0.65, all of which reached a preliminary result of acceptable fit. Next, I renamed such 7 factors as “Use of aided technologies”, “getting help”, “Handling side effects of painkillers”, “Communication with healthcare providers on topic of pain and use of painkillers”, “Change the use of painkillers”, “Communication with families on topic of pain and use of painkillers”, “Surmount concerns related with pains and painkillers”. Upon questions of the Scale are determined, I analyzed its confidence and validity, where the given group method and convergent validity both showed significant difference and the discriminant validity showed secondary to the “Change the use of painkillers” scale, with significant negative correlation with patients’ current pain level(r= -.208，p< 0.007). In respect of confidence, the Cronbach’s value α indicted from the “Self-Efficacy Scale on Cancer Pain Management” Scale containing 24 questions was 0.79, indicating that the Scale showed convinced reliability and validity, which can be a reference for assessing abilities and cognitive cases of pain-from-cancer patients on topic of pain treatment, so as to realize the confidence level that such patients deal with the pain caused by cancers, and intensify guidance on nursing and care for questions scored lower to increase their confidence in the control of pain
[[alternative]]The Effect of App-Based Mindfulness-Based Stress Reduction on Physiological and Psychological Factors in Patients With Heart Failure: A Randomized Controlled Trial
No full text[[abstract]]背景：心衰竭病人的情緒症狀、正念及復原力對其生活品質和不良事件風險具有重要的影響，但過去研究僅探討單項情緒作用，較少探討正念及復原力所扮演的中介角色；且文獻指出正念減壓經過學習後即可自我練習。於後疫情時代的數位照護發展趨勢下，期待採用應用程式 (application, APP) 正念減壓的效益。目的：本研究旨為探討心衰竭病人的正念、復原力、憂鬱及生活品質的關係，及施以正念減壓APP介入的生理及心理效益。方法：本文以兩部分研究進行；第一部分採橫斷式研究，於2023 年 09 月至 2024 年 02 月於臺灣某大學附設醫院之心臟專科病房、門診接觸合乎研究條件之病人，納入 180 名研究對象進行問卷調查，收集基本資料、正念、復原力、憂鬱、生活品質量表。病人健康問卷 (patient health questionnaire, PHQ-9) 篩檢總分 ≧ 5分之研究對象，邀請參加第二部分研究。單盲隨機對照研究納入研究對象 68 名( 34 : 34 )，藉由研究者設計的正念減壓APP介入為期八週。結果：經由橫斷性研究發現，第一部分研究假設成立。(1) 研究對象的正念得分越高者（正念越好）、復原力越高分（復原力越好）與心理生活品質得分越高者（生活品質越好）、憂鬱得分越低（越不憂鬱）有關；(2) 研究對象的正念作為憂鬱和心理生活品質的中介因子，使其中的負向影響削弱 4.51%；(3) 研究對象之復原力作為憂鬱和心理生活品質的中介因子，削弱 11.24% 負向影響；(4) 經序列中介分析發現正念及復原力同時作為部分中介因子，對於憂鬱和心理生活品質的負向關係削弱 21.99%。唯生理生活品質與正念的關係並不顯著。第二部分隨機對照研究之假設部分成立；(1) 接受正念減壓APP介入未能降低研究對象的血壓；(2) 介入措施後，雖然實驗組及對照組研究對象的氨基末端腦鈉肽前體之組內皆顯著降低，但組間差異不顯著；(3) 正念減壓APP能顯著減少低頻數值，增加低頻/ 高頻比值；(4) 介入顯著提升正念；(5) 介入顯著提升復原力；(6) 介入顯著減少憂鬱；(7) 但介入對生理或心理生活品質都未達顯著差異。結論：本研究發現，心理生活品質的提升與憂鬱減少有關，正念的提升正向影響復原力以及心理生活品質；中介因子正念和復原力各自都會削弱憂鬱對於心理生活品質的負向關係，而且當正念和復原力同時做為中介因子時削弱的幅度增加 6.24%。建議增益心衰竭患者的心理措施，首選增加正念及復原力的方法。經正念減壓APP介入能改善具有憂鬱情緒之心衰竭患者的心率變異之低頻、正念、復原力、憂鬱，期藉此經驗能有助於臨床應用正念減壓APP，以低耗而高效的策略提升心理健康。[[abstract]]Background: Emotional symptoms, mindfulness, and resilience have significant impacts on quality of life and risk of adverse events in the patients with heart failure (HF). However, previous studies have mainly focused on individual emotional effects, with limited exploration of the mediating roles of mindfulness and resilience. Additionally, shows that mindfulness training can lead to self-practice. With the emerging trend of digital healthcare in the post-pandemic era, there is anticipation for the benefits of utilizing mindfulness-based stress reduction applications (apps).Objective: This study aims to investigate the relationships between mindfulness, resilience, depression, and quality of life in patients with heart failure, as well as the physiological and psychological benefits of mindfulness-based stress reduction app intervention.Methods: The study consists of two parts. The first part adopted a cross-sectional design and conducted a questionnaire survey on 180 eligible patients in the cardiology department of a university-affiliated hospital in Taiwan from September 2023 to February 2024 to collect demographic, mindfulness, resilience, depression, and quality of life data.Research subjects with a total patient score of ≥ 5 points on the Patient Health Questionnaire (PHQ-9) are invited to participate in the second part of the study. The single-blind randomized controlled study included 68 subjects (34:34), who were intervention with the mindfulness-based stress reduction APP designed by the researchers for 8 weeks.Results: This cross-sectional study revealed that higher levels of mindfulness and resilience were associated with higher psychological quality of life scores and lower depression scores. Furthermore, both mindfulness and resilience individually mediated the effects of depression on psychological quality of life, reducing the negative effects by 4% and 1%, respectively. Notably, these mediators also exerted a synergistic effect, indirectly reducing the negative effects of depression by 9%.The findings from this study partially confirmed the study hypothesis. The mindfulness-based stress reduction app did not reduce blood pressure in participants. Although significant intragroup changes (reductions) were observed in the level of N-terminal pro-brain natriuretic peptide (NT-pro BNP) after the intervention, no significant intergroup differences were noted. The app significantly reduced low-frequency values and increased the ratio between low- and high-frequency values. Furthermore, the intervention significantly increased levels of mindfulness and resilience and reduced levels of depression. However, the app did not lead to significant improvements in physical or psychological quality of life.Conclusion: This study indicates that reducing depression can improve psychological quality of life and enhancing mindfulness can improve both resilience and psychological quality of life. Together, mindfulness and resilience can reduce the negative effects of depression on psychological quality of life by 6.24%. Therefore, strategies for enhancing mindfulness and resilience must be devised to improve mental health in patients with heart failure. Mindfulness-based stress reduction apps can not only improve mindfulness and resilience but also mitigate heart rate variability and depression in patients with heart failure and depressive symptoms. Thus, these apps must be integrated into routine care to improve patients’ mental health in a cost-effective manner
[[alternative]]Explore the Effectors of The Transtheoretical Model on nutritional education in patients on hemodialysis
No full text[[abstract]]背景根據台灣腎病年報2022年統計資料顯示，2020年新發血液透析患者平均年齡增加至68.8歲(台灣腎臟醫學會，2024)，隨著血液透析高齡化的推進，其營養問題逐漸凸顯出來，蛋白質熱量營養不良是高齡血液透析患者常見且嚴重的病理情況，可能危及生命 (Mahjoub et al., 2019)。透析相關之營養不良常伴隨著多重因素，與尿毒症和其合併症有關；透析和營養就像同一個硬幣的兩個面向—透析可以凈化由食物攝入產生的代謝廢物。因此，必須實施飲食限制，以限制磷酸鹽的攝入。血液透析患者，如果沒有適當的營養管理，僅靠透析往往不能有效地對抗營養不良。因此，如何提升血液患者對飲食習慣的遵從性，是很重要的事情。目的血液透析患者的營養狀況取決於他們的整體飲食習慣，而知識卻是影響飲食習慣的一個重要因素，藉由營養教育的介入，以提升飲食習慣的遵從性。儘管提供營養教育的策略很多，但是鼓勵患者採取健康的飲食習慣，仍然需要考慮許多層面。跨理論模式是透過為患者提供與其行為相關的策略，並賦予其權力及鼓勵其積極的參與自我照護，被證實能夠有效地改變不良的飲食習慣( Martins et al., 2017)。因此，以跨理論模式擬定血液透析患者之營養照護方案，幫助血液透析患者在面對蛋白質、熱量之營養不良及高血磷症的健康問題時， 有積極的影響。方法本研究設計以簡單隨機分派組別之實驗性研究設計介入成效評估，資料收集為單盲設計。收案條件為年齡51歲以上、能自行由口進食、溝通無困難者；近三個月抽血報告，兩次抽血報告:血磷值≥ 5.5 mg/dL或白蛋白值5%或最近一週進食量只達需求量之50-75%)之營養不良現象。實驗組接受研究者以跨理論模式為基礎之血液透析患者營養照護方案介入營養管理，每週一次約20分鐘的教育課程，共計8次課程及常規營養衛教(護理師每個月抽血後衛教及營養師每半年營養諮詢一次)；控制組則接受常規營養衛教(護理師每個月抽血後衛教及營養師每半年營養諮詢一次)。結果共招募43位長期血液透析患者，將他們簡單隨機分配為實驗組（n=22）或對照組（n=21）。實驗組，最後完成者為19人，流失3人，對照組最後完成者20人，流失1人，最後39位納入最終研究結果分析，流失率9.3%。實驗組在8週營養照護方案介入後，主要評估11項營養狀況指標，實驗組與對照組間在不同檢測時間以GEE進行成效分析，結果改變量有顯著差異有三項目―血清磷在T1 (p=0.001)、簡易飲食攝取頻率量表在T1(p=0.028)、飲食知識態度行為量表T3 (p=0.048)；介入後有影響，但沒有統計顯著性有一項目―簡易迷你營養評估表在T2 (p=0.064)。結論 健康的飲食習慣，影響著末期腎臟病變患者之營養狀況。經過8週的跨理論模式為基礎之營養照護方案介入後，在血清磷、飲食知識態度行為量表、簡易飲食攝取頻率量表，確實能達到顯著性的進步，在簡易迷你營養評估量表顯示出邊際療效。血液透析患者保持良好的營養狀況並不容易，其中蛋白質熱量營養不良只是一個方面，而炎症、合併症、缺乏運動訓練和透析不足都會加助其臨床表現。因此，鼓勵高齡血液透析患者在日常生活中，納入身體活動訓練，以提升其營養代謝。跨理論模式對血液透析患者之營養教育的成功具有附加價值，尤其是在血清磷、飲食知識態度行為量表、簡易飲食攝取頻率量表的改善。因此，建議未來臨床護理實務可以應用以提升血液透析患者之專業照護品質。