Even though influenza vaccinations were provided free to all healthcare workers in the United States, healthcare workers were not 100% compliant. The non-compliance with influenza vaccinations may expose their patients, their families, and the public at large to a high-risk source of influenza infection. This study's research questions included how registered nurses perceived influenza and influenza vaccination; registered nurses' self-reported incidents with influenza vaccination; and factors that contributed to registered nurses' non-compliance with influenza vaccination. Guided by the theory of reasoned action and the theory of planned behavior, the purpose of this qualitative study was to determine the factors that contributed to the non-compliance of registered nurses with receiving the influenza vaccination. Twenty participants from a healthcare facility in Florida were interviewed using an interview guide. Audio data was transcribed to text data; text data was coded and thematically analyzed by using ATLAS.ti software. Results revealed that 70% of registered nurses were afraid of influenza vaccination, while 80% of them saw influenza vaccination as ineffective; 90% of them had bad experiences or have seen colleagues/friends who have had bad experiences after influenza vaccination. In addition, 40% of registered nurses claimed that they already had good immunity, while 20% of them declined influenza vaccination because of personal choices. Research findings from this study may be utilized to bring positive social change to society at large. The findings may be utilized to enhance existing strategies or policies or even help formulate new policies and strategies that would address the concerns of HCWs, especially registered nurses.

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Le but de cette étude est de cerner, à partir de leur propre point de vue, la trajectoire d’adaptation de conjoints dont l’épouse est atteinte d’un cancer de l’ovaire. Une approche qualitative, la théorisation ancrée, a été utilisée dans le cadre de cette recherche. Les données ont été recueillies à l’aide d'entretiens semi-structurés effectués auprès de neuf conjoints qui accompagnaient leur épouse lors de leurs traitements dans une unité montréalaise ultra-spécialisée de soins pour les cancers gynécologiques. Nos résultats font ressortir qu’une fois passé le choc de l’annonce du diagnostic, nos répondants se ressaisissent et élaborent toute une série de stratégies de protection pour leur épouse et eux-mêmes, puis d’attaque de la maladie. Au bilan, pour eux, le cancer se révèle une expérience « transformante» aux plans personnel, conjugal et social. Les contrastes observés entre nos résultats et ceux des études antérieures, qui insistent sur le désarroi de conjoints, peuvent être expliqués par la prise en charge efficace de la femme par le réseau de la santé, qui valorise le rôle du conjoint et qui l’outille pour accompagner son épouse. S’ajoutent à cela la force du lien conjugal, trempé par les épreuves passées, certains traits de personnalité des conjoints et l'action du réseau de soutien personnel. En regard de la pratique infirmière, notre recherche met en évidence le bien-fondé des politiques soutenant l’intégration des familles dans les plans de soins et les retombées positives d’une approche concertée entre tous les intervenants de la santé. Répéter une telle étude dans d'autres institutions du réseau de la santé permettrait de cerner encore plus finement son impact sur l’adaptation de conjoints à la maladie. / This research focuses on how nine men recall their adaptation trajectory to their spouses’ ovarian cancer. The qualitative analysis made use of the grounded theory approach; semistructured interviews were conducted with husbands accompanying their spouses during their treatments in an ultra-specialized unit for gynaecological cancers in a Montreal hospital. Our results show that after the initial shock initiated by the announcement, the respondents develop a set of strategies, first to protect their wives and themselves, and then to attack the illness. Accompanying their wives through the experience of cancer proves to be, for the husbands, a transformative experience at all levels: personal,conjugal, and social. The perceived efficacy of the health network and its preoccupation with the husband’s caretaker role may explain the sharp contrast we observe between results from the literature, insisting on the husbands’ helplessness in such a context, and our data, which underline their fighting spirit. Other factors identified are the strength of the conjugal link, forged in common ordeals, personality traits of both husbands and wives, and support from their personal network. Concerning nursing practice, this research suggests that the importance and the support given by the health professionals to the family caregivers is of utmost importance for the couple’s quality of life throughout this experience. Besides, the coordination of the health professionals, throughout the women’s illness, is crucial in diminishing the anxiety linked to the cancer diagnosis. The duplication of such a study in other cancer care units would allow a finer analysis of the impact the health network can have on the adaptation of both spouses to illness.

當受虐婦女欲尋求協助時，初始多以非正式支持網絡為主要求助管道，其中，家庭支持為最具情感性與義務性之協助。援此，本研究先瞭解臺灣受虐婦女家庭支持的經驗，從而分析影響受虐婦女家庭支持的原因，並以質性研究深入訪談七位受虐婦女，運用復元觀點於此問題向度，研究結果發現如下： 一、依受虐婦女獲得的家庭支持功能類型，整理發現情緒性支持為三種功能類型中最重要的一種；資訊性支持中家人最常以「提供想法與建議」做為支持的方式，顯見婦女需要與信任的支持者討論行動策略；工具性支持則為三種功能型態中，最實質可視的協助。 二、影響家庭支持型態因素，前人研究多以負向特質描述受虐婦女，本研究從微視層面觀點發現除了兩樣被動面特質外，受虐婦女有相當多正向主動面特質；此外，受虐婦女其主要支持者的個人特質，主要為「船錨」的角色，提供婦女一種歸屬感，帶給婦女穩定與安定的力量。中介層面觀點探究家庭系統、家庭互動關係與家庭權力關係，研究發現「長輩」或「手足」為受虐婦女的主要支持者，且手足排行序會影響誰成為婦女的主要家庭支持者。此外，家中掌權者多為主要支持者，其同時會影響其他家庭成員提供支持多寡，及影響受虐婦女因應暴力的態度；在家庭權力關係中：1)「婦女為家庭位階最低者，而支持者為家庭位階最高者」，其之間的權力關係差距最大；2)「同一位階或位階接近者」，因彼此間緊密的親情情感，成為時常頻繁聯繫的家庭成員，因此亦能成為婦女的主要支持者；同時受虐婦女均自覺於原生家庭中的權力位階為最低或者相對較低。鉅視層面探討扭曲與偏頗的價值觀念會負面影響受虐婦女其家人提供支持的意願，且結果發現這些負面影響主要為婆婆的回應方式與想法；正面影響除了有正面加強作用外，亦可能扭轉婦女自身負面的傳統觀念，協助受虐婦女走出暴力情境。 三、本研究依據受虐婦女於復元統合模式之復元指標達成的數量，將受訪者劃分為完全復元型、半復元型與初學型，並發現家庭支持對受虐婦女正面影響的主要效應，為促使受虐婦女前往復元道路邁進的動力因子；同時具有舒緩受虐婦女生活壓力之負面排除的緩衝效應。 本研究深入探討臺灣受虐婦女家庭支持之功能、影響家庭支持的因素，及家庭支持促進復元的作用機制。結果顯示家庭支持的作用對於受虐婦女而言，是能夠促使其復元的重要力量之一，研究成果能夠對目前協助受虐婦女復元的工作提供參考依據，以作為臺灣受虐婦女復元之本土經驗參考。 / When abused women seek help, the main way is informal support network at first, in the meanwhile, the family support is the most emotional and responsible support. Therefore, this study discussed the experience of abused women obtained the family support in Taiwan and analyzed the causes of the influence on the family support for abused women. This study adopted Nature research to in-depth interview seven abused women and then used Recovery to analyze the problems. The research results were shown as follow. 1. According to the result in this study, the emotional support is the most important among three types of the function of the family support. In the information support, the family often adopt “providing ideas and suggestions” as supports for abused women. This indicates that abused women need to discuss the action strategies with reliance supporters. The instrumental support is the most substantial and visible support among all types of the function. 2. When discussing the causes of influence of the family support states, many researchers described the situation of abused women based on negative traits. In this study, the results on the micro-level showed that abused women had not only two passive traits but also many positive traits. Besides, the main supporter of abused women played a role as “anchor”, and he/she provided the sense of belonging to abused women for the stable and peace power. On the meso-level, this study discussed the family system, family interaction and familial power relations. The results indicated that “elder” or “sibling” would be the main supporter, and “birth order” would affect the person becoming abused women’s main supporter. In addition, the power holders in a family were mostly the main supporters; moreover, they would have an influence on the support from other family members and the attitude of abused women to cope with the violence. For familial power relations: 1) “Abused women were the lowest family hierarchy; the supporters were the highest family hierarchy”. The difference of the power relation between these two hierarchies was largest. 2) “Abused women and the supporters were the same or close family hierarchy”. Because of the close kinship between them and the frequently contacting to each other, the supporters would also be the main supporters. Furthermore, abused women became conscious that their family hierarchies were the lowest or the lower hierarchy in the original family. On the macro-level, this study discussed that the distorted and biased values would be the negative influence on that if the family were willing to provide support. The results indicated that the negative influences were mostly obtained from the mother-in-law’s responses and thoughts. The positive influence would be positive reinforcement effect and could reverse the negative and traditional concepts of the abused women, and it would help abused women to leave violence situations. 3. According to the recovery target of the Unity Model of Recovery which abused women achieved, the respondents were divided into full-recovery, semi-recovery and novitiate recovery. The results indicated that the main effect of the positive influence from the family support to abused women was the power factor to promote abused women toward the recovery. The positive influence could also mitigate abused women’s life stress and be the buffer effect to obviate the negatives. This study deeply discussed the function of the family support for abused women, the causes of the influence on the family support and the mechanism for the family support promoting abused women to the recovery. The results showed that the family support was the important power for abused women to recovery. The contributions of this study are to provide the conference for the recovery work of abused women and the local experiences of the recovery of abused women in Taiwan.

