Shou-Yu Wang

Background and Objectives: Older adults residing in long-term care (LTC) homes (also referred to as LTC facilities) often have limited opportunities to access nature environments, which are known to support psychological well-being. Virtual reality (VR) offers a novel approach to delivering immersive nature experiences for this population. This qualitative study explored the perceptions of using VR to view nature landscapes among older adults in LTC homes. Research Design and Methods: Using purposive sampling, we recruited 16 older adults (aged 60–84) from 10 LTC facilities in Taiwan. Participants viewed six 360-degree nature videos (each about 2 min long) in a single VR session via a VR headset. Within 1 week of the VR session, participants completed individual, face-to-face, semi-structured interviews. Data were analyzed using content analysis. Results: Five themes and corresponding categories were generated: (1) as a window to the past, revisiting childhood/youth and reconnecting with places once visited; (2) embracing serenity, feeling relaxed/lightness, savoring the joy, sensing ease/comfort, and feeling inner calm/tranquility; (3) escaping the confines of reality, unlocking a sense of freedom and revisiting natural landscapes; (4) rekindling the healing power of dreams/hope, reigniting hope and motivation and fulfilling unfinished dreams; and (5) unreal and unsettling realities, expressing negative experiences including loneliness, dizziness, and a virtual-reality gap. Discussion and Implications: Immersive VR nature experiences can evoke nostalgic memories, promote relaxation, provide a temporary sense of freedom, and inspire hope. However, some participants also reported challenges such as dizziness, feelings of artificiality, or loneliness, highlighting the importance of careful design and individualized implementation.

Background: The number of patients with end-stage renal disease (ESRD) in Taiwan continues to rise steadily, and hemodialysis is the primary treatment for these patients. More than 50% of patients on hemodialysis are over 65 years of age, indicative of an aging patient population. Changes in lifestyle, dietary habits, and social roles after commencing hemodialysis easily cause patients to feel uncertain, depressed, and/or lonely. However, a limited number of studies have examined the issue of loneliness among older adults on hemodialysis. Purpose: This study was designed to better understand loneliness and its associated factors among older patients receiving hemodialysis. Methods: A cross-sectional research design with convenience sampling was employed with a total of 146 patients. Eligible participants aged 65 years or older and receiving hemodialysis for more than 3 months were recruited from two hospitals in northern Taiwan. Structured questionnaires, including a demographic characteristics questionnaire, the Hemodialysis Patient Fatigue Scale, Social Support Scale, and UCLA Loneliness Scale version 3, were used to collect data. Results: The mean loneliness score was 41.5 out of a maximum of 80. A significant positive relationship was found between fatigue and loneliness, and a significant negative relationship was found between social support and loneliness. Gender, fatigue, and social support were identified as predictors of loneliness. Conclusions/Implications for Practice: The results indicate that older patients receiving hemodialysis have a moderate level of loneliness. Based on the identified predictors, nurses should pay particular attention to patients who are female, are experiencing a higher fatigue level, and/or have lower social support. Future studies may use these results to develop strategies for preventing and improving loneliness among older adults receiving hemodialysis.

Background: Family members experience decision-making conflicts regarding changes in patient care. If the medical team does not attempt to understand the family members’ awareness of palliative care, family members may experience medical decision-making stress and dilemmas. This study examined the decision-making conflicts of the family members of patients dependent on prolonged mechanical ventilator regarding palliative care in Taiwan. Methods: A cross-sectional design was used in this study. Family members of such patients in the subacute respiratory care ward and the respiratory intensive care unit of a medical center in Taiwan were recruited. A structured questionnaire was used to collect data. Results: Among the family members of the 127 patients included, 57.5% hesitated to make palliative medical decisions and 61.4% experienced palliative medical decision conflicts. The absence of other chronic diseases, family members’ inability to accept the movement of patients to palliative care, and family members’ hesitation in palliative care medical decision-making resulted in decision-making conflicts. In this study, 127 prolonged mechanical ventilation-dependent patients (PMVDP) and their family members were examined. The results revealed that family members experienced palliative care medical decision-making difficulties (61.40% = <2.5). Predictors of palliative care decision-making conflict for PMVDP and their family members included the following: absence of other comorbid chronic diseases, the inability of family to accept palliative care on behalf of patients, and hesitation in palliative care medical decision-making by family members. Conclusion: The study results are able to help Taiwanese medical staff in evaluating such conflicts and palliative care medical decisions of PMVDP.

