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Aim s : The objective of this study was to examine the relationship between caregiving burden and pre‐death grief, with a specific focus on adult‐child caregivers in mainland China. Additionally, the study explored whether coping strategies played a mediating role in this correlation. Methods: A convenience sample of 320 adult‐child caregivers of older parents with dementia from Kunming, mainland China, was recruited for the study. Data were collected using the Chinese version of the Marwit‐Meuser Caregiver Grief Inventory‐Short Form, the Burden Scale for Family Caregivers, and the Ways of Coping Checklist‐Revised. Results: Results using linear regression and multiple mediation analysis with Hayes' process model indicated that caregiving burden was positively related to pre‐death grief and that active coping mediated the relationship between them. In the female group, active coping partially mediated the association between caregiving burden and pre‐death grief, but in the male group, this mediating effect did not exist. Conclusion: The study found evidence supporting the link between caregiving burden and pre‐death grief among adult‐child caregivers of older parents with dementia in mainland China. Furthermore, the caregiving burden prevented the use of active coping, and this decrease in coping increased the perception of pre‐death grief. These associations only existed in the female group. Implications: This paper presented the importance of active coping skills in the dementia caregiving process. Impact: The findings of this study emphasize the necessity for health practitioners to provide targeted interventions regarding pre‐death grief among dementia caregivers and strengthen caregivers' active coping strategies to reduce their pre‐death grief. Community‐based and personal care support services should be promoted to alleviate their caregiving burden. Reporting Method: We have adhered to the transparent reporting of evaluations with quantitative design statements and the corresponding checklist was followed. Patient or Public Contribution: 'No patient or public involvement'. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: Loneliness is common among young and middle‐aged stroke survivors. It not only hinders the recovery of their neurological and physical functions but also increases the risk of stroke recurrence, disability, and even death.Improving the mental health of young and middle‐aged stroke survivors is of utmost importance. However, previous research has not yet investigated the impact of interpersonal sensitivity and resilience on the relationship between stigma and feelings of loneliness. What the paper adds to existing knowledge?: This study confirms that stigma has a positive impact on loneliness among young and middle‐aged stroke survivors.Interpersonal sensitivity partially mediates the relationship between stigma and loneliness, and resilience plays a moderating role in the mediating mechanism. What are the implications for practice?: Mental health nurses can formulate nursing interventions to reduce loneliness of young and middle‐aged stroke survivors with the goals of improving stigma, reducing interpersonal sensitivity and cultivating resilience. Introduction: Previous studies have not explored the impact of interpersonal sensitivity and resilience on the relationship between stigma and loneliness. However, improving the resilience of young and middle‐aged stroke survivors and increasing their social participation is of great significance for reducing patients' loneliness of patients and promoting their physical and mental rehabilitation. Aims: To investigate the influence of stigma, interpersonal sensitivity and resilience on loneliness among young and middle‐aged stroke survivors. Methods: A cross‐sectional design was used to collect data. A total of 330 participants completed measures of stigma, resilience, interpersonal sensitivity and loneliness. The descriptive statistical approach, Pearson's correlation analysis and Hayes' PROCESS Macro Model 4 and 7 in regression analysis were used to analyse the available data. Results: The results revealed that young and middle‐aged stroke survivors' stigma, resilience, interpersonal sensitivity and loneliness were significantly correlated between every two variables, with coefficients ranging between −0.157 and 0.682. Interpersonal sensitivity played a partial mediating role in stigma and loneliness, accounting for 63.27% of the total effect; This process was moderated by resilience. Discussion: Stigma positively predicts participants' loneliness. As a mediating mechanism with moderating, interpersonal sensitivity and resilience further explain how stigma affects loneliness. Implications for Practice: Understanding this mechanism is of guiding significance to reduce loneliness of young and middle‐aged stroke patients and promote their physical and mental rehabilitation. [ABSTRACT FROM AUTHOR]

Aims: To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit. Design: Experience‐based co‐design. Methods: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis. Results: Twenty‐three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient–provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow‐up care. Conclusion: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes. Implications for the Profession and/or Patient Care and Impact: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life. Reporting Method: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting. Patient or Public Contribution: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience‐based co‐design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co‐design events, to support symptom management for people with multimorbidity. [ABSTRACT FROM AUTHOR]

Aims: To explore the feasibility and effects of the programme based on information‐motivation‐behavioural skills (IMB) model (IMB programme) on adherence to inhalation therapy and other health outcomes in chronic obstructive pulmonary disease (COPD) patients. Background: Poor adherence to inhalation therapy is common among COPD patients. The IMB model is supported by previous studies as useful in promoting adherence to health behaviours. Methods: This pilot randomized controlled trial randomized 35 COPD patients to receive either the IMB‐based programme or usual care. The 4‐week IMB programme consisted of a face‐to‐face and two telephone sessions to empower patients with skills and knowledge on using inhalation therapy and support their goal attainment for treatment compliance. Outcome evaluation including adherence to inhalation therapy, inhalation techniques, disease impact, and quality of life was conducted at baseline and at 6 weeks after randomization. Feasibility of the IMB programme was evaluated by a satisfaction survey and implementation experience. Results: Thirty patients completed the study, with an attrition rate of 14.3%. The intervention group (n = 15) had significant improvements in inhalation adherence, inhalation techniques, and quality of life than the control group over the evaluation period. Patient satisfaction survey results and observations on programme implementation suggested the feasibility of the IMB programme. Conclusion: A IMB model is a feasible and potentially effective intervention for improving COPD patients' adherence to inhalation therapy. SUMMARY STATEMENT: What is already known about this topic? Information‐motivation‐behavioural skills (IMB) models have produced positive effects on adherence behaviour in patients with acquired immune deficiency syndrome, coronary heart disease, and diabetes. What this paper adds? No study has evaluated the effects of the IMB model on an intervention for adherence behaviour in patients with chronic obstructive pulmonary disease (COPD).The pilot randomized controlled trial (RCT) showed that the IMB model used in the intervention was effective in improving COPD patients' adherence to inhalation regimen and techniques.The pilot study found that the IMB intervention programme was feasible for implementation in outpatient settings and was highly accepted by COPD patients. The implications of this paper: This programme may be effective in improving COPD patients' adherence to inhalation regimen and inhalation techniques.The programme is feasible and acceptable.There is need to conduct an adequately powered multisite RCT to provide stringent outcome evaluation of the IMB intervention programme. [Correction added on 28 January 2020: 'The implications of this paper' section has been amended.] [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe individuals' with type 2 diabetes mellitus sense‐making of blood glucose data and other influences impacting self‐management behaviour. Background: Type 2 diabetes mellitus prevalence is increasing globally. Adherence to effective diabetes self‐management regimens is an ongoing healthcare challenge. Examining individuals' sense‐making processes can advance staff knowledge of and improve diabetes self‐management behaviour. Design: A qualitative exploratory design examining how individuals make sense of blood glucose data and symptoms, and the influence on self‐management decisions. Methods: Sixteen one‐on‐one interviews with adults diagnosed with type 2 diabetes mellitus using a semi‐structured interview guide were conducted from March–May 2018. An inductive–deductive thematic analysis of data using the Sensemaking Framework for Chronic Disease Self‐Management was used. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in completing this paper. Results: Three main themes described participants' type 2 diabetes mellitus sense‐making and influences on self‐management decisions: classifying blood glucose data, building mental models and making self‐management decisions. Participants classified glucose levels based on prior personal experiences. Participants learned about diabetes from classes, personal experience, health information technology and their social network. Seven participants expressed a need for periodic refreshing of diabetes knowledge. Conclusion: Individuals use self‐monitored glucose values and/or HbA1C values to evaluate glucose control. When using glucose values, they analyse the context in which the value was obtained through the lens of personal parameters and expectations. Understanding how individuals make sense of glycaemic data and influences on diabetes self‐management behaviour with periodic reassessment of this understanding can guide the healthcare team in optimising collaborative individualised care plans. Relevance to clinical practice: Nurses must assess sense‐making processes in self‐management decisions. Periodic "refresher" diabetes education may be needed for individuals with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: To explore how emerging adult‐aged women self‐manage their sexual and reproductive health and to generate a grounded theory of these self‐management processes. Design: Grounded theory methods using a constructivist approach. Methods: Between September 2019 and September 2020, 18‑ to 25‐years‐old women (n = 13) were recruited from a 4‐year university, a 2‐year community college, and neighbourhoods surrounding the institutions of higher education. Individual interviews were transcribed verbatim and qualitatively analysed using a constant comparative method and inductive coding. Results: The theory purports that core processes of sexual and reproductive health self‐management used by the women in this study included both passive and (re)active processes. These processes expanded upon and/or maintained the women's accessible sexual and reproductive health knowledge, behaviour and beliefs, defined as the sexual and reproductive health repertoire. The processes appeared to be cyclical and were often initiated by a catalysing event or catalyst and resulted in conversations with confidantes, or trusted individuals. A catalyst was either resolved or normalized by expanding or maintaining the sexual and reproductive health repertoire. Conclusion: The resulting theory, EMeRGE Theory, offers insight into the complex and cyclical processes emerging adult‐aged women use to simultaneously develop and adapt their foundational sexual and reproductive health knowledge, behaviours and beliefs. Implications for the Profession and/or Patient Care: This explication of emerging adult‐aged women's sexual and reproductive health self‐management processes can be used by nurses and nurse researchers to better address this population's unique health needs. Impact: The EMeRGE Theory provides valuable guidance for future exploratory and intervention research aimed at improving the health and well‐being of emerging adult‐aged women. Reporting Method: The authors adhered to the Consolidated Criteria for Reporting Qualitative studies (COREQ) in preparation of this publication. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: To examine the presence of symptom clusters and synergistic effects of symptom clusters on quality of life in rheumatoid arthritis patients. Background: Rheumatoid arthritis patients frequently experience multiple concurrent symptoms of pain, fatigue, and depression. Design A nonexperimental, cross‐sectional correlation design. Methods: The study participants were 179 rheumatoid arthritis patients. Data were collected between August and December 2016. A hypothetical model was developed based on the Theory of Unpleasant Symptoms Model: physiological antecedents included disease activity and obesity; symptoms of pain, fatigue, and depression were hypothesized as being clustered, and quality of life was taken as the outcome variable. Results: Disease activity had significant direct effects on pain, fatigue, and depression and indirect effects on fatigue and depression, whereas obesity had a significant direct effect on fatigue alone. Three symptom clusters, namely, pain fatigue, fatigue depression, and pain‐fatigue depression were identified and found to have significant synergistic effects on quality of life. Conclusions: Our findings support the importance of managing clusters of symptoms simultaneously, that is, collective symptom management. Inter‐cluster dynamics between symptoms should be considered when nurses develop symptom management strategies or self‐management programs to improve the quality of life of rheumatoid arthritis patients. SUMMARY STATEMENTS: What is known about this topic? A symptom cluster is a stable group of different symptoms that co‐occur in association with a specific disease.Rheumatoid arthritis patients frequently experience multiple concurrent symptoms of pain, fatigue, and depression. What this paper adds? The most common and distressing rheumatoid arthritis symptoms of pain, fatigue, and depression were found to co‐occur and to be interrelated, which are the two major criteria of symptom clusters.Three symptom clusters, namely, pain fatigue, fatigue depression, and pain‐fatigue depression, were identified and found to have significant synergistic effects on quality of life. The implications of this paper: Our findings support the importance of managing clusters of symptoms simultaneously, that is, collective symptom management.The complicated intercluster dynamics demonstrated between symptoms in the present study should be considered when nurses develop effective symptom management strategies or self‐management intervention programs to improve the quality of life of rheumatoid arthritis patients. [ABSTRACT FROM AUTHOR]

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

Aim: We tested key hypotheses derived from the Cultural Determinants of Trauma Recovery Theory (CDTR) with an American sample. Design: A cross‐sectional study using anonymous online surveys. Methods: This study was conducted with 225 American survivors of gender‐based violence (GBV) between August to November 2019. Demographics, distress (depression: PHQ8; PTSD: PCL‐5), mental health service utilization (counselling and medication), sense of coherence (SOC), internal barriers to help‐seeking (shame, frozen and problem management subscales: BHS‐TR Internal) and the GBV healing (GBV‐Heal) were used. Structural equation modelling (SEM) was conducted to test the hypotheses. Results: The final SEM model showed that the relationship between distress and mental health service utilization was not mediated by internal help‐seeking barriers; the relationship between distress and trauma healing was partially mediated by internal help‐seeking barriers; the relationship between internal help‐seeking barriers and trauma healing was partially mediated by SOC; mental health service utilization was not significantly associated with trauma healing. Overall, the relationship between distress and trauma healing was partially mediated by internal help‐seeking barriers and SOC. Conclusions: This study confirmed some hypothetical pathways between distress and trauma healing. Further research with larger and international samples should be necessary to test the overall CDTR and compare groups. Impact: This study can help us focus on psychological interventions that enhance meaning and mitigate internal help‐seeking barriers to promote holistic trauma recovery. Public and public contribution: The sample was gathered from a clinical population registry that alerts patients of potential research opportunities. [ABSTRACT FROM AUTHOR]

Aim: First, to identify which aspects of missed care accurately define the integration of care and context of care dimensions of the Fundamentals of Care Framework. Second, to test the Framework for validity and reliability and lastly, to explore how leadership influences care integration. Design: A non‐experimental research design using self‐audit data collected information about variations in nursing care as exemplars for dimensions of the Framework. Methods: A multi‐variate approach using path analysis was used to apply the consensus scores of 3079 Australian residential care nurses and carers to define the dimensions of the Framework. Results/Findings In the Australian residential care setting, the factors that define both the contexts of care and the integration of care dimensions constructs are now empirically established. The most direct predictor for the integration of care dimension arises from both the leadership and resource allocation variables, while the remaining context of care factors have indirect but significant effects. The integration of psychosocial care in the residential care sector is not influenced by any of the Framework's context‐based factors. Conclusion: The component variables of the Framework show both good reliability and convergent validity. These findings confirm a predictive relationship exists between the elements of the context of care and the different types of nursing activities that form the integration of the care dimension, including organizational leadership. [ABSTRACT FROM AUTHOR]

Aim: Although normative and ethical procedures are extremely critical for health care providers, during this unique time, when the pandemic suddenly increased job requirements and workloads, maintaining a morally appropriate working style became an increasingly difficult challenge for nurses. Few previous studies have examined whether these highly increased job demands influence nurses' resource condition, in turn affecting their deviance and task mastery. Designs: In the current study, we proposed a theoretical model examining whether nurses' job demands (the predictor) will affect task mastery and deviance (the outcomes) by increasing resource depletion. Methods: A multiwave field study of 172 nurses from two comprehensive hospitals was conducted to test the proposed theoretical model from April to August 2020. Descriptive statistics, confirmatory factor analyses, correlation coefficients and linear regressions were used to test the hypotheses. Results: The results suggested that even though job demands may temporarily increase nurses' task mastery and decrease their organizational deviance, they ultimately have a negative influence since resource depletion acts as a side effect that suppresses the two direct effects. Conclusion: The theoretical contributions and practical implications of our findings were discussed. Specifically, we suggested that healthcare institutions should provide abundant support for nurses to supplement their resource reserves to avoid the risk of potential medical malpractice. Impact: Practically, this study tried to emphasize the important role of nurses' resource condition. Especially we aimed to remind managers and leaders cannot just improve nurses' job demand to deal with the public health crises. They also need to focus on their resource condition during pandemics. [ABSTRACT FROM AUTHOR]

Among women, cardiovascular disease is the leading cause of mortality worldwide. After experiencing an acute cardiovascular event, a woman's physical health, the prevalence of morbidities, likelihood of being treated with coronary artery bypass graft surgery, likelihood for referral for cardiac rehabilitation are less favourable than men. The social support resources of marginality and religiousness are associated with physical and mental health outcomes following cardiovascular crises. This study aimed to evaluate the reliability and validity of the translated versions (Japanese, Ukrainian, Tagalog, Hispanic and Arabic) of the Koci Marginality Index and the Duke University Religion Index among 282 women (aged 35-92 years) representing seven cultures. Results showed that reliability and validity were strong (coefficient alpha of 0.79 and 0.84). Understanding a woman's social isolation and whether she has a connection to religious groups assists health-care professionals to identify a woman's social support resources during recovery following acute cardiovascular episodes. [ABSTRACT FROM AUTHOR]

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

Aims and objectives: To explore the role of health beliefs in affecting patients' chronic diabetic complication (CDC) screening. Background: Patients' adherence to the guideline‐recommended CDC screening was far from optimal. While many demographic and clinical characteristics were documented to influence patients' adherence, psychological profiles, such as health beliefs, were not well studied before. It is crucial to understand how health beliefs affect patients' CDC screening behaviour and thus to provide implications for future intervention programmes. Design: A cross‐sectional study was conducted. Methods: 785 type 2 diabetes were enrolled from the community health centre in Wuhou District, Chengdu, China. Structured questionnaires were used to collect data regarding the demographic and clinical information, knowledge about CDC, health belief model constructs and CDC screening behaviour. Mediