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Aim: To analyse the risk factors and incidence of falls in geriatric outpatients in a university hospital ward in Hangzhou, China. Methods: From May 2020 to August 2022, 1712 geriatric outpatients in a university hospital ward in Hangzhou, China, were screened using a socio‐demographic questionnaire (e.g. gender, age, living arrangement, etc.) and assessment scales. The correlation between each factor and falls was preliminarily analysed by chi‐squared tests. Finally, binary logistic regression analysis was conducted to further analyse the risk factors of falls. The STROBE checklist was used in reporting this study. Results: Of the 1712 geriatric outpatients recruited, 1626 participants (60–79 and ≥ 80 years old) with complete questionnaire and assessment data were included. The occurrence of falls for those in the 60–79 age group was 8.4%, and for those in the ≥80 age group it was 13.4%. Age (p =.007), use of a walking assistance device (p <.001), the Stay Independent Brochure Questionnaire (SIB) (OR = 7.751, 95% CI = 5.089–11.806, p <.001), living arrangement (p =.004), timed up and go test (TUGT) (p =.007) and three diseases or above (OR = 2.496, 95% CI = 1.358–11.4.586, p =.003) reached statistical significance. Conclusions: Older people have a high incidence of falls. In this study, age, disease history, SIB scores (≥4 points), living arrangement, TUGT and walking assistance device increased the probability of falls in older Chinese adults. Personalised interventions should be carried out according to the specific situation of older people to effectively reduce their incidence of falls and improve their quality of life. Relevance to Clinical Practice: The basic characteristics and fall risk factors of the older can help nurses identify fall risk, and early intervention by caregivers can reduce fall‐related injuries, which has practical significance for promoting healthy aging. Patient or Public Contribution: The subjects of this study were older patients ≥60 years old, and the demographic characteristics and fall‐related information of patients were obtained by questionnaire. The team worked closely with a team of experts in the field of health care. Some researchers collect data and rewrite them, while other researchers analyse the information and write a paper. All authors read and approved the final manuscript. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aims to propose a self‐management clusters classification method to determine the self‐management ability of elderly patients with mild cognitive impairment (MCI) associated with diabetes mellitus (DM). Background: MCI associated with DM is a common chronic disease in old adults. Self‐management affects the disease progression of patients to a large extent. However, the comorbidity and patients' self‐management ability are heterogeneous. Design: A cross‐sectional study based on cluster analysis is designed in this paper. Method: The study included 235 participants. The diabetes self‐management scale is used to evaluate the self‐management ability of patients. SPSS 21.0 was used to analyse the data, including descriptive statistics, agglomerative hierarchical clustering with Ward's method before k‐means clustering, k‐means clustering analysis, analysis of variance and chi‐square test. Results: Three clusters of self‐management styles were classified as follows: Disease neglect type, life oriented type and medical dependence type. Among all participants, the percentages of the three clusters above are 9.78%, 32.77% and 57.45%, respectively. The difference between the six dimensions of each cluster is statistically significant. Conclusion(s): This study classified three groups of self‐management styles, and each group has its own self‐management characteristics. The characteristics of the three clusters may help to provide personalized self‐management strategies and delay the disease progression of MCI associated with DM patients. Relevance to clinical practice: Typological methods can be used to discover the characteristics of patient clusters and provide personalized care to improve the efficiency of patient self‐management to delay the progress of the disease. Patient or public contribution: In our study, we invited patients and members of the public to participate in the research survey and conducted data collection. [ABSTRACT FROM AUTHOR]

Aims: To investigate the change and associated factors of care needs within 6 months post‐discharge in older people with hospital‐associated disability, and the relationship between time‐varying care needs and physical function. Background: Older people with hospital‐associated disability will have various care needs post‐discharge. Understanding their care needs will help to improve their health. However, studies on this population are still limited. Design: A longitudinal study. Methods: The older people who met the inclusion and exclusion criteria were selected in 2 tertiary hospitals in Zhejiang Province, China. The questionnaire survey method was used to collect data about socio‐demographic characteristics, physical function and care needs. The data of 375 older people who completed follow‐up were analysed using logistic regression analysis, generalised estimating equations and generalised additive mixed model. We followed STROBE checklist for reporting the study. Results: The care needs of the older people with hospital‐associated disability declined unevenly, it decreased rapidly in the first three months, and then flattening out. The percentage of people with care needs in each dimension decreased over time, but daily care and rehabilitation needs were consistently more important. Socio‐demographic factors and physical function had different effects on need at different time points, the physical function was the main factor among them. There were non‐linear relationships between the physical function and different care needs with different inflection points. Conclusion: This research revealed change patterns of the care needs of older people with hospital‐associated disability post‐discharge and the non‐linear relationship between physical function and care needs. These findings may help healthcare professionals and caregivers to provide accurate care. Relevance to clinical practice: The findings can be used to identify effective approaches to address the care needs of older people with hospital‐associated disability based on the time of discharge, in conjunction with age, education, and especially physical function, which will promote the justify allocation of nursing resources. What does this paper contribute to the wider global clinical community? [ABSTRACT FROM AUTHOR]

Aims and objectives. To describe nurses' perceptions concerning their professional practice environment in mainland China and identify factors associated with these views. Background. Globally, the environments in which nurses work influence the quality of nursing practice and health care. Design. A cross-sectional descriptive survey using both paper- and online-based delivery modes was used. Method. A convenience sampling method was used. The survey questionnaire was composed of sociodemographic items and the 38-item Chinese version of Professional Practice Environment survey. The content of the paper-based questionnaire was identical to the online survey. Pearson's chi-square test was conducted to compare the demographic characteristics of these two data sets. Descriptive statistics analysis included frequency, percentage, mean and standard deviation. Multiple linear regression analysis using the Backwards method was applied to identify independent predictors of each subscale of the 38-item Chinese version of Professional Practice Environment. Results. A total of 573 questionnaires were analysed. The mean score of each subscale of the 38-item Chinese version of Professional Practice Environment in this study ranged from 2-66-3-05. All subscales except work motivation (3-05, standard deviation: 0-44) scored less than 3-0. Areas rated as most in need of improvement included control over practice, interpersonal interaction, supportive leadership and handling conflict, and staff relationships with physicians and autonomy. Conclusion. This study has identified nurses' perspectives regarding their workplaces in contemporary China. These data have provided an important baseline for developing and implementing culturally appropriate strategies to improve the working environment of Chinese nurses. Relevance to clinical practice. A supportive and enabling work environment promotes professional development and the safety and quality of health care. Addressing these factors is important in optimising work place environments. [ABSTRACT FROM AUTHOR]

Aim: This research aimed to explore the level of hope and symptom burden of breast cancer women undergoing chemotherapy, and predictive factors of hope were also investigated. Background: Chemotherapy brings physical and psychological stress to breast cancer patients. As an effective coping strategy, hope gives them the courage to overcome difficulties and improve prognosis and survival. Therefore, efforts are needed to raise hope. Design/Methods: A total of 450 women who were undergoing breast cancer chemotherapy participated in this cross‐sectional study. Sociodemographic data, disease characteristics, and measures of hope and symptom burden were collected using questionnaires. Hope was assessed using the validated Herth Hope Index, and the previously validated Memorial Symptom Assessment Scale was used to assess symptom burden. This paper adhered to the STROBE guidelines. Results: Chinese breast cancer chemotherapy women hope average scores of 30.15 ± 4.82 were in the medium range of the Hearth Hope Index as specified by Herth to be 24–35. Patients with age ≤45, religious beliefs and lighter symptom burden have a higher level of hope. These variables explained a total of 22.9% of the variation in hope. Conclusions: The level of hope for women undergoing breast cancer chemotherapy still needs to be further improved. Symptom burden can negatively predict hope. Relevance to clinical practice: If nurses can decrease breast cancer chemotherapy women symptom burden, there is an impact on increasing levels of hope. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the mental health status, stressors and self‐adjustment of nurses in isolation wards at different periods in Wuhan, China. Background: Mental health issues easily occurred among the frontline medical workers of a major epidemic. However, the stressors and psychological adjustments experienced by nurses have not been well described. This is crucial to improving clinical quality and nursing safety and ensuring nurses' physical and psychological health. Methods: We performed a cross‐sectional prospective study using the Self Reporting Questionnaire‐20, stressor and self‐adjustment questionnaire administered to frontline nurses in Wuhan at two time points: after they had worked in isolation wards for 7–10 days (T1) and 2 months (T2). This paper complies with the STROBE reporting guideline for cross‐sectional studies. Results: T1 has 92 respondents, and T2 has 86. The positive rates of mental health problems were 26.09% and 9.30%, respectively, showing significantly different in the two periods. The main factors influenced mental health were self‐perceived stress and only child status. The most common stressors were as follows: a large infected population, high infectivity; concerned about family's health status; high mortality if not treated in time (T1); and long duration of the epidemic, separate from family for a long time (T2). In terms of self‐adjustment, 97.83%(T1)/88.04%(T2) of nurses thought it was necessary, but 9(T1) /5(T2) chose to avoid addressing it, and 8(T1) /5(T2) utilised a professional psychological counselling hotline. Conclusions: Mental health problems among frontline nurses fighting COVID‐19 need special attention, so administrators should offer timely counselling and strengthen effective psychosocial support to improve their mental resilience. Relevance to clinical practice: This study surveyed the mental problems and self‐adjustment status among nurses working Wuhan during the outbreak of COVID‐19, to provide administrators with a scientific basis to effectively intervene. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to explore the association between transition shocks and professional identity and the mediating roles of self‐efficacy and resilience among Chinese novice nurses. Background: Novice nurses experience transition shock when they start their careers, which might lead to decreased professional identity and ultimately turnover. By contrast, self‐efficacy and resilience are excellent psychological resources that may be associated with higher professional identity. It is unclear how transition shock affects professional identity by influencing these two internal resources. Design: A cross‐sectional survey. Methods: The STROBE guidelines were followed to report this study. Convenience sampling was used to recruit participants, and 252 novice nurses completed the Transition Shock of Novice Nurses Scale, the Professional Identity Assessment Scale, the General Self‐Efficacy Scale and the Connor‐Davidson Resilience Scale between April 2022 and May 2022. Influencing factors were primarily identified using independent‐sample t‐tests and a one‐way ANOVA. Structural equation modelling was used to detect the mediating effects of self‐efficacy and resilience. Results: Differences in novice nurses' levels of professional identity were found across age groups, hospitals and departments. Transition shock was negatively related to professional identity. Self‐efficacy and resilience mediated the complete chain relationship between transition shock and professional identity. Conclusion: To our knowledge, this study is the first to explore the mediating effect of self‐efficacy and resilience on transition shock and professional identity. Higher transition shock may lead to lower professional identity by reducing self‐efficacy and resilience. Relevance to Clinical Practice: Nursing managers ought to emphasise the significant role of psychological resources in the work adaptation process of novice nurses. It may be more effective to improve professional identity and maintain the stability of the health care system. Patient or Public Contribution: Nursing administrators working at seven preselected hospitals actively assisted us in the process of collecting self‐report questionnaires from novice nurses, such as by booking appointments and providing access for questionnaire administration. In addition, the participants were actively involved in the data collection process. [ABSTRACT FROM AUTHOR]

