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Abstract: Background: As cardiovascular diseases have become the leading cause of death in many countries including China, nurses are increasingly required to be abreast of technological advances and the skills necessary to manage this increasing health care problem. Chinese nurses are under pressure to provide skilled electrocardiography monitoring, and be sufficiently skilled to detect myocardial ischemia and infarction, in this large patient population. This presents a challenge for the nursing profession in China, particularly for nurses working in coronary care in a country where advancement has been so rapid, yet little research has been conducted or reported in the literature. Objectives: The two main objectives were: to explore the demographic and educational factors that affect the use of ST-segment monitoring and correct electrode placement by CCU/ICU nurses in China; and to explore the factors both individual and institutional that affect monitoring and lead placement. Methods: A self-administered questionnaire was distributed to nurses in 126 randomly selected tertiary hospitals, which were stratified into three homogeneous regions across China. The instrument examined demographics, information about hospitals, electrocardiogram devices, current practice patterns and perceptions toward monitoring and lead placement. Data from 734 nurses and 59 nurse managers from 59 hospitals were analyzed using t-tests, ANOVA, Chi-square test and logistic regression. Results: Electrocardiogram monitoring was used to detect myocardial ischemia by 43.7% of respondents, and 35.1% selected leads according to electrocardiogram or angiography findings. Most (70%) agreed that monitoring for acute coronary syndrome was important, while 39.2% did so, and 15.7% were able to identify correct placement. Logistic regression revealed a significant relationship between the uses of ST-segment monitoring and number of hospital beds, continuing education and a belief in its use and ease of use. Correct electrode placement was significantly correlated with respondents from university hospitals, hospitals with more acute coronary syndrome admissions and more independent thinking nurses. Conclusions: Despite best practice evidence, less than half of the sample used electrocardiogram monitoring to detect myocardial ischemia and the majority could not identify correct electrode placement, while ST-segment monitoring was not used routinely. This paper highlights the need for improvements in education both in universities and hospitals and discussion addresses conventions in units, which inhibit development of nurses’ skills. [Copyright &y& Elsevier]

Newly graduated nurses have comparatively high levels of occupational stress. Previous studies have evaluated stress across this population as a whole; however, little is known about potentially different occupational stress responses among new nurses and the impact of demographic and work-related characteristics on occupational stress responses. To determine differences in occupational stress levels of newly graduated nurses at different time points during the first 3 years of practice; to identify potential subgroups of nurses who perceive different occupational stress levels over time; and to evaluate differences in identified subgroups based on demographic and work-related characteristics. An observational longitudinal study. Four tertiary hospitals in Shanghai were selected randomly using a computer-generated random number table. All 343 newly graduated nurses employed in the selected hospitals were invited to participate. The inclusion criteria were (1) newly graduated without nursing experience, excluding nursing internship; (2) current employment in in-patient departments/ICU/operation room; and (3) consented to participate. A total of 152 participants met criteria and completed all four points of data collection. Participants completed an annual paper survey. Occupational stress levels were measured using the Job Stress Scale for Newly Graduated Nurses. Occupational stress scores at different time points were compared using latent growth modeling. Group-based trajectory modeling was performed to identify subgroups of occupational stress trajectory. ANOVA and Fisher's exact test were conducted to examine the differences of demographic characteristics between classes. The entire sample of newly graduated nurses experienced a significant decrease in occupational stress during the first three years. The best-fitting group-based trajectory model described three distinctive trajectories: low occupational stress (19.1% of sample); medium occupational stress (67.1%) and high occupational stress (13.8%). The low occupational stress subgroup had a higher proportion of nurses from Shanghai, and the majority were employed as contact- based nurses. In comparison, the high occupational stress subgroup had the largest proportion of nurses from other provinces (outside of Shanghai), almost half of participants were employed as "bianzhi" nurses, and the majority reported to be assigned preceptor by shift. Newly graduated nurses perceived occupational stress differently over time. Identified subgroups with different demographic characteristics have significantly different perceptions of occupational stress over the first three years of practice and future intervention programs such as peer-support programs or a standardized preceptorship should be tailored to meet the unique needs of these different subgroups. [ABSTRACT FROM AUTHOR]