<p>The main purpose of this thesis was to apply the WHO and NHS palliative care approach to dementia care. </p><p>Thirty-one staff-members in mid-Sweden (studies I and II) and 20 next-of- kin (study IV) were interviewed. In study III, 316 staff-members from dementia care and 121 staff-members from palliative cancer care responded to a questionnaire about family support. The interviews were tape-recorded and analysed with a qualitative phenomenographic (I and II) and a hermeneutic approach (IV). The questionnaires (III) were analysed using qualitative and quantitative content analysis.</p><p>The staff-members stated almost unanimously that daily leadership was lacking, and consequently clear goal formulations and care planning were rare (I). Proper teamwork between the doctor and the staff who worked on a daily basis with the patients was absent (I). With respect to existential issues, education and staff discussions were lacking (II). The staff were at a loss concerning how to deal with these issues. Nevertheless, these issues are central to family-members who have to deal with an existential crisis (IV). Important questions emerged about obligation and guilt, faithfulness, responsibility, and paying back what you once received. Existential isolation could be identified e.g. in the reversal of roles experienced as "being a parent to your parent" and in the burden of "visiting a living dead person". </p><p>There were no routines for bereavement visits. The type of support suggested for dementia family members is partly similar to support in palliative cancer care, but it also differs in other respects such as feelings of guilt because the early signs of the disease are misunderstood, the need for respite because of the long trajectory of dementia diseases, and the occurrence of anticipatory grief because in the late phase family members can no longer make any contact at all with the patient (III).</p><p>A palliative approach can improve the quality of life for the dementia patient and for the family. It can be used as a basis for a clear goal formulation. Some of the suggestions listed in this thesis for improving the quality of care are more a reflection of the need for a change in attitudes rather than the need for substantial budget increases.</p>

The main purpose of this thesis was to apply the WHO and NHS palliative care approach to dementia care. Thirty-one staff-members in mid-Sweden (studies I and II) and 20 next-of- kin (study IV) were interviewed. In study III, 316 staff-members from dementia care and 121 staff-members from palliative cancer care responded to a questionnaire about family support. The interviews were tape-recorded and analysed with a qualitative phenomenographic (I and II) and a hermeneutic approach (IV). The questionnaires (III) were analysed using qualitative and quantitative content analysis. The staff-members stated almost unanimously that daily leadership was lacking, and consequently clear goal formulations and care planning were rare (I). Proper teamwork between the doctor and the staff who worked on a daily basis with the patients was absent (I). With respect to existential issues, education and staff discussions were lacking (II). The staff were at a loss concerning how to deal with these issues. Nevertheless, these issues are central to family-members who have to deal with an existential crisis (IV). Important questions emerged about obligation and guilt, faithfulness, responsibility, and paying back what you once received. Existential isolation could be identified e.g. in the reversal of roles experienced as "being a parent to your parent" and in the burden of "visiting a living dead person". There were no routines for bereavement visits. The type of support suggested for dementia family members is partly similar to support in palliative cancer care, but it also differs in other respects such as feelings of guilt because the early signs of the disease are misunderstood, the need for respite because of the long trajectory of dementia diseases, and the occurrence of anticipatory grief because in the late phase family members can no longer make any contact at all with the patient (III). A palliative approach can improve the quality of life for the dementia patient and for the family. It can be used as a basis for a clear goal formulation. Some of the suggestions listed in this thesis for improving the quality of care are more a reflection of the need for a change in attitudes rather than the need for substantial budget increases.

Le but de cette étude est de cerner, à partir de leur propre point de vue, la trajectoire d’adaptation de conjoints dont l’épouse est atteinte d’un cancer de l’ovaire. Une approche qualitative, la théorisation ancrée, a été utilisée dans le cadre de cette recherche. Les données ont été recueillies à l’aide d'entretiens semi-structurés effectués auprès de neuf conjoints qui accompagnaient leur épouse lors de leurs traitements dans une unité montréalaise ultra-spécialisée de soins pour les cancers gynécologiques. Nos résultats font ressortir qu’une fois passé le choc de l’annonce du diagnostic, nos répondants se ressaisissent et élaborent toute une série de stratégies de protection pour leur épouse et eux-mêmes, puis d’attaque de la maladie. Au bilan, pour eux, le cancer se révèle une expérience « transformante» aux plans personnel, conjugal et social. Les contrastes observés entre nos résultats et ceux des études antérieures, qui insistent sur le désarroi de conjoints, peuvent être expliqués par la prise en charge efficace de la femme par le réseau de la santé, qui valorise le rôle du conjoint et qui l’outille pour accompagner son épouse. S’ajoutent à cela la force du lien conjugal, trempé par les épreuves passées, certains traits de personnalité des conjoints et l'action du réseau de soutien personnel. En regard de la pratique infirmière, notre recherche met en évidence le bien-fondé des politiques soutenant l’intégration des familles dans les plans de soins et les retombées positives d’une approche concertée entre tous les intervenants de la santé. Répéter une telle étude dans d'autres institutions du réseau de la santé permettrait de cerner encore plus finement son impact sur l’adaptation de conjoints à la maladie. / This research focuses on how nine men recall their adaptation trajectory to their spouses’ ovarian cancer. The qualitative analysis made use of the grounded theory approach; semistructured interviews were conducted with husbands accompanying their spouses during their treatments in an ultra-specialized unit for gynaecological cancers in a Montreal hospital. Our results show that after the initial shock initiated by the announcement, the respondents develop a set of strategies, first to protect their wives and themselves, and then to attack the illness. Accompanying their wives through the experience of cancer proves to be, for the husbands, a transformative experience at all levels: personal,conjugal, and social. The perceived efficacy of the health network and its preoccupation with the husband’s caretaker role may explain the sharp contrast we observe between results from the literature, insisting on the husbands’ helplessness in such a context, and our data, which underline their fighting spirit. Other factors identified are the strength of the conjugal link, forged in common ordeals, personality traits of both husbands and wives, and support from their personal network. Concerning nursing practice, this research suggests that the importance and the support given by the health professionals to the family caregivers is of utmost importance for the couple’s quality of life throughout this experience. Besides, the coordination of the health professionals, throughout the women’s illness, is crucial in diminishing the anxiety linked to the cancer diagnosis. The duplication of such a study in other cancer care units would allow a finer analysis of the impact the health network can have on the adaptation of both spouses to illness.

