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Aims and Objectives: The aim of this study was to explore the mental health of transplant recipients, especially psychological integration and the donor‐recipient relationship. Background: Psychological integration and the donor‐recipient relationship are unique psychological perception of recipients with transplantation, which have important effects on their mental health and recovery. However, few studies have focused on the feelings and attitudes of cadaveric liver transplant recipients. Design: A qualitative descriptive design was used. Methods: Individual semi‐structured interviews were conducted face‐to‐face with 30 recipients after liver transplantation. Qualitative content analysis was used and data saturation was achieved. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) were used. Results: Three themes and eight subthemes were identified. (1) Psychological integration—acknowledging the transplanted liver was a part of their own body and attaching great importance to the liver; (2) Attitudes towards the donor—gratitude to the donor, being inspired by the dedication of the donor and mourning the donor's misfortune; and (3) Living in the moment—health behaviours of self‐care, emotional regulation and positive attitude about life. Conclusion: The psychological integration of recipients of cadaveric liver transplants is smooth, and the attitudes towards the donor are positive. From the perspective of positive psychology, we observed the important role of post‐traumatic growth of the recipient and positive emotions in promoting the recipient's health behaviours for self‐care, emotion regulation and attitudes towards life. Relevance for Clinical Practice Medical staff should help recipients to deal with these issues about the organ and its donor constructively and guide them to focus on postoperative inner growth and positive emotion. [ABSTRACT FROM AUTHOR]

Aim and objectives: This qualitative study explores why breast cancer patients do not share disease‐related information with their dependent children. Background: 'Open' communication between breast cancer patients and their children is beneficial to both. However, some still try to avoid discussing their diagnosis and related information with their children. Some worries lie in communicating with dependent children, but the underlying cause remains unclear. Design: Qualitative descriptive study. Methods: Semi‐structured interview was used in this study. Twenty breast cancer patients with children (aged 8–18 years) were recruited at two urban tertiary hospitals in mainland China. Qualitative content analysis was conducted to analyse and identify themes and subthemes. This study followed the COREQ checklist for qualitative studies. Results: Three main themes were identified: (1) Uncertainty about the future: Their struggles with cancer remain a sensitive subject with their children. They described the uncertainty surrounding their disease prognosis and their children's response. They were also unsure whether, when and how to inform their children of their conditions; (2) Useless and risky for their children to know the truth: They considered it useless because their children can neither understand nor change the existing facts. They were concerned that it could affect their children's emotional state, character and academic performance; and (3) All for their children's sake: They were willing to take care of their affairs without troubling their dependent children as much as possible. Conclusion: Most mothers delayed communicating disease‐related information to their dependent children. However, they often underestimated children's abilities and ignored their thoughts and wishes. Motherhood leads to avoidance and concealment in discussing health issues with their children. Relevance to clinical practice: Mothers should try to understand their children's views towards cancer earlier. Healthcare professionals, especially nurses, should provide further consultation and intervention services to assist mothers and their children. [ABSTRACT FROM AUTHOR]

Aims and objective: To explore the experiences of frontline nurses through analyzing nurse online diaries during the pandemic. Background: Over 42,600 healthcare professionals took care of patients with COVID‐19 in Wuhan in the initial months between 23 January 2020 and 8 April 2020. Many used to write online diaries on Sina Microblog and still wrote about their experiences in the front line on this site. However, there has been little research on frontline nurses' experiences in the initial months of the pandemic through analyzing their narratives. Design: A qualitative descriptive design. Methods: A qualitative content analysis was used to analyze online diaries written by frontline nurses in Wuhan. A total of 205 entries in online diaries were collected from 12 frontline nurses, as accessible to those who subscribed to Sina Microblog social media site, between 23 January 2020 and 8 April 2020. NVivo12 was used to help analyze the data, and COREQ reporting guidelines were also used in this study. Results: Two themes were identified: constructing a better self and constructing a strong support network. A better self was constructed in describing positive emotions, commitment to care, pride and achievements, and whole‐person growth. A strong support network was constructed through social support via different sources and gaining self‐support via narrating their personal experiences in diaries. Conclusions: Frontline nurses demonstrated personal growth, psychological well‐being, and professionalism in the process of constructing a better self and a strong support network. Relevance to clinical practice: The findings indicate that frontline nurses can use narratives as debriefing opportunities and a way of gaining self‐support. We suggest that online communities of professional support be used as an essential platform for sharing narratives and gaining a more comprehensive understanding of frontline nurses in the COVID‐19 pandemic and other global public health events. [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]

Aims and objectives: We explored dispatched nurses' experiences of wearing full gear personal protective equipment to care for patients with coronavirus disease‐2019 (COVID‐19) in Wuhan, China. Background: Full gear personal protective equipment is the primary and foremost measure to prevent the contact and transmission of severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV2); however, working in full gear personal protective equipment may hinder nursing care activities and thus negatively affect patients' and nurses' health. Design: This descriptive qualitative inquiry followed the COREQ guidelines. Methods: Individual semi‐structured telephone interviews were conducted in a purposive sample of 15 frontline nurses who were dispatched to the outbreak epicentre from March to April 2020. Verbatim transcripts were content analysed. Results: Four themes emerged from the data: inadequate preparedness for working with full gear personal protective equipment, full gear personal protective equipment stimulated stress responses, coping strategies and professional growth. Participants learned a great deal from problem‐focussed and emotion‐focussed strategies to tackle challenges related to the prolonged wearing of full gear personal protective equipment for quality nursing care and reduced risk of exposure. They became more vigilant to the adherence to evolving protocols and appropriate training concerning full gear personal protective equipment use. Conclusions: Frontline nurses confronted various but diminishing challenges related to the use of full gear personal protective equipment when caring for patients with COVID‐19 across the approximate 40‐day period. Consistent use of coverall personal protective equipment to protect from SARS‐CoV‐2 in high exposure settings would be feasible if nurses were better prepared; therefore, scenario‐based skill training concerning the prolonged use of full gear personal protective equipment should be offered regularly and intensively. Relevance to clinical practice: This study informs future decisions concerning improved full gear personal protective equipment‐related psychomotor training and promoting ways for nurses to cope with the stress that comes from working in highly contiguous environments. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the understanding of caring in the practice of community nursing from the perspectives of patients and nurses. Background: An increasing population of patients with chronic disease has produced a need for humanistic caring in communities. As a result, caring has become a core value of community nursing professionals. However, community nurses meet many difficulties in trying to practice person‐centred care with their clients. Furthermore, most community nurses—especially in China—lack systematic education and training about caring because the practical meaning of caring in community practice is unknown. Design: The qualitative study described herein employed inductive content analysis. Methods: Eleven community patients with chronic disease and fifteen community nurses who were nominated as a caring nurse from different community clinics in Beijing, China, participated in thirty‐one interviews during January to August in 2018. Nine documents from the interviewed nurses were collected. Both interview data and documents were analysed using strategies of inductive content analysis. The COREQ checklist was used. Results: Patients and their corresponding nurses described a wide range of caring experiences that were generalised into 28 concepts. Caring emerged as an inter‐dynamic system that comprised the foundation and quality of a caring relationship, the caring philosophy and behaviours of interactions, and positive feedback from caring interactions. A relationship‐based framework of caring in community nursing practice was constructed. Conclusions: Identifying this systematic concept of caring provides insights that are applicable to the creation of targeted management, education and practice interventions to ultimately enhance the quality of community health care—in China or elsewhere. Relevance to clinical practice: The systematic understanding of caring in community nursing practice will inform nurses in community health clinics, their educators and their managers on how to provide care to community patients and how to develop caring competence for community nurses. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences of how Chinese adults cope with multiple chronic conditions in everyday life. Background: Having multiple chronic conditions is stressful, requiring people to make physical and mental adaptations. There is little evidence exploring how people cope with multiple chronic conditions, especially in an Asian context. Design: A qualitative descriptive design was employed. The Consolidated criteria for reporting qualitative research (COREQ) was used to report this study. Methods: This study was conducted in a tertiary referral and teaching hospital in Bengbu, Anhui, China, between August and October 2018. A purposive sample of 14 people with multiple chronic conditions, aged between 32 and 75 years, completed a demographic questionnaire and semi‐structured face‐to‐face interviews. The interviews were digitally recorded and transcribed verbatim. Qualitative content analysis guided data analysis. Results: Four distinctive themes comprising subthemes were developed from participants' narratives pertaining to coping with multiple chronic conditions: (a) appraising multiple chronic conditions, (b) addressing multiple chronic conditions management, (c) maintaining psychological well‐being and (d) fulfilling a social role. Illustrative quotations were cited to support each theme. Conclusions: This study underscores that people cope with multiple chronic conditions in everyday life by using a compendium of coping strategies. As one of the influencing factors, culture dominates the ways of coping at different levels among people with multiple chronic conditions. These findings expand the current literature on coping based on an Asian perspective and inform further cross‐culture research on this topic. Relevance to clinical practice: Healthcare professionals should understand peoples' experiences of coping with multiple chronic conditions to provide more holistic and dynamic health care to address their actual needs. Healthcare professionals should be acquainted with how culture impacts individuals' coping and develops culture‐tailored supportive programmes such as family‐based interventions, to promote the health of people with multiple chronic conditions. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe experiences and nursing needs of school-age Chinese children undergoing lumbar puncture for the treatment of acute lymphoblastic leukaemia. Background Lumbar puncture is an invasive procedure, causing psychological changes and physical discomfort in patients. In a previous study, it was proved that distraction intervention, such as music therapy, relieves pain and anxiety. There is limited evidence regarding the experience and needs of school-age children during lumbar puncture after being diagnosed with acute lymphoblastic leukaemia. To minimise their anxiety and pain during the procedure, it is important to collect information directly from these children. Design A descriptive qualitative research. Methods Twenty-one school-age children with acute lymphoblastic leukaemia participated in semi-structured interviews at a Children's Hospital in China. Data were collected by an experienced and trained interviewer. Qualitative content analysis was chosen to describe experiences of children undergoing lumbar puncture. Results While undergoing lumbar puncture for the treatment of acute lymphoblastic leukaemia, school-age Chinese children experienced complex psychological feelings (fear, tension, helplessness, sadness and anxiety). They also experienced physical discomfort. They had multipolar needs, such as information, communication, respect, self-actualisation, environment and equipment. Conclusions This study identified important areas that must be closely monitored by healthcare staff, performing lumbar puncture on acute lymphoblastic leukaemia children. Thus, a successful and smooth procedure can be performed on these patients, and their quality of life can be improved. Relevance to clinical practice The experiences described in this study contribute to a better understanding of the needs of acute lymphoblastic leukaemia children undergoing lumbar puncture. They also provide valuable information to professional medical care staff that develops future nursing assessments. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the differing perspectives of patients and providers and their assessment of supportive care needs in breast cancer patients receiving oral chemotherapy. Background The patient-provider concordance in patients' needs assessment is critical to the effective management of cancer. Self-administered oral chemotherapy greatly shifts responsibilities for side-effect monitoring, symptom management and dose adjustments from the provider to the patient. Home-based care plans will be central to the effective management of these patients. Design A descriptive qualitative design was used. Methods A purposive sample of nine breast cancer patients, four oncologists and four oncology nurses were recruited in Shanghai, China. Semi-structured and in-depth interviews were conducted to collect data. A qualitative content analysis aimed at finding manifest and latent meanings of data was applied to analyse the information. Results Four themes of needs emerged from the interviews with patients and providers: information/knowledge, communication, social support and symptom management, but patients and providers only agreed on the assessment of symptom and side-effects management needs. Patients want more positive encouraging information from providers, but providers think patients need more information of efficacy and safety. Patients appreciate support from other peer patients with similar experiences, but providers think the support from families and friends are readily available to them. Patients discussed their spiritual needs, while oncologists see the need to improve patient adherence to medication. Conclusion Breast cancer patients differed from their providers in assessment of healthcare needs. Further investigation of the relationships between patient-provider discordance and patient outcomes may guide interventions to improve care for cancer patients receiving oral chemotherapy. Relevance to clinical practice Oncology nurses should develop a holistic home-based care plan by exploring and integrating the discordance of needs assessment of both patients and health providers. [ABSTRACT FROM AUTHOR]