[[abstract]]BackgroundAccording to the Annual Report on Kidney Disease in Taiwan (2022), statistics indicate that the average age of new hemodialysis patients in 2020 rose to 68.8 years (Taiwan Society of Nephrology, 2024). As the aging of the hemodialysis population advances, nutritional issues have become increasingly prominent. Protein-energy malnutrition is a common and severe pathological condition among elderly hemodialysis patients and can be life-threatening (Mahjoub et al., 2019). Dialysis-related malnutrition is often associated with multiple factors, including uremia and its complications. Dialysis and nutrition are inextricably linked—dialysis helps cleanse the metabolic waste produced by food intake. Therefore, dietary restrictions are necessary to limit phosphate consumption. For hemodialysis patients, dialysis alone is often insufficient to effectively combat malnutrition without proper nutritional management. Thus, enhancing patient adherence to dietary guidelines is crucial.PurposeThe nutritional status of hemodialysis patients largely hinges on their overall dietary habits, with knowledge playing a crucial role in shaping these behaviors. The objective is to improve adherence to healthy dietary practices through targeted nutritional education. While there are various strategies for delivering nutritional education, promoting healthier eating habits among patients requires addressing multiple factors. By implementing a nutrition care plan grounded in the transtheoretical model, the aim is to positively influence patients' ability to manage health challenges like protein-energy malnutrition and hyperphosphatemia.MethodsThis study employed an experimental design with simple random group assignment to evaluate the intervention's effectiveness, utilizing a single-blind approach for data collection. Participants were eligible if they were 51 years or older, could eat independently, and had no communication difficulties. Nutritional deficiencies were identified based on blood test results from the past three months, with inclusion criteria requiring at least two reports indicating one or more of the following: serum phosphate levels ≥ 5.5 mg/dL, albumin levels 5% within three months or recent food intake reduced to 50-75% of the required amount over the past week). The study sample comprised hemodialysis patients from a dialysis center in Kaohsiung City. Patients undergoing hemodialysis on Mondays, Wednesdays, and Fridays were assigned to the experimental group, while those receiving dialysis on Tuesdays, Thursdays, and Saturdays formed the control group. The experimental group received a nutrition care plan based on the transtheoretical model, which included nutritional management interventions and a weekly 20-minute educational session over eight weeks, along with standard nutritional health education offered by nurses monthly following blood tests and biannual nutritional consultations with dietitians. The control group received only the standard nutritional health education provided by nurses monthly after blood tests and biannual consultations with dietitians. Using data collected on serum phosphate levels, serum albumin levels, normalized protein catabolic rate, creatinine levels, cholesterol levels, dry weight, body mass index, handgrip strength, Mini Nutritional Assessment-Short Form (MNA-SF) scores, as well as dietary knowledge, attitude, and behavior scales, and simple dietary intake frequency scales, the two groups of study subjects were assessed at baseline before the intervention, immediately after the intervention, and at the second and fourth months post-intervention to evaluate the effectiveness of the nutrition care plan.ResultsA total of 43 long-term hemodialysis patients were recruited and randomly assigned to either the experimental group (n=22) or the control group (n=21). In the experimental group, 19 participants completed the study, while three were lost to follow-up. In the control group, 20 participants completed the study, with one lost to follow-up. In total, 39 participants were included in the final analysis, yielding a dropout rate of 9.3%. After eight weeks of intervention with the nutrition care plan, 11 nutritional indicators were assessed. Generalized Estimating Equations (GEE) analysis of the effectiveness between the experimental and control groups at various measurement times revealed significant differences in three indicators: serum phosphate levels at T1 (p=0.001), the simple dietary intake frequency scale at T1 (p=0.028), and the dietary knowledge, attitude, and behavior scale at T3 (p=0.048). One indicator showed a post-intervention effect without statistical significance: the MNA-SF at T2 (p=0.064).ConclusionHealthy dietary habits significantly impact the nutritional status of patients with end-stage renal disease. After an eight-week intervention using a nutrition care plan based on the transtheoretical model, notable improvements were observed in serum phosphate levels, the dietary knowledge, attitude, and behavior scale, and the simple dietary intake frequency scale, with marginal effects on the MNA-SF. Maintaining optimal nutritional status in hemodialysis patients is challenging, as protein-energy malnutrition is just one of many factors, while other contributing factors include inflammation, comorbidities, lack of exercise, and inadequate dialysis. Therefore, encouraging elderly hemodialysis patients to include physical activity in their daily routines is essential for improving their nutritional metabolism. The transtheoretical model adds value to nutrition education for hemodialysis patients, particularly in improving serum phosphate levels, dietary knowledge, attitude and behavior scales, and dietary intake frequency scales. It is recommended that future clinical nursing practices integrate this approach to boost the quality of care for hemodialysis patients
Frailty and Its Associated Factors in Patients With Atrial Fibrillation: A Cross-Sectional Study
No full text[[abstract]]This study aimed to investigate the prevalence of frailty and its predictors among Taiwanese patients with atrial fibrillation (AF). A cross-sectional study was conducted, enrolling 188 AF patients aged over 20 years from a medical center in northern Taiwan. Participants were recruited from September 1 to December 30, 2022. Structured questionnaires were used to gather data on demographics, disease characteristics, Study of Osteoporotic Fractures Index, Short Portable Mental Status Questionnaire, Mini Nutritional Assessment Short-Form, Chinese Version Pittsburgh Sleep Quality Index, and Hospital Anxiety and Depression Scale. Among Taiwanese AF patients, over two-thirds were at risk of frailty, with susceptibility increasing with age. Key potential predictors included sex, cognitive function, nutritional status, sleep quality, and depression, jointly explaining 47.6% of the variation, with nutritional status being the most significant. These findings underscore the importance of comprehensive assessment and management strategies to address frailty in AF patients and improve overall health outcomes
Development and Validation of the Nurse Workplace Resilience Scale for Occupational Health During Public Health Emergencies
No full text[[abstract]]Introduction: Public health emergencies such as the coronavirus disease 2019 pandemic place immense demands on nurses worldwide, with high patient loads and resource constraints. Emergency nurses face extreme workloads, unpredictable patient surges, and psychological distress, yet existing resilience measures may not fully address these crises. This study developed and validated the Nurse Workplace Resilience During Emerging Infectious Diseases scale to assess and strengthen nurses' resilience, support mental well-being, and enhance preparedness in high-risk settings.
