title: Surviving a life-threatening crisis: Taiwan's nurse leaders' reflections and difficulties fighting the SARS epidemic.
abstract: OBJECTIVE
  This study explored Taiwan's nurse leaders' reflections and experiences of the difficulties they encountered and survival strategies they employed fighting the severe acute respiratory syndrome epidemic and the background context framing these phenomena.
  
  
  BACKGROUND
  On several continents in 2002-2003, the highly infectious severe acute respiratory syndrome overwhelmed health care systems and health professionals who had to provide care in situations involving high personal risk and stress, some becoming infected and dying. Nurse leaders in Taiwan had to develop new strategies and support systems for nursing care.
  
  
  METHODS
  A two-step within-method qualitative triangulation research design.
  
  
  METHODS
  Focus group in-depth interviews held with 70 nurse leaders from four Northern Taiwan hospitals involved in the severe acute respiratory syndrome epidemic. Participants then completed an open ended questionnaire. Content analysis was undertaken with data and stages and themes generated. Data were then analysed using Hobfall's concepts of conservation of resources to further discuss participants' reactions and actions in the severe acute respiratory syndrome crisis.
  
  
  RESULTS
  Participants worked under incredible stress to lead the profession through a period of crisis. Five stages arose in the participants' involvement against severe acute respiratory syndrome over 12 weeks: facing shock and chaos; searching for reliable sources to clarify myths; developing and adjusting nursing care; supporting nurses and their clients; and rewarding nurses.
  
  
  CONCLUSIONS
  Nurse leaders become important executors of intervention in this health disaster, requiring emotional intelligence to manage their internal conflicts and interpersonal relationships effectively. They developed sociopolitical and analytical abilities and crucial requirements for planning and implementing strategies in areas where none previously existed. Building support systems was an important resource for managing conflicts between familial and professional roles. Relevance to clinical practice. Findings will assist nurse leaders to prepare themselves and the profession to better deal with disaster management in similar infectious outbreaks in the future.
authors.affiliation: School of Nursing, National Yang-Ming University, Taipei, Taiwan. fjshih@ym.edu.tw
authors.forename: Fu-Jin
authors.initials: FJ
authors.lastname: Shih
authors.forename: Sue
authors.initials: S
authors.lastname: Turale
authors.forename: Yaw-Sheng
authors.initials: YS
authors.lastname: Lin
authors.forename: Meei-Ling
authors.initials: ML
authors.lastname: Gau
authors.forename: Ching-Chiu
authors.initials: CC
authors.lastname: Kao
authors.forename: Chyn-Yng
authors.initials: CY
authors.lastname: Yang
authors.forename: Yen-Chi
authors.initials: YC
authors.lastname: Liao
mesh_terms: D000328:Adult; D003140:Communicable Disease Control / Q000458:organization & administration*; D016638:Critical Illness / Q000453:epidemiology / Q000451:nursing; D003906:Developing Countries; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D007588:Job Satisfaction; D007857:Leadership; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009718:Nurse Administrators / Q000458:organization & administration / Q000523:psychology; D024802:Nurse's Role / Q000523:psychology; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000523:psychology; D011361:Professional Competence; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000451:nursing*; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult