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The aim of this assessment was to determine the information needs, resources, and resource preferences and self/family-management challenges of parents caring for a child with asthma in China. The acceptance of asthma and consolidated framework for implementation research guided the study. A cross-sectional, descriptive design was used. Seventy-one parents of a child receiving care in an outpatient respiratory clinic completed a three-part, pragmatic, self-report survey. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. Parents, who needed more knowledge about asthma, sought information from internet sources. However, most parents preferred receiving information during in-person consultation with trained specialists. Management challenges revolved around understanding asthma information, formulating beliefs about asthma, experiencing distressing thoughts and feelings, forming supportive networks, and meeting their child’s emotional needs. Evidence supports expanding nursing roles in China to include extended time for initial in-person parental interactions and follow-up using reliable clinic-based internet counseling.

The health beliefs and practices regarding cervical cancer screening among women in the mountainous and Terai region of Nepal were investigated and examined for the differences. A descriptive cross-sectional study was conducted with a purposive sample of 216 in mountainous and 294 in Terai. The interview tools were a socio-demographic scale, a Nepalese Health Belief Model Scale for Cervical Cancer followed by the Screening Test. Chi-square test, binary logistic regression, Mann-Whitney U, and Kruskal-Wallis were used to analyze the data. The results showed that the screening rate was low for both regions with a significant difference in the benefit of screening and health motivation. Being older and having a positive family history of cervical cancer were shown to be predictors screening practice. Women from both groups preferred female doctors for screening. Culturally appropriate educational interventions focused on the benefits and obstacles of screening is needed to improve the beliefs of cervical cancer and screening and increase the screening rate. Nurses need to be aware of health beliefs regarding cervical cancer during cervical screening and education.

Spiritual care competence of nurses is crucial to satisfy the spiritual needs of the clients, but the dearth of conceptual frameworks has hindered the clarification of the construct, especially for nurses in the People's Republic of China. This article developed a 3*3*3 matrix framework to clarify the components of spiritual care competence for Chinese nurses through the synthesis of existing empirical and theoretical work, which includes three aspects (awareness, understanding, and application) on three levels (intrapersonal, interpersonal, and transpersonal) of three contents of spirituality (namely, worldview, connectedness, and transcendence). The proposed framework can be used as a model to promote spiritual care competence of nurses in China. Adoption of the framework to guide studies would allow for the design of interventions for the attainment of this competence.

In this report from the field, we describe the challenges and opportunities for nursing practice and education, and ways to improve nurse mobility across Asia. We also explain the collaboration within the Southeast and East Asian Nursing Education and Research Network to influence policy development and review. The collaborative process was supported by evidence drawn from discussions at Network meetings, and with nursing and other leaders, an examination of literature and policy documents, and member surveys. We reviewed the region's regulatory statutes which all support diversity in the nursing workforce. The Southeast Asian Nursing Education and Research Network was established in 2015 to support policy development around the upgrading of nurse education, clinical competencies and research capacity, in hospital and primary health care; and facilitating the movement of nurses across national boundaries. Most countries have tried to address policy gaps and their efforts to implement changes are seen in policy expansion and development at the national level. We focus on two policies from the Association of Southeast Asian Nations from 2006 and 2012, that cover nurse mobility, information exchange, nurse capacity building and education and mutual professional recognition of nurses' credentials. However, we found significant variances in education, regulatory policies and clinical competencies that have restricted, and continue to restrict policy implementation. Nursing in South-East Asia has made significant progress in upgrading standards for education by increasing bachelor degree bridging programs, master and doctoral degrees. Participating countries have passed legislation on licensure, competencies and credentialing of internationally qualified nurses wishing to practice in various contexts. However, much work remains to be done. IMPLICATIONS FOR NURSING POLICY, EDUCATION AND PRACTICE: Governing bodies determine entry into practice law which requires dialogue to enhance policies for domestic and international practitioners for mutual exchange and recognition. Nursing practice and education are under government regulatory bodies but require new policies and laws to ensure adequate educational requirements for safe quality practice.

Background: Understanding parents’ experiences is a prerequisite to developing interventions that are sensitive to needs of children and families. In China, little is known about parental experiences of having a young child with acute lymphoblastic leukemia (ALL). This phenomenological study aimed to describe parental experiences of having a young child with ALL in China. Method: Ten parents, recruited in central China using purposive sampling, participated in face-to-face, in-depth interviews using Haase’s adaptation of Colaizzi’s phenomenological method. Results: Five theme categories were identified: (a) The Cancer Diagnosis as a Terrible Disaster—The Sky is Falling, (b) Fighting the Beast, (c) Putting on a Happy Face and Other Coping Strategies, (d) Diagnosis Disclosure: If We Tell and How to Tell, and (e) Hope-Filled Expectations: Returning to Normal Life. Conclusion: Parents put their child’s health as their top priority. They strive to manage uncertainty about prognosis and cope with enormous pressures caused by children’s suffering, financial burden, and stigma. Parents also express their resilience and hope throughout their child’s cancer journey. Support services to strengthen specific families’ protective factors (i.e., family/community support, hope, and positive coping) are needed to foster resilience and quality of life. Health care professionals should systematically assess parents’ needs, provide validated education materials, and implement tailored interventions across the cancer continuum. Public education and advocacy about cancer is also necessary to decrease cancer-related stigma, and provide financial aid and health care resources in pediatric oncology.

Purpose The purpose of this study was to explore the effect of a home-based resistance exercise program for people living with physical disability. Design A quasiexperimental study. Method Forty participants enrolled, and 24 completed the 12-week study with 13 in the intervention group and 11 in the control group. Outcomes were measured by pretests and posttests, including Six-Minute Walk Test, Five Times Sit-to-Stand Test, 10-Meter Walk Test, Timed Up and Go, One Repetition Maximum, World Health Organization Disability Assessment Schedule 2.0, and Self-administered Short Form Health Survey. Findings Outcomes of participants within intervention group improved significantly after the training. Conclusions This home-based resistance exercise demonstrated impact on improving the functioning of the participants. Clinical relevance A well-developed home-based resistance exercise for people with disability will improve their physical functioning. The trainers for the home-based program should have frequent interaction with the group to determine how to improve the outcome of physical abilities. Community health nurses could be taught how to conduct resistance exercise so that it will become routine care in the community health centers for people with disability.

Background Interprofessional education is essential for developing a collaborative workforce. However, interprofessional education is not the norm in health professional education in China. More evidence is needed to testify to the effectiveness of interprofessional education. This study describes the process of developing a simulation-based interprofessional intervention in academic settings in China and explores the impacts on baccalaureate health students. Methods A quasi-experimental, pre and post design was used. Thematic analysis analyzed the students' feedback in debriefing. Results Satisfaction with the simulated interprofessional learning experience was high. Positive attitudinal changes towards teamwork were expressed after simulation; however, significant gaps existed in the students' team performance. Also, the nursing students' prescores and postscores of teamwork attitudes were lower than the medical students. Conclusion Further studies should address: (a) building a more comprehensive, constructive organizational culture through integrating patient-centered, holistic care model in all health curriculum designs; (b) threading interprofessional education and collaborative practice in the entire trajectory of professional education, assessing of the impact of doing so, and redesigning the clinical learning to improve students' actual performance; and (c) exploring Chinese students' perceptions of different components of simulation, and engaging them in the simulation design.

Objectives The study aim was to identify the perceived perspectives of baccalaureate nursing students toward the peer tutoring in the simulation laboratory. Insight into the nursing students' experiences and baseline data related to their perception of peer tutoring will assist to improve nursing education. Design Q methodology was applied to explore the students' perspectives of peer tutoring in the simulation laboratory. Participants A convenience P-sample of 40 baccalaureate nursing students was used. Method Fifty-eight selected Q statements from each participant were classified into the shape of a normal distribution using an 11-point bipolar scale form with a range from − 5 to + 5. PQ Method software analyzed the collected data. Results Three discrete factors emerged: Factor I (“Facilitate or empower” knowledge acquisition), Factor II (“Safety Net” Support environment), and Factor III (“Mentoring” learn how to learn). Conclusions The findings of this study support and indicate that peer tutoring is an effective supplementary strategy to promote baccalaureate students' knowledge acquisition, establishing a supportive safety net and facilitating their abilities to learn in the simulation laboratory.

Background The aims of this study were twofold: to explore Chinese health students' perceptions of roles and responsibilities and to explore students' understanding of interprofessional education. Methods A descriptive, qualitative design was used. An inductive approach was used to extract themes from students' statements in a survey with open-ended questions. The National League for Nursing/Jeffries simulation framework and debriefing for meaningful learning were used in the design and implementation of the interprofessional simulation. Result Two themes were "similar perceptions and stereotypes" and "positive learning outcomes." Conclusions Students reported an improved perception of roles and responsibilities. However, the common stereotypes held by students imply that a single simulation-based interprofessional education program was insufficient to facilitate students' accurate role perceptions. Common stereotypes held by students inform the need for health curricula reform in China.

Introduction: Teenage pregnancy is a public health concern. Maternal and neonatal health outcomesare negatively impacted in teenage pregnancy. The objective of the study is to find the prevalence ofteenage pregnancy in a community hospital of rural Nepal. Methods: A descriptive cross-sectional study was conducted at Okhaldhunga Community Hospital,Okhaldhunga, Nepal. Ethical approval was taken from the Institutional Review Committee of thehospital. Data were retrieved from July 2007 to July 2017 from the hospital record books. The total of7054 records of deliveries were reviewed from the hospital records and whole sampling was done.Subgroup analysis was done on basis of age, ethnicity, gravida, para, period of gestation, mode ofdelivery, maternal or neonatal complications and birth weight. Datas were entered and analyzedusing Microsoft Excel. Results: The total of 7054 deliveries were conducted in ten years among which 2050 (29.06%) wereteenage deliveries at the confidence interval of 95% (28.52% - 29.06%). The highest percentage ofteenage delivery was found among Janajati ethnicity of 1056 (53.3%). Amongst teenage delivery, asignificant tear was found in 157 (7.9%) as a maternal complication. Perinatal deaths were found in27 (1.4%). The cesarean section rate was 839 (11.9%) among all deliveries. Conclusions: The trend of teenage pregnancy remains almost same over ten years in theOkhaldhunga Community Hospital. The overall prevalence of teenage delivery is higher than thenational figure. Low birth weight babies, premature delivery, perineal and cervical tears were thecommon complications. Further health education and awareness programs might help to reduce theteenage pregnancy rate.

This study was designed to investigate the association of quality of life, perceived stigma, and medication adherence among Chinese patients with schizophrenia, and to ascertain the predictors of quality of life. A cross-sectional correlation study was conducted with 146 participants. All participants completed self-report scales: the Schizophrenia Quality of Life Scale, Link's Stigma Scale, and the Morisky Medication Adherence Scale. Pearson parametric correlations and stepwise multiple regressions were performed. The total quality of life score and psychosocial subscale was significantly positively correlated with perceived stigma, coping orientation of withdrawal, and feelings of stigma, and negatively correlated with age and medication adherence. The means of all subscale scores except perceived devaluation-discrimination and different/guilty feelings were significantly higher than the midpoint of 2.5. The best predictors of quality of life and psychosocial domains were stigma-related feelings: feeling misunderstood, feeling different/shame, and age. Our findings suggest that an individual's negative emotional response may strengthen internalized stigma and decrease quality of life. As the best predictor, age indicated that adaptation to mental illness may relieve perceived stigma and achieve favorable quality of life.

Q-methodology was used to investigate the health beliefs of Chinese clinical nurses and nurse academics. Twenty-eight participants from one hospital and nursing school in China were involved. The four stages of this study included: (i) concourse development from literature review, Internet searches, and key informant interviews; (ii) A pilot study to develop the Q-sample from the concourse; (iii) participants sorted the Q-sample statements along a continuum of preference (Q-sorting); and (iv) PQ data analysis using principal component analysis and varimax rotation. Five viewpoints were revealed: (i) factor 1--health management and the importance of evidence; (ii) factor 2--challenging local cultural belief, and Eastern and Western influences; (iii) factor 3--commonsense; (iv) factor 4--health and clinical practice; and (v) factor 5--health and nursing education. This study presents a need for nurses and nurse academics to think critically, examine their long-held health beliefs, and promote the use of evidence-based practice.

We aimed to assess the quality of life (QOL) of the patients with cervical cancer after initial treatment, the factors affecting QOL and their clinical relevance. A total of 256 patients with cervical cancer who visited Zhongnan Hospital of Wuhan University from January 2017 to December 2017 were enrolled in this study. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 item (EORTC QLQ-C30) and cervical cancer module (EORTC QLQ-CX24) was used to assess the QOL of patients. More than half of the patients with cervical cancer reported an excellent QOL. Symptoms mostly experienced were insomnia, constipation, financial difficulties, and menopausal symptoms. Global QOL and social functioning were statistically associated with education level, occupation, the area of living, family income and treatment modality. Similarly, role functioning showed significant association with the stage of cancer, treatment modality and time since diagnosis. The rural area of living and poor economic status of the patients with cervical cancer has a negative impact on overall quality of life. Younger and educated patients are more worried about sexuality. Patients treated with multiple therapies had more problems with their QOL scales than patients treated with surgery only.

Background Cervical cancer is the most common cancer among women in Nepal. The prevalence of human papillomavirus (HPV) 16 and or HPV 18 among women with cervical pre-cancer and cancer is higher than the incidence of HPV in the world population. The population-based epidemiological data of HPV in the general population in most parts of the country remains unknown. The objective of this study was to assess the prevalence and type distribution of HPV infection and association of abnormal cytology with high risk HPV infection among women in mid-western rural, Nepal. Methods A population-based cross sectional study was conducted in Jumla, one of the most remote districts in Nepal. A total of 1050 cervical samples were collected from married and non- pregnant women aged 20–65 years during mobile Cervical Cancer Screening Clinics conducted from May 2016 to January 2017. The presence of HPV DNA was firstly confirmed by HPV consensus PCR using PGMY09/PGMY11 designed primers, then HPV positive samples were further genotyped by the membrane hybridization method to detect the 21 high-risk HPV (HR-HPV) and low-risk HPV types. The prevalence of HR-HPV among women with normal and abnormal cytology was calculated. Data were analyzed using SPSS software for Windows. P

Introduction: Worldwide breast cancer is the common invasive cancer among the females. The quality of life of women after treatment, which is often a mastectomy, is frequently decreased. Objective: To determine the life quality of Nepalese women post mastectomy. Materials and Methods: One hundred seven women after a mastectomy were selected and interviewed by using the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and its Breast Specific Module to assess women’s quality of life. Result: The study findings revealed a good score on global health status/quality of life. The respondents performed well on functional and symptom scales. In the Breast Specific Module, all respondents performed poor regarding sexual function and sexual enjoyment. Global Health Status was found useful among the women involved in service/business/agriculture and the survivors using breast prosthesis. In Breast Specific Module, systemic therapy side effects showed strong statistical associations with age, marital status, occupation, education, use of breast prosthesis and co-morbidity. Body image was highly significant with age, occupation, education, use of breast prosthesis and co-morbidity. Conclusion: Based on the study findings, counseling, and a structured educational programme is recommended to improve the QOL of women after a mastectomy.

There are few studies about how healthcare decisions are made for women with breast cancer in China and this knowledge is vital, both to further develop person-centered health care and to ensure that women have a voice in their healthcare decisions. This phenomenological study explored the meaning of women's lived experiences of making healthcare decisions about their breast cancer in China. Semistructured, in-depth interviews were conducted with a purposive sample of eight women with breast cancer. Data were analyzed using Colaizzi's phenomenological analytic method. The results of this study identified four themes: authority and expertise, lack of knowledge, family support, and Chinese cultural and social influences. Women were deferential to medical authority and perceived expertise, but they wanted to be involved to a greater degree in healthcare decisions. It is important for health professionals to optimize women's participation in decision-making by removing barriers and advocating on their behalf.

© 2015 Elsevier Ltd. Healthcare is dynamic and complex, and against this background, nursing students must negotiate the transition from lay person to healthcare professional. Diverse life experiences and learning styles can further complicate this journey of transformation. The contemporary role of the nurse includes caring for and making clinical decisions about patients based on ethical principles. Learning about and integrating ethical comportment as part of the transformative journey requires nurse educators to create and implement learning experiences that challenge nursing students to think deeply and broadly about the experiences they encounter, to question their previous assumptions and prejudices, to consider the world of healthcare through a new lens, and to reflect on and learn from the process. The judicious use of film has the potential to assist students to recognize and develop ethical comportment as they prepare for real-world clinical practice experiences. In this paper, we present three film exemplars and related teaching strategies designed to facilitate transformative learning and development of ethical comportment.

Objective To examine the effectiveness of music listening on pain, anxiety, and vital signs among patients after thoracic surgery in China. Design and setting A randomized controlled clinical trial was conducted in the thoracic surgery department of two tertiary hospitals in Wuhan, China. 112 patients were recruited and randomly assigned to either experimental ( n =56) or control ( n =56) group respectively. Intervention The experimental group received standard care and a 30-min soft music intervention for 3 days, while the control group received only standard care. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate), patient controlled analgesia, and diclofenac sodium suppository use. Results The experimental group showed statistically significant decrease in pain, anxiety, systolic blood pressure and heart rate over time compared to the control group, but no significant difference were identified in diastolic blood pressure, respiratory rate, patient controlled analgesia and diclofenac sodium suppository use. Conclusion The findings provide further evidence to support the practice of music therapy to reduce postoperative pain and anxiety, and lower systolic blood pressure and heart rate in patients after thoracic surgery in China.

