ObjectiveThis pilot study aimed to evaluate the efficacy of a digital cognitive behavioral therapy in patients with cancer experiencing sleep problems.MethodsA total of 57 participants aged 25–65 years were randomly assigned to three groups—21 participants to a dCBT program, 20 participants to an app-based attentional control program, and 16 participants to a waitlist control group—and evaluated offline before and after the program completion. Of the 57 participants, there were a total of 45 study completers, 15 participants in each group. The (...) dependent variables were sleep quality scores, measured by the Pittsburgh Sleep Quality Index and health-related quality of life scores, measured using the Short-Form 36, and attentional bias scores from a dot-probe computer task.ResultsFor both the intention-to-treat and study-completers analyses, a significant increase supported by a large effect size was found in the quality of sleep score of the HARUToday Sleep group compared to both the app-based attentional control and the waitlist control group. However, no significant changes were found in the quality of life and attentional bias scores.ConclusionOur results suggest that the HARUToday Sleep app has the potential to serve as an intervention module to enhance the sleep quality of patients with cancer experiencing sleep problems. (shrink)

Background: Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses’ values, the physician–nurse power hierarchy, and the influence of the culture. Research objective: To analyze the main causes for moral distress with interpretive interactionism. Research design: A qualitative study was adopted. Participants: Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples. Ethical considerations: Approval from the Institutional Review Board of the Kaohsiung (...) Medical University Hospital. Findings: Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician–nurse power hierarchy, and the Oriental culture affect nurses’ goodness-based intention for patients, which deteriorates moral distress. Discussion: The main cause for moral distress is the moral goodness of nurses. If nurses’ goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients’ right to know about their diseases, the choice of treatment, and patients’ autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care. Conclusion: The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses’ confidence and cultural sensitivity, so as to reduce the moral distress of nurses. (shrink)

Background: As moral action could help nurses reduce moral distress, it is necessary to carry out qualitative research to present the experiences in which nurses apply moral action. Aim: To describe and analyze the phronesis applied by nurses in the face of moral distress. Research design: The research participants were invited to participate in in-depth interviews. The research materials were based on the stories described by the research participants and recorded by means of first-person narrative. Narrative analysis was applied to (...) interpret the nurses’ phronesis. Participants: Twenty-seven nurses from Taiwan. Ethical considerations: The Institutional Review Board of the Kaohsiung Medical University Hospital in Taiwan confirmed that this study passed the research ethical review. Findings: According to the narrative analysis results, the phenomenon of moral distress contains difficulty, action, and idea transformation. The difficulty is the source of moral distress, action is the practice of moral courage, and idea transformation is the nurse’s emotional movement. Action and idea transformation are collectively called phronesis in this study. Discussion: Moral distress refers to a state of suffering caused by situations in which nurses cannot carry out their ethical intentions. Phronesis is the process through which nurses take actions and relocate the subjects and is an ethical way to find relief from moral distress. Starting with empathy and respectful attitudes arising from self-reflection, nurses may be helped to get relief from the suffering of moral distress. Conclusion: Phronesis can help nurses positively face the emotional strain of moral distress. This article puts forward a narrative method to complete the four steps of phronesis: write about the care experience, identify the difficulties in the stories, seek the possibility of action, and form a new care attitude, which could help nurses learn to reduce their moral distress. (shrink)

In this article we describe four previous Tai-Chi models based on the I-Ching and their limitations. The I-Ching, the most important ancient source of information on traditional Chinese culture and cosmology, provides the metaphysical foundation for this culture, especially Confucian ethics and Taoist morality. To overcome the limitations of the four previous Tai-Chi models, we transform I-Ching cultural system into a psychological theory by applying the cultural system approach. Specifically, we propose the Jun-zi Self-Cultivation Model, which argues that an individual (...) can become an ideal person, or jun-zi, through the process of self-cultivation, leading to good fortune and the avoidance of disasters. The state of jun-zi is that of the well-functioning self, characterized by achieving one’s full potential and an authentic, durable sense of wellbeing. In addition, we compare egoism and jun-zi as modes of psychological functioning. The JSM can be used to as a framework to explain social behavior, improve mental health, and develop culturally sensitive psychotherapies in Confucian culture. Finally, an examination of possible theoretical directions, clinical applications, and future research is provided. (shrink)

This study aimed at exploring the impact of post-epidemic era on teachers’ behavioral intention of distance education. In this study, purposive sampling method was used to enroll 390 teachers in colleges and universities, high schools and vocational schools, and junior high and elementary schools to be the research subjects for the questionnaire survey. A total of 360 questionnaires were collected for statistics, and AMOS 23.0 statistical software was used to analyze the correlation between variables. Meanwhile, a structural equation model was (...) used to analyze and verify the impact of the technology acceptance model, information system success model, and diffusion of innovations theory. According to the results, the system quality of distance teaching platforms certainly affected perceived usefulness, and perceived usefulness affected teachers’ attitudes toward using distance teaching systems. In addition, perceived ease of use had an impact on perceived usefulness, and trialability had an impact on teachers’ attitudes toward using distance teaching systems. Finally, teachers’ attitude toward using a distance teaching system also affected their behavioral intention. According to the results, suggestions were made in this study to teachers and students for distance teaching. Additionally, the main contribution of this study lies in providing specific strategies for further distance teaching through empirical results in combination with on-site teaching. (shrink)

Microsaccades, small saccadic eye movements occurring during fixation, have been suggested to be modulated by various sensory, cognitive, and affective processes relating to arousal. Although the modulation of fatigue-related arousal on microsaccade behavior has previously been characterized, the influence of other aspects of arousal, such as emotional arousal, is less understood. Moreover, microsaccades are modulated by cognitive processes that could also be linked to arousal. To investigate the influence of emotional arousal, saccade preparation, and global luminance levels on microsaccade behavior, (...) emotional auditory stimuli were presented prior to the onset of a fixation cue whose color indicated to look either at the peripheral stimulus or in the opposite direction of the stimulus. Microsaccade behavior was found to be significantly modulated by saccade preparation and global luminance level, but not emotional arousal. In the pro- and anti-saccade task, microsaccade rate was lower during anti-saccade preparation as compared to pro-saccade preparation, though microsaccade dynamics were comparable during both trial types. Our results reveal a differential role of arousal linked to emotion, fatigue, saccade preparation, and global luminance level on microsaccade behavior. (shrink)

This book explains the general intellectual climate of the early Ch'ing period, and the political and cultural characteristics of the Ch'ing regime at the time. Professor Huang brings to life the book's central characters, Li Fu and the three great emperors - K'ang-hsi, Yung-cheng, and Chien-lung - whom he served. Although the author's main concern is to explain the contributions of Li Fu to the Lu-Wang school of Confucianism, he also gives a clearly written account of the Lu-Wang and (...) Ch'eng-Chu schools from the twelfth century to the eighteenth. In a clear, succinct style, Huang explains the historical differences between the Ch'eng-Chu and Lu-Wang schools without sacrificing the subtleties of either. The book culminates in a discussion of the hero-emperor K'ang-hsi's appropriation of the 'Tradition of the Way' from his intellectual officials, which denied them their traditional role as moral censors and critics of the emperor's exercise of authority. (shrink)

Previous research has shown implicit semantic processing of faces or pictures, but whether symbolic carriers such as words can be processed this way remains controversial. Here we examine this issue by adopting the continuous flash suppression paradigm to ensure that the processing undergone is indeed unconscious without the involvement of partial awareness. Negative or neutral words projected into one eye were made invisible due to strong suppression induced by dynamic-noise patterns shown in the other eye through binocular rivalry. Inverted and (...) scrambled words were used as controls to provide baselines at orthographic and feature levels, respectively. Compared to neutral words, emotion-described and emotion-induced negative words required longer time to release from suppression, but only for upright words. These results suggest that words can be processed unconsciously up to semantic level since under interocular suppression completely invisible words can lead to different processing speed due to the emotion information they carry. (shrink)

Social enterprises, as typical hybrid organisations, are embedded in a plural institutional environment in which some stakeholders regard achieving social goals as fundamental, while others see economic profit as the priority. A great challenge for social enterprises is dealing with the conflicts resulting from the diverse expectations of stakeholders. Based on the existing works on organisational legitimacy and the social business model, we propose a legitimacy-based social enterprise model composed of three main phases, namely, legitimacy proposition, legitimacy strategy planning, and (...) legitimacy strategy implementation. Our model is meant to serve as an effective legitimacy-building tool for social enterprises of various kinds. (shrink)