Aims: To comprehensively examine the prevailing condition of care dependence among middle‐aged individuals who have experienced hemiplegia subsequent to a stroke and were currently undergoing post‐acute rehabilitation. Additionally, the study sought to analyse the determinants that impacted this phenomenon. Design: A single‐centre, cross‐sectional study design. Methods: During the period from January 2020 to October 2022, a cohort of 196 hemiplegic stroke patients, aged between 40 and 65, and within 6 months of their stroke onset, was selected from the cerebrovascular outpatient clinic at a tertiary hospital in Hangzhou. The demographic and disease‐related data, care dependence level, mental state, nutrition and depression status were collected. Furthermore, all collected data were analysed by descriptive and correlative statistical methods. Results: The care dependence level was 51.04 ± 9.42, with an incidence of care dependence of 78.1%. Multivariate regression analysis showed that age, history of falls, physical dysfunction, chronic comorbidities, depression, nutritional status and cognitive dysfunction were influencing factors for care dependence in the participants after a stroke. Conclusion: The incidence of care dependence among hemiplegic patients aged from 40 to 65 years old in the early stage after a stroke was high. Nursing staff should focus on these patients with a history of falling, physical dysfunction, comorbidity, depression status, nutritional status and cognitive dysfunction in clinical practice. Relevance to Clinical Practice: The incidence of care dependence in middle‐aged hemiplegic patients following a stroke is significantly increased. Some risk factors should be assessed, monitored, and controlled by nursing staff as early as possible in order to reduce the dependence levels in post‐acute rehabilitation period and improve the quality of life of hemiplegia patients. Reporting Method: Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross‐sectional studies (see Table S1). Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: To determine the contributions of different kinds of symptoms to the quality of life and mediating effect of psychological and physical symptoms between heart failure symptoms and quality of life. Design: A multi‐centre cross‐sectional study. Methods: 2006 chronic heart failure patients from four cities were recruited in China from January 2021 to December 2022. Patients' symptoms and quality of life were self‐reported, and data were analysed using correlation analysis, dominance analysis and mediating effects analysis. Results: The dominance analysis revealed that the overall mean contributions of heart failure, psychological and physical symptoms were.083,.085 and.111; 29.5%, 30.2% and 39.5% of the known variance. And heart failure symptoms could negatively affect quality of life through psychological and physical symptoms, accounting for 28.39% and 22.95% of the total effect. Heart failure symptoms could also affect quality of life through the chain‐mediated effect of physical and psychological symptoms, accounting for 16.74%. Conclusions: Physiological symptoms had the strongest effect on quality of life and heart failure symptoms had the weakest. Most of the effect for heart failure symptoms on quality of life in chronic heart failure patients was mediated by psychological and physiological symptoms. Relevance to Clinical Practice: It is important to design non‐pharmacological intervention plans for the enhancement of physical and psychological symptoms' management skills, to reduce the adverse impact of heart failure symptoms on quality of life. Reporting Method: Study methods and results reported in adherence to the STROBE checklist. No Patient or Public Contribution: No patients or members of the public were involved in the study. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were to (i) compare the prevalence of multidimensional frailty in middle‐aged and older people with stroke and to (ii) explore the relationship between multidimensional frailty and quality of life (QoL) in this patient population. Background: In recent years, stroke patients have become increasingly younger. As an important risk factor for stroke patients, frailty has gradually drawn research attention because of its multidimensional nature. Design: This study used a cross‐sectional design. Methods: The study included 234 stroke patients aged 45 and older. Multidimensional frailty was defined as a holistic condition in which a person experiences losses in one or more domains of human functioning (physical, psychological and social) based on the Tilburg Frailty Indicator, and QoL was based on the short version of the Stroke‐Specific Quality of Life Scale. Hierarchical regression was used to analyse the correlation factors of QoL. STROBE checklist guides the reporting of the manuscript. Results: A total of 128 (54.7%) participants had multidimensional frailty, 48 (44.5%) were middle aged and 80 (63.5%) were older adults. The overall QoL mean score of the participants was 47.86 ± 9.04. Multidimensional frailty was negatively correlated with QoL. Hierarchical regression analysis showed that multidimensional frailty could independently explain 14.6% of the variation in QoL in stroke patients. Conclusions: Multidimensional frailty was prevalent in middle‐aged and older people with stroke, and it was a significant factor associated with QoL in stroke patients. Relevance to Clinical Practice: This study emphasises the importance of the early identification of multidimensional frailty. And targeted interventions should be studied to prevent the occurrence of multidimensional frailty and thereby improve the QoL of patients. Patient or Public Contribution/s: There are no patient or public contributions to this study. [ABSTRACT FROM AUTHOR]

Aims: To identify latent profiles of competence and perceptions of spiritual care among clinical nurses and explore the possible influencing factors. Background: Understanding nurses' level of spiritual care competence and their perceptions and acceptance of such care is important, which could help devise nurse training programmes to address such competence in clinical nurses. However, research addressing interindividual variability in competence and perceptions among Chinese nurses is lacking. Design: Multicentre cross‐sectional study. Methods: Nurses working in departments with critically ill patients from 12 community, 5 secondary and 10 tertiary hospitals in Shanghai completed a demographic information questionnaire and the Chinese versions of the Spiritual Care Competence Scale, Spiritual Care‐Giving Scale and Spiritual Perspectives Scale. The data were analysed using IBM SPSS v26.0 and Mplus version 8.3. Latent profile analysis identified subgroups with different levels of spiritual care competence. Results: In total, 1277 Chinese nurses were recruited. Four profiles of competence and perceptions of spiritual care were revealed: Low ability (23.8%), High ability (6.4%), High acceptance (34.9%) and Moderate (34.9%). The level of job position, spiritual care‐related education, hospital grade and nurses' perceptions and perspectives of spiritual care predicted the probability of profile memberships in their competence. Conclusions: There was heterogeneity in the characteristics of spiritual care competence. Nursing managers can implement individualised interventions, including relevant training, according to the influencing factors of different competence profiles to improve the level of such competence among nurses. Relevance to Clinical Practice: The results provide a new and expanded view of improving nurses' spiritual care competence. Interprofessional collaboration with clinicians, administrators, educators and spiritual leaders can contribute to the development of related education and training. Reporting Method: EQUATOR guidelines, STROBE checklist: cross‐sectional studies. Patient or Public Contribution: All participants were clinical nurses. Participants were informed they could withdraw from the study at any time. [ABSTRACT FROM AUTHOR]

Aims: To investigate the trajectory, influencing factors and dynamic relationships between fear of cancer recurrence (FCR) and quality of life (QOL) in lung cancer patients. Design: Prospective longitudinal study. Methods: Longitudinal data from 310 lung cancer patients across three hospitals in China were assessed at 1, 3, 6 and 12 months postoperatively (T1–T4). Descriptive statistics characterised patient demographics, clinical characteristics, levels of FCR and QOL. A linear mixed‐effects model was employed to analyse FCR trajectories, identify influencing factors on these trajectories, and predict the impact of FCR on QOL. Results: FCR changed significantly over time, with a slight decrease during T1–T2, an increase at T3 and gradual decline at T4. Higher fear levels were associated with female sex, suburban or rural residency, being a family breadwinner, presence of comorbidities and negative coping behaviours, and low family resilience. QOL negatively correlated with FCR, and FCR predicted lower QOL. Conclusions: At 3 and 6 months postoperatively, lung cancer patients, especially women, suburban or rural residents, family breadwinners, those with comorbidities, negative coping behaviours and low family resilience, reported high levels of FCR. Healthcare providers should pay special attention to lung cancer patients especially during the period of 3–6 months post‐surgery and offer tailored interventions to improve their QOL. Implications for the Profession and Patient Care: Understanding the FCR trajectories, its influencing factors and its negative impacts on QOL can guide the development of targeted interventions to reduce fear and enhance well‐being in patients with cancer. Impact: Identifying the trajectories and influencing factors of fear of lung cancer recurrence in patients at different time points informs future research on targeted interventions to improve QOL. Reporting Method: The study adhered to the guidelines outlined in the Statement on Reporting Observational Longitudinal Research. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to investigate the relationship between burnout and post‐traumatic stress disorder (PTSD) among frontline nurses who went to assist the epidemic situation in Wuhan, China, during the outbreak in 2020. The study also explored the mediating role of depression and the moderating role of age in the main relationship. Background: The relationship between burnout and PTSD in nurse has rarely been investigated in the context of the COVID‐19 pandemic. Understand the relationship between these variables can provide empirical evidence for developing interventions and protocols that improve the health of nurses in future public health emergencies. Design: An online cross‐sectional survey of targeted local 327 nurses who went to assist the COVID‐19 epidemic situation in Wuhan during the initial outbreak. Methods: This study was conducted in August 2020, the burnout scale, the PTSD scale and the depression scale were used to survey participants. The moderated mediation model was used to test research hypotheses. Results: Burnout could affect the PTSD symptoms in nursing staffs and depression could mediate this relationship. Age moderated the relationship between burnout/depression and PTSD, and the effects was strong and significant among younger participants in the relationship between burnout and PTSD. Conclusions: Burnout was identified as a core risk factor of PTSD in nurses. Depression and age played significant roles in the relationship between burnout and PTSD. Relevance to Clinical Practice: PTSD, as a symptom that manifests after experiencing a stressful event, should be a key concern among frontline healthcare professionals. This study suggests that PTSD in nurses can be further reduced by reducing burnout. Attention should also be paid to the PTSD status of nurses of different age groups. Patient or Public Contribution: Patients and the public were not involved in the design and implementation of this study. Frontline nurses completed an online questionnaire for this study. [ABSTRACT FROM AUTHOR]

Aims: To establish a cognitive appraisal path model that examines the impact of stroke knowledge on stigma with the parallel mediating effects of negative and positive coping traits, as well as the moderating effects of family functioning. Background: Stroke‐related stigma, a 'mixture' of negative emotions involving internal criticism and external judgement, has been shown to impair patients' health outcomes. However, the specific factors underlying cognitive appraisals and their pathways remain unknown. Design: A cross‐sectional design. Methods: The cross‐sectional sample was from two stroke centres in China. Questionnaires were administered to collect sociodemographic data, stroke knowledge, coping traits, family functioning and stigma. Hierarchical regression models and the moderated parallel mediation model were constructed to analyse influencing pathways. The study adhered to the strengthening the reporting of observational studies in epidemiology guideline. Results: All 144 samples reported stigma symptoms with a moderate‐to‐high standardising score. The best hierarchical regression model explains 55.5% of the variance in stigma. The parallel mediation model indicated that negative and positive coping traits co‐mediating the association of stroke knowledge and stigma. After adding the family functioning as a moderator, the moderated parallel mediation model was confirmed with adequate fit indices. Conclusion: Among the cognitive appraisal factors affecting stroke‐related stigma, stroke knowledge reduces stigma by modifying coping traits, while poor family functioning may serve as an opposing moderator. Notably, when family support is insufficient, enhanced stroke knowledge might paradoxically exacerbate the stigma. Relevance to Clinical Practice: This study contributes knowledge on transforming health education and emphasises the pivotal roles of clinical nursing practitioners. In similar global contexts, the study highlights integrating health education, psychological counselling and family support to advance systematic nursing practices. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Aim: To construct key quality indicators for aged care facilities in China. Background: Evaluating the care quality in aged care facilities is problematic. Evaluation of nursing care quality is important for improving nursing and self‐supervision in aged care facilities. However, a few regulations and studies regarding care quality evaluation have been implemented in China. Design and Method: This two‐tier Delphi study aimed to achieve consensus on key quality indicators for aged care facilities in China. The entry pool was determined by literature review and research team discussion, followed by a discussion by a panel of experts to establish the items of the Delphi study. Finally, key care quality indicators were established through a two‐round Delphi study. This study followed the SQUIRE 2.0 guidelines. Results: The initial 16 quality indicators of the entry pool was developed based on a literature review and a group discussion. Sixteen quality indicators were reduced to eight after the expert discussion. After two rounds of expert consultation, the eight quality indicators became nine, which were then evaluated for importance, formula rationality, and operability using Kendall's harmony coefficients (first round: 0.150, 0.143 and 0.169, respectively; second round: 0.209, 0.159 and 0.173, respectively). Conclusions: Key quality indicators provide quantifiable evidence for evaluating the care quality in aged care facilities, but their applicability needs continuous improvement. Relevance to Clinical Practice: Nine key quality indicators were selected from numerous indicators for measuring the care quality in aged care facilities, supporting the evaluation of the care quality and self‐supervision for aged care facilities. Elderly or Public Contribution: No elderly or public contribution. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to describe the knowledge, attitudes and practices (KAP) of nurses in implementing advance directives (ADs) for older patients and analyze the influencing factors before the establishment of the first advance directives act in China. Design: Multicenter cross‐sectional survey. The standards for reporting the STROBE checklist are used. Methods: This cross‐sectional study developed a self‐designed structured questionnaire to assess nurses' knowledge, attitudes and practices about ADs. Nurses were recruited by stratified random sampling through the Nursing Departments of 12 hospitals in southwest China and were asked to fill out the questionnaire face to face about knowledge, attitudes and practices. Data were analyzed following descriptive statistics, rank‐sum test and multiple linear regression. Results: This study included 950 nurses. The study found that nurses were extremely supportive of ADs. Unmarried nurses had better knowledge of ADs than married ones. Nevertheless, there was a discrepancy between the participants' knowledge, attitude and practice. The participants' practice was lower (4.3%) compared with their attitude (81.9%) and knowledge (42.2%). Knowledge on, attitudes towards and standardized procedures for ADs in the workplace affected nursing practice. Conclusions: The study recommends that courses on ADs and appropriate support from medical institutions should be provided to nurses to increase their knowledge and confidence in implementing ADs. Healthcare professionals should be sufficiently equipped to implement ADs and handle their execution appropriately to provide adequate end‐of‐life care corresponding to patients' wishes. Relevance to Clinical Practice: The study results inform rich insights as it discusses the numerous interrelating factors influencing these three fundamental aspects that affect the success of any AD policy by surveying the knowledge, attitudes and practices of clinical nurses. Furthermore, our results hint at distinct areas of improvement in the nursing practice to facilitate the wider implementation and acceptance of ADs in China. Patient or Public Contribution: This study involved no patient. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To develop and validate a behavioural driving model for adherence to home‐based cardiac rehabilitation exercise in patients with chronic heart failure, and to explain the potential driving mechanism of social support on exercise adherence. Background: Despite the benefits of home‐based cardiac rehabilitation exercise, adherence among patients with chronic heart failure remains suboptimal. Several factors contributing to adherence have been confirmed; however, the specific pathway mechanisms by which these factors impact exercise adherence have not been thoroughly explored. Design: An exploratory sequential mixed‐methods study was conducted in this study. Methods: A total of 226 patients with chronic heart failure were recruited using convenience sampling. Quantitative data were collected using a series of self‐report questionnaires. Hierarchical regression analysis was performed to verify multiple pathways. Subsequently, 12 patients with chronic heart failure were drawn from the quantitative stage. The interview data were thematically analysed. This study followed the Good Reporting of a Mixed Methods Study (GRAMMS) guidelines (Appendix S1). Results: Perceived social support had a direct positive predictive effect on exercise adherence. Importantly, exercise self‐efficacy and exercise fear played a chain‐mediating role between perceived social support and exercise adherence. As a result of the qualitative phase, scale, tightness and homogeneity of social support networks emerged as potential drivers of the effectiveness of social support on exercise adherence. Conclusions: This study reveals a potential pathway mechanism for social support to improve adherence to home‐based cardiac rehabilitation exercises. Social support network plays a crucial role in the effect of social support on exercise adherence. Relevance to Clinical Practice: To enhance exercise adherence in home‐based cardiac rehabilitation for patients with chronic heart failure, establishing a social support network is recommended. This strategy has the potential to promote exercise self‐efficacy and alleviate exercise fear. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Objectives: Taking a dimensional view, this study aims to understand, among professional caregivers after patient deaths, the symptom distribution and development of the short‐term bereavement reaction (SBR) network and the node‐level links between the meaning of patient death (MPD) and the SBR network. Methods: A cross‐sectional secondary analysis was conducted with existing data from 220 Chinese urban hospital nurses and physicians who experienced the most recent patient death within a month. MPD was measured by the 10 formative items of the meaning of patient death model, and SBR was measured by the Short‐term Bereavement Reactions Subscale of the Professional Bereavement Scale. Both Gaussian graphical network analysis and Bayesian network analysis were applied to the SBR network, and Gaussian graphical network analysis was used to estimate the MPD‐SBR network. Results: Frustrated and guilty are central nodes in the regularized partial correlation SBR network. Meanwhile, a traumatic event and failure at work are important bridge nodes between the MPD network and the SBR network. In the Bayesian SBR network, moved by the family's understanding, moved by the family's gratitude and sad mainly drive other nodes. Conclusion: After a patient death, nurses' and physicians' SBR networks feature professional‐dimension symptoms at their core, while they follow 'personal to professional' and 'concrete to abstract' symptom development patterns. The personal meaning of a traumatic event and the professional meaning of a failure at work play key roles in bridging the MPD and SBR networks, and meanings of both the personal and the professional dimensions can link to professional‐dimension reactions. Reporting Method: The manuscript followed the STROBE checklist for reporting cross‐sectional studies. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify the factors influencing the intent to provide care among nurses involved in coronavirus disease 2019 (COVID‐19) care. Background: COVID‐19 was first reported in Wuhan, China, in 2019. In 2020, the World Health Organisation declared it a pandemic, leading to 5,827,104 deaths and 421,203,495 confirmed cases as of 19 February 2022. The high transmissibility of COVID‐19 has prolonged the pandemic for over 2 years, resulting in deleterious effects on nurses' physical and mental health. The fear of infection and isolation may lead to negative experiences and perceptions among COVID‐19 frontline nurses, which may ultimately degrade the quality of patient care. Thus, it is essential to identify factors influencing of nurses' intent to provide care. Design: Cross‐sectional study. Methods: Data were collected from 169 nurses involved in direct COVID‐19 care at a hospital designated for infectious disease care in Korea from August to September 2021 using an online questionnaire. STROBE checklist was followed. Results: Nurses' intent to provide care significantly differed based on whether they lived with parents and had adequate availability of personal protection equipment. The correlation analysis indicated that the intent to provide care was significantly positively correlated with normative beliefs, control beliefs, attitude towards the behaviour, subjective norms and perceived behavioural control. Perceived behavioural control, control beliefs and attitude towards the behaviour were significant factors influencing nurses' intent to provide COVID‐19 care. Conclusion: This study showed that nurses perceived behavioural control and positive behaviour towards providing COVID‐19 care fundamentally influenced their intent to provide care. Relevance to clinical practice: In clinical practice, the safety and rights of individual nurses who participated in COVID‐19‐related patient care are promoted, and ultimately, the quality of patient care is improved. Furthermore, active support at the organisation and government level is needed to strengthen the capabilities necessary for nursing patients with infectious diseases. [ABSTRACT FROM AUTHOR]

Aims and objectives The primary aim of this study was to examine the correlations between patient and caregiver characteristics with caregiver burden, anxiety and depression in Alzheimer's Disease. Secondary aim was to determine which behavioural and psychological symptoms had the greatest impact on caregiver burden, anxiety and depression in Alzheimer's Disease. Background Caregivers of individuals with Alzheimer's Disease experience high levels of burden, both psychologically and physically. Previous studies have examined caregiver burden, anxiety and depression separately. However, no paper has examined these three psychological conditions simultaneously. Design A cross-sectional design. Methods A total of 310 patients with probable Alzheimer's Disease and their primary caregivers were assessed. Cognitive impairment and neuropsychiatric symptoms were assessed with the Mini Mental State Examination, Montreal Cognitive Assessment, Clock Drawing Test and Neuropsychiatric Inventory, respectively. Caregiver burden, anxiety and depression were assessed with the ZBI, Generalised Anxiety Disorder Scale-7 and Patient Health Questionnaire-9, respectively. Results All 12 neuropsychiatric symptoms in the Neuropsychiatric Inventory were significantly correlated with caregiver burden, anxiety and depression, with the top three neuropsychiatric predictors being depression, apathy and anxiety. Furthermore, higher levels of caregiver anxiety were associated with a longer duration of being a caregiver. Within caregivers, higher levels of depression were independently associated with higher numbers of additional caregivers, lower educational background and being the spouse of the patient. Higher levels of burden were associated with a longer duration of being a caregiver and being the spouse of the patient. Caregiver burden, anxiety or depression were not significantly correlated with hours/day of caring for the patient. Conclusions Caregiver burden, anxiety and depression were significantly correlated with different neuropsychiatric symptoms in the Neuropsychiatric Inventory. Relevance to clinical practice Practitioners are able to identify caregivers at risk for burden, anxiety and depression. Understanding which Neuropsychiatric Inventory symptom is more closely associated with distress in caregivers will help practitioners to be more specific and effective in detecting caregiver distress. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop and test a predictive model of women's help-seeking intention for urinary incontinence that was developed using the theory of planned behaviour and to identify factors that influenced women's help-seeking intention. Background Urinary incontinence is a chronic progressive condition if left untreated, but few women seek help from healthcare providers. Reasons for not seeking help have been studied in Western countries while relatively little information is available from mainland China. Design Questionnaire-based cross-sectional survey was performed in this study. Methods From May-October 2011, a cross-sectional survey was conducted with a representative sample of 346 incontinent women from three communities in Jinan using strict inclusion and exclusion criteria. Data were collected via a self-administered pencil-and-paper survey that consisted of a multi-item questionnaire. Predictive model estimation was performed using structural equation model. Results The resultant model demonstrated that incontinent women's help-seeking intention could be predicted by their perceived self-efficacy and perceived social impact from urine loss. Perceived self-efficacy was the negative predictor, while the perceived social impact was the positive one. Overall, the predictive model explained 36% of the variance for incontinent women's help-seeking intention. Conclusion The theory of planned behaviour can be used to predict help-seeking intention in women who have urinary incontinence. Community nurses should increase patients' help-seeking intention by addressing perceived social impact and perceived self-efficacy in managing incontinent symptoms. Relevance to clinical practice Our findings suggest that high perceived self-efficacy in dealing with incontinent symptoms could hinder incontinent women from seeking help from healthcare providers. The strong social impact women perceived, however, facilitates intention to seek help. Nurses should understand and address these factors through education and evidence-based practices to increase help-seeking in incontinent women. [ABSTRACT FROM AUTHOR]

Aim: To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context. Design: A sequential, explanatory, mixed‐method study was performed. Methods: Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third‐level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor–Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi‐structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann–Whitney U test, Kruskal–Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following‐a‐thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden. Results: The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta‐themes and nine meta‐subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients' suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID‐19 and spousal relationship with patients) and factors that mitigate burden (social support). Conclusion: Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family‐centred palliative care must be further developed. Implications for the profession: It is important to develop family‐centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture‐oriented death education in palliative units. Impact: This study adopted a mixed‐method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context.Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent.The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family‐centred care in Chinese palliative units. Reporting Method: The results of this study are reported based on the guidelines of the Mixed‐Methods Article Reporting Standards. Patient or Public Contribution: Eligible caregivers were invited to participate in the study and semi‐structured interviews. Nurse managers of the palliative unit helped us access the patient‐management system. [ABSTRACT FROM AUTHOR]

Aim: To investigate the impact of socio‐demographic factors and job stressors on the emotional intelligence of psychiatric nurses. Background: Emotional intelligence plays a crucial role in enabling nurses to effectively manage their own emotions, comprehend the emotions of others and assist individuals in dealing with diverse stressors. Nevertheless, a comprehensive conceptualization of the relationship between job stressors and emotional intelligence remains lacking. Design: This study employs a multi‐centre cross‐sectional design. Methods: A multi‐centre cross‐sectional survey involving 1083 registered nurses from 11 psychiatric hospitals across four provinces in China was conducted. Non‐probability sampling was utilised. The survey encompassed assessments of nurse job stressors, emotional intelligence using a scale and socio‐demographic characteristics using a questionnaire. A multiple linear regression model was applied to identify significant variables associated with emotional intelligence based on demographic attributes and various nurse job stressors. The study adhered to the STROBE checklist. Results: The findings revealed a noteworthy negative correlation between nurse job stressors and emotional intelligence. Socio‐demographic factors and job stressors of certain nurses were able to predict emotional intelligence and its dimensions among psychiatric nurses, with percentages of 44.50%, 40.10%, 36.40%, 36.60% and 34.60%. Conclusion: Providing emotional intelligence training for psychiatric nurses could enhance their capacity to cope effectively with workplace stress, particularly among younger nurses who engage in limited physical activities. Relevance to Clinical Practice: The analysis of the relationship between emotional intelligence and nurse job stressors could facilitate early detection and intervention by managers based on pertinent factors. This, in turn, could elevate the emotional intelligence level of psychiatric nurses. No Patient or Public Contribution: This study did not recruit participants, so details of participants were not be involved. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The purpose of this empirical study was to explore the current status and associated factors of lymphedema self‐management behaviours among Chinese breast cancer survivors. Background: Breast cancer‐related lymphedema is a lifetime concern for survivors and is currently incurable. Lifetime lymphedema self‐management takes a significant role in preventing development and progression of lymphedema. Understanding influencing factors of lymphedema self‐management behaviours can help to develop targeted intervention programs. Design: A multicentre cross‐sectional study. Methods: From December 2021 to April 2022, a convenience sample of 586 participants were recruited at four tertiary hospitals in four cities in China. Self‐reported questionnaires were used to measure socio‐demographic characteristics, disease‐and treatment‐related characteristics, lymphedema self‐management behaviours, lymphedema knowledge, illness perception, self‐efficacy, self‐regulation and social support. Descriptive analysis, bivariate analysis and hierarchical multiple regression were conducted. This study was registered at Chinese Clinical Trial Registry (ChiCTR2200057084), and was reported followed the STROBE checklist. Results: Breast cancer survivors reported moderate level of lymphedema self‐management behaviours. Promotion of lymph reflux management was ranked the least performed self‐management behaviours, while the affected limb protection management ranked the most. 36.2% of self‐management behaviours was explained by exercise regularly, level of attention on lymphedema prevention, unclear about the tumour stage (vs. stage I), knowledge, self‐efficacy, emotional illness representation and social support. Conclusions: Lymphedema self‐management behaviours of breast cancer survivors was insufficient. Performance of lymphedema self‐management varied with different socio‐demographic characteristics, along with different levels of knowledge, self‐efficacy, perception and social support. All these identified predictors should be reckoned in assessment and intervention of lymphedema self‐management behaviours. Relevance To Clinical Practice: This study addressed that breast cancer survivors' lymphedema self‐management behaviours should be promoted. Focusing on identified predictors, further lymphedema surveillance, knowledge education or social facilitation programs are recommended to enhance their self‐management performance and adherence. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to determine the relationship between the demand for telenursing and the chronic illness resources available to patients with type 2 diabetes mellitus (T2DM), as well as the factors that affect this requirement. Design: Cross‐sectional. Methods: This study included 586 participants with T2DM. A telenursing needs questionnaire developed by the research team was used to assess the telenursing needs of patients with T2DM, and the Chinese version of the Chronic Illness Resources Survey was used to assess the participants' community chronic disease resources. A one‐way ANOVA and multiple regression analysis were used to determine the factors influencing the demand for telenursing and to estimate the relationship between chronic illness resources and the need for telenursing. The STROBE checklist was followed. Results: The patients' telenursing needs, ranked from high to low, are as follows: individualized skills and safety; basic disease care; psychological and spiritual needs; respect and social support; and high‐level health management. The chronic disease resource score was 3.47 ±.02, which suggested that patients with T2DM have relatively rich disease resources. Multiple regression analyses showed that resources for chronic diseases, the course of diabetes and complications, family income and other chronic diseases accounted for 79.6% of the variance in T2DM patients' telenursing needs. Conclusions: The telenursing needs of patients with T2DM are prominent, and primarily focus on basic nursing needs for the disease. To some extent, chronic disease resources affect the telenursing needs of patients with T2DM. Relevance to Clinical Practice: It is crucial to pay attention to research on telenursing for T2DM patients from the patients' perspective. Enhancing resources for chronic diseases may help meet the telenursing needs of T2DM patients. Patient or Public Contribution: Parents and diabetes management specialists participated in designing the telenursing needs questionnaire. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to investigate the role of the family in supporting diabetes self‐management and explore the possible mechanisms between family and diabetes self‐management among rural patients in China. Background: The prevalence of Type 2 diabetes mellitus (T2DM) is growing rapidly in rural areas of China, where healthcare resources remain relatively poor and family members play an important role in chronic disease self‐management. Design: This was a multicentre cross‐sectional study. Methods: A total of 276 adults with T2DM were recruited from nine county hospitals in China. Diabetes self‐management, family support, family function, and family self‐efficacy were evaluated using the mature scales. A theoretical model was built based on the social learning family model and previous studies and then verified using a structural equation model. The STROBE statement was used to standardise the study procedure. Results: Family support and general family factors, including family function and self‐efficacy, were positively correlated with diabetes self‐management. Family support fully mediates the relationship between family function and diabetes self‐management and partially mediates the relationship between family self‐efficacy and diabetes self‐management. The model explained 41% of the variability in diabetes self‐management and had a good model fit. Conclusion: General family factors can explain nearly half of the change in diabetes self‐management in rural areas of China, while family support is a mediator between general family factors and diabetes self‐management. Family self‐efficacy, a potential intervention point of family based diabetes self‐management education, can be improved by building special lessons for family members. Relevance to Clinical Practice: This study emphasises the role of family in diabetes self‐management and proposes suggestions for diabetes self‐management intervention among patients with T2DM in rural areas of China. Patient or Public Contribution: Patients and their family members completed the questionnaire which was used for data collection. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim was to identify latent trajectories in physical activity (PA) and their determinants in adults with chronic obstructive pulmonary disease (COPD) based on the socio‐ecological model. Background: PA has been linked to poor long‐term outcomes in patients with COPD. However, few studies have explored their PA trajectories and their predictors. Design: Cohort study. Methods: We used data from a national cohort and included 215 participants. PA was quantified using a short PA questionnaire, and group‐based trajectory modelling was used to explore the PA trajectories. Multinomial logistic regression was conducted to identify the predictors of PA trajectories. Generalised linear mixed models were used to elucidate the associations between predictors and PA during follow‐up. A STROBE checklist was used to guide the reporting of this study. Results: Three PA trajectory patterns were identified among 215 COPD participants with an average age of 60.51 ± 8.87: stable inactive group (66.7%), sharp decline group (25.7%) and stable active group (7.5%). The logistic regression showed that age, sex, income, peak expiratory flow, upper limb capacity, depressive symptoms, the frequency of contact with children were PA predictors. Upper limb capacity weakness and depressive symptoms were found to be associated with a sharp decline in PA during follow‐up. Conclusions: This study revealed three PA trajectories among patients with COPD. In addition to strengthening the physical functions and mental health of patients, support from the family, community and society also play a crucial role in promoting PA of patients with COPD. Relevance to Clinical Practice: It is essential to identify distinct PA trajectories in patients with COPD to develop future interventions that promote PA. No Patient or Public Contribution: A national cohort study was used and no patients or the public were involved in the design and implementation of this study. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to gain comprehensive insight into the quality of life of parental living liver donors after liver donation. Background: Several studies reported good quality of life of living liver donors with the SF‐36 scale. Care demand from the recipient and responsibility of being parent might make a difference in parental donors' personal experienced quality of life after transplantation surgery. Methods: It is a cross‐sectional study. The parental donors' demographics, clinical data and post‐donation complications were obtained. Quality of life was assessed using the Medical Outcomes Study SF‐36 and the Quality of Life Scale of Living Organ Donors‐Common Module. Patient or Public Contribution: The enrolled participants were contacted by electronic questionnaires and telephonic interview. Results: A total of 345 parental donors were included, with recruited period ranging from 3 to 85 months post‐donation. 8.1% of donors had post‐operative complications, mostly classified as Clavien grade II. Donors' general quality of life was higher than the Chinese general norm. Issues related to surgical incision, fatigue, worries about income and personal health, effects on work capability, increased medical expenses and difficult reimbursement and suspected donation decision were the prominent problems among donors. Mother–son relationship (OR = 1.87) and equal or less than 2 years after donation (OR = 3.08) were the influencing factors for poor physical quality of life, while unmarried status (e.g. divorced or widowed) was found negatively associated with mental quality of life (adjusted OR = 3.61). Conclusions: General health among parental donors is good but those female, unmarried and near post‐donation might in low life quality. Incision, fatigue, finance, reimbursement and donation decision are prominent problems. Relevance to Clinical Practice: Post‐donation care of living donors should cover social and financial domain besides physical and mental dimension. Providing follow‐up care and counselling is necessary to ensure their life quality. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to describe the prevalence of reproductive concerns among young female patients with colorectal cancer and explore the associated factors. Background: With the trend of longer survival and younger age at diagnosis of colorectal cancer patients, reproductive concerns have become increasingly prevalent among young female colorectal cancer patients. Design: Cross‐sectional design. Methods: The study included 150 young female patients with colorectal cancer who completed cancer treatment at 2 hospitals in Guangzhou, China, between November 2020 and December 2021 completed an investigation comprising A general questionnaire, The Reproductive Concerns After Cancer scale, The Family Adaptation and Cohesion Evaluation Scale II and unmet fertility information needs questionnaire. Multivariable linear regression analysis was performed in order to identify factors that influence reproductive concerns. This study was prepared and is reported according to the STROBE checklist. Results: The mean (SD) score on the Reproductive Concerns After Cancer scale was 54.78 ± 8.97. The highest score was for the children's health subscale (3.84 ±.92) and the lowest was for acceptance (2.24 ±.70). Multiple regression analysis showed that patients with fewer children, female children, lower education level (less than undergraduate degree), earlier disease stage, lower family function and higher unmet need for fertility information had more reproductive concerns, which explained 26.9% of the total variation of the model. Conclusions: The patients with fewer children, female children, low cultural degree (less than bachelor), early clinical patients, poorer family function and higher unmet fertility information needs had higher reproductive concerns. Relevance to clinical practice: These findings can guide the development of interventions to mitigate reproductive concerns, including understand and meet their fertility information needs, improve the level of family function. Patient or public contribution: Survey questionnaires were completed by participants among young female with colorectal cancer in this study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate the oral health literacy (OHL) of nurses and explore the factors affecting their OHL. Background: OHL is important for improving the oral health outcomes. Nurses' OHL may affect the oral health of themselves, families, and patients. Few studies have examined the OHL and its related factors among nurses. Design: A cross‐sectional design following the STROBE guideline. Methods: A total of 449 nurses were recruited from tertiary hospitals in the minority areas of southwest China. The participants completed an online questionnaire, which contained questions related to the OHL, sociodemographic factors, general health, oral health and related behaviours, oral health knowledge, attitudes, and oral health‐related quality of life. OHL was measured using the validated Chinese version of the short‐form Health Literacy of Dentistry (HeLD‐14) scale. Descriptive statistics, the Mann–Whitney U test, Spearman's correlation, and multiple linear regression analysis were used to analyse the data. Results: The median HeLD‐14 score (p25–p75) was 50.0 (44.0–54.0). The regression model for OHL was found to be significant. The factors that influenced OHL included oral health knowledge, oral health attitudes, self‐reported oral health, annual household income, and dental flossing; these factors accounted for 13.9% of the variance in OHL. Conclusions: The nurse' OHL has room for improvement. Nurses' OHL could be improved by enriching their oral health knowledge, promoting their positive oral health attitudes, increasing their household income, and helping them build correct oral health behaviours. Relevance to clinical practice: The findings of the study could be used to make a case for changing nursing curricula. Oral health knowledge curriculum or programmes targeted towards nurses should be developed to improve their OHL. Patient or public contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine knowledge, attitude, and practice regarding postoperative delirium and the relationships among cardiac surgery nurses in China. Background: Postoperative delirium is a prevalent and devastating complication following cardiac surgery. Nurses play a part in multi‐disciplinary collaboration for preventing and managing postoperative delirium, of whom knowledge, attitude, and practice are essential. Design: A cross‐sectional multi‐centre study. Methods: Nurses from cardiac surgery wards and intensive care units of five tertiary hospitals in Wuhan, Hubei Province, China were enrolled. Data were gathered online using a self‐administered questionnaire. Student's t‐test, or analysis of variance, or non‐parametric tests were performed to compare differences across groups. Bootstrapping mediation analysis was conducted to examine the relationship between knowledge, attitude, and practice. The STROBE checklist was used for the reporting of this study. Results: Of 429 nurses, a moderate level of knowledge and high levels of attitude and practice regarding postoperative delirium were revealed. Nurses with higher education, higher academic title, 5–10 years of practice in nursing and cardiac surgery nursing exhibited increased knowledge. With advanced age, practice in a specialised hospital, and training experience, nurses reported a better degree of practice. Attitude played a full mediating effect in the relationship between knowledge and practice, accounting for 81.82% of the total effects. Conclusions: Knowledge, attitude, and practice regarding postoperative delirium are promising among Chinese cardiac surgery nurses, with knowledge of screening tools and perioperative nonpharmacological interventions and practice of screening in need of enhancement. Attitudes act as an intermediary between knowledge and practice regarding postoperative delirium. Relevance to Clinical Practice: Innovative and stratified in‐service education is warranted to address knowledge enhancement. Meanwhile, organisations are suggested to make efforts to foster nurses' positive attitudes, particularly in creating a favourable culture and developing institutional protocols for postoperative delirium management to improve practice. No Patient or Public Contribution: This study is focused on cardiac surgery nurses' knowledge, attitude, and practice regarding postoperative delirium, and the research questions and design are from clinical nursing practice, literature review, and expert panel review, in which the patient or public is temporarily not involved. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the acceptances and associated influences of organ donation in mainland China. Background: The shortage of organ donors has limited the development of organ transplantation in China. It is important to recognise the target population who has high intention to donate their organs may change the status. Design: We conducted a cross‐sectional, multi‐stage sampling study collected demographic data and individuals' willingness to accept organ donation. Methods: A stepwise linear regression analysis was adopted to evaluate the factors related to the attitudes toward organ donation. Results: We collected 11,031 valid samples for the survey. The willingness to donate organs among Chinese residents averaged 56.93 points. To be specific, males (β = −.03), religious believers (β = −.01) and parents with a different number of children (all: β = −.04) are less willing to donate their organs. Respondents who live in an urban area (β =.03), have higher education level (High school or junior college β =.04, Bachelor degree or above β =.09), feel anxious (mild, moderate β =.02), feel pressured (moderate, severe β =.08), have higher scores of the Short‐Form Health Literacy Instrument (HLS‐SF12) (β =.31), The Self‐Management Scale (SHMS) (β =.16), EuroQol Five Dimensions Questionnaire (EQ‐5D) (β =.04) and EuroQol Visual Analogue Scale (EQ‐VAS) (β =.24), are more positive to donate. Conclusions: This study firstly discusses the public acceptance of organ donation through a nationwide sample around China. In this study, we discovered that Chinese residents' acceptance level of organ donation and that gender, house, anxiety, pressure, social support and health literacy were the main influencing factors on residents' attitudes. Relevance to Clinical Practice: To figure out the Chinese public acceptance and its influencing factors of organ donation can help nurse transplant coordinators to recognise the target population and the obstacles of organ donation. Patient or Public Contribution: At the phase of collecting data, participants were recruited to fill the questionnaires. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the effects of effort‐reward imbalance (ERI) on emergency nurses' turnover intention and the role of depressive symptoms between ERI and turnover intention. Background: Turnover intention is crucial for clinical practice due to its relationship with turnover behaviour and destructive effect on stability of nursing staff. The ERI is a mainstream model to explain job stress, which seems to be one of the key variables, but the direct evidence is not adequate. In addition, there have been only a few studies looking into the complexity of the relationship between ERI and turnover intention, and more research is needed. Methods: This is a cross‐sectional study conducted from July to August 2018, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed. We employed a standardised questionnaire to collect sociodemographic information and target turnover intention. Hierarchical multiple logistic regression and mediation analyses were performed for the data analyses. Results: This study included responses from 17,582 emergency nurses in China. On turnover intention, ERI exerted both direct effect and indirect mediating effect. The results also indicate that depressive symptoms partially mediated the effect of ERI on turnover intention, and that 27.4% of this effect can be explained by mediating effects. Conclusions: To improve the turnover intention, it is necessary to consider reducing ERI and depressive symptoms of emergency nurses as powerful measures not to be ignored. Relevance to Clinical Practice: This study provides important insights regarding how nursing administrators should better reduce the workload of caregivers and improve depressive symptoms to avoid turnover intention. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the evidence‐based nursing practice (EBNP) competencies of clinical and academic nurses and their collaboration needs for supporting EBNP. Background: Academic‐practice partnerships have strong potential to overcome the key barriers to EBNP. However, there is little known about the collaboration needs of clinical and academic nurses for EBNP. Design: A cross‐sectional study. Methods: We recruited clinical and academic nurses online during November 2021 to January 2022. Using a reliable and validated scale and adapted questionnaires, data were collected relating to demographic information, EBNP‐related resources availability, EBNP competencies and EBNP collaboration needs. These data were described using descriptive statistical methods. The t test, χ2 test and Mann–Whitney U test were used to evaluate if the different responses between clinical and academic nurses were statistically significant. This study was reported following the STROBET checklist. Results: Two 240 clinical nurses and 232 academic nurses submitted questionnaires. There was no difference in overall EBNP competence between clinical and academic nurses. However, clinical nurses reported lower levels of competence and stronger intentions to collaborate with academic nurses when searching for, appraising, and synthesising evidence. Academic nurses reported lower levels of competence and stronger intentions to collaborate with clinical nurses for disseminating and implementing evidence. Conclusion: Clinical and academic nurses both reported high needs for collaborating to overcome their perceived role limitations. Clinical and academic nurses have different strengths and limitations in EBNP. These role differences and intentions to collaborate for different dimensions of EBNP competence suggest that clinical and academic nursing roles could be complementary to each other, offering opportunities for synergistic collaborations to better support overall EBNP. Relevance to clinical practice: Healthcare and academic institutions should promote academic‐practice partnerships as opportunities to gain complementary expertise on different dimensions of EBNP, and to improve nurses' competencies and confidence in EBNP overall. [ABSTRACT FROM AUTHOR]

Purpose: To understand key factors for shared decision‐making (SDM) and the quality improvement of nursing decisions in the orthopaedic clinical environment. Method: This study applied the consistent consistent fuzzy preference relations (CFPRs) and importance‐performance analysis (IPA) methods to explore the attribute weights and SDM performance, respectively. The dataset was collected from 16 orthopaedic clinical nurses' experiences in a third‐grade and first‐level general hospital in Taizhou, China. This study was performed according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. Results: The results showed that "I made clear to my patient or patient's family that a nursing care decision needs to be made", "I explained the advantages and disadvantages of the nursing care options to my patient or patient's family" and "I told my patient or patient's family that there are different nursing care options for caring his/her medical condition" were key factors for affecting SDM. The statistical significance confidence and difference error of weight results were 98.321% and 1.679%, respectively. In addition, "I asked my patient or patient's family which nursing care option he/she prefers" was the key factor for improving orthopaedic clinical nursing in the case hospital. Conclusion: The hybrid CFPRs‐IPA model can help hospital managers effectively understand the key factors of SDM quality and improve the orthopaedic clinical nursing performance from nurses' perspectives. Relevance to Clinical Practice: A quantitative decision‐making model can help nurses understand the key factors affecting the quality of SDM in nursing decision‐making and promote nursing decision‐making and patient‐centred nursing service quality. A series of corresponding SDM training courses (i.e. concepts, knowledge and skills) can be provided for hospital and nursing department managers to maximise the potentially available resources. Patient or Public Contribution: The clinical care process should be committed to involving patients in their care decisions and also provide an opportunity for patients to gain a comprehensive understanding of the care decision‐making process in order to inform future patient contributions to care decisions. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate the use of physical restraints in aged care facilities(ACFs)and analyse its associated risk factors. Background: Physical restraints have been widely used in ACFs worldwide, but they can cause physical and mental harm to older people. It is important to regulate the use of physical restraint. Design: A cross‐sectional observational and correlational multicentre study. Methods: By convenience sampling method, we selected eight ACFs in four representative regions of Hunan province, China, for this study. The ACF‐related information was obtained by interviewing the managers and reviewing records. We conducted investigation and observation on the elderly in the ACFs to understand the use of physical restraints at three different times: 9:30–11:30, 16:00–18:00 and 19:30–21:30 on a working day. The STROBE checklist was followed for this cross‐sectional study. Results: This study found that the utilisation rate of physical restraints was 23.2%. The critical risk factors affecting the use of physical restrains include the following: (1) the ratio of nursing staff to the elderly residents; (2)whether there is a dementia care unit at the facility; (3) the number of elderly residents in each room; (4) the elderly residents' age, degree of education, marital status, care dependence and cognitive impairment; (5) whether the elderly has suffered from a stroke or senile dementia; (6) whether the elderly carries medical catheters. Conclusion: There is a lack of standardisation in the use of physical restraints in ACFs of central China. Chinese ACFs should develop guidelines and reduction measures to standardise the use of physical restraints, basing on the key factors affecting the use of physical restraints. Relevance to clinical practice: The use of physical restraints in ACFs is threatening the safety of the elderly residents. Understanding the implementation of physical restraint in ACFs can provide reference for reducing the use of physical restraint. [ABSTRACT FROM AUTHOR]

Aims and objectives: The study aimed to (1) investigate the changes in maternal and paternal depression, along with social support, across the 6‐month postpartum period; (2) explore the relationships between maternal and paternal depression and social support during the 6‐month postpartum period; and (3) compare the differences in postpartum depression and social support between mothers and fathers at 2–3 days, 6 weeks, 3 months and 6 months postpartum. Background: An increasing body of evidence now shows that postpartum depression affects both mothers and fathers. The notable increase in postpartum depression in China is particularly concerning. Design: A longitudinal study was conducted, guided by the STROBE checklist. Methods: 122 pairs of parents were recruited from September 2020 to October 2021 at a teaching hospital in Guangzhou, China. Data were collected from each parent at 2–3 days, 6 weeks, 3 months and 6 months postpartum, using the Edinburgh Postnatal Depression Scale and the Social Support Rating Scale. We also acquired socio‐demographic and obstetric data at 2–3 days postpartum. Results: Maternal depression was lowest at 2–3 days postpartum compared with that measured at 6 weeks, 3 months and 6 months postpartum. Maternal and paternal social support was highest at 2–3 days postpartum compared with that measured at 6 weeks, 3 months and 6 months postpartum. Maternal depression was significantly correlated with paternal depression while maternal social support was significantly correlated with paternal social support at different time points. Conclusion: Postpartum depression in mothers and social support in both mothers and fathers, showed significant changes during the 6‐month postpartum period. Relevance to clinical practice: Healthcare providers should pay attention to the mental health of both parents, view them as a team and provide both family‐based and women‐cantered interventions. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study examines the effects of family beliefs and family strength on individual resilience and quality of life among young breast cancer survivors and determines whether family strength mediates the effect of family beliefs on individual resilience and quality of life. Background: Family beliefs and family strength are meaningful protective factors that help individuals maintain physical and mental health. However, few studies have explored their impact on individual resilience and quality of life. Design: This study was conducted using a cross‐sectional survey with a three‐stage, stratified, convenience sampling approach following the STROBE guideline. Methods: From August 2020 to May 2021, participants completed the shortened Chinese version of the Connor–Davidson Resilience Scale, the Chinese version of the Family Beliefs Scale, the Family Strength Scale and the Functional Assessment of Cancer Therapy‐Breast scale. Structural equation modelling and multiple mediation effects test were used to explore the relationships among family beliefs, family strength, individual resilience and quality of life. Results: The final model accounted for 44.5% and 78.1% of the total variance of individual resilience and quality of life, respectively. Family beliefs had an indirect effect on both individual resilience and quality of life through family strength. Family strength had a direct effect on individual resilience and had both a direct and an indirect effect on quality of life. Family strength mediated the correlations of family beliefs with individual resilience and quality of life. Conclusion: Mobilising family resources to establish healthy family beliefs and exert positive family strength will help increase young breast cancer survivors' individual resilience and improve quality of life. Relevance to clinical practice: This study confirms the importance for clinical nursing practice to mobilise family resources and develop interventions centred on family beliefs and family strength. [ABSTRACT FROM AUTHOR]

Background: Caregivers of lung cancer patients frequently experience psychological distress and high caregiver burden. Previous studies have focused on caregiver burden for patients with advanced lung cancer, while few studies focused on the caregiver burden among informal caregivers of postoperative patients with early‐stage non‐small cell lung cancer (NSCLC). Objectives: This study aimed to (a) examine caregiver burden for caregivers of patients with early‐stage NSCLC after surgical treatment and (b) identify predictive factors related to caregiver burden of patients with early‐stage NSCLC. Methods: A cross‐sectional study was conducted in a university‐affiliated hospital in Changsha, China. A total of 385 patients with early‐stage NSCLC and postsurgical treatment and their caregivers were included in this study. Caregiver burden was evaluated using the Zarit caregiver burden interview (ZBI). A set of questionnaires was used to assess psychosocial characteristics of participants, including simplified coping style questionnaire, social support rate scale, and hospital anxiety and depression scale. Hierarchical regression analysis was applied to identify factors associated with caregiver burden. We followed STROBE checklist for reporting the study. Results: The average ZBI score was 29.1 ± 11.4. Most caregivers (62.6%) demonstrated mild to moderate caregiving burden. The duration of caregiving (β = 0.18, p <.001), passive coping of caregiver (β = 0.17, p =.001) and anxiety (β = 0.13, p =.007) were significant predictors of caregiving burden. A variance of 17.6% in caregiving burden was explained by these identified factors. Conclusions: Caregivers of early‐stage NSCLC patients experience a mild to moderate level of caregiver burden. The duration of caregiving, passive coping and anxiety are factors associated with caregiver burden. Relevance to clinical practice: Clinicians should provide early care to support new roles of family members as caregivers. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the association between sedentary behaviour (SB), physical activity (PA), and frailty and frailty subdomains in community‐dwelling older women. Background: Frailty is associated with numerous adverse health outcomes in older people, and women had a higher prevalence than men. However, older adults may face different health risks due to different combinations of frailty subdomains; therefore, specific studies on frailty subdomains are needed. Design: A cross‐sectional study guided by the STROBE. Methods: In total, 1099 community‐dwelling older Chinese women (60–70 years) were included. SB and PA were objectively obtained using a validated triaxial accelerometer. Frailty was defined using the Fried Phenotype (FP) Model. Results: After adjusting for confounders, a significant association was found between SB, PA and the prevalence of frailty. The optimal cut‐off values of total SB time, light PA (LPA) time, and moderate‐to‐vigorous PA (MVPA) time to discriminate between frailty and non‐frailty were 625.4 min/day, 379.3 min/day and 20.1 min/day, respectively. For frailty subdomains, total SB time was positively associated with low PA. When it comes to total LPA time, the association with low PA was negative. Total MVPA time was significantly and negatively associated with exhaustion, weakness, slowness and low PA, and the optimal cutoff value was 24.4 min/day, 26 min/day, 29.5 min/day and 20.8 min/day, respectively. Conclusions: Effective management of frailty requires consideration of different combinations of frailty subdomains. Increasing MVPA and limiting SB may help deal with frailty for community‐dwelling older Chinese women. Additional research is needed to determine whether PA are useful for prevention of frailty. Relevance to clinical practice: The results of this study could help caregivers provide professional and specific physical activity guidance for order women, who are on a risk of or already suffered frailty. [ABSTRACT FROM AUTHOR]

Aim and objectives: This study investigated the incidence of thirst and contributing factors in intensive care unit (ICU) patients by analysing differences in physiologic, psychological, and disease‐ and environment‐related parameters in ICU patients with vs without thirst. Background: Little is known about the factors that influence thirst, and there are no standardised methods for identifying at‐risk patients in the ICU. Previous studies generalised the risk of thirst in ICU patients because of a lack of data on relevant variables. Here, we examined the factors contributing to thirst based on symptom management theory. Design: Prospective descriptive design. Methods: Physiologic, psychological, disease‐related and environment‐related data were collected for 301 patients from 4 ICUs (medical, surgical, cardiac and emergency ICUs) of a hospital from 15 December 2017–10 July 2019 through a screening interview, questionnaires and from electronic medical records. The data were analysed with descriptive statistics, the t‐test and chi‐squared test, and by logistic regression. Binary stepwise logistic regression was used to identify thirst‐associated factors. The findings are reported according to the STROBE checklist for cross‐sectional studies. Results: In total, 210/301 (69.8%) ICU patients experienced thirst. Risk factors were nil per os order (odds ratio [OR] = 4.10, 95% confidence interval [CI]: 1.44–11.69), surgery (OR = 2.96, 95% CI: 1.11–7.93), high glucose (OR = 3.36, 95% CI: 1.01–11.17) and greater disease severity (OR = 1.13, 95% CI: 1.02–1.24). Conclusion: Thirst is common in ICU patients. Timely detection of patients' thirst and identification of those at high risk by ICU nurses can ensure the implementation of effective and safe interventions. Relevance to clinical practice: The results of this study highlight the need to evaluate thirst symptoms in patients with severe disease and develop relief strategies for fasting, perioperative, and hyperglycaemic patients and others who are at high risk of thirst. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study is to estimate differences in health‐promoting behaviour levels throughout the pregnancy trimesters, to identify distinct patterns of health‐promoting behaviour trajectories during pregnancy and to evaluate predictors of these trajectory group memberships. Background: Promoting healthy lifestyle behaviours during pregnancy could decrease devastating outcomes for the mother and foetus. However, there is currently limited insight into the dynamics of health‐promoting behaviours during pregnancy. Design: An observational longitudinal study. Methods: 158 pregnant women were recruited from June 2020 to June 2021 in Qingdao, China. The Health‐Promoting Lifestyle Profile was used to assess health‐promoting behaviours. Latent growth model was performed to compare health‐promoting behaviours at different time points. Group‐based trajectory model was applied to identify health‐promoting behaviour trajectories. Multinomial logistic regression was adopted to determine the predictors of trajectory group memberships. We used the STROBE checklist to report this study. Results: The entire sample of pregnant women experienced a significant increase in health‐promoting behaviours during pregnancy. Three trajectories were identified including a 'low‐increase behaviour trajectory (20.1% of sample)', a 'moderate‐increase behaviour trajectory (58.0% of sample)' and a 'stable then increased behaviour trajectory (21.9% of sample)'. Low maternal sense of coherence, lack of pre‐pregnancy exercise habit, artificial insemination and low monthly family income were significantly associated with the low‐increase behaviour trajectory. High self‐efficacy and pre‐pregnancy exercise habit were significantly associated with the stable then increased behaviour trajectory. Conclusions: Pregnant women exhibit different health‐promoting behaviours throughout the pregnancy trimesters. Meanwhile, three trajectories were identified among pregnant women. Thus, more attentions should be paid on early identification and targeted intervention in a future study. Relevance of clinical practice: Healthcare providers should pay closer and earlier attention to identify women in the low‐increase trajectory subgroup at the outset of pregnancy. Similarly, increased efforts should be made to improve maternal self‐efficacy and develop good pre‐pregnancy exercise habit in future study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To establish a set of scientific and practical nursing care quality evaluation indicators for PACU in China. Background: No unified nursing care quality evaluation indicators for post‐anaesthesia care unit (PACU) were found in China. Design: An international literature review, domestic cross‐sectional survey and two‐round e‐Delphi study. Methods: The international literature review and domestic cross‐sectional survey were conducted to identify the potential nursing care quality evaluation indicators for PACU. A total of 38 and 32 indicators were extracted from 24 articles and the cross‐sectional survey respectively. Two rounds of e‐Delphi study were conducted to collect opinions from a panel of 20 independent experts and establish the final version of the nursing care quality evaluation indicators for PACU. A GRRAS checklist was used to guide the reporting of this study. Results: Of 20 experts, 19 completed the first round of e‐Delphi study and 18 completed the second round, with a response rate of 95% and 90% respectively. The experts' authority coefficient in the two rounds of e‐Delphi study was 0.91 and 0.90 respectively. The Kendall W value of the two rounds ranged between 0.108 and 0.385 (p <.01). Four structure indicators, 12 process indicators and seven outcome indicators were included in the nursing care quality evaluation indicators for PACU. Conclusions: With the methods of literature review, cross‐sectional survey and e‐Delphi study, we established a set of scientific and practical nursing care quality evaluation indicators for PACU, to improve the nursing care quality, reduce incidence of complications and ensure patient safety. Relevant to clinical practice: The findings from this study enable nurses and managers in PACU settings to evaluate clinical nursing care quality using a robust framework. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine the prevalence and the associated factors of self‐perceived medical errors among Chinese emergency department nurses. Background: The emergency department is a place with a high incidence of medical errors. Studies about the occurrence and related influencing factors of medical errors among emergency nurses in China are very insufficient. Design: A nationwide cross‐sectional study. Methods: A nationwide cross‐sectional study was conducted from July 2018–August 2018. A total of 17,582 emergency department nurses from 31 provinces across China were eventually included in the analysis. Logistic regression is applied to examine the association of the independent variables with the perceived medical errors. The reporting of this study was compliant with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross‐sectional studies. Results: Of 17,582 participating nurses, 4445 (25.28%) reported self‐perceived medical errors in the past 3 months. Nurses who were serving as nurses‐in‐charge; who reported fair or bad physical health; who reported staff shortage; who were exposed to more verbal abuse at work; who experienced effort–reward imbalance; who reported more over‐commitment; or who had depressive symptoms were more likely to report medical errors. Older age and female gender were protective factors. Conclusions: In this study, a quarter of the emergency nurses reported that they had made medical errors in the past 3 months. Self‐perceived medical errors are associated with multiple domains of work‐related factors and personal distress. Feasible measures should be taken to reduce nurses' workload, improve their working environment, monitor and minimise the occurrence of medical errors among emergency department nurses. Relevance to clinical practice: Emergency nurses, who are the most frequently in contact with patients, play an important role in identifying risk factors and preventing medical errors. Identifying risk factors that may lead to medical errors in the medical environment from both internal and external aspects will help nursing practitioners, hospital administrators and policy makers to take timely preventive measures to reduce the occurrence of medical errors and reduce harm to patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To assess the prevalence and associated factors of depression and anxiety among caregivers of patients with atrial fibrillation. Background: Depression and anxiety are common in caregivers of patients with cardiovascular diseases, including heart failure and coronary artery disease. However, studies about depression and anxiety among caregivers of patients with atrial fibrillation are limited. Design: Cross‐sectional study. Methods: We enrolled 465 dyads of patients with atrial fibrillation and their primary family caregivers from Beijing Anzhen Hospital between September 2020 and March 2021. The patient–caregiver dyads were excluded if primary family caregivers had previous mental disorders before the patient diagnosis of atrial fibrillation. Depression and anxiety of patients and caregivers were measured by Patient Health Questionnaire‐9 and Generalized Anxiety Disorder‐7 scale. Multivariate logistic regression analysis was used to assess factors associated with depression and anxiety of caregivers. STROBE guidelines were followed to report this study. Results: The prevalence of caregiver depression (Patient Health Questionnaire‐9 score ≥5) and anxiety (Generalized Anxiety Disorder‐7 score ≥5) was 14.0% and 13.5% respectively. Caregiver number of comorbidities ≥2 and patient depression were significantly associated with caregiver depression. Caregiver age ≥65 years, caregiver female sex and patient anxiety were predictors of caregiver anxiety. Conclusions: Depression and anxiety are common in caregivers of patients with AF. Better management of caregiver mental problems and associated factors may benefit both patients and caregivers. Relevance to clinical practice: Clinicians and nurses should pay more attention to depression and anxiety in caregivers of patients with atrial fibrillation, and provide support to caregivers in most need. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the relationship between illness uncertainty, self‐perceived burden and quality of life and explore the mediating role of self‐perceived burden between illness uncertainty and quality of life in patients with chronic myeloid leukaemia. Background: Patients with chronic myeloid leukaemia need long‐term, potentially lifelong therapy to control the disease, which affects their quality of life. There is a need for exploring potentially changeable factors to develop interventions. Little is known about the effects of illness uncertainty and self‐perceived burden on quality of life in this population. Design: A cross‐sectional study. Methods: A convenience sample of 248 patients with chronic myeloid leukaemia was recruited from four university hospitals from February to August 2020. Participants were assessed with the Mishel Uncertainty in Illness Scale, Self‐Perceived Burden Scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The STROBE checklist was used to report the results. Results: Illness uncertainty and self‐perceived burden were negatively associated with quality of life in patients with chronic myeloid leukaemia. Self‐perceived burden partially mediated the relationship between illness uncertainty and quality of life. The indirect effect was −0.101, accounting for 22.9% of the total effect. Conclusion: The findings revealed the relationship between illness uncertainty, self‐perceived burden and quality of life in patients with chronic myeloid leukaemia. Self‐perceived burden exerted a mediating role between illness uncertainty and quality of life in this population. Relevance to clinical practice: This study alerts healthcare providers to pay attention to patients' illness uncertainty and self‐perceived burden, which can contribute to develop effective interventions to improve the quality of life among patients with chronic myeloid leukaemia in the clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore hospital healthcare professionals' knowledge and attitudes towards dementia care in China. Background: Hospital healthcare professionals deliver most diagnosis and treatment for people with dementia in China. Literature shows that healthcare professionals' knowledge and attitudes are of great importance in providing optimum dementia care. However, there is limited research of healthcare professionals' dementia knowledge and attitudes within hospital contexts in China. Design: A cross‐sectional survey was conducted between April and December 2019. Methods: A self‐report questionnaire composed of demographics and knowledge and attitude scales related to dementia was used for doctors and registered nurses working in settings where people with dementia are cared for in eleven public tertiary hospitals in Hebei Province, China. The STROBE checklist was adhered to in this study. Results: In total, 603 healthcare professionals completed the study. The majority of respondents were registered nurses (71.3%). The overall mean knowledge score was 20.7 (SD = 2.9) out of a maximum possible score of 30. The overall mean score for attitudes was 91.3 (SD = 15.9) out of a maximum possible score of 140. Standard multiple linear regression analysis revealed that the highest level of education, the experience of searching for dementia‐related information and willingness to receive dementia training or education were significant predictors of knowledge scores. The department, the experience of working with people with dementia, length of dementia care, interest in dementia care and training type were significant predictors of attitude scores. Conclusions: Deficits in the knowledge of dementia and a low level of positive attitude were identified among the healthcare professionals who work in hospital settings where people with dementia are cared for in China. Relevance to clinical practice: Education and training in dementia care should be integrated into undergraduate nursing and medical programmes and provided for healthcare professionals after commencing employment. [ABSTRACT FROM AUTHOR]

Aims: To translate 25‐item Dementia Knowledge Assessment Scale into Chinese and evaluate its psychometric properties amongst Chinese healthcare providers. Background: The prevalence of dementia is increasing in China, but development of relevant training for healthcare providers is still in its infancy stage. A comprehensive, valid and reliable Chinese knowledge‐of‐dementia measure is needed to identify training needs and evaluate the effect of educational interventions. Design: A cross‐sectional survey. Methods: The Dementia Knowledge Assessment Scale was translated into Chinese following the modified Brislin's translation model. Content and face validity were established by an expert panel in dementia care and healthcare providers. A convenience sample of 290 healthcare providers in care homes and hospitals was recruited. Construct validity was evaluated through confirmatory factor analysis, concurrent validity and known groups' comparisons method. Reliability was evaluated through internal consistency reliability and 2‐week test–retest reliability. This study used the STROBE checklist for reporting. Results: The content validity index was 0.98. The confirmatory factor analysis model revealed that the four‐factor model was partly supported in the present study. The moderate correlation between Chinese version of Dementia Knowledge Assessment Scale and Alzheimer's Disease Knowledge Scale indicated acceptable concurrent validity. The mean score of the scale and subscale scores showed significant differences between health professionals and care assistants, except for the subscale of "Care Considerations." The reliability was demonstrated with Cronbach's alpha of.77 and intra‐class correlation coefficients of each subscale between.74 and.92 among 56 respondents. Conclusions: The Chinese version of Dementia Knowledge Assessment Scale demonstrated acceptable concurrent validity but marginal factorial validity and satisfactory reliability amongst Chinese healthcare providers. Therefore, applying the four‐factor structure of Chinese version scale should be considered. Relevance to clinical practice: Chinese version of Dementia Knowledge Assessment Scale can be used to understand the training needs of healthcare providers in dementia. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the current situation and analyse influencing factors of resource utilisation in maintenance haemodialysis patients. Background: The self‐management level of patients undergoing maintenance haemodialysis in China is low. The applicability of the Chronic Illness Resources Survey in Chinese maintenance haemodialysis patients has been validated, and this survey can be used to assess the utilisation of self‐management support resources among haemodialysis patients. Determining the influencing factors of resource utilisation can help improve the self‐management behaviour of haemodialysis patients and control the progression of the disease. Design: A descriptive study design was chosen. Methods: A convenience sample of 314 patients undergoing haemodialysis was recruited from dialysis centres in three hospitals in western Xinjiang from June 2018–April 2019. SPSS19.0 software was used to describe the current situation of resource utilisation. Moreover, t test, analysis of variance and multivariate linear regression were applied to explore the influencing factors of patients' resource utilisation. Standards for observational studies STROBE Statement checklist‐v4 were chosen on reporting the study process. Results: The average score of the total resource utilisation was 2.95 ± 0.51. The average item score of seven dimensions from high to low was 3.46 for medical staff, 3.32 for personal, 3.22 for family and friends, 3.16 for work‐related, 3.12 for media policy, 2.55 for neighbourhood/community and 2.23 for organisation. Multiple linear regression showed that there have six main factors, which explained 65.4% of the variance of haemodialysis patients' resource utilisation. Conclusions: The personal, family and friends, work and media and policy subscales were rated the highest, with support from neighbourhood/community and organisation rated the lowest. In general, participants perceived moderate levels of support. Government and healthcare team should pay more attention on haemodialysis patients who had low level of education, poor economic conditions and poor mental condition. Relevance to clinical practice: ESRD has caused a burden on healthcare expenditure and has become a critical public health problem worldwide. Self‐management is particularly important for dialysis patients which have attracted extensive interest. In the future research, we can use this questionnaire to evaluate the related resources of disease management of dialysis patients, encourage patients to make full use of the resources around them and focus on those patients with low education and monthly income level and bad mental state. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the effects of a blended emergent research training programme for clinical nurses on research competence and critical thinking. Background: With the development of the nursing discipline and evidence‐based nursing practice, nursing research competence is increasingly important for clinical nurses. Current nursing research training programmes cannot meet the needs of clinical nurses. Design: A quasi‐experimental study. Methods: A total of 104 clinical nurses from two tertiary hospitals participated in this study. The intervention group received a blended emergent research training programme for clinical nurses, and the control group received no intervention. Nursing research competence and critical thinking were measured at baseline, after the intervention and three months after the intervention. The satisfaction with the training of clinical nurses in the intervention group was also measured after the intervention. Generalised linear mixed models were used to evaluate the effects of the intervention on outcome variables. Qualitative data were analysed by two researchers using the content analysis method. Our reporting complies with the TREND checklist. Results: The blended emergent research training programme for clinical nurses finally showed positive effects on nursing research competence and critical thinking. The effects lasted until three months after the training programme. 'Learner‐centred Training', 'Skilled Trainers', 'Encouraging Training Environment' and 'Positive Outcomes' are the main categories generated from the qualitative data. Conclusion: The blended emergent research training programme for clinical nurses could be used for clinical nurses' research education to improve their nursing research competence and critical thinking. Relevance to clinical practice: The blended emergent teaching method could be considered as an effective method to provide an encouraging learning environment and promote learner‐centred teaching for clinical nurses. The blended emergent research training programme could be used to improve nursing research competence and critical thinking of clinical nurses which are important for evidence‐based nursing practice. [ABSTRACT FROM AUTHOR]