Summary Background While Asia has the dubious distinction of being the world's most natural disaster-prone area, disaster nursing education and training are sparse in many Asian countries, especially China where this study took place. Objective To explore the earthquake disaster experiences of Chinese nurses and develop a substantive theory of earthquake disaster nursing that will help inform future development of disaster nursing education. Design A qualitative study employing grounded theory, informed by symbolic interactionism. Participants and Setting Fifteen Chinese registered nurses from five hospitals in Jiangxi Province who undertook relief efforts after the 2008 Wenchuan Earthquake. Methods Data were collected in 2012–2013 in digitally-recorded, semi-structured, in-depth interviews and reflective field notes, and analyzed using Glaser's grounded theory method. Results Participants were unprepared educationally and psychologically for their disaster work. Supporting the emergent theory of “working in that terrible environment”, was the core category of “turning into a strong nurse”, a process of three stages: “going to the disaster”; “immersing in the disaster”; and “trying to let disaster experiences fade away”. The participants found themselves thrust in “terrible” scenes of destruction, experienced personal dangers and ethical dilemmas, and tried the best they could to help survivors, communities and themselves, with limited resources and confronting professional work. Conclusions Our rich findings confirm those of other studies in China and elsewhere, that attention must be paid to disaster education and training for nurses, as well as the mental health of nurses who work in disaster areas. Emergent theory helps to inform nurse educators, researchers, leaders and policy makers in China, and elsewhere in developing strategies to better prepare nurses for future disasters, and assist communities to prepare for and recover after earthquake disasters.

A cross-sectional study was carried out to explore the knowledge level of newborn care and to investigate the relationship between newborn-care knowledge and selected demographic variables among primiparous mothers. It was carried in outpatient department of a maternity and women's hospital in Kathmandu, Nepal with 276 primiparous mothers between 38 and 42 weeks of gestation. Data were collected during the antenatal period with using two instruments: the Newborn-care Knowledge Questionnaire and State-Trait Anxiety Inventory for Adults. Participants had a moderate level of knowledge on newborn care (56%), and among its four components, participants had lowest knowledge in breastfeeding (44%) and adequate knowledge (78%) of immunization. Maternal education and socioeconomic status had a significant, positive association with newborn-care knowledge. Newborn-care knowledge was strongly predicted by anxiety. This is the first study to examine the maternal levels of knowledge of newborn care in Nepal. This study identified specific knowledge gaps in newborn care among primiparous mothers. Moreover, the results suggest the need of maternal-education programs in improving the health and well-being of mothers and newborns.

BACKGROUND: Globally, nurses becoming more aware of getting better prepared for disaster relief, but in China, disaster nursing knowledge, courses and research are still limited. INTRODUCTION: China has long been prone to disasters, but disaster nursing education and training is in its infancy. AIM: This study explored the skills, knowledge and attitudes required by registered nurses from across China who worked in the aftermath of three large earthquakes to try to determine future disaster nursing education requirements. METHOD: The Questionnaire of Nurses' Disaster Nursing Skills at Earthquake Sites, assessing nursing skills, knowledge and attitudes, was distributed to 139 registered nurses in 38 hospitals in 13 provinces across China who had worked in one or more earthquake disaster zones. Descriptive statistics were used for quantitative data, and content analysis for qualitative data. RESULTS: Eighty-nine questionnaires were returned, a response rate of 68.3%. No respondent had ever received specific disaster nursing training prior to their post-earthquake nursing. Skills most often used by respondents were haemostasis bandaging, fixation, manual handling, observation and monitoring, debridement and dressing, and mass casualty transportation. Respondents identified that the most important groups of skills required were cardiopulmonary resuscitation; haemostasis, bandaging, fixation, and manual handling; and emergency management. They emphasized the need for psychological care of victims as well as that of fellow health workers. CONCLUSION: No respondent had ever received disaster nursing training prior to engagement at the earthquake disaster sites. All believed that there were important gaps in their knowledge and skills, and supported disaster nursing courses in the future. IMPLICATIONS FOR NURSING AND HEALTH POLICY: China urgently needs to develop disaster nursing courses, with the support of nurse leaders, educationalists and government, to implement training using an all hazards approach in accordance with international best practice and trainees' background clinical experience and knowledge. Language: en

Examination of the relationship between patients' coping style, pregastroscopy information, and anxiety associated with gastroscopy in China was the aim of this study. A pretest, post-test, nonrandom assignment study with a two by two design was conducted. One hundred forty-five patients who underwent initial gastroscopy without sedation were classified into 2 groups on the basis of the coping style: information seekers or information avoiders using the Information Subscale of the Krantz Health Opinion Survey (KHOS-I). All participants were given standardized procedural information about gastroscopy as routine care. Half of each group was assigned to receive additional sensory information describing what sensation they would experience and how to cooperate to alleviate the discomfort. State anxiety assessed by the State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory, blood pressure, and pulse were measured at enrollment and before gastroscopy. The information seekers and avoiders who received additional sensory information experienced significantly less state anxiety after the intervention. In contrast, the information seekers and avoiders who received standardized procedural information maintained their preintervention state anxiety level. Most patients reported their preference for sensory information. In conclusion, the provision of sensory information could significantly reduce patients' pregastroscopy anxiety regardless of patients' information coping style.

Objective: To find out the knowledge, attitude, practice, and barriers of cervical cancer screening in mid-western rural, Nepal. Methods: A hospital-based cross-sectional study was conducted. Women aged 20 or more were interviewed using a structured questionnaire regarding the socio-demographic information, knowledge, attitude, practice, and barriers to the cervical cancer screening. Results: Total of 360 participants were recruited for this study, mean age was 30.13±10.4 years. More than 87% of participants had inadequate knowledge, but around 72% had a favorable attitude towards cervical cancer screening. There was a significant portion of women (86.4%) had never done any cervical cancer screening test. Despite being higher literacy rate of Brahmin and Chhetri ethnic group, they were less likely to attend the cervical cancer screening than Dalit and Janajati (p

Aim To understand Chinese nurses’ perceptions of health beliefs, their content, origin and the influence of sociocultural factors, as a basis of their evidence-based practice. This study contributes to a larger study to establish the health beliefs of Japanese, Australian, Chinese, South Korean and Thai nurses. Background Registered nurses teach patients and students about maintaining or attaining health are subject to the same range of influences and their health beliefs may be antithetical to current health evidence. Methods Q-method design using q-sort and interview was used to explore the perspectives on a range of health beliefs of 60 nurses in four cities in China. Findings Three factors arose from the perceptions of the participants about health and accounted for 50.2% of the total variance: (1) social impact, (2) ‘the importance of evidence’, and (3) beliefs rooted in culture. Discussion Influence on nurses’ health beliefs was explored in terms of the internalized and frequently unconscious beliefs, values and norms tying them to their communities, reflecting the need for nurses to be aware of their health beliefs and behaviours. Conclusions Education for nurses in practice needs to acknowledge that individual practitioners’ beliefs strongly influence health teaching for patients and families. In order to implement evidenced-based practice and teach in line with current evidence nurses need to critically examine and reflect on the impact of culture, society and the media on their own health beliefs. Implications for nursing policy and health policy Education policy needs to consider that culture and societal pressures affect nurses’ health beliefs and practice. Critical thinking, reflective and evidence-based practice need to be emphasized in clinical training and nurse education. China also needs to develop policies to allow nurses to be able to assess the reliability of health information on the Internet and to make quality health research more available.

OBJECTIVE Workplace violence and its impact on mental health nurses have yet to be thoroughly explored in China. This study aims to investigate the incidence, type, related factors, and effects of workplace violence on mental health nurses as well as identifying coping strategies. METHODS A researcher - designed workplace violence questionnaire and the Maslach Burnout Inventory-General Survey were distributed to nurses at a mental health hospital in Wuhan, China. RESULTS Most nurses reported a high incidence of workplace violence (94.6%) in the past year ranging from verbal aggression, sexual harassment, to physical attack. The forms of violence significantly correlated with each other (r > 0.5, p = 0.000). Working on the psychiatric intensive care unit for adult males and being a male nurse placed nurses at significantly higher risk for workplace violence. Providing routine treatment, caring for male patients, and working the night shift increased the risk of sexual harassment. Nurses who believed that workplace violence was preventable experienced a significantly lower incidence of violence. Burnout levels of the mental health nurses were relatively mild, but increased with age, professional title, years of employment and frequency of workplace violence. CONCLUSION The incidence of workplace violence among mental health nurses is common, and its frequency is correlated with nurses' level of burnout. Management and clinical nurses should work together on an organization-wide strategy targeting the major identified risk areas to reduce the incidence of workplace violence and minimize its impact on nurses.

Aim To explore nurses' perspectives about the Samoan Philosophy of Nursing, and determine its feasibility for nursing care of Samoans internationally. Background This philosophy is the conceptual cultural framework for nursing law, practice, education and research in Samoa, and was developed by Samoan nurses who recognized the need for guidance to deliver quality, culturally competent and proficient health care. Design A mixed method study, employing a questionnaire and ethnographic methods. Method The Samoan Philosophy of Nursing Questionnaire sought demographic data and aspects about the philosophy from 95 registered nurse clinicians, administrators and educators throughout Samoa during 2012. Descriptive statistics were used for data analysis. Additionally, 19 focus groups (5–6 participants each) and 19 in-depth interviews were held to further explore these aspects, as well as participant observations. Descriptive statistics were used to analyse quantitative data, and Spradley's ethnographic method was adopted for analysing the qualitative data. Findings Of 95 questionnaires analysed, 70% of participants reported using the philosophy all the time, and 30% most of the time. They placed a high satisfaction rate, value and importance on this philosophy. From the ethnography, six major themes emerged: valuable framework of learning; conceptual framework for holistic assessment; benchmark for regulating and monitoring practice improving interaction and culturally proficient practice; potential use for Samoans overseas; and maintaining quality health and the dignity of people. Conclusion This first-time study evaluated the Samoan Philosophy of Nursing and adds to nursing knowledge. Findings confirmed its usefulness as a culturally based conceptual framework to facilitate, regulate and monitor education, research and practice for sustainable health outcomes in Samoa, and for Samoans living abroad. Implications for nursing policy and education It is important that Samoans living abroad receive culturally proficient care, but this requires the support of policymakers, nurse leaders and educators so that nurses internationally can access and competently utilize relevant aspects of this philosophy in practice.

This review describes the traditional ancient Chinese postpartum practice of "doing the month" or "zuoyuezi", the evidence for specific practices, maternal adherence to practices, and their effect upon the maternal postpartum physical and psychological health. A comprehensive search yielded 38 English or Chinese publications about common practices, adherence to practices, and their effects upon Chinese women's physical and psychological health. Doing the month involves a series of practices related to the maternal role, physical activity, maintenance of body warmth, and food consumption that are believed to restore maternal postpartum health and prevent future disease. Strengths of these practices include acknowledgment of the woman's societal and familial contribution to childbearing and the provision of consistent family support. There is concern for the effect of some practices upon both maternal physical and psychological health, particularly for postpartum depression. Current evidence about the effects of doing-the-month practices upon maternal health needs to be integrated into the traditional practices of doing the month to improve maternal health.

Background: Prevalence of osteoporosis (OP) is high among Chinese adults with diabetes. Assessment of OP and fracture risk as well as patient education should be included as part of the management of diabetes. Purpose: The purpose of this pilot study was to test the effectiveness of an educational self-efficacy intervention on knowledge about OP, dietary calcium intake, the importance of physical activity (PA), and glycemic control among Chinese adults with type 2 diabetes residing in Wuhan, China. Method: A quasi-experimental design with repeated measures was employed. Participants were assigned to either the intervention ( n = 23) or the control group ( n = 23). Intervention participants attended 6 weekly 1-hr educational sessions comprising presentations, demonstration, and discussions. Control participants received standard care. Data were collected via questionnaires at pre- and postintervention and at 3-month follow-up, and blood was drawn at preintervention and 3-month follow-up. Results: Participants in the intervention group had significant improvement in OP knowledge, F(2, 43) = 11.504, p < .001; OP self-efficacy, F(2, 43) = 6.915, p = .003; dietary calcium intake, F(2, 43) = 7.856, p = .002; level of PA, F(2, 43) = 4.787, p = .011; diabetes self-care activities, F(2, 43) = 14.009, p < .001; diabetes self-efficacy, F(2, 43) = 19.722, p < .001; and glycemic control (A1C level; t = 2.809, p = .010) compared to the control group at the 3-month follow-up. Conclusion: The results demonstrate the effectiveness of OP prevention education based on self-efficacy theory among Chinese adults with type 2 diabetes.

Background There is little research on the use of simulation in Chinese nursing education. This research was focused on the effects of using simulation in promoting a range of outcomes among Chinese nursing students in a baccalaureate nursing program in China. Method In this descriptive study of 50 sophomore students, three instruments were translated and evaluated to determine the identified outcomes. Results The students were satisfied with the simulation, and their confidence level was increased after participating in the simulation activity. Best practices were thought to be embedded in the simulation. Conclusion This study showed that simulation is an effective teaching strategy for Chinese nursing students.

Background High-fidelity simulation has been demonstrated to be an efficient teaching method, although high-fidelity manikins are more expensive than low- or moderate-fidelity simulation manikins. This study was designed to explore differences in outcomes related to use of moderate-fidelity versus high-fidelity simulations in Chinese nursing education. Method A comparative, quasi-experimental design was employed among 59 junior students in a BSN program in the People's Republic of China. Results The moderate-fidelity simulation received significantly higher scores in students' satisfaction and self-confidence ratings, while the high-fidelity simulation showed better implementation of the simulation design elements. Conclusion Both simulation methods had beneficial outcomes for students. There is a need for additional research evaluating these simulation interventions.

AIM: To determine the effectiveness of an educational intervention for improving nurses knowledge and practice regarding newborn care in Kathmandu Nepal. BACKGROUND: Four million neonatal deaths occur annually especially in developing countries. In 2010 in Nepal the neonatal mortality rate was 28/1000 births. Modern nursing and research education is still developing in Nepal but the countrys nurses are in a unique position to help combat avoidable morbidity and mortality. This study was designed to assist nurses working in maternity units to obtain and/or sustain knowledge and competence in practice to ensure the health and safety of vulnerable newborns and thereby to help reduce mortality and morbidity. THEORETICAL FRAMEWORK: Concepts from the Transtheoretical Model of behaviour change developed in the USA informed this study in the belief that an educational intervention would assist in behaviour changes in nurses caring for newborns. DESIGN: Quasi-experimental time-series pre-test/post-test. SETTING: Maternity and womens hospitals in Kathmandu Nepal. PARTICIPANTS: Convenience sample of 30 nurses working in emergency room delivery room and birthing centre. METHODS: Nurses were measured on study outcomes at multiple time points: before a self-directed educational intervention and discussion immediately 1 and 3 months after intervention. Data were collected using three instruments: a demographics questionnaire the Knowledge Survey Questionnaire and the Skills Learning Checklist (SLC). The SLC was completed during nursing practice in observations by the researcher. RESULTS: Significant findings suggested that this educational intervention was effective for improving nurses knowledge and practice regarding newborn care and there was a positive correlation between knowledge and practice. CONCLUSION: This was the first study of its kind in Nepal a small step in enhancing nurses abilities to improve their knowledge and competence regarding care of newborns. However continued education and guidance are required to sustain knowledge and competence in practice and our educational intervention needs further testing with other populations of nurses. There are various policy implications required to enable this to happen. This includes health ministry funding and support for in-service education; hospitals and universities working together to offer in-service education competency testing and revised curricula; and nurse registering authorities requiring ongoing nurse education programmes and competency testing. (c) 2013 The Authors. International Nursing Review (c) 2013 International Council of Nurses.

Objective: Nurses, who are indispensable constituents of first responders, should be equipped to respond in a disaster. This study evaluated the effectiveness of a course to prepare undergraduate nursing students for disaster response. Methods: The course included three-hour overviews, one-hour case studies, and a three-hour disaster drill with six simulation skill stations among 120 junior nursing students. To measure education practice, simulation design, and outcomes embedded in the Jeffries’ framework, three Chinese-version self-evaluation scales designed by the National League for Nursing (NLN) were used. In addition, facilitators’ observation of student performance skills, two group interviews and one feedback questionnaire were utilized. Results: Of the three self-evaluation scales, the Simulation Design Scale and Educational Practices Questionnaire indicated that the simulation design was effective and promoted students’ learning practices. The Satisfaction and Self-Confidence Scale demonstrated satisfaction with current learning (4.39±0.46) and self-confidence in learning (4.27±0.53). Facilitator observation and group interviews revealed that most students need more time to prepare and practice for the disaster nursing drills. Conclusions: The study indicated that students were interested in the disaster nursing drill and satisfied with the diverse teaching methods and the motivating teaching materials used in the simulation. Simulation as a teaching strategy was an effective approach to improve team-work, active learning, problem-solving, satisfaction level and self-confidence during the disaster nursing drill. It is essential for nurse educators to provide disaster training programs for nursing students to prepare them for an active role in disaster response.

Background the health and survival of newborns depend on high levels of attention and care from caregivers. The growth and development of some infants are unhealthy because of their mother's or caregiver's lack of knowledge or the use of inappropriate or traditional child-rearing practices that may be harmful. Objective to develop a newborn care educational programme and evaluate its impact on infant and maternal health in Nepal. Design a randomised controlled trial. Participants one hundred and forty-three mothers were randomly assigned to the intervention (n=69) and control (n=74) groups. Eligible participants were primiparous mothers who had given birth to a single, full-term, healthy infant, and were without a history of obstetric, medical, or psychological problems. Methods prior to being discharged from the postnatal unit, the intervention group received our structured newborn care education programme, which consisted of one-on-one educational sessions lasting 10–15minutes each and one postpartum follow-up telephone support within two weeks after discharge, in addition to the hospital's routine general newborn care education. The control group received only the regular general newborn care education. Outcomes were measured by using Newborn care Knowledge Questionnaires, Karitane Parenting Confidence Scale, State-Trait Anxiety Inventory for Adults and infant health and care status. Findings the number of mothers attending the health centre due to the sickness of their babies was significantly decreased in the intervention group compared to the control group. Moreover, the intervention group had significant increases in newborn care knowledge and confidence, and decreases in anxiety, compared with the control group. Conclusions the structured newborn care education programme enhanced the infant and mother health. Moreover, it increased maternal knowledge of newborn care and maternal confidence; and reduced anxiety in primiparous mothers. Thus, this educational programme could be integrated into routine educational programs to promote maternal and infant well-being in Nepalese society.

In this study, we established design feasibility and evaluated the effects of cognitive behavior therapy provided to individuals with Parkinson's disease. A single-group interrupted time series design was used in this pilot study. Analyses were conducted on 22 participants, who provided data at pretest, post-test, and 3 month follow up. At each time point, participants completed a sleep diary and Parkinson's disease sleep scale. There was a significant difference between pretest and post-test (P

BACKGROUND: In recent years, with the rapid development of nursing in China, the number of undergraduate nursing students has increased significantly. As professional perception has a great influence on the development of nursing students and the future quality of nursing, exploring factors that influence this perception are very important. AIM: To describe undergraduate nursing students' attitudes towards nursing and to explore if their perceptions of nursing are influenced by demographic characteristics, clinical experience and/or different curriculum designs. METHODS: A cross-sectional descriptive study was carried out in two nursing schools: one with a traditional curriculum and one that had undertaken curriculum reform. Following institutional approval, 176 (92.6%) of the targeted population of 190 students responded to a demographic questionnaire with two semi-structured questions and the Attitude Towards the Nursing Profession Scale. The results were analysed using descriptive statistics, t-test and Spearman correlation analysis. FINDINGS: No correlations were found between nursing students' attitudes towards nursing and their demographic characteristics. Clinical experience apparently had no impact on nursing students' professional perception. However, the curriculum design appears to play an important role in forming the students' attitudes towards nursing. Significant implications and suggestions for nursing educators and nursing managers are presented.

Limited research exists on the workplace and personal factors that might be associated with the physical and mental health of nurses working in China. Therefore, the purposes of this study were to examine, in Chinese hospital nurses, the most frequently occurring workplace stressor, the most often used coping strategy, and the relationships that exist among workplace stressors, coping strategies, psychological hardiness, demographic characteristics, and physical and mental health. Four-hundred-and-eighty hospital nurses from five hospitals in three major Chinese cities were administered five self-report questionnaires. The findings indicated the most frequently cited workplace stressor was workload, while the most commonly used coping strategy was positive reappraisal. Numerous positive and negative correlations were found, suggesting the importance that workplace stress, coping strategies, psychological hardiness, and demographic characteristics play in relationship to each other, as well as to both the physical and mental health of Chinese nurses.

Review of literature: Prior research has suggested that nurses contend with a variety of workplace stressors and personal factors that can contribute either positively or negatively to their physical and mental health. However, limited research in this area has been conducted on nurses within China. Aim: The study sought to determine in Chinese hospital nurses: (a) the most common workplace stressors, (b) the most frequently used ways of coping with stress, and (c) which combination of variables (workplace stressors, ways of coping, psychological hardiness and demographic characteristics) was the best predictor of both physical health and mental health. Methods: The subjects were 480 nurses working in a variety of clinical settings, within five hospitals, located in three major mainland Chinese cities. A survey design was implemented using five self-report instruments. Results: Workplace stressors most frequently identified were workload and dealing with death and dying. Ways of coping most often cited were positive reappraisal, self-control and planful problem solving. The best predictors of physical health were psychological hardiness, conflict with other nurses, uncertainty about patient treatment, seeking social support and confrontive coping. The best predictors of mental health were psychological hardiness, conflict with other nurses, workload, seeking social support, age, likelihood to leave nursing within the next 12 months and escape–avoidance coping. Discussion: These findings suggest areas of concern that need to be addressed, by both hospital and nursing administration, in order to establish a positive and productive work environment for Chinese nurses.

Research evidence suggests that educating nurses about traditional Chinese medicine (TCM) significantly improves their nursing care practice and the health care outcomes of community residents. The purpose of this study was to describe the current use of TCM by China's nursing workforce, as well as the typical nurse to physician ratio and types of TCM education that nurses receive in health care facilities. A large retrospective survey was conducted in Hubei Province, China, in 2010. The sample included 620 non-TCM hospitals, 120 TCM hospitals, and 1254 community health centers (CHCs). Descriptive analysis and 1-way analysis of variance were used to test statistical differences. There were 79 447 nurses employed, of which 1527 had a TCM degree and 5689 had on-the-job TCM education. Non-TCM hospitals employed more nurses than TCM hospitals and CHCs, and TCM hospitals employed more TCM nurses than non-TCM hospitals and CHCs. The median nurse to physician ratio varied by level of urbanization and type of health care facility, from 0.6 in rural CHCs to 1.3 in rural non-TCM hospitals. Differences in TCM education preparation of nurses were significantly different in the urban and rural settings and by type of health care facility. The study suggested a shortage of nurses educated in TCM in Hubei Province China, as well as uneven TCM workforce distribution. More opportunities for TCM education are needed for nurses, especially in CHCs where health promotion and chronic disease management are the most important and mandated functions.

This study was designed to investigate the association of quality of life, perceived stigma, and medication adherence among Chinese patients with schizophrenia, and to ascertain the predictors of quality of life. A cross-sectional correlation study was conducted with 146 participants. All participants completed self-report scales: the Schizophrenia Quality of Life Scale, Link's Stigma Scale, and the Morisky Medication Adherence Scale. Pearson parametric correlations and stepwise multiple regressions were performed. The total quality of life score and psychosocial subscale was significantly positively correlated with perceived stigma, coping orientation of withdrawal, and feelings of stigma, and negatively correlated with age and medication adherence. The means of all subscale scores except perceived devaluation-discrimination and different/guilty feelings were significantly higher than the midpoint of 2.5. The best predictors of quality of life and psychosocial domains were stigma-related feelings: feeling misunderstood, feeling different/shame, and age. Our findings suggest that an individual's negative emotional response may strengthen internalized stigma and decrease quality of life. As the best predictor, age indicated that adaptation to mental illness may relieve perceived stigma and achieve favorable quality of life.

The community-based mental health services were encouraged to improve the quality of life for individuals with chronic mental disorders in Mainland China. This study aims to explore how the quality of life, perceived stigma, and medication adherence differ among a Chinese population with schizophrenia prior to and one-month following discharge.One hundred and twenty-eight Chinese people with schizophrenia completed the self-report scales: the Schizophrenia Quality of Life Scale (SQLS), the Link' Stigma Scale, and the Morisky Medication Adherence Scale (MMAS-8) prior to discharge and at one month after discharge. Data were analyzed using descriptive statistics and a paired sample t-test.The findings of SQLS demonstrate deterioration on psychosocial and motivation/energy domain (P0.001) accompanied by improvement of symptom/side effect (P0.05) after discharge. The scores of perceived stigma and actual stigma coping orientations (P0.001) after discharge were found to be significantly higher than before discharge. Medication adherence was significantly reduced after discharge than before discharge (P0.001).The results of this study provide implications for clinical practices, such as provision of psychosocial and educational rehabilitation programs for individuals who are in a stable mental status and plan to discharge; and to provide effective family education in order to improve family coping strategies and caring capabilities when patients return to the community. The findings provide important policy implications as well to facilitate individuals with schizophrenia to reintegrate into the community and benefit from a favorable QOL.

There are few studies about how healthcare decisions are made for women with breast cancer in China and this knowledge is vital, both to further develop person-centered health care and to ensure that women have a voice in their healthcare decisions. This phenomenological study explored the meaning of women's lived experiences of making healthcare decisions about their breast cancer in China. Semistructured, in-depth interviews were conducted with a purposive sample of eight women with breast cancer. Data were analyzed using Colaizzi's phenomenological analytic method. The results of this study identified four themes: authority and expertise, lack of knowledge, family support, and Chinese cultural and social influences. Women were deferential to medical authority and perceived expertise, but they wanted to be involved to a greater degree in healthcare decisions. It is important for health professionals to optimize women's participation in decision-making by removing barriers and advocating on their behalf.

Q-methodology was used to investigate the health beliefs of Chinese clinical nurses and nurse academics. Twenty-eight participants from one hospital and nursing school in China were involved. The four stages of this study included: (i) concourse development from literature review, Internet searches, and key informant interviews; (ii) A pilot study to develop the Q-sample from the concourse; (iii) participants sorted the Q-sample statements along a continuum of preference (Q-sorting); and (iv) PQ data analysis using principal component analysis and varimax rotation. Five viewpoints were revealed: (i) factor 1--health management and the importance of evidence; (ii) factor 2--challenging local cultural belief, and Eastern and Western influences; (iii) factor 3--commonsense; (iv) factor 4--health and clinical practice; and (v) factor 5--health and nursing education. This study presents a need for nurses and nurse academics to think critically, examine their long-held health beliefs, and promote the use of evidence-based practice.

An increasing number of foreign students, especially those of Asian ethnicity, are enrolling in graduate nursing programs in the United States. The transition of these students into graduate nursing programs is not always easy. While a language difference may pose difficulties, a more crucial problem is the difference that often exists between the basic educational nursing preparations of Asian and American graduate students. Some Asian-educated students entering graduate nursing programs may not be prepared to the same degree as their U.S.-educated counterparts. This article presents some of the critical differences in educational philosophy, nursing faculty, types of nursing programs, admission criteria, nursing classroom and clinical experiences, and professional licensure that exist between Japan and the United States. Recommendations are proposed that could help mitigate some of these differences and facilitate the transition of Japanese graduate nursing students into the U.S. educational system.

A cross-sectional study was carried out to explore the knowledge level of newborn care and to investigate the relationship between newborn-care knowledge and selected demographic variables among primiparous mothers. It was carried in outpatient department of a maternity and women's hospital in Kathmandu, Nepal with 276 primiparous mothers between 38 and 42 weeks of gestation. Data were collected during the antenatal period with using two instruments: the Newborn-care Knowledge Questionnaire and State-Trait Anxiety Inventory for Adults. Participants had a moderate level of knowledge on newborn care (56%), and among its four components, participants had lowest knowledge in breastfeeding (44%) and adequate knowledge (78%) of immunization. Maternal education and socioeconomic status had a significant, positive association with newborn-care knowledge. Newborn-care knowledge was strongly predicted by anxiety. This is the first study to examine the maternal levels of knowledge of newborn care in Nepal. This study identified specific knowledge gaps in newborn care among primiparous mothers. Moreover, the results suggest the need of maternal-education programs in improving the health and well-being of mothers and newborns.

Disasters require well trained nurses but disaster nursing education is very limited in China and evidence is urgently required for future planning and implementation of specialized disaster education. This describes the themes arising from narratives of Chinese registered nurses who worked in disaster relief after two major earthquakes. In-depth interviews were held with 12 registered nurses from Hubei Province. Riessman's narrative inquiry method was used to develop individual stories and themes, and socio-cultural theory informed this study. Five themes emerged: unbeatable challenges; qualities of a disaster nurse; mental health and trauma; poor disaster planning and co-ordination; and urgently needed disaster education. Participants were challenged by rudimentary living conditions, a lack of medical equipment, earthquake aftershocks, and cultural differences in the people they cared for. Participants placed importance on the development of teamwork abilities, critical thinking skills, management abilities of nurses in disasters, and the urgency to build a better disaster response system in China in which professional nurses could more actively contribute their skills and knowledge. Our findings concur with previous research and emphasize the urgency for health leaders across China to develop and implement disaster nursing education policies and programs.

The number of elderly citizens in Samoa is increasing and caregivers are needed to meet the challenge of home care. Nurses provided a low-cost and effective workshop for family caregivers of the elderly. The purposes of the study were to determine a relatively inexpensive method to educate many caregivers; to determine the impact of the workshops on the individual caregivers; to assess the impact on the care given to the elderly as a result of the workshops and to determine potential policy issues related to the elderly for Samoa. The results of this qualitative study indicate information sessions were effective, a support network for the caregivers developed, the quality of care of the elderly improved, community awareness about the needs of the elderly increased, and an interdisciplinary group met to formulate a policy for government action to provide needed services for the elderly.