Methods: A cross-sectional survey was conducted at a tertiary hospital in northern Taiwan. Data were collected from eligible clinical nurses in 2 phases from August 2022 to March 2023. In phase 1, in-depth interviews with 30 nurses generated 33 initial items. In phase 2, psychometric testing with 492 nurses was conducted, including factor analysis, criterion validity assessment, and reliability testing.
Results: The final scale consisted of 22 items, structured into 3 subscales: overcoming adversity, coping with stress, and enduring physical and mental stress. The 3 factors explained 64.21% of the variance. Confirmatory factor analysis indicated acceptable model fitness, and Cronbach's alpha (.96) demonstrated excellent internal consistency.
Discussion: Our findings suggest that the Nurse Workplace Resilience During Emerging Infectious Diseases scale is a valid and reliable instrument for assessing nurses' resilience during public health crises. Its application can inform resilience-building education and preparedness strategies, supporting sustainable nursing practice in high-pressure emergency settings
[[alternative]]Exploring Family Conflict Experiences in the Dietary Adherence of a Vegetarian Ever since One's Birth
No full text[[abstract]]本研究主要探討胎裡素者因飲食堅持而引發的家庭衝突經驗，期能透過不同的視角觀察胎裡素飲食堅持者，如何經歷、面對和因應因飲食習慣不同所引發的家庭關係衝突，及此經驗帶來之影響，並對這份生命經驗提出更多元的解釋。是以，本研究採用質性研究取向，在半結構式深度訪談後採用主題分析法探究12位研究參與者之家庭衝突經驗。研究發現如下：壹、胎裡素者於家庭衝突前的成長經驗一、被茹素父／母決定成為一位胎裡素者二、幼年階段，經歷葷食挑戰意外經驗，仍堅持茹素三、離開父母庇佑，進入學校系統即是堅持素食挑戰的開始四、成長過程，須面對同儕和職場他人眼光與擔心被貼上標籤的壓力貳、因茹素而產生的家庭衝突與因應策略一、家族內部，因茹素型態而關係緊張二、親族關係，因飲食衝突多在長輩營養觀念的差異三、手足關係，當手足改吃葷食會感受到被背叛等異樣情緒四、婚姻伴侶關係，衝突在於飲食方式與習慣五、看待家庭衝突經驗與因應參、堅持茹素的理由、價值觀念與意義詮釋一、面對葷食有明顯生理不適感二、面對生命渴望存活產生同理感觸三、堅持茹素如同生活習慣四、貫徹茹素理念與生命價值五、成年後飲食生活的應對往來最後，針對本研究之結果與發現，對未來研究提出相關建議，期盼對相關實務與研究領域能有所助益。[[abstract]]This study primarily investigates the experiences of family conflict among those who have adhered to a vegetarian diet since birth due to their dietary commitment. It aims to observe, from different perspectives, how these individuals experience, confront, and cope with family relationship conflicts arising from their dietary habits, as well as the impacts of these experiences. Additionally, it seeks to provide more diverse interpretations of these life experiences. Therefore, this study adopts a qualitative research approach, employing thematic analysis to explore the family conflict experiences of 12 study participants through semi-structured in-depth interviews.The findings of the study are as follows:A. Life experiences of born vegetarians before family conflicts.1. Became a vegetarian due to the decision of vegetarian parents.2. In early childhood, faced accidental challenges with non-vegetarian food but continued to adhere to vegetarianism.3. Leaving parental protection and entering the school system marked the beginning of challenges in maintaining a vegetarian diet.4. During the growth process, had to face peer and workplace pressures, as well as the fear of being labeled.B. Family conflicts and coping strategies due to vegetarianism.1. Tensions within the family due to vegetarian practices.2. Conflicts with relatives, often arising from differences in nutritional beliefs held by elders.3. Strained sibling relationships, with feelings of betrayal when siblings switch to eating meat.4. Marital conflicts arising from differences in dietary habits and preferences.5. Perspectives on and coping with family conflict experiences.C. Reasons, values, and interpretations for adhering to vegetarianism.1. Experiencing noticeable physical discomfort when facing meat.2. Developing empathy towards the desire of all living beings to survive.3. Adherence to vegetarianism as a lifestyle habit.4. Upholding vegetarian principles and life values.5. Managing dietary practices and social interactions in adulthood.At the end, based on the results and findings of this study, we proposed the suggestion for future research, hoping to contribute to related practical and academic fields
[[alternative]]A Study of Group Art Therapy's Effects on Mental Health of Elderly with Mild Dementia
No full text[[abstract]]本研究旨在探討藝術治療團體對於輕度失智長者的心理健康效果，探討藝術治療團體對輕度失智長者的療效因子，以及藝術治療團體應用於輕度失智長者的限制。為了達到以上研究目的，本研究使用質性研究，以半結構式訪談團體成員、協同帶領者、團體觀察員及團體成員之醫師，將所收集之文本謄寫為逐字稿，透過主題分析法進行資料分析與編碼，統整出文本中的意義概念，並發展成主題，歸納後得出研究成果。研究分析得出藝術治療團體對於輕度失智長者的心理健康效果，在認知方面，藝術治療團體可訓練輕度失智長者的大腦認知功能，學習新知識、連結舊知識、提升思考專注力及接受感官感覺刺激；在情緒方面，輕度失智長者能從藝術治療創作活動中培養情緒調節能力，獲得心流的專注感受、增加正向情緒感受並減輕負向情緒感受。在行為方面，藝術治療團體可促進輕度失智長者的人際社交行為，增進人際互動、模仿行為、利他行為並能建立信任關係；在自我價值感方面，藝術創作能提升輕度失智長者自我效能，自我價值感提升、獲得正向肯定、賦權及自我照顧的能力。最後，根據研究結果提出未來相關研究及實務工作之期許與建議。[[abstract]]This study aimed to explore the impact of art therapy groups on the mental health of the elderly with mild dementia, to explore the effective factors of art therapy groups on the elderly with mild dementia, and to explore the limitations of art therapy groups when applied to the elderly with mild dementia. In order to achieve the above research objectives, this study used qualitative research method, using semi-structured interviews with group members, co-leaders, group observers, and psychiatrists of group members. The collected texts were transcribed into verbatim manuscripts, and the data were analyzed and coded through thematic analysis by integrating the meaning concepts in the text and developing them into themes, and then summarizing the research results. Study the mental health effects of integrated art therapy groups on the elderly with mild dementia. The study found that art therapy groups have several psychological health effects on older adults with mild dementia. In terms of cognition, art therapy groups can train cognitive functions such as learning new knowledge, connecting old knowledge, enhancing concentration, and providing sensory stimulation. In terms of emotions, elderly people with dementia develop their emotional regulation abilities through art therapy creative activities, gain a focused feeling of flow, increase positive emotion and reduce negative emotion. In terms of behavior, art therapy groups promote the interpersonal social behavior of the elderly with mild dementia, enhance interpersonal interaction, imitative behavior, altruistic behavior, and build trusting relationships. In terms of self-worth, artistic creation can improve the social behavior of the elderly with mild dementia. Self-efficacy, increased self-worth, ability to obtain positive affirmation, empowerment and self-care. Finally, based on the research findings, recommendations and expectations for future related research and practical applications were put forward
[[alternative]]Research on how Mandarin Film Songs Integrate into the Development of Life Education Curriculum for Seniors