Background: Family caregivers have a vital role to play in palliative care for chronically ill patients. In Taiwan, caregiver demographics are evolving, with the number of male caregivers increasing. Gender differences influence psychosocial behaviours, thought processes and communication styles. In healthcare, acknowledgement of gender differences facilitates effective delivery of high‐quality care.Aim: The aim of this study is to explore male caregivers' decision‐making process for palliative care for chronically ill family members.Methods: This study employed grounded theory to generate a substantive theory of male caregivers' decision‐making process for palliative care for chronically ill family members. We recruited 22 male participants from three inner‐city teaching hospitals in Taiwan.Findings: Regarding the decision‐making process of palliative care of chronic ill family, where male caregivers do not want their loved ones suffering anymore, the male caregivers' decision‐making process was impacted, first, by caregivers' views on the last stage of life; second, by their wish for good care during the end of life; and third, by their conviction that the patients' wishes should be respected. Furthermore, caregivers' philosophy of life and death is also a supportive ground for decision‐making. This philosophy was influenced by their education in palliative care, financial status and religious beliefs and practices. The core category emerging from this study is encapsulated by a participant's assertion, ‘How difficult is it? There are no male and female differences’.Conclusion: We found that palliative care experiences of male caregivers are important for the decision‐making process for palliative care for their chronically ill family members. Caregivers want their loved ones to receive good care as the last step in life, to respect their wishes and no more suffering for the patient. Therefore, health professionals should be familiar with the palliative care process that caregivers go through to offer updated information when needed.

Background:​ Empathy is a fundamental component of the therapeutic relationship between healthcare providers and patients and has the potential to yield significant benefits, including heightened care satisfaction, enhanced care quality, and improved mental well‐being for patients. As nursing assistants (NAs) are primary direct care providers in long‐term care facilities (LTCFs), it is necessary to understand NAs’ views on empathy in their care provision for residents, but a gap exists in the literature regarding NAs’ perspectives on empathy in this context.Aim: In this study, we aimed to explore perceptions of empathy among NAs in LTCFs.Research Design: A qualitative approach was applied in this study.Participants and Research Context: Through purposive and snowball sampling, 18 NAs who provided care for residents in six LTCFs in Taiwan were recruited. Face‐to‐face in‐depth interviews were conducted using a semistructured interview guide, and data were analyzed using a content analysis.Ethical Considerations: Ethical approval was obtained from the Institutional Review Board. All participants signed a written informed consent form prior to the interview.Results: Four themes encompassing 11 categories were generated including “being fundamental to caregiving to establish trust and enhance quality care,” “practicing altruistic behavior in the pursuit of ethical caregiving,” “cycling empathic flow in care,” and “facing challenges in delivering empathetic care.”Conclusions: NAs in LTCFs viewed empathy as an essential element of the caregiving process. They saw empathy as selfless care, assistance to others, and alleviation of residents’ suffering. Understanding residents’ emotions, thoughts, and needs, active listening and compassionate engagement were vital to expressing empathy. However, NAs faced challenges in expressing empathy due to demanding tasks, time limitations, and insufficient knowledge and communication skills. In addition, emotional desensitization further complicated the provision of empathic care. The findings of this study can provide information for nurse managers and directors to understand NAs’ perspectives on empathy and difficulties when providing empathic care in the long‐term care context.

Aim: To understand and report on the perceptions and experiences of registered nurses in the aged care sector. Design: An exploratory qualitative study. Methods: Semi‐structured telephone interviews were utilised as the primary data collection method. Fifteen registered nurses were interviewed. All interviews were recorded, transcribed verbatim and analysed using conventional content analysis. Participants were quoted verbatim to ensure authenticity. Results: The results indicated a demand for increased administrative and staffing support in the aged care workplace. Poor morale and unethical practices contributed to negative perceptions and attitudes among nurses towards aged care. Managing and communicating with older people was reported as challenging, which impacts nursing staff recruitment and retention. Future work is needed to ensure that outstanding clinical role models and leadership support nursing staff recruitment and retention. Incorporating aged care content into the nursing curriculum and providing professional development opportunities to aged care professionals would be the foundation towards solutions, as the study primarily explored nurses' perspectives.

This study evaluated the effectiveness of a multiple-intervention program (MIP) on the life satisfaction, social support, and depressive tendencies of older adults. A cross-sectional, pretest-posttest design involving a questionnaire survey was adopted. Thirty-seven older adults were recruited from 2 daycare centers for an 8-week MIP comprising 60-min sessions conducted once a week. The questionnaire comprised the Short Portable Mental Status Questionnaire, Geriatric Depression Short Form-15 (GDS-SF15), Life Satisfaction Scale (LSS), and Inventory of Social Support Scale (ISSB). The participants’ average GDS-SF15 score decreased considerably (by 35.3%), their average ISSB score increased from 61.9% to 80.9%, and their average LSS score increased from 48% to 64%. The outcomes for depressive tendencies, social support, and life satisfaction were measured before and after the intervention, and the participants successfully engaged in the MIP throughout its duration and exhibited improvement. The MIP can serve as a basis for planning group activities for older adults. The MIP benefits older adults at daycare centers. Incorporating multiple activities into daily care can help increase the diversity, uniqueness, and innovativeness of a daycare center.