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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]

Aim: To design a protocol based on the experiences of long‐term survivors to facilitate resilience for oesophageal cancer patients in rural China. Background: According to the latest Global Cancer Statistics Report, 604,000 new cases of oesophageal cancer were reported, of which over 60% of the disease burden is distributed in China. The incidence of oesophageal cancer in rural China (15.95/100,000) is twice as high as those in urban areas (7.59/100,000). To be sure, resilience can help patients better adapt to post‐cancer life. But universal interventions involving improving the resilience of oesophageal cancer patients have much less been explored, especially for rural patients. Methods: The two‐arm, parallel design, non‐blinded, randomised controlled trial will be implemented in 86 adults diagnosed with oesophageal cancer and will be randomly assigned to the control group or the intervention group via the blocked randomisation. The intervention group will undergo an intervention with one‐on‐one guidance from a nurse while viewing a CD of the experiences of long‐term survivors with oesophageal cancer in rural areas. Every 2 weeks, a theme session will be introduced, and the entire intervention will continue for 12 weeks. Psychosocial variables (resilience, self‐efficacy, coping mode and family support) will be surveyed at baseline, post‐intervention and 3 months after the intervention. The paper complies with the Standard Protocol Items: Recommendations for Intervention Trials 2013 and Consolidated Standards of Reporting Trials guidelines for study protocols adapted for designing and reporting parallel group randomised trials. Conclusion: The intervention programme transitions from hospitalisation to discharge, which includes one‐on‐one interventions by medical personnel and a portable CD describing the experiences of long‐term survivors with rural oesophageal cancer. Once the intervention's effectiveness is proven, this protocol will provide psychological support for massive oesophageal cancer patients. Relevance to clinical practice: The intervention programme may be used as an auxiliary therapy to promote patients' postoperative psychological rehabilitation. This programme has the advantages of being cost‐effective, flexible, accessible, and convenient and can be implemented without the limitation of time, place and clinical medical staff. Trial registration: The Chinese Clinical Trial Registration number is ChiCTR2100050047. Registered on 16 August 2021. [ABSTRACT FROM AUTHOR]

Aims and objectives: To detect the mediating effect of resilience on the relationship between perceived social support and burnout in Chinese palliative nurses. Background: Palliative nurses are a group that is vulnerable to burnout. Perceived social support may contribute to decreasing palliative nurses' burnout and facilitating their personal resilience, and resilience may be associated with lower levels of burnout. However, these relationships were unclear in the Chinese context. Design: A cross‐sectional design. Methods: The STROBE guideline was performed to report this study. A mixed sampling method including convenience sampling and stratified sampling was used to recruit participants, and a total of 319 palliative nurses completed the Nursing Burnout Scale, the Perceived Social Support Scale and the Connor–Davidson Resilience Scale from May 2021 to September 2021. Influencing factors were primarily identified using independent‐sample t tests and one‐way ANOVA. Bootstrap method was used to detect the mediating effect of resilience. Results: The level of burnout in palliative nurses (23.4 ± 7.68) was higher than that of general nurses in China. Education level, health condition and monthly income were influencing factors of burnout. Resilience was detected as a mediator in the relationships between perceived social support and dimensions of burnout. Conclusions: Chinese palliative nurses experience a relatively high level of burnout, which may be influenced by several sociodemographic variables. Resilience could mediate the effect of perceived social support on the dimensions of burnout. Problem‐oriented and palliative‐tailored strategies should be developed to further address burnout in Chinese palliative nurses. Relevance to clinical practice: Nurse managers and policy makers should support nurse ongoing education, adopt health‐promoting interventions and optimise salary systems. In addition, perceived social support resources and resilience training programmes are also warranted. Patient or public contribution: All participants were invited to complete the informed consent form and paper questionnaires. Human resource managers helped us collect some subjective data through the personnel management system. Nurse managers of palliative units conducted regular staff meetings to promote the data collection process. [ABSTRACT FROM AUTHOR]

Background: Obstetric critical illness is an important factor that leads to an increase in maternal mortality. Early warning assessment can effectively reduce maternal and neonatal mortality and morbidity. However, there are multiple early warning systems, and the effect and applicability of each system in China still need to be explored. Objectives: To elaborate on the application, effectiveness and challenges of the existing early warning systems for high‐risk obstetric women in China and to provide a reference for clinical practice. Design: A scoping review guided by the Arksey and O'Malley framework and reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis for scoping review (PRISMA‐ScR) guidelines. Eligibility criteria: We included original studies related to early warning and excluded those that were guidelines, consensus and reviews. The included studies were published in Chinese or English by Chinese scholars as of June 2021. Data sources: CNKI, Wanfang, VIP, Cochrane, CINAHL, Embase, PubMed and Web of Science databases were searched systematically, and the reference sections of the included papers were snowballed. Results: In total, 598 articles were identified. These articles were further refined using keyword searches and exclusion criteria, and 17 articles met the inclusion criteria. We extracted data related to each study's population, methods and results. Early warning tools, outcome indices, effects and challenges are discussed. Conclusions: Although all studies have shown that early warning systems have good application effects, the use of early warning systems in China is still limited, with poor regional management and poor sensitivity for specific obstetric women. Future research needs to develop more targeted early warning tools for high‐risk obstetric women and address the current challenges in clinical applications. [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 establish an understanding of healthcare professionals' dementia knowledge and attitudes towards dementia care, and family carers' perceptions of dementia care in China. Background: Healthcare professionals and family carers of people with dementia deliver most of the dementia care in China. However, little research on healthcare professionals' dementia knowledge and attitudes towards dementia care, and family carers' dementia care perceptions has been conducted in China. Methods: An integrative review was conducted and reported based on the PRISMA guidelines and Whittemore and Knafl's framework. Eight English databases were searched without date restriction: CINAHL Plus with Full Text, MEDLINE, PubMed, Web of Science, Cochrane Library, Embase, PsycINFO and Scopus; and three Chinese databases: China National Knowledge Infrastructure, Chongqing Weipu and Wanfang, plus a manual search of reference lists. Results: Thirty‐eight primary research papers were included in the review. Three themes were identified from the synthesis: (a) knowledge and competency; (b) attitudes towards dementia care; and (c) carers' burden and unmet needs. Healthcare professionals' dementia knowledge ranged from low to moderate levels and attitudes towards dementia care were generally negative. With low levels of knowledge of dementia and negative attitudes including stigma, family carers were under stress with insufficient support, and they expected more support from community nurses. Conclusions: There is an apparent need for a national policy on healthcare professional education and training to improve dementia care practice in China. Such a policy may improve support services for family carers. Relevance to clinical practice: Nurses, and particularly community nurses, are well‐positioned to support family carers in China. However, healthcare professionals in China are not prepared for this. Therefore, education and training on dementia care should be integrated into medical and nursing undergraduate programmes and provided for healthcare professionals after commencing employment, and strategies to reduce stigma are needed. [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. 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]

Aims and objectives This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. Background Ambiguities remain about how patients participate in routine measures designed to promote patient safety. Design Systematic review using integrative methods. Methods Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: 'patient', 'healthcare provider', 'task', 'work environment', 'organisation & management'. Results We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives. Conclusions Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures. Relevance to clinical practice Patients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety. [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]