No full text[[abstract]]本研究旨在設計一套適合社區照顧關懷據點「華語電影歌曲」生命教育課程教案，與探討「華語電影歌曲」生命教育課程對社區照顧關懷據點高齡者的學習感受。研究者以生命教育「終極關懷」之內涵為架構，第一階段於臺北市A社區照顧關懷據點，共實施十一單元課程（2023年10月6日至2023年12月19日，n=19）。第二階段於新北市B社區照顧關懷據點實施四單元課程（2024年1月24日至2024年2月21日，n=16）。課程任務引導高齡者面對生命老年期的中心任務，以自我品質進行「道謝」、「道愛」、「道歉」、「道別」的覺察與省思，提升生活品質及創造高齡者生命意義與價值。透過課程完成其結果：一、「華語電影歌曲」生命教育課程，高齡者皆不排斥並且可侃侃而談、分享生命教育終極關懷議題。二、「華語電影歌曲」生命教育課程，提升了高齡者對生命教育終極關懷議題的興趣，適切表達對人的關懷，人際間的交流，自在談起老、病、死的議題。三、「華語電影歌曲」生命教育課程有系統、主題性、熟悉歌曲有助於大部分高齡者課程實施時心情的愉悅。高齡者的世代沒有生命教育課程，藉由「華語電影歌曲」生命教育課程，融入社區文化，可貼近高齡者日常生活，有助於高齡者對生命教育的接受並產生共鳴。希望研究結論與建議，可提供參與社區活動樂齡的相關單位作為課程安排之參考。[[abstract]]This study aims to design and evaluate a life education curriculum that integratesMandarin film songs for seniors in community care centers. The research focuses onthe concept of "ultimate care" within life education. In the first phase, elevencurriculum units were implemented at Community Care Point A in Taipei City (fromOctober 6, 2023, to December 19, 2023, involving 19 participants). In the secondphase, four units were implemented at Community Care Point B in New Taipei City(from January 24, 2024, to February 21, 2024, involving 16 participants).The curriculum was designed to help seniors address key tasks associated withaging, enhancing their self-awareness and reflection through themes such as"expressing love," “showing gratitude," "apologizing," and "saying goodbye." Theaim was to encourage seniors to cherish their time, improve their quality of life, andfind meaning and value in their later years. The study yielded the following results:1. The "Mandarin film songs" life education curriculum was well-received, withseniors engaging openly in discussions and sharing their thoughts on ultimate caretopics.2. The curriculum heightened seniors' interest in topics related to ultimate care,fostering their ability to express care for others, engage in meaningful interpersonalcommunication, and comfortably discuss issues related to aging, illness, and death.3. The curriculum's systematic and thematic approach, combined with thefamiliarity of the songs, contributed to a positive emotional experience for mostseniors during the classes.This generation of seniors did not have access to life education courses in thepast. However, by integrating the "Mandarin film songs" curriculum into thecommunity culture, it resonated with their daily lives, facilitating acceptance andengagement with life education. The findings and recommendations of this study areintended to provide valuable insights for organizations involved in communityactivities for the elderly
[[alternative]]Reliability and validity of Palliative Performance Scale in elderly people with end stage renal disease
No full text[[abstract]]目的：台灣末期腎病高盛行率為世界之首，加上高齡人口的驟增，讓老年末期腎病患者人口攀升不減。這群患者除了身體功能衰弱之外，他們共同特徵為容易有多重共病的問題這些因素讓疾病快速進展，尤其當臨床治療及處置效果不彰時，醫療照護人員如何以患者最大利益下提供有效信息方向，協助患者及家屬能及早做出符合病情發展現狀的最佳醫療決策，或考量緩和療護轉介時機，須仰賴有一可靠測量工具，幫助臨床醫療照護人員有效評量老年末期腎病患者在疾病變化過程中整體狀態。緩和療護功能量表第二版 (Palliative Performance Scale Version 2, PPSv2)已被其他國家研究證實，為有助臨床醫療評估末期患者病情進展與預後判斷的良好工具，本研究目的為驗證PPSv2於老年末期腎病患者之再測信度 (test-retest reliabilty)、收斂效度 (convergent validity)和預測效度 (predictive validity)。方法：本研究招募62位診斷慢性腎衰竭Stage 4-5之北部照護中心老年末期腎病個案。以PPSv2與臨床常用評估工具，支持性及緩和療護指標工具 (Supportive and Palliative Care Indicators Tool, SPICT)、巴氏量表 (Barthel Index, BI)、迷你營養評估量表-短版 (Mini Nutritional Assessment-Short Form, MNA-SF)和台灣簡明版世界衛生組織生活品質問卷 (WHO Quality of Life Questionnaire, WHOQOL-BREF)分別對參與者進行第一次施測，在距離第一次施測時間一個月後進行第二次施測；最後在距離第一次施測時間後第三個月進行第三次施測。完成施測後將第一次、第二次及第三次測試結果透過統計以組內相關係數 (intraclass correlation coefficient, ICC)驗證再測信度。第一次施測結果透過統計以Pearson’s r關聯程度，分析PPSv2與SPICT、BI、MNA-SF和WHOQOL-BREF四個範疇(生理健康、心理、社會和環境)之相關，進行收斂效度之驗證。第一次PPSv2與第三次施測之BI、MNA-SF和WHOQOL-BREF(生理、心理、社會和環境)之相關r值，進行預測效度之驗證。結果：再測信度方面，施測第一次、第二次及第三次再施測之結果ICC為0.998，顯示PPSv2具備良好再測信度。收斂效度方面，PPSv2與SPICT之相關r值為0.72，與BI之相關r值為0.95，與MNA-SF之相關r值為0.66，與WHOQOL-BREF四個範疇相關r值為0.40-0.72。預測效度方面，PPSv2與BI相關r值為0.95，與MNA-SF之相關r值為0.64、與WHOQOL-BREF四個範疇相關r值分別為0.35-0.67。