隨著母乳哺育觀念的普及化，部份哺乳媽媽有多餘的奶水，希望有機會分享給他人，臺灣第一座母乳庫於2004年12月開幕以來至今已將近4 年，為使其早產兒能有源源不斷之捐贈母乳可享用，因此需靠這些捐乳媽媽能持續不斷的捐乳，故如何提升這些捐乳媽媽持續捐乳，這個議題值得深究。 本研究旨在了解捐乳媽媽捐乳動機、家庭支持及捐乳服務滿意情形，以質性研究之「半結構式深度訪談」方式，訪談12人。 本研究發現：一、助人行善，可積福報：捐乳媽媽的捐乳動機與是否為做善事行為有似乎有較大影響力。二、行有餘力，捐贈餘奶：家庭經濟好捐乳媽媽可專心哺餵母乳其泌乳量源源不絕，對於知識認知及教導的吸收度似乎會影響其執行率，更間接影響其再捐乳動機。親朋好友及網路訊息得到母乳庫可以捐乳可以引發捐乳媽媽捐乳動機。三、足夠訊息，引發動機：門診產檢及住院期間即作宣導可以增加捐乳量。四、親朋欽羨，激勵捐乳：家人對捐乳有正向看法並且捐乳活動全家能夠一起動起來，支持系統增強。五、宗教信仰支持助捐乳：宗教信念之支持，捐乳媽媽大都因有此概念更願意捐乳，分享愛給需要的寶寶。六、寶寶健康，泌乳量增：捐乳者的寶寶越健康似乎讓媽媽信心大增泌乳量持續增加會更願意捐乳。七、哺乳經驗，有助捐乳：第二胎、媽媽、姐妹有哺乳經驗者可支持捐乳媽媽捐乳。八、溫馨服務，以客為尊：捐乳媽媽對於捐乳服務很滿意，持續捐乳。九、捐乳時間，力求彈性：彈性開放時間讓上班族便利性增加，捐乳媽媽滿意覺得方便性是重要影響因素。十、捐乳滿意，推廣他人：服務滿意，更可讓捐乳媽媽有意願推廣他人來捐乳。 本研究根據提供以下建議：ㄧ、捐乳動機：增強宣導內容，以利捐乳：訊息宣導內容以幫助早產兒渡難關為主打主題再以助人行善幫自己寶寶積福報為理念，捐乳為舉手之勞更能夠有成就感；慎選對象，捐乳率高：宣導捐乳的對象首選社經地位高，經濟優渥學歷高之媽媽；訊息傳遞，產前開始：由門診產檢時或是在住院期間即作宣導。二、支持來源-家庭支持：家庭支持，組成團隊：母乳庫組成支持團體給予適時關心掌握捐乳家庭使之持續捐乳。三、捐乳服務滿意：親切服務，持續捐乳；增加車位，彈性時間：解決停車位的問題及開放彈性捐乳時間。 / With the popularization of the concept of breast-feeding, some nursing mothers with extra milk, and hope to have the opportunity to share to others, Taiwan's first breast milk bank opened in December 2004 has been nearly 4 years for it to have premature children steady flow of donated breast milk can enjoy, so be donated by the mother can breast milk continued to donate, how to improve these mothers continue to donate breast milk donation, the subject worth studying. This study was to donate breast milk donation mother, motivation, family support and service satisfaction donated milk cases to qualitative research "semi-structured interviews" approach, interviews 12. The study found that: first, to help others do good, be positive reward: milk donation mother's motives and whether the milk donated to charity behavior seems to have more influence. Second, any energy left, donated more than milk: milk donation families well breastfeeding mothers can concentrate on their milk yield inexhaustible knowledge of cognition and instruction for the degree of absorption seems to affect the rate of implementation, even indirectly affect donate another milk motivation. Friends and network information can be donated breast milk bank to donate breast milk can cause milk donation mother motivation. Third, sufficient information, cited Engine: hospital out-patient check-and that is to donate milk yield can increase public awareness. Fourth, gained the admiration of friends, encouraging milk donation: the family's donation has a positive view of milk and milk donation activities the whole family can work together to move, support system enhancement. Fifth, religious support to help to donate milk: religious beliefs, support, donor milk mother mostly due to the concept are more willing to donate milk to share love to the needs of the baby. 6, baby health, lactation increase in volume: donor milk more healthy baby who seems to have greatly increased the confidence of lactating mothers continued to increase the amount will be more willing to donate milk. 7, breastfeeding experience, help to donate milk: a second child, mother, sisters, can support other nursing mothers to donate milk to donate milk. 8, warm service, customer-oriented: to donate breast milk donation mother to a very satisfactory service, continuing to donate milk. 9, donated milk time, seek flexibility: flexible opening hours for the convenience of office workers increased milk donation mother satisfied that convenience is an important factor. 10, donated milk satisfaction, promote others: service satisfaction, but also the willingness to donate milk mothers to donate milk to promote others. This study offers the following suggestions: Your donations, milk motivation: increased content of propaganda, in order to facilitate donor milk: the message content of propaganda to help tide over the crisis in premature children to play the theme-based charity to help people help themselves and then the baby product reward for the idea of donation milk for the little things better to have a sense of achievement; carefully choose targets, high milk donation: the object of propaganda to donate milk the first choice of high social status, economic generous educated the mother; message delivery, prenatal start: from the clinic for check-ups or when during hospitalization or for advocacy. Second, sources of support - family support: family support, the composition of the team: the composition of breast milk library support group to donate milk to give timely concern to control the family continued to donate milk to make it. Third, donor milk service satisfaction: friendly service, continued to donate milk; increase in parking spaces, flexible time: to solve the problem of parking spaces and open flexible hours to donate milk.