Grieving in silence: Experiences of bereaved Taiwanese family members whose loved ones died from cancer

PURPOSE

To explore the experience of grief in bereaved Taiwanese family members whose loved ones died from cancer.

METHOD

A qualitative study was used in this interview-based investigation. A purposive sampling technique and maximum variability were used to obtain a comprehensive overview. A total of 16 Taiwanese adults whose beloved family member had died of cancer were recruited from a palliative care unit of a medical center in southern Taiwan. Interviews were transcribed verbatim and analyzed using thematic analysis. The data analysis and interpretation were critically evaluated and discussed until final agreement was achieved. Recruitment was terminated when the data were found to be saturated.

RESULTS

Four "TEAR" themes reflecting the experience of grief in bereaved Taiwanese family were extracted from the transcript analyses: taboo topics, emotion hiding, asynchronous grief, and relational tension. The participants endured the mutual influence of the family atmosphere, which was akin to silently walking the grief journey and inconsistent with TEAR model of task-oriented mourning. Silent grieving dominated their lives, which is different from Western culture with a more explicit expression of grief.

CONCLUSIONS

Silent grief provides a new avenue for exploring grief among bereaved families, potentially impacting their ability to fully grieve through the expressed feelings proposed by William Worden's TEAR model of task-oriented mourning. Thus, this silent grieving should be acknowledged. The findings provide support for developing family-centered, culturally tailored bereavement care. Healthcare professionals play an important role in detecting changes in family dynamics that may interfere with support from family members.

A qualitative exploration of the fear of recurrence among Taiwanese breast cancer survivors

OBJECTIVE

Fear of cancer recurrence (FCR) is the most commonly reported problem and unmet need among breast cancer survivors. The aim of this qualitative study was to explore the experience of recurrence fears among Taiwanese breast cancer survivors.

METHODS

Three focus groups were included in this study. A purposive sampling technique was used to recruit 11 recurrence-free women at least 20 years of age from southern Taiwan who were diagnosed with breast cancer within the previous 2 years. Data were analysed and interpreted using content analysis.

RESULTS

Three themes reflecting the experience of FCR were extracted from the transcript analyses: "Trapped in insecurity," "Suffering in silence," and "Pretending as if nothing happened." Participants endured a complex set of circumstances akin to silently walking the survival tightrope. Breast cancer survivors were still insecure and suffering, rather than celebrating survival, after the completion of treatment. Fear of cancer recurrence silently dominated their lives.

CONCLUSIONS

An avoidance mindset and an unspoken FCR leave survivors insecure, resulting in a silent survival journey. These difficult thoughts and feelings that may impact the reconstruction of post-cancer life should be acknowledged. The development of appropriate survivorship care programs and emotional resilience regarding recurrence is needed for Taiwanese breast cancer survivors.

Does One Size Fit All? Examining the Application of Neurosurgery Residency Milestones Developed in the United States to a Taiwanese Culture

BACKGROUND

The Milestone Project was launched in 2009, charging specialties to develop specific educational accomplishments required to establish clinical competency. The milestone assessment method was first introduced to Taiwan in 2013 and before applying milestone assessments to our medical education system, the validity and reliability of these questionnaires needed to be evaluated.

METHODS

Twenty neurosurgical faculty members representing 3 clinical divisions and all 4 branch institutes completed milestone questionnaires for 26 residents semiannually, resulting in 435 resident assessments being collected and analyzed.

RESULTS

Cronbach's α, Kuder-Richardson Formula 20, and Kendall's W were used to show acceptable reliability and validity. Rater consistencies for nonskilled parts found that rater consistency progressively improved with time. Not all raters were able to assess the residents for the skilled parts resulting in nonassessable rates ranging from 9.5%-89.4%. For nonskilled and skilled items, milestone level as assessed by the staff improved as the resident progressed from residency year 3 (R3) to R6 in the residency program and showed that the milestone achievement level for an R3 was lower than that of an R6.

CONCLUSIONS

Milestone assessments have high reliability and may be a helpful assessment tool. Although milestone assessment can provide thorough feedback concerning performance and the content of the training program, they may not perfectly suit all residency-training programs, especially in different countries or different cultures. Modifications should be done before applying milestones to different areas; therefore the results can truly reflect the progress and condition of the training and learning process.

The working experiences of novice psychiatric nurses in Taiwanese culture: a phenomenological study

Novice psychiatric nurses experience heavy workloads, insufficient training and support in Taiwan. The aim of this study was to understand the working experiences of novice psychiatric nurses during their first year in a clinical setting. A qualitative phenomenological approach, using semi-structured face-to-face interviews was used. Narratives were analyzed using Colaizzi's seven-step method. Data saturation was reached after interviews were conducted with 15 nurses based on the purposive sampling. Four themes and eight sub-themes were identified: struggling (lacking a sense of security and competency), emulating (learning the process of interaction with clients and families, learning an appropriate role from nursing staff), prevailing (developing core competency, creating a therapeutic environment) and belonging (coping with the job, becoming a part of the psychiatric nursing staff). The findings from this study demonstrate that nurses are often inadequately prepared for psychiatric nursing. They have little understanding of mental illness, are unable to communicate appropriately with clients and struggle to cope with the conditions. Our study supports the importance for helping nurses to improve their essential knowledge and skills for coping with the job and providing good quality care, particularly in the first year.