結論：本研究資料分析與討論所得結果為PPSv2是具有良好再測信度、好的收斂效度及可接受的預測效度，能有效評估出老年腎病末期患者整體身體功能表現狀態，未來有助於臨床照護人員評估轉介緩和療護之時機、相關照護計畫之擬定與調整，以有效的掌握末期個案整體狀況追踪和管理。[[abstract]]Objective: Taiwan has the highest prevalence of end-stage renal disease worldwide, and with the rapid increase in the aging population, the number of elderly people with end-stage renal disease continues to rise. These people not only face physical frailty but also commonly experience multiple comorbidities. These factors contribute to rapid disease progression, especially when clinical treatment and management are ineffective. Healthcare providers must rely on a reliable assessment tool to evaluate the overall condition of people with end-stage renal disease during disease progression, especially when providing effective information to help individuals and their families make timely and appropriate medical decisions that align with the current state of disease development, or when considering the timing of palliative care referrals. The Palliative Performance Scale Version 2 (PPSv2) has been validated in other countries as a useful tool for assessing disease progression and prognosis in terminally ill individuals. This study aimed to verify the test-retest reliability, convergent validity, and predictive validity of the PPSv2 in elderly people with end-stage renal disease.Methods: The study recruited 62 elderly peoplewith end-stage renal disease diagnosed with chronic renal failure Stage 4-5 from long-term care centers. During the first assessment, the PPSv2 was administered along with the following commonly used clinical assessment tools: the Supportive and Palliative Care Indicators Tool (SPICT), Barthel Index (BI), Mini Nutritional Assessment-Short Form (MNA-SF), and WHO Quality of Life Questionnaire (WHOQOL-BREF). A second assessment was conducted one month later, and a third assessment was performed three months after the first. The results from these assessments were statistically analyzed using intraclass correlation coefficient (ICC) to verify test-retest reliability. Convergent validity was evaluated by analyzing the correlation (Pearson's r) between the PPSv2 and the SPICT, BI, MNA-SF, and the four domains of the WHOQOL-BREF (physical, psychological, social, and environmental) from the first assessment. Predictive validity was assessed by analyzing the correlation between the results of first assessment of the PPSv2 assessment and third assessment for the BI, MNA-SF, and the four domains of the WHOQOL-BREF.Results: In terms of test-retest reliability, the ICC for the results of the first, second, and third assessments was 0.998, indicating that the PPSv2 had excellent test-retest reliability. For convergent validity, the correlation between the PPSv2 and SPICT was r = 0.72, with BI r = 0.95, MNA-SF r = 0.66, and the four domains of the WHOQOL-BREF ranging from r = 0.40 to r = 0.72. Regarding predictive validity, the correlation between the PPSv2 and BI was r = 0.95, MNA-SF r = 0.64, and the four domains of the WHOQOL-BREF ranging from r = 0.35 to r = 0.67.Conclusion: The findings demonstrate that the PPSv2 has excellent test-retest reliability, good convergent validity, and acceptable predictive validity. It can effectively assess the overall physical function of elderly people with end-stage renal disease. This tool is expected to assist healthcare providers in evaluating the appropriate timing for palliative care referrals and in formulating and adjusting related care plans, thereby facilitating effective tracking and management of the overall condition of terminally ill individuals