Aims and objectives This study aimed to explore the experiences and factors associated with insomnia in Chinese breast cancer survivors. Background Insomnia is a common and significant symptom in breast cancer survivors. Quantitative studies are unable to describe the experience of insomnia and the sleep-associated factors from a personal point of view. A profound understanding of the experience of insomnia in breast cancer survivors can provide information for health workers and caregivers to allow them to provide more effective support. Design A descriptive qualitative research was adopted. Methods In-depth interviews were conducted with 22 insomniac breast cancer survivors. A qualitative content analysis was used to analyse the data. Results Three themes emerged concerning the experiences of insomnia, including sleep neglect, insomnia perception and insomnia anxiety. Participants reported their own opinions on three insomnia-associated factors, including factors associated with hospitalisation, factors associated with breast cancer and the therapies and too much attention placed on sleep. Conclusions Survivors would neglect their sleep problems in the early stage after diagnosis. When they became aware of their sleep problems, they were inclined to worry too much and sought help from traditional Chinese medicine. Anticipatory sleep anxiety, excessive negative cognitive activities and insomnia became a vicious circle for insomniac breast cancer survivors. Relevance to clinical practice The findings provide detailed information to help nurses understand the experiences of breast cancer survivors with insomnia. Nurses could provide proper care to help prevent insomnia or improve sleep. [ABSTRACT FROM AUTHOR]

Aims and objectives This study explores how sleep and energy levels were affected in Chinese women diagnosed with HIV in China employing the Actiwatch actigraphy system to collect data on the women's sleep characteristics. Background The worldwide AIDS pandemic, a major impetus behind the recent focus on global aspects of health, is one area in which the behavioural and biomedical expertise of nursing science is sorely needed. In particular, few studies of HIV+ women have examined the association of HIV-related stress with sleep disturbance and fatigue. Especially, fatigue and sleep disturbances are a common complaint among people with HIV. Design A qualitative study with actigraphy device used. Methods In-depth interviews were conducted with 19 HIV+ women in Shanghai, China, from December 2009- March 2010 and within this group, nine of the women agreed to wear an Actiwatch actigraphy device for 72 hours. Results Two major themes emerged from the in-depth interviews are as follows: sleep disturbance and fatigue. Participants presented varying amounts of sleeplessness, and fatigue resulting from nightmares, worrying about whether to disclose their diagnosis, and whether they might transmit the disease to their partners or children. Among the nine Actiwatch study participants, data shown that those who experienced fragmented sleep also slept more during the daytime. Conclusions In this study, Chinese HIV+ women described how stress had caused them to become sleepless. The objective data collected via Actiwatch showed that these women required longer nap times, which indicates they did not have refreshing nocturnal sleep. Designing a culturally acceptable stress management intervention for these women is urgently needed. Relevance to clinical practice Sleep and fatigue level should be evaluated in each visit with HIV care. Nurses need to be trained in evaluating the HIV+ patients' sleep and fatigue status and refer them to psychologist and/or relaxation technique accordingly. Self-management intervention for HIV+ individuals should also include the sleep hygiene into consideration. [ABSTRACT FROM AUTHOR]

Aims. To explore Chinese baccalaureate-prepared nurses' perceptions of the concept and practices of clinical decision-making. Background. Clinical decision-making is an integral part of nursing practice. Several studies have explored the experiences and factors which influence nurses' clinical decisions and these have recognised the cultural impact. However, little is known about the experience of clinical decision-making from the perspective of Chinese baccalaureate-prepared nurses. Design. A qualitative, exploratory study. Method. Data were obtained through in-depth, semi-structured interview with a convenience sample of 12 baccalaureate-prepared registered nurses. Interviews focused on registered nurses' understanding and perceptions of clinical decision-making in clinical practice. They were tape-recorded, transcribed verbatim and content analysed. Results. Two major themes were identified, namely, functional perspectives of clinical decision-making and perceived autonomy in clinical decision-making. There were two sub-themes for the first theme: emphasising a full understanding of the patient's health status and undertaking appropriate nursing judgements and problem-solving. Three sub-themes emerged for perceived autonomy in clinical decision-making: relying on a doctor's instructions, making judgements on a doctor's orders and making decisions independently in emergency care. Conclusions. The findings indicate that Chinese nurses understand the essence of clinical decision-making, but they have low autonomy in such decisions in their daily practice. More importantly, the results also reveal the importance of social and cultural factors in nurses' perceptions of this topic. Relevance to clinical practice. A better understanding of the perceptions and concepts of clinical decision-making among nurses in mainland China and other countries as well, can help in establishing nurses' roles and responsibilities in participating in making effective decisions for patient care. The findings can also inform us of potential strategies which may be adopted to develop the knowledge and skills of Chinese baccalaureate-prepared nursing students and graduates in making autonomous and accurate clinical decisions. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to explore and describe the content of telephone intervention conversations conducted by an enterostomal nurse with patients discharged home with a colostomy. Background. People discharged home with a new colostomy often encounter stoma-related difficulties. Postdischarge care with telephone follow-up by an enterostomal nurse is a helpful way to provide support for patients and ensure continuity of care. There is a paucity of studies reporting the content of telephone follow-up of colostomy patients. Information on the content of such follow-up is important in helping to formulate telephone call protocols that can help these patients. Design. A qualitative exploratory study conducted in a university-based cancer centre in China. Methods. The contents of 25 intervention phone calls to colostomy patients from January-August 2009 were subject to qualitative content analysis. Results. Five themes emerged from the qualitative content analysis: 'education for stoma care', 'access to stoma care', 'encouraging stoma self-care', 'resuming normal living' and 'general postoperative problems'. Conclusions. Colostomy patients experienced stoma-related problems and difficulties after discharge, most of which could be effectively managed via telephone follow-up by an enterostomal nurse. The telephone follow-up satisfied patients' need for information and facilitated their adjustment to the permanent stoma. The findings suggested that patients had unmet needs after discharge and needed follow-up on returning home. Relevance to clinical practice. This study provides important information to guide practice and education. The themes extracted from the qualitative content analysis provide a useful framework to guide the nurse in discussing care with the stoma patients and ensuring patients' adjustment to the permanent stoma. Further work can be done using this framework to develop protocols as standards of care and education materials when educating nurse specialists in stoma care. [ABSTRACT FROM AUTHOR]

Aim. To explore the experiences of patients with coronary heart disease in China. Background. The morbidity and mortality rates of people with coronary heart disease have been growing rapidly in the past decades in China, yet little is known about the experiences of Chinese patients with the disease. Design. A qualitative descriptive study. Methods. Face-to-face semi-structured interviews were employed in this study. Using a purposive sample, 11 participants who had been diagnosed with coronary heart disease for at least one month were recruited. A content analysis was used to identify themes. Results. Three themes were identified from the data: experiencing a life-threatening illness, strategies for adapting to living with coronary heart disease and help-seeking behaviour. Conclusion. Chinese patients with coronary heart disease experienced the disease as a life-threatening illness related to chest pain. Chinese culture, values and beliefs influenced their adaptation strategies and help-seeking behaviour. Their misconceptions about coronary heart disease and the information needs for lifestyle changes were evident in this study. This study highlights the need for health education to support coronary heart disease patients in China. Relevance to clinical practice. The findings provide useful information for Chinese health professionals to develop interventions for Chinese patients with coronary heart disease. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore: the selection criteria for first responder nurses during disaster; scope of practice for disaster relief nurses; appropriate nurse - medical practitioner ratio at the disaster site. Background. Nurses are key members of disaster response medical teams. A scarcity of literature exists relating to nurses attending disasters, their qualifications, experience, scope of practice and appropriate staffing ratios. Design. Qualitative and quantitative data were collected via survey using self-developed questionnaires. Participants were 95 medical workers, who participated in emergency rescue teams following the 2008 Wenchuan earthquake in China. A response rate of 93·7% achieved. Method. The questionnaire included questions relating to nurses: previous experience in disaster relief; scope of practice at the disaster site; optimal ratio of medical practitioners to nurses in disaster relief teams. Results. Following a disaster, first responder nurses considered most suitable were those with at least three years clinical experience, particularly in the emergency department or having emergency rescue skills training. The scope of practice for disaster relief nurses was different to that of nurses working in a hospital. The majority of participants reported insufficient nurses during the relief effort, concluding the optimal ratio of medical practitioner to nurse should range between 1:1-1:2 depending on the task and situation. Conclusion. At the scene of disaster, the preferred first responder nurses were nurses: with emergency rescue training; experienced in the emergency department; with at least three years clinical experience. The scope of practice for first responder nurses needs to be extended. Appropriate nurse - medical practitioner ratios in responding medical teams is dependant on the specific medical requirements of the disaster. Relevance to clinical practice. The recommendations made by this study provide a guide to ensure that nurses can contribute effectively as essential members of first responder emergency disaster relief teams. [ABSTRACT FROM AUTHOR]