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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: 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 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]

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]

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]

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: 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 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: 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: To describe the specific domains of diabetes distress and factors associated with these domains. Background: Diabetes distress is a common problem but not well recognised in adolescents by healthcare providers or adolescents themselves. There is insufficient evidence on how specific domains of diabetes distress exist in adolescents, making it challenging to select precise components to alleviate diabetes stress. Design: A quantitative, descriptive and cross‐sectional study. Methods: Data were collected on socio‐demographic and clinical characteristics, diabetes distress, perceived stress, self‐efficacy and diabetes self‐management using established questionnaires. Multivariate linear regression was conducted to examine the associations between specific factors and four domains in diabetes distress. STROBE checklist was used as the guideline for this study. Results: A total of 100 adolescents with type 1 diabetes aged 12 to 18 years participated in this study. Adolescents experienced the highest levels of distress in the regimen‐related distress [2.41 (SD =0.82)] and physician‐related distress [2.40 (SD =0.80)] domains. Older age, female gender, more diabetes problem‐solving and higher levels of perceived stress were associated with higher regimen‐related distress (β = 0.21 ~ 0.45, p < 0.05). Older age, female gender, a lower degree of endorsement of relevant diabetes‐related goals and higher levels of perceived stress were associated with higher physician‐related distress (β = −0.29 ~ 0.34, p < 0.05). Conclusions: Diabetes distress was reported more on regimen‐related and physician‐related domains among adolescents with type 1 diabetes in China, associating with older age, female, increased perceived stress and poor diabetes‐related problem‐solving. Relevance to clinical practice: Nurses need to screen the specific domains of diabetes distress among adolescents with type 1 diabetes, especially for the older adolescents and girls. This study highlighted the importance of incorporating diabetes‐related problem‐solving support and stress management strategies into diabetes management for adolescents with type 1 diabetes, which could help relieve diabetes distress. [ABSTRACT FROM AUTHOR]

Aims and objectives: To clarify both the potential influencing factors and the current status of front‐line nurses' work engagement, and thus provide a reference for targeted interventions. Background: After coronavirus disease 2019 outbreak, front‐line nurses embraced remarkable potential stress and huge workload when caring for coronavirus disease 2019 patients, which may lead to new challenges to work engagement. Design: A large sample survey was conducted at the end of February 2020 in a designated hospital treating coronavirus disease 2019 patients in Wuhan, the capital of Hubei Province, in China. t Test, one‐way ANOVA, chi‐squared test, Pearson's correlation and hierarchical multiple regression were performed among 1,040 nurses using SPSS 24.0. The STROBE checklist was followed for observational studies. Results: The final model interpreted 27.3% of the variance, of which each block could explain 11.7%, 10.3% and 7.9% R2 changes including sociodemographic characteristics, stress and workload, respectively. Work engagement was negatively correlated with stress and workload. The potential influencing factors included sociodemographic characteristics (married, rescue staff, cabin ward), stress (infection control, PPE discomfort) and workload (mental demand, performance, frustration). Conclusions: Front‐line nurses perceived low stress and workload, but high work engagement, especially in self‐dedication. However, infection control, PPE discomfort and frustration were negatively associated with nurses' work engagement, while mental demand and good performance were positively associated with nurses' work engagement. Future interventions focused on decreasing front‐line staff's infection risk and enhancing their self‐confidence may be recommendable to promote their work engagement. [ABSTRACT FROM AUTHOR]

Background: Burnout affects the quality of work and health of newly graduated nurses, increases the turnover rate among newly graduated nurses and leads to a shortage of nurses. Reducing job burnout among newly graduated nurses is critical. However, the factors that impact burnout among newly graduated nurses are currently not well known. Objective: This exploratory study aims to identify the factors that influence burnout among newly graduated nurses in China. Methods: We conducted a cross‐sectional study of newly graduated nurses from 15 cities in 13 provinces in China. We used online questionnaires to conduct the survey and obtain the results in this study. A STROBE checklist was used to report the results. Results: Of the 2400 questionnaires distributed, 2071 (86.29%) were returned. Job satisfaction, professional rank, hospital level, professional values and core competence were negatively correlated with burnout, while negative emotions were positively correlated with burnout. Women were more prone to burnout than men. Conclusions: Burnout among newly graduated nurses was divided into three dimensions based on the Maslach Burnout Inventory Scale. Our findings provided new evidence that newly graduated nurses had average levels of emotional exhaustion and depersonalisation and low levels of personal accomplishment. Job satisfaction, professional rank, hospital level, gender, professional values, negative emotions and core competence were predictors of job burnout among NGNs in China. Relevance to clinical practice: Nursing managers should pay attention to burnout management, standardise training about professional values, core competence and coping mechanisms and promote mental health and job satisfaction among newly graduated nurses. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the role of resilience in anxiety and depression and to clarify their relationships among patients with mild symptoms of coronavirus disease 2019 (COVID‐19) in Wuhan, China. Background: The outbreak of COVID‐19 has negatively affected some individuals, but resilience plays a decisive role in the response of individuals under pressure and can help them deal with pressure more effectively. Design: The cross‐sectional descriptive correlational survey was reported in line with the STROBE guidelines. Subject and setting: In total, 296 patients from FangCang Hospital in Wuhan, Hubei, China, with mild symptoms of COVID‐19 were recruited. Methods: Participants were recruited through convenience sampling. The data collected included their demographic information, the Connor‐Davidson Resilience Scale and Hospital Anxiety and Depression Scale. Results: A small number of patients in this study had above threshold anxiety (subthreshold anxiety and major anxiety) and depression (subthreshold depression and major depression). The mean total resilience score of the participants was slightly below the normal level of ordinary Chinese adults. Resilience was inversely associated with and was a protective factor for both anxiety and depression in our samples. Risk factors for anxiety include being female and having colleagues with COVID‐19, while a risk factor for depression was having family members with COVID‐19. Conclusions: This study shows that after taking the general demographics into consideration, higher levels of resilience were associated with lower anxiety and depression among mild COVID‐19 patients in Wuhan, China. Relevance to clinical practice: Health professionals, especially clinical nurses, need to be aware of the psychological status of COVID‐19 patients and promote resilience to improve their mental health. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the psychological trajectories of women who have had a diagnosis of foetal abnormality from the time of receiving a definite diagnosis to one month after discharge. Background: Foetal abnormalities are not uncommon worldwide. Such situations are devastating, and the termination of a pregnancy due to foetal abnormalities is a traumatic and stressful event for the mother. Design: A descriptive qualitative approach using expressive writing. Methods: The study included 20 women recruited through purposive sampling at a tertiary hospital in China. The participants were asked to write four 15‐min essays related to their experiences with foetal abnormalities. Thematic analysis was used to generate themes. The COREQ checklist (see Supporting Information Appendix S1) was used. Results: Four themes that reflected the women's psychological trajectories were identified: (a) traumatic response, (b) ruminant meditation, (c) positive coping and (d) post‐traumatic growth stages. The psychological trajectories were dynamically shaped, and different responses were displayed in each stage. Conclusions: Various responses were observed during each of the four psychological trajectories, which indicated that awareness regarding the psychological impacts associated with foetal abnormalities should be increased. The present findings suggest that healthcare services should be made accessible for women who have had a diagnosis of foetal abnormality to allow them to receive targeted nursing care at different stages and improve their psychological well‐being. Relevance to clinical practice: Midwives, nurses and other healthcare professionals should pay more attention to the mental health of women pregnant with foetuses diagnosed with abnormalities. Interventions designed based on women's worries and demands during various phases should be offered. In terms of the present research method, expressive writing possesses unique advantages that can be applied for relevant qualitative research. [ABSTRACT FROM AUTHOR]

Aim and objectives: To examine the dissimilarity between Chinese myocardial infarction (MI) patients' and spouses' illness perceptions (IPs), and to explore the relationship between patients' IP, differences in couples' IP and patients' lifestyle after discharge. Background: An individual's IP is affected and moderated by several factors, including the social context. One of the most influential members of the social network of patients is the spouse. Design: Cross‐sectional design. Methods: From April 2016–April 2017, 111 MI patients and their spouses were recruited. Before discharge from hospital, revised Illness Perception Questionnaire was administered to MI patients and their spouses separately. Two months after discharge, patients' lifestyle was assessed using Health Promoting Lifestyle Profile II. The manuscript was organised according to STROBE guidelines. Results: Spouses were more likely to believe that the illness would last for a long time, and patients perceived MI as being more controllable than their spouses did. The patient–spouse dissimilarity in the perception of consequences was negatively correlated with both nutrition and stress control behaviours. Patients in couples with more dissimilar perception of environmental factors as a cause were more likely to choose a healthy diet, while patients in couples with more dissimilar perceived treatment control were more able to control stress. Conclusion: There are both similarities and dissimilarities between MI patients' and spouses' IP, and these dissimilarities contributed the majority of the explained variance in patients' lifestyle after discharge. Relevance to clinical practice: We should consider both couples when examining how a patient copes with a chronic illness. [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]

Objective: To investigate the relationship between psychosocial adaptation and quality of life of patients with ostomies and to provide reference data for clinical care practice. Background: Surgical enterostomy impacts the life of patient. Most patients are transferred to home or community hospital after discharge and require long‐term nursing care. These patients typically face problems with physical, psychological and social adaptation. Design: Descriptive, cross‐sectional study. Methods: Between March 2017–June 2017, the following questionnaires were electronically administered to 1,053 patients with enterostomy residing in 22 provinces, 4 autonomous regions for ethnic minorities and 4 direct‐controlled municipalities in China: Social Support Revalued Scale, validated Chinese version of Ostomy Adjustment Inventory and Stoma‐Quality of life‐Chinese. Univariate analysis, correlation analysis and hierarchical regression analysis were used to assess the relationship between adaptation level and quality of life of patients with enterostomy, in order to provide reference data for clinical care practice and further improve the quality of life of these patients. The STROBE checklist was used in reporting this study. Results: The mean score for psychosocial adaptation was 43.13 ± 13.09, which corresponded to a medium level; the mean score for quality of life was 56.54 ± 16.87. The level of psychosocial adaptation and each dimension showed a positive correlation with the quality of life of patient and each dimension (r = 0.349–0.890, p < 0.01). Univariate analysis revealed a signification association of quality of life with education level, medical payment method, area of residence, peristomal complications, regular defecation, occurrence of leaking, ability for self‐care of stoma, communication between patient and medical staff, and knowledge and skills pertaining to care of stoma. Results of hierarchical regression analysis indicated that psychosocial adaptation level was a predictor of quality of life (R2 = 0.708; p < 0.001). Conclusions: In this study, the quality of life of patients with enterostomy was generally of a medium level. The level of psychosocial adaptation of the patient was closely linked to quality of life. During clinical care, concerted efforts should be made to encourage the patients to deal with the stoma positively and to help the patient and their families accept the stoma and change of image to reduce the adaption course and improve the quality of life. Relevance to clinical practice: Patients tend to take a long time to adapt to the stoma after ostomy formation. Facilitating the adjustment of patients with enterostomy may improve their quality of life. Medical care providers should focus more attention on patients who have lower ostomy adjustment scores. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine the relationship between health literacy (HL) and adherence to secondary coronary heart disease (CHD) prevention behaviours in patients in China. Background: Adherence of patients to secondary CHD prevention behaviours is important in order to slow or reverse disease progression. The relationship between HL and adherence is varied across populations and warrants further research in order to inform nurses caring for such patients how to direct their teaching. Design: A descriptive cross‐sectional design. Methods: A total of 598 patients with CHD were recruited during hospitalisation for a myocardial revascularization procedure at either of two tertiary hospitals in China. Data were collected by self‐report on demographics, HL and adherence to secondary CHD prevention behaviours (medication‐taking and heart‐healthy lifestyle) prior to this admission. HL was measured by the short version of European Health Literacy Survey Questionnaire (HLS‐EU‐Q16), while adherence was measured with the Medical Outcomes Study Specific Adherence Scale (MOS‐SAS). Descriptive, chi‐square test and regression analyses were conducted. The study was reported based on STROBE checklist. Results: Overall, 74.5% of the patients had limited HL. Adherence rates to medication‐taking and heart‐healthy lifestyle were 84.7% and 53.2%, respectively. HL was not significantly associated with medication adherence, but in regression models patients with limited HL demonstrated significantly increased odds for nonadherence to heart‐healthy lifestyle (OR 1.69). Conclusion: HL was not significantly associated with medication adherence but was related to heart‐healthy lifestyle adherence. Relevance to clinical practice: Nurses should assess the health literacy of discharging patients with CHD and focus on patients with limited health literacy to improve heart‐healthy lifestyle behaviours, and not just taking medications. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop and validate an instrument to measure nurses' empathy motivation in China (See Supporting Information Appendix S1). Background: Nurses are increasingly expected to empathise with patients in clinical settings. However, research investigating nurses' empathy motivation in China is lacking, and no specific instrument exists worldwide. Design: Two‐stage cross‐sectional study, which follows the STROBE guidelines. Instrument development and psychometric evaluation were used (See Supporting Information Appendix S1). Methods: A literature review and qualitative interviews with nurses were conducted to generate the initial items. Convenience samples of 340 (for item analysis) and 640 (for psychometric evaluation) clinical nurses working at four tertiary hospitals in Anhui Province were recruited. The scale was validated by content validity, surface validity and item analysis. A total of 640 participants were randomly divided into two equal groups. Exploratory factor analysis (EFA) was used with varimax rotation, confirmatory factor analysis (CFA) and internal consistency reliability to analyse the psychometric properties of the scale (See Supporting Information Appendix S1). Results: From the initial 90‐item pool, 27 items were retained by the item analysis. The EFA (N = 290) showed the following six factors on the scale explained 71.266% of the overall variance: amotivation, external regulation, introjected regulation, identified regulation, integrative regulation and intrinsic motivation. Furthermore, when limited to three factors, that is autonomy motivation, controlled motivation and amotivation, 56.578% of the variance was explained. The findings showed high internal consistency. The six‐factor solution and three‐factor solution of the scale, including 27 items, were both confirmed by the CFA, for example χ2/df = 1.744, 2.261; RMSEA = 0.051, 0.066; GFI = 0.882, 0.847; TLI = 0.942, 0.902; and RMR = 0.039, 0.049, respectively. Conclusions: The nurses' empathy motivation scale presents good psychometric properties and can be used to explore nurses' empathy motivation in China (See Supporting Information Appendix S1). Relevance to clinical practice: This study offers insight into nurses' complicated reasons for exhibiting empathy. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop and validate the Chinese version of Verbal and Social Interaction Questionnaire for Nursing Students. Background: The development of caring interaction skills is particularly important for achieving better nursing student–patient interactions. Nursing students in China, as in most countries, have often failed to establish a caring interaction with their patients. There is a lack of instruments to explore the difficulties and problems in nursing student–patient interactions in China. Design: A descriptive, cross‐sectional survey was carried out. Methods: Data for cross‐cultural adaptation and psychometric testing purposes were collected between May 10, 2017 and November 11, 2017. Exploratory and confirmatory factor analyses were performed; pilot testing, content validity and reliability were assessed for the translated questionnaire. EQUATOR guidelines for observational studies (strengthening the reporting of observational studies in epidemiology) were applied. Results: 716 nursing students from four universities in China completed the questionnaire. A pilot testing (n = 32) was conducted at a university hospital. The internal consistency reliability and the intra‐class correlation coefficients were satisfactory. The overall content validity index was 0.95. Exploratory factor analysis resulted in a four‐factor solution, explaining 61.26% of the variance, and the items had factor loadings ranging from 0.46–0.82. The final model's fit indexes were relatively acceptable. Overall, this instrument demonstrated sound psychometric properties. Conclusion: The Chinese version of Verbal and Social Interaction Questionnaire for Nursing Students has a high level of reliability and acceptable content validity. However, some values in the construct validity assessment were lower than was hypothesised, suggesting a need for further model modification. Relevance to clinical practice: This easy‐to‐use instrument may help nursing educators, clinicians and managers in the assessment and development of students' interactional skills during their training or student–nurse transition period. Using the questionnaire could both provide the students with a greater understanding of caring interactions and help the nursing educators gain a better comprehension of the students' verbal, social and interactional skills. [ABSTRACT FROM AUTHOR]

Aims and objectives: To translate and validate the Nurse Spiritual Therapeutics Scale (NSTS) among cancer patients in Beijing, China. Background: Spirituality is an essential and integrating facet of persons. However, spirituality is a new concept for most people in mainland China. Methods: The NSTS was translated, adapted and content‐validated. The psychometric evaluation was performed with data collected from cancer patients hospitalised in one of the two academic medical centres. After computing the scale content validity index (S‐CVI), exploratory factor analysis was conducted to understand the content validity of the scale. Internal consistency was evaluated using Cronbach's alpha. GRRAS checklist was used to enhance the quality and transparency of this research. Results: Participants (N = 153) completed the 18‐item C‐NSTS. The S‐CVI of the C‐NSTS was 0.92. Cronbach's alpha of C‐NSTS was 0.88. The C‐NSTS was observed to include three factors (providing of religious support, listening to one's life perception and finding of one's value) and three additional items that did not adequately load onto a factor, yet were retained given their face value. Together, these factors explained 65.2% of the variance. Conclusion: This initial psychometric evaluation of the 18‐item C‐NSTS demonstrated it to be a valid and reliable instrument to assess cancer patients' wishes regarding nurse‐provided spiritual care in the Chinese culture. Relevance to clinical practice: These findings could be used for spiritual care, hospice and palliative care, undergraduate or graduate studies. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the barriers in administering enteral feeding to critically ill patients from the nursing perspective. Our objectives are to provide tailored interventions for addressing identified barriers and propose an optimal enteral nutrition (EN) practice in intensive care unit (ICU). Background: Despite the availability of numerous verified clinical practice guidelines focusing on enteral feeding of critically ill patients, a wide gap remains between the guideline recommendations and actual nutrition performances. Underfeeding is also a global problem. Therefore, to further understand the reasons of the systemic iatrogenic underfeeding in ICUs, several potential issues are investigated. Design: This research is a cross‐sectional descriptive study. Methods: A total of 808 nurses were recruited from 10 comprehensive hospitals from different districts in China. The nursing staff demographic, the unit's EN management information and the Chinese version of barriers to enteral feeding critically ill patients questionnaire were the parameters used to collect data via WeChat app. Moreover, the collected data were analysed by descriptive and correlative statistical analysis methods. Results: Results obtained by multiple linear regression showed that frequency of EN‐related training, full‐time ICU nutritionist, hospital level, specific protocols for enteral feeding and position were significantly influencing the enteral feeding of ICU patients. Conclusions: Enteral feeding barriers of ICU patients are at a moderate level and are influenced by multiple aspects. Hence, hospital departments should strengthen standardisation and systematic EN training, provide ICU full‐time nutritionists and distribute medical resources and personnel rationally. Moreover, construction of a localised feeding process and exerting subjective initiative of clinical nurses from an evidence‐based guideline are important. Multifaceted tailored interventions should be implemented to address these barriers. Relevance to clinical practice: The findings of this study can be used to inform future intervention and guidelines aimed at addressing these barriers systematically and improving adherence to critical care nutrition guidelines for the provision of enteral nutrition. [ABSTRACT FROM AUTHOR]

Aims and objectives: To translate the Patient Perceptions of Patient‐Empowering Nurse Behaviours Scale (PPPNBS) into Chinese and to psychometrically test the Chinese version of PPPNBS (PPPNBS‐C) in chronically ill patients. Background: The growing prevalence and burden of chronic illnesses became the driving force for the need of empowerment as an approach to engage patients in self‐management. The PPPNBS was developed to assess patient perceptions of the process of empowerment during hospitalisation. Extending its application to different clinical context and ethnicities is worth pursuing. Design: A cross‐sectional survey. Methods: The PPPNBS was translated according to Brislin's translation guidelines and was culturally adapted. A questionnaire survey was carried out to determine the reliability and validity of the PPPNBS‐C among a total of 517 hospitalised patients with chronic illnesses. Results: The content validity was found to be good with a content validity index of 0.94. Exploratory factor analysis identified six factors explaining 68.56% of the total variance and confirmatory factor analysis confirmed this six‐factor structure. The hypothesised differences were demonstrated through contrasted group comparisons by time since diagnosis and length of hospital stay. The score of the PPPNBS‐C was significantly and positively associated with that of the Client Satisfaction Questionnaire, as was the Self‐Efficacy for Managing Chronic Disease 6‐Item Scale score, providing evidence of convergent validity. The Cronbach's alpha coefficient was 0.960 and the intraclass correlation coefficient was 0.86 for the total scale, explaining good internal consistency and time stability. Conclusions: The PPPNBS‐C has preliminary verification of the validity and reliability and could be useful in measuring patient perceptions of patient‐empowering nurse behaviours. Relevance to clinical practice: The PPPNBS‐C can be applied to chronically ill patients as a metric of the implementation status of patient‐empowering nurse behaviours and can be used as a guide to encourage nurse's intentional utilisation of empowering behaviours. [ABSTRACT FROM AUTHOR]

Aims and objectives: To establish evidence‐based nursing‐sensitive quality indicators for emergency nursing in China. Background: China lacks nursing‐sensitive quality indicators necessary for assessing the quality of emergency nursing and essential to nursing management. Design: Prospective. Methods: A literature search for relevant evidence‐based studies was performed using several databases from January 2009–May 2014. Previously reported quality indicators were identified as appropriate for assessment by a panel of 40 experts in emergency medicine and nursing. Two successive rounds of Delphi surveys were conducted using questionnaires designed by the experts. Kendal's W coordination coefficients were calculated for indicator importance, rationality of calculation and feasibility of data collection. Results: Thirty‐three quality indicators were initially proposed for expert evaluation. After round 1 of expert discussion, Kendal's W coordination coefficients were .152 for importance, .092 for rationality and .141 for feasibility of data collection (all p < .001). Seven unsuitable items were discarded in round 1 and 11 discarded in round 2, which also added one new item. Finally, the experts reached consensus on 16 items established as appropriate nursing‐sensitive quality indicators for emergency nursing care. Conclusion: Evidence‐based nursing‐sensitive quality indicators were established through a consensus of experts in emergency nursing and medicine. Relevance to clinical practice: The current findings may provide a theoretical basis for establishing an emergency nursing quality database and improving the quality of emergency nursing care in China. [ABSTRACT FROM AUTHOR]

Aims and objectives The study aimed to evaluate the proportion of Chinese patients with hypertension who meet the Chinese Hypertension Management Guideline recommendations for weekly physical activity and to determine possible associated factors that impact meeting the weekly physical activity recommendation. Background Accurate evaluation of physical activity levels for hypertensive patients is important to determine patients' health outcomes and intervention measures. However, most of the evidence on the prevalence of physical activity comes from developed countries; therefore, studies from developing countries are needed. Design Across-sectional design was adopted for the study. Methods The participants were recruited using a convenience sampling method from three healthcare community centres in Guangzhou, southern China. The data were collected using self-report questionnaires. Ordinal logistic regression was used to test factors associated with meeting the weekly physical activity recommendation. Results Two hundred and seventy-six (58.6%) hypertensive patients in our study did insufficient physical activity (<150 min/week). One hundred thirty-four (31.3%) patients achieved the weekly physical activity recommendation (≥150 min/week), and 52 (10.1%) met the recommendation for physical activity for additional health benefits (≥300 min/week). In the adjusted ordinal logistic regression analyses, patients over 60 years of age ( OR = 1.35, p < .001), who were unemployed ( OR = 1.24, p = .036), had lower blood pressure levels ( OR = 0.88, p = .019) and no hypertension-related complications ( OR = 1.18, p = .021), and regarded self-rated health as good or excellent ( OR = 2.37, p = .018), had a higher likelihood of meeting the weekly physical activity recommendation. Conclusions Our results showed that the number of Chinese hypertensive patients meeting the weekly physical activity recommendation is suboptimal. Age, employment status, blood pressure, self-rated health and complications related to hypertension were associated with meeting the weekly physical activity recommendation. Relevance to clinical practice The findings implied that hypertensive patients who did insufficient physical activity were subgroups that needed specific instructions in physical activity and motivation to take part in physical activity. Nurses should consider providing counselling and supervision to these patients. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate caregiver burden and factors that influence this burden among caregivers and patients with Alzheimer's disease in China. Background Long-term care can reduce the quality of life for caregivers and result in both mental and physical exhaustion. However, little is known about caregiver burden and associated factors in China. Design The study had a quantitative cross-sectional design. Methods A total of 309 caregivers and their patients were included in the study. The patients' cognitive, psychological and functional status and their caregivers' burden, sleep quality and mental state were evaluated. Descriptive analyses, single-factor regression and stepwise factor regression were used to determine the effects of various factors on caregiver burden. Results Older females and spouses still play an important role in providing family care for those with dementia. Most of the caregivers were the sole full-time caregiver and had little time for themselves. Sleepiness was a common physical problem for caregivers, and some of them had moderate to severe depression and anxiety. A lower functional status of the patient was associated with higher caregiver burden. Poorer physical status compared with before caregiving began, lower life satisfaction, and higher degrees of depression and anxiety were associated with higher caregiver burden. Conclusion Depression, anxiety and sleep problems are the main challenges that are faced by family caregivers of patients with Alzheimer's disease. Caregivers' functional status, lower life satisfaction, depression and anxiety influenced caregiver burden. Caregiver burden was related to the severity of the patient's dementia and the personal factors of the caregivers. Relevance to clinical practice To provide information about caregivers' current status while caring for patients with Alzheimer's disease and to understand caregiver burden and its related factors. Professionals who work with Alzheimer's disease should pay more attention to caregiver burden, especially those with mental and physical problems. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify determinants of self-efficacy and quality of life in patients with temporary enterostomy. Background Anterior resection with temporary enterostomy is the preferred treatment for patients with rectal cancer, which may impair patients' quality of life. So far, most studies have focused on quality of life in patients with permanent enterostomy, but few studies have looked at that in those with temporary enterostomy. Self-efficacy may determine quality of life in these patients, but few studies have identified determinants of self-efficacy and quality of life. Design Multicentre, cross-sectional survey and regression analysis to identify determinants of self-efficacy and quality of life. Methods A convenience sample of patients undergoing temporary enterostomy at five hospitals in Guangdong Province (China) were surveyed at least four weeks after stoma surgery using validated Chinese versions of internationally recognised questionnaires, including a Stoma Self-Efficacy Scale and the City of Hope Quality of Life-Ostomy Questionnaire. Backward multiple regression analysis was performed to identify whether quality of life was determined by self-efficacy and other clinico-demographic characteristics. Results Of the 180 questionnaires distributed, 149 (82·8%) were returned, and 135 (75%) were used in the final analysis. Mean global quality of life was 5·40 ± 1·58, and mean global self-efficacy was 79·59 ± 20·21. Significant determinants of self-efficacy and quality of life were identified (β = 0·62, p < 0·01). Quality of life was determined by type of enterostomy (β = 0·18, p = 0·01) and payment method (β = 0·14, p = 0·03). Conclusions Quality of life may be determined by self-efficacy, type of enterostomy and payment method, after temporary enterostomy. Relevance to clinical practice Promoting stoma-related self-efficacy in patients with temporary enterostomy may improve their quality of life. Healthcare providers should focus on quality of life in those either with temporary loop ileostomy or entirely self-funded for medicine. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine young women's perceptions and acceptability of human papillomavirus vaccination and factors influencing acceptability in mainland China. Background In the light of current concepts, human papillomavirus vaccines serve as new paradigms in cervical cancer prevention programme for young women. However, knowledge and acceptability of human papillomavirus vaccination and factors influencing acceptability among young Chinese women are not known. Design We implemented a cross-sectional descriptive study in the Hunan province of China. Methods One hundred and seventeen female undergraduate students completed confidential surveys in 2012. The questionnaire included five parts: background information, awareness and knowledge of human papillomavirus vaccine and cervical cancer, attitudes towards the vaccine and intentions to be vaccinated, psychosocial burden of human papillomavirus infection, and human papillomavirus-related sexual stigma. Results Only 44% of the participants were willing to be vaccinated in the future. Young women demonstrated low awareness and knowledge about human papillomavirus vaccine and cervical cancer. Their intention to receive future vaccination was associated with the high levels of knowledge about risk factors for cervical cancer and perceptions that infected women are responsible for their own infection of human papillomavirus. Conclusion The results of this study suggest low awareness and knowledge among young Chinese women about the preventive nature and value of human papillomavirus vaccination. Social and cultural factors including moral obligation and STD-related stigma may influence young women's intention to future vaccination. Relevance to clinical practice Educational interventions are necessary to promote public awareness and deliver information about human papillomavirus vaccination and cervical cancer prevention. Results of this study can help health care practitioners develop appropriate programmes for the promotion of human papillomavirus vaccination among this population. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the associations among professional self-concept, organisational commitment and burnout, and to analyse the mediating role of organisational commitment on the relationship between professional self-concept and burnout among community health nurses in Chengdu, China. Background Previous studies have focused on work environmental variables that contributed to burnout in nurses. However, no study has explored the mediating effect of organisational commitment on the correlation between professional self-concept and burnout in community health nurses. Design A cross-sectional descriptive study. Methods This study was conducted at 36 community health centres in Chengdu, China with 485 nurses sampled using a two-stage sampling method. The measures used in our study included Nurses' Self-concept Questionnaire, Organisational Commitment Scale and Maslach Burnout Inventory. Results The results of structural equation model techniques indicated that, in the direct approach, positive professional self-concept resulted in increased organisational commitment and reduced burnout. Higher organisational commitment resulted in less burnout. In the indirect approach, organisational commitment performed as a partial mediator on the correlation between professional self-concept and burnout. Conclusions Positive perception of professional self-concept can result in reduced burnout via enhancing organisational commitment. Relevance to clinical practice It is crucial for nursing administrators to develop effective intervention strategies such as skills escalator training and assertive training, and establishing a supportive working environment to enhance nurses' professional self-concept and organisational commitment, and decrease burnout. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the impact of emotional intelligence and organisational justice on work engagement in Chinese nurses and to examine the mediating role of organisational justice to provide implications for promoting clinical nurses' work engagement. Background The importance of work engagement on nurses' well-being and quality of care has been well documented. Work engagement is significantly predicted by job resources. However, little research has concentrated simultaneously on the influence of both personal and organisational resources on nurses' work engagement. Design A descriptive, cross-sectional design was employed. Methods A total of 511 nurses from four public hospitals were enrolled by multistage sampling. Data collection was undertaken using the Wong and Law Emotional Intelligence Scale, the Organizational Justice questionnaire and the Utrecht Work Engagement Scale-9. We analysed the data using structural equation modelling. Results Emotional intelligence and organisational justice were significant predictors and they accounted for 44% of the variance in nurses' work engagement. Bootstrap estimation confirmed an indirect effect of emotional intelligence on work engagement via organisational justice. Conclusions Emotional intelligence and organisational justice positively predict work engagement and organisational justice partially mediates the relationship between emotional intelligence and work engagement. Relevance to clinical practice Our study supports the idea that enhancing organisational justice can increase the impact of emotional intelligence. Managers should take into account the importance of emotional intelligence and perceptions of organisational justice in human resources management and apply targeted interventions to foster work engagement. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the differences in the knowledge and compliance with secondary prevention of stroke between transient ischaemic attack patients with and without subsequent stroke. Background No previous study has demonstrated whether there are differences in the knowledge and compliance with secondary prevention of stroke between transient ischaemic attack patients with and without subsequent stroke. If there are differences, the health education regarding the stroke knowledge should be conducted separately and differently for the two groups. Methods and design We consecutively recruited 355 transient ischaemic attack patients with/without subsequent stroke from our hospital from 1 December 2008-31 December 2011. There were 304 patients receiving health education both upon hospital discharge and 90 days after discharge. Through telephone interviews, six months after discharge, only 180 patients completed the survey to determine in detail their general knowledge and compliance with secondary prevention of stroke. Results The transient ischaemic attack patients with subsequent stroke exhibited a higher identification rate of speech disorder, weakness and decreased sensation or inability to feel things, compared with those without subsequent stroke (76·1 vs. 66·3%, p < 0·05; 91·5 vs. 73·5%, p < 0·05; 62·2 vs. 46·9%, p < 0·05). The compliance rates to antiplatelet agents and statins therapy were higher in transient ischaemic attack patients with subsequent stroke compared with those without subsequent stroke (80·5 vs. 65·3%, p < 0·05; 53·7 vs. 35·7%, p < 0·05). Conclusions The transient ischaemic attack patients with subsequent stroke exhibit a higher identification rate of most of the warning signs of stroke and a better compliance with antiplatelet agents and statins therapy of stroke compared with those without subsequent stroke. Thus, we suggest that transient ischaemic attack patients should receive additional health education to increase their awareness of the harms of stroke. Relevance to clinical practice Clinicians should be aware of conducting different health education to patients with transient ischaemic attack and stroke. Also, it is important to give health education to individualised patients based on their actual risk of stroke. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the association between disease stigma and quality of life and whether disease stigma mediates the relationship between symptom severity and quality of life among community-dwelling women with stress urinary incontinence in China. Background Urinary incontinent patients perceived great stigma, which inhibited from seeking medical help. There is evidence that stigma associated with some other diseases had a complex relationship with illness severity and quality of life. However, little empirical research has examined the role that stigma plays among urinary incontinent population. Design A cross-sectional, descriptive design was used. Methods A purposive sample of 333 women with stress urinary incontinence from a Chinese city was enrolled. Data were collected on symptom severity, disease stigma and quality of life using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, Social Impact Scale and Incontinence Quality-of-Life Measure, respectively. The mediate effect of disease stigma was analysed using a series of hierarchical regression models. Results Disease stigma negatively correlated with quality of life among stress urinary incontinent women. Social isolation and internalised shame, but not social rejection, the domains of disease stigma, partially mediated the effect of symptom severity on quality of life, attenuating the effect by 34·3% together. Conclusions Disease stigma impairs quality of life of women with stress urinary incontinence and mediates the association between symptom severity and quality of life. Health workers may improve their quality of life by addressing perceived stigma. Relevance to clinical practice Our findings suggest that in clinical practice, stigma reduction may have the potential to not only improve quality of life, but also mitigate the impact of the severity on quality of life among urinary incontinent women. Social isolation and internalised shame should be more concerned in targeted interventions. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine the current status of dementia patient's quality of life and compare influencing factors in China and Japan to inform nursing care and potentially improve the patient's quality of life. Background The prevalence of dementia is increasing related to lack of a cure, thus prompting some researchers and clinicians to focus on patient's quality of life. Design A cross-sectional study. Methods A convenience sample of 200 mild-to-moderate dementia patients was obtained in Jinan city and 205 ones in Wakayama city. Then, we measured patient's quality of life and analysed the relation between general demographic information, cognitive function, activities of living, behavioural and psychological symptoms, and the patient's quality of life. Results The total score of Dementia Quality of Life in Jinan city was 89·82 ± 15·11; multiple linear regression showed that the influencing factors of quality of life were marital, economics, characteristics, activities of living, hypertension and irritability. And the total score in Wakayama city was 118·30 ± 14·56; the influencing factors were education, body mass index, activities of living and depression. Conclusions The total score of Dementia Quality of Life in Jinan city was significantly lower than Wakayama city. The same influencing factor between these two cities was activities of living. Relevance to clinical practice Nurses could implement interventions to focus on many of the patient's influencing factors, so that to improve their mental and physical health, which may slow the disease process and further improve the patient's quality of life. In addition, Chinese government could learn some experience from Japanese government, such as perfect the system of nursing insurance for elderly and introduce professional geriatric nursing talents to provide better service for the elderly. [ABSTRACT FROM AUTHOR]

Aims and objectives The purposes were (1) to explore pain experiences and the use and perceived effectiveness of pain self-management methods among middle-aged and older adults with osteoarthritis or rheumatoid arthritis in mainland China and (2) to compare those with diagnoses of osteoarthritis and rheumatoid arthritis. Background Prior research has suggested that pain is a major concern for people with arthritis. However, studies systematically investigating pain experiences and self-management status of arthritis patients are scarce in mainland China. Design Descriptive survey. Methods Participants ( n = 197) aged 45 and over, diagnosed with either osteoarthritis or rheumatoid arthritis, and experiencing persistent pain were administered three self-report questionnaires: the Demographic Data Questionnaire, the Brief Pain Inventory and the Pain Management Inventory. Results The mean of the overall pain intensity was 5·6 (SD = 1·3). The median of number of pain sites was 7·0 (QR = 7·0) and the overall pain interference was 6·0 (QR = 2·6). Most participants experienced moderate to severe pain and interference. The current methods used for managing pain were perceived as only moderately effective. The sample used a median of 4·0 (QR = 3·0) self-management methods. Most often used were prescribed medicine, massage, heat and activity pacing. Methods perceived as most helpful included prescribed medicine, over-the-counter medicine, hot baths and heat. Persons with rheumatoid arthritis had significantly more pain sites, higher pain intensity and greater number of pain management methods used compared to those with osteoarthritis. Conclusions Pain management is a significant problem in this population. The findings highlight the importance of helping the individual to identify and appropriately use a variety of self-management methods, selecting the appropriate method(s) at any one time. Relevance to clinical practice Healthcare providers are urged to develop appropriate interventions on pain management tailored to arthritis patients in mainland China. [ABSTRACT FROM AUTHOR]

Aims and objectives To improve the development of the Chinese version of Perceived Nursing Work Environment ( C- PNWE) scale by examination and application and to explore the nurses' perception of their working environment in a hospital. Background The C- PNWE scale was translated and revised from the PNWE scale. The least of perfection is that the development of C- PNWE ignored that the psychometric properties of the PNWE instrument were established of critical care nurses and further application and testing of the PNWE in various patient care settings were recommended. Design This is a cross-sectional design. Nurses from different departments of a hospital were sampled by convenience sampling and investigated by self-administrated questionnaire. Methods Data obtained through questionnaires were analysed by descriptive statistical analyses and profile analyses using the Statistical Package for the Social Sciences ( SPSS) Chinese version 17.0 software. Results The coincident and level profile analyses indicated that these groups can merge into one group, and the profile of measurement result of this merged group would not exhibit flatness. Among six dimensions of C- PNWE scale, the Staffing and Resource Adequacy got the lowest average score. Among 41 items, 'Opportunity for staff nurse to participate in policy decisions' got the lowest mean. Conclusions The C- PNWE scale shows good psychometric properties and can be used to explore nurses' perspectives of the nursing practice environment in China. And the situation of nurses' perceived working environment in China needs further study. Relevance to clinical practice Shaping nursing practice environments to promote desired outcomes requires valid and reliable measures to assess practice environments prior to, during and following efforts to implement change. The C- PNWE scale can be a useful measurement tool for administrators to improve the nursing work environment in China. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the common symptom cluster in lung cancer patients with surgical treatment and to evaluate the relationships between symptom cluster and patients' disease outcomes, including functional status and quality of life. Background Lung cancer is one of the leading causes of cancer-related death for both men and women, and its incidence is increasing in China. Growing number of researches confirmed that symptoms in lung cancer patients with chemotherapy and radiotherapy occurred as 'symptom cluster' across the disease trajectory and influenced disease outcomes. However, few studies focused on the symptom cluster and its effects on quality of life and functional status of lung cancer surgery patients. Design This is a descriptive, cross-sectional design. Methods Symptoms in lung cancer surgery were assessed by M.D. Anderson Symptom Inventory, Karnofsky Performance Scale and Quality of Life Instruments for Cancer Patients - Lung Cancer. One hundred and forty-five individuals were involved in the survey. Results The top four common and most severe symptoms were pain, fatigue, disturbed sleep and distress for lung cancer surgery patients. 4·8% ( n = 7) and 17·2% ( n = 25) of patients reported co-occurrence of two or three symptoms of pain, fatigue, disturbed sleep and distress. About 76·6% ( n = 111) of patients reported co-occurrence of all the four symptoms. There were strong negative relationships between the top four symptoms and Karnofsky Performance Scale and Quality of Life Instruments for Cancer Patients - Lung Cancer scores. Conclusion Pain, fatigue, disturbed sleep and distress constituted the common symptom cluster during the disease trajectory in patients with lung cancer who got surgical treatment and negatively affected their quality of life and functional status. Relevance to clinical practice Symptoms in lung cancer surgery patients often occurred as cluster during the trajectory of disease. To improve the well-being of patients, attentions need to be focused on developing symptom cluster management strategies. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the prevalence of anxiety and depression in parents of hospitalised neonates and to analyse their relationship with other factors such as stress and social support, to provide evidence for targeted clinical interventions. Background The perinatal period, a special susceptibility to negative emotions, is a period that women and their spouses have to face. In this time, the fact that the neonates have to be hospitalised is no doubt a huge psychological stress to their parents. Little understanding of the hospitalisation environment, lacking awareness of neonatal diseases as well as concerns about the neonates' safety, can easily lead to negative emotions in parents. Under the influence of negative mood, parents could become irritable and vulnerable, which may do harm to their physical and mental health, impact family harmony and even result in ineffective communication with doctors, affecting the care of neonates. Design This study applied a cross-sectional study design. Methods The psychological status of 600 parents (400 fathers and 200 mothers) was assessed in the first week of the hospitalisation of neonates, using the Self- Rating Anxiety Scale, Self- Rating Depressive Scale, Social Support Rating Scale and Perceived Stress Scale. Results The results of the cross-sectional survey showed that 20% of fathers and 24% of mothers had symptoms of anxiety, while 30·8% of fathers and 35% of mothers had depressive symptoms. The total scores for anxiety and depression in these parents were significantly higher than the normal population ( p < 0·01). The level of social support and perceived stress were the most important factors relating to parental anxiety and depression. Conclusion Parents of hospitalised neonates are more prone to suffer from negative emotions than normal population. Anxiety and depression are common emotions in these parents. However, the social support they receive is far from satisfactory, so timely and effective nursing interventions are essential. Relevance to clinical practice Health professionals should understand the mental health of parents with hospitalised neonates and take measures to reduce their psychological pressure so as to improve their care of the neonates, and help to maintain the harmony and stability of families and the whole society. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine Chinese cancer patients' fatigue self-management, including the types of self-management behaviours used, their confidence in using these behaviours, the degree of relief obtained and the factors associated with patients' use of fatigue self-management behaviours. Background Fatigue places significant burden on patients with cancer undergoing chemotherapy. While some studies have explored fatigue self-management in Western settings, very few studies have explored self-management behaviours in China. Design Cross-sectional self- and/or interviewer-administered survey. Methods A total of 271 participants with self-reported fatigue in the past week were recruited from a specialist cancer hospital in south-east China. Participants completed measures assessing the use of fatigue self-management behaviours, corresponding self-efficacy, perceived relief levels plus items assessing demographic characteristics, fatigue experiences, distress and social support. Results A mean of 4·94 (±2·07; range 1-10) fatigue self-management behaviours was reported. Most behaviours were rated as providing moderate relief and were implemented with moderate self-efficacy. Regression analyses identified that having more support from one's neighbourhood and better functional status predicted the use of a greater number of self-management behaviours. Separate regression analyses identified that greater neighbourhood support predicted greater relief from 'activity enhancement behaviours' and that better functional status predicted greater relief from 'rest and sleep behaviours'. Higher self-efficacy scores predicted greater relief from corresponding behaviours. Conclusions A range of fatigue self-management behaviours were initiated by Chinese patients with cancer. Individual, condition and environmental factors were found to influence engagement in and relief from fatigue self-management behaviours. Relevance to clinical practice Findings highlight the need for nurses to explore patients' use of fatigue self-management behaviours and the effectiveness of these behaviours in reducing fatigue. Interventions that improve patients' self-efficacy and neighbourhood supports have the potential to improve outcomes from fatigue self-management behaviours. [ABSTRACT FROM AUTHOR]

Aims and objectives. To verify with empirical evidence the hypothesised relation and the effect of quality of work life, job embeddedness and affective commitment on turnover intention of clinical nurses in China. Background. High turnover of the nursing workforce in healthcare organisations is a difficult and recurring problem in China as well as in many other countries in the world. It leads to great waste of resources and increases management cost. Developing and retaining the nursing workforce, which is a major challenge faced by human resources practitioners in hospitals and public health agencies, also becomes a subject of interest for management studies. Most of the literature about voluntary turnover focused on such traditional measures as job satisfaction and job alternatives in the past. The introduction of such new concepts as quality of work life, job embeddedness and affective commitment, which views the issue from a much broader and comprehensive spectrum, made a great breakthrough in the turnover study. In this study, we selected quality of work life, job embeddedness and affective commitment - three of the most important factors in employer-employee relations - and analysed the interaction between each one of them, as well as their co-effect on turnover intention of Chinese nurses. Methods. Cross-sectional survey and structural equation modelling were applied in studying the self-report questionnaires distributed to 1000 nurses employed in five large-scale government-owned hospitals in Heilongjiang Province, Northeast China. Findings. Our study confirmed the hypothesised positive relation of quality of work life with job embeddedness and affective commitment and the hypothesised negative relation of quality of work life with turnover intention, that is, high quality of work life perceived by the nurses enhances their job embeddedness and affective commitment and thus reduces their intention to leave the job. Conclusions. The effect of quality of work life is positive on job embeddedness and affection commitment and negative on turnover intention. Relevance to clinical practice. Nurse managers should pay great attention to the nurses' perception of quality of work life, and make great efforts in developing strategies and projects that can strengthen the nurses' embeddedness or connection with the job. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore the relationships of demographic and clinical variables and attendance at diabetes educational programmes with diabetes knowledge among a community sample of older Chinese adults with type 2 diabetes residing in Beijing. Background. Knowledge of diabetes is an important component of diabetes self-management. Level of education, duration of diabetes, visits to a dietician and diabetes self-management are associated with diabetes knowledge. A few studies have examined these relationships in older Chinese with diabetes. Design. A descriptive correlational study. Methods. The study was conducted in face-to-face interviews with 108 older adults with type 2 diabetes and an average age of 68 (SD = 8·41) years residing in six residential apartment complexes in Beijing. Along with the assessment of diabetes knowledge and diabetes self-management, assessments of glucose, blood pressure, body mass index (BMI) and waist circumference were obtained. Results. Age and systolic blood pressure were negatively associated with diabetes knowledge. Diabetes knowledge was not related to diabetes self-care activities or glucose level. A regression model with age, education and clinical variables significantly predicted diabetes knowledge, explaining 29% of the variance in knowledge. Participants who had a family history of diabetes, visited traditional Chinese medicine (TCM) doctors and ophthalmologists and attended diabetes educational programmes were more likely to have high scores on diabetes knowledge. Conclusions. Age, education, a family history of diabetes, visits to TCM providers and ophthalmologists and attending diabetes class are factors associated with increased levels of diabetes knowledge. Relevance to clinical practice. Healthcare providers need to provide age-specific, low literacy and family-focused diabetes education programmes and consider integrating principles and holistic perspectives of TCM in diabetes educational programmes for older Chinese with diabetes. [ABSTRACT FROM AUTHOR]

Aims and objectives. The purpose of this study was to describe knowledge about stroke warning signs and risk factors in patients with previous stroke or transient ischaemic attacks in China and to investigate the relationship between socio-demographic characteristics & health status and patients' knowledge about stroke. Background. Stroke is the leading cause of death and functional impairment in China. Survivors are at high risk of new vascular events. Secondary prevention after stroke or transient ischaemic attacks is not satisfactory. Previous research suggests that awareness of stroke plays an important role in facilitating secondary prevention. However, little is known about knowledge of stroke warning signs and risk factors among patients with previous stroke/transient ischaemic attacks. Design. A cross-sectional questionnaire study. Methods. This study was conducted in Hunan Province, China, between July and December in 2010. Subjects were recruited using a cluster sampling method. A questionnaire was administered to 1600 patients with stroke/transient ischaemic attacks diagnose from eight hospitals, and 1200 patients (75%) responded. Patients' knowledge about stroke warning signs and risk factors were collected and analysed. Results. Patients' knowledge about stroke warning signs was very poor (only 3·3% identified all warning signs and 28·3% identified three). Patients' knowledge about important risk factors (e.g. atrial fibrillation, diabetes, metabolic syndrome, etc.) was also very poor (<30%). Patients' action in emergency was extremely poor (only 9·2% reported to call emergency service). The age, education, stroke-related diagnoses and family history of cardiovascular disease were significantly associated with patients' knowledge about stroke. Conclusions. Knowledge about stroke warning signs and risk factors was very poor in patients with previous stroke or transient ischaemic attacks in China. Relevance to clinical practice. Dissemination of stroke knowledge should be a core responsibility for Chinese clinical nurse. Future clinical education to improve patient's knowledge about stroke and further intervention to manage cardiovascular risk factors are indicated. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study was designed to examine the applicability of World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in adolescents in China for internal consistency and factorial validity. Background. The conceptualisation of impairments, activity limitation and participation restriction as disability underpins WHODAS 2.0. Available evidence is mainly about the use of WHODAS 2.0 in adults with little attention to adolescents. Design. Survey design. Methods. A total 314 adolescent inpatients were recruited using a purposive sampling strategy and self-measured with a range of scales related to puberty development, family function, 36-item WHODAS 2.0, extended version of Strength and Difficulties Questionnaire (Ext-SDQ). The same amount of junior high school student data was randomly selected to facilitate the model invariance examination through confirmatory factor analysis with the assistance of amos 19 and spss 19. Results. Adolescents (mean, 14·07; SD, 2·866) varied greatly in demography, health conditions, body mass index, puberty development, family function, disability and difficulties as well as prosocial status. After the removal of the item on sexual activity, the internal consistency for the 35-item WHODAS is satisfactory, overall and dimensional. The six-factor WHODAS model was found to be a good model fit, moderately correlated with the overall difficulty measured by the 20-item four-factor SDQ, with the ability to differentiate the group of adolescent inpatients and junior high school students. Conclusion. The 35-item WHODAS is useful with adolescents with satisfactory internal reliability and factorial validity. Relevance to clinical practice. This study supports the use of 35-item WHODAS in adolescents with or without health conditions in school and hospital settings, which paves the way for a better understanding about and health service delivery to adolescents during the transition from childhood to adulthood. [ABSTRACT FROM AUTHOR]

Aims. To discover the latent psychosocial construct of female nurses' sensitivity to male genitalia-related care in the context of sexual conservativeness. Background. Many nursing activities involve direct exposure or contact with male external genitalia. In the sexually conservative culture and the predominance of female nurses, this area is the subject of continuing interest and investigation. Design. Methodological research design. Methods. An item pool related to male genitalia-related care was generated through a panel of experts and then reduced to a short form questionnaire, the Female Nurses' Sensitivity to Male Genitalia Related Care scale. Using data from a purposive sample of 588 female nurses, the structure of the questionnaire was examined using structural equation modelling. The validity was examined against existing scales. Results. The 13-item Female Nurses' Sensitivity to Male Genitalia Related Care scale has a two-factor structure with high internal consistency (α = 0·87) and test-retest reliability of 0·90. Nearly all model fit measures reach the criteria of being an acceptable model fit except chi-squared statistics. Scores on Female Nurses' Sensitivity to Male Genitalia Related Care can be best predicted by that of brief Fear of Negative Evaluation Scale, Embarrassability Scale and Situational Susceptibility to Embarrassment Scale. Conclusions. The anxiety of projecting a positive image and the pursuit of sexual propriety may underpin female nurses' sensitivity to male genitalia-related care. This trait can be measured by the 13-item female nurses' sensitivity-male genitalia-related care scale with satisfactory psychometric properties including internal consistency, reliability, content validity and construct validity. Relevance to clinical practice. Particular attention shall be paid to the negative effects of social rules or norms including sexual propriety rules over (female) nurses' perceptions, attitudes and behaviours. Strengthening nursing education in this regard is important to overcome negative effects on female nurses of male genitalia-related care. [ABSTRACT FROM AUTHOR]

The article presents a study to translate the heart disease fact questionnaire (HDFQ) from English to Chinese (C-HDFQ) and to determine its reliability and validity among Hong Kong Chinese people. The study showed that the Chinese heart disease fact questionnaire (C-HDFQ) demonstrated acceptable reliability and validity and also indicated that the heart disease risk knowledge in people with diabetes deserves both clinical and research attention in Hong Kong.

Aims and objectives. To examine cognitive function and its relationships to demographic characteristics and social support among elders in central China. Background. Cognitive decline is prevalent among elders. Few studies have explored the relationship between social support and cognitive function among elders. Design. A cross-sectional, descriptive correlational study. Methods. A quasi-random, point of reference sample of 120 elders residing in central China was recruited for study. Instruments used included a: Socio-demographic Questionnaire, the Multidimensional Scale on Perceived Social Support and the Mini-Mental State Examination. Hierarchical multiple regression was performed to examine the relationships among demographic variables, social support and cognitive function. Results. Age, education and social support accounted for 45·2% of the variance in cognitive function. Family support was the strongest predictor of cognitive function. Elders who had higher educational levels and more family support had better cognitive function. Relevance to clinical practice. Community healthcare providers should consolidate social support among elders in China and use family support interventions to reduce or delay cognitive decline, especially among those of increased age who are illiterate. Conclusion. Elders who had higher educational level and more family support had better cognitive function levels. Interventions that include family support are needed to improve cognitive function among elders in China. [ABSTRACT FROM AUTHOR]