Fan-Ko Sun

A concept analysis of suicidal behavior.

OBJECTIVE Suicidal behavior is a significant global public health problem. Despite this, many health care professionals remain unaware of the distinction among suicidal behavior, self-mutilation, and deliberate self-harm. The aim of this study was to conduct a concept analysis of suicidal behavior. METHOD Walker and Avants 8-step method of concept analysis was used to examine the concept of suicidal behavior. Sources for analysis were identified using a systematic search of Medline, CINAHL, ProQuest Nursing & Allied Health Source, and the reference lists of related journal articles. RESULTS Suicidal behavior was found to be associated with a constellation of external hazards and internal crises, lack of coping mechanisms and social support structures, and degree of suicidal intent, which, in the worst-case scenario, results in successful suicide. The antecedents of suicidal behavior are vulnerability characteristics that make painful events seem unbearable, and the consequences are death or failed suicide. In cases of failure, the medical consequences may be serious and long lasting. CONCLUSIONS Defining the concept of suicidal behavior provides a basis for public health nurses to better understand suicidal behavior, thus improving their ability to care for suicidal patients during home visits.

Development and Psychometric Testing of the Suicide Caring Competence Scale (SCCS) for Family Caregivers in Taiwan

Suicide caring competence is important for family caregivers to care their relatives with suicidal tendencies. The purpose of this study was to develop and test the psychometric properties of the Suicide Caring Competence Scale (SCCS) for family caregivers in Taiwan. A 20-item SCCS was tested on 165 family caregivers. Confirmatory factor analysis indicated that five subscales with 19 items best fit the data. The Cronbachs α and test-retest reliability of the SCCS was 0.90 and 0.81, respectively. The SCCS demonstrated acceptable construct validity and reliability. Nurses can use the SCCS to assess the suicide caring competence of family caregivers.

Development and Psychometric Testing of the Suicidal Recovery Ability Scale (SRAS) for Assessing Individuals Who Have Attempted Suicide

Abstract Assessing the recovery ability of individuals who have attempted suicide is crucial for psychiatric health nurses. The purpose of this study was to develop and test a psychometric Suicidal Recovery Ability Scale (SRAS). Confirmatory factor analysis (CFA) indicated that three subscales with 15 items best fit the data. The global SRAS score showed significant negative correlation with the Beck Hopelessness Scale (BHS) score. The Cronbach’s α and test-retest reliability scores for the global SRAS and the subscales all exceeded 0.70. Nurses can use the SRAS to assess the recovery ability of individuals who have attempted suicide and provide proper care to help them.

The relationships between uncertainty and coping Behaviors of patients with liver Cirrhosis

Background: Patients tend to develop a sense of uncertainty when they lack control over the progress of the disease, and physical discomforts. The sense of uncertainty that patients develop when facing their disease or treatment may elicit physical and psychological distress which can influence the patients’ coping behaviors. Purpose: This study investigated the relationships between cirrhotic patients’ sense of uncertainty and coping behaviors. Methods: A cross-sectional, correlational research design was used. Convenience sampling was performed to select 76 cirrhotic inpatients in the division of gastroenterology at a hospital in Southern Taiwan. Three structured questionnaires (Personal Characteristics Questionnaire, Mishel Uncertainty in Illness Scale, Coping Behaviors Scale) were used for data collection. Results: (a) Cirrhotic patients perceived a moderate or increased level of uncertainty and problemoriented coping behaviors were the most frequently used coping behaviors. (b) Patients who had no religion, who had fatigue or severe disease conditions exhibited comparatively high levels of uncertainty. (c) Patients who were singled or unemployed, or fatigue often showed emotion-oriented coping behaviors. Consuming alcohol frequency, illness severity was positively correlated with emotionoriented coping behaviors. (d) Patients who were unemployed often exhibited problem-oriented coping behaviors. Educational level and consuming alcohol frequency were positively correlated with problemoriented coping behaviors. (e) Patients’ sense of uncertainty was positively correlated with emotion- and problem-oriented coping behaviors. Conclusions/ Implications for Practice: Since cirrhotic patients frequently exhibit emotion-oriented coping behaviors and have high level of uncertainty, nurses could encourage them to express their emotions and problems, and listen to them patiently. If patients were high levels of uncertainty, and exhibit problem-oriented coping behaviors, by spontaneously providing disease-related information and social support, they can readily adopt to their disease conditions.

The Effects of Muscle Relaxation and Therapeutic Walking on Depression, Suicidal Ideation, and Quality of Life in Breast Cancer Patients Receiving Chemotherapy

Background: The suicide rate of cancer patients is high in Taiwan. Breast cancer has a high incidence rate and is the leading cause of cancer in women. There is a lack of research examining breast cancer–related depression, suicidal ideation, and quality of life. Objectives: This study evaluated the effects of muscle relaxation and therapeutic walking on depression, suicidal ideation, and quality of life in breast cancer patients receiving chemotherapy. Methods: An experimental approach was adopted. A group of 87 breast cancer patients receiving chemotherapy were randomly assigned into an experimental group (n = 44) or a control group (n = 43). The subjects in the experimental group received 2 interventions for 3 months. This study used 3 instruments, including (1) the Center for Epidemiological Studies Depression Scale, (2) the Beck Scale for Suicidal Ideation, and (3) the World Health Organization Questionnaire on Quality of Life. Results: The results showed no significant difference in any outcome variable in the pretest. The results of the posttest indicated that the 2 groups scored significantly differently only on the Center for Epidemiological Studies Depression Scale (U = 638.00, P < .05). The breast cancer patients who participated in the 3 month muscle relaxation and therapeutic walking interventions had a lower level of depression (RE¯ = 37.00) than those who did not (RC¯ = 51.16). Conclusion: The muscle relaxation and therapeutic walking program was effective in the reduction of breast cancer patients’ depression. Implications for Practice: Nursing staff could teach muscle relaxation and therapeutic walking to breast cancer patients to reduce their depression.

Category 3 and 4 Controlled Drugs Users' Perceptions of Participating in Drug-Abuse-Health Prevention Lectures in Taiwan.

Abstract This study was designed to explore Category 3 and 4 controlled drug users’ perceptions of participating in health‐prevention lectures. A phenomenological approach was used. Twelve participants were interviewed after completing the lectures. Findings revealed five themes (1) mixed emotions; (2) self‐development; (3) finding the lectures lacked practicality and relevance; (4) highlighting three stages for discontinuing drug‐usage; and, (5) suggesting tips for the advancement of lectures. These findings could be used as a map to help health professionals understand drug users’ perceptions of attending health prevention lectures and provide insight into how young people might stop using drugs. HighlightsCategory 3 and 4 controlled drugs users experienced fear and helplessness before attending the lectures.Category 3 and 4 controlled drugs users experienced positive growth after attending the lectures.Self‐awareness helps controlled drugs users realize drugs are unhealthy and living in a drug‐free environment is better.It is important for controlled drugs users to find help from diverse sources and support systems.Interactive teaching and learning processes could improve controlled drugs users’ motivation during the lectures.

The Psychological Process of Breast Cancer Patients Receiving Initial Chemotherapy: Rising From the Ashes.

Background: In Taiwan, breast cancer is the most common cancer in women. Most breast cancer patients are willing to receive chemotherapy and experience adverse effects and suffering during the process of chemotherapy. Objectives: The aim of this study was to explore patients’ psychological process when receiving initial chemotherapy for breast cancer. Methods: A qualitative grounded theory approach was used. Data were collected through semistructured interviews of 20 patients who were from 1 district teaching hospital during 2012 to 2013. Results: A substantive theory was generated to describe the psychological process experienced by breast cancer patients in their initial treatment. The core category was “rising from the ashes.” Four categories emerged and represented 4 stages of the psychological process experienced by breast cancer patients. They were (1) fear stage: patients are frightened about permanent separation from family, chemotherapy, and the disease getting worse; (2) hardship stage: patients experience physical suffering and mental torment; (3) adjustment stage: patients fight against the disease, find methods for adjustment, and get assistance from supporting systems; (4) relaxation stage: patients were released from both the physical and mental sufferings, and patients accepted the disease-related change in their lives. Conclusion: Each stage is closely related to the other stages, and each is likely to occur repeatedly. It is important to help patients achieve the relaxation stage. Implications for Practice: The results of this study may enhance nurses’ understanding of the psychological process of patients receiving initial chemotherapy for breast cancer, thereby helping nurses to provide appropriate assistance to improve the quality of patient care.

Post-Stroke Depression: The Associated Factors and Effective Intervention

Stroke is a major health problem in the elderly population in Taiwan. Patients who have had strokes are at significant risk for various neuropsychiatric illnesses. The most common and important neuropsychiatric illnesses is poststroke depression (PSD). PSD affects the speed of recovery, functional outcome, and has an important impact on the quality of life of patients with stroke. PSD also increase institutional length of stays and health care cost. Therefore, PSD is an important public health issue and has received the most attention in stroke research. In clinical practice, only minority of PSD patients are diagnosed and even fewer are treated. This paper reviews the current literature on PSD and offers an integrated approach to PSD concepts, prevalence of PSD, associated factors, and practical pharmacologic and nonpharmacologic intervention for PSD. Effective pharmacologic treatment includes anti-depressants: SSRI, TCA; Chinese pharmacy (tonic to the heart and spleen & smooth depression decoction) etc. Nonpharmacologic treatment includes ECT, Psychotherapy, and educational counselling. Drug therapy is the first choice intervention for PSD. This paper highlights the importance of early recognition and emphasis on clinical support and therapy in the care of patients with depression following stroke. Research to prevent and reduce depression after stroke might be a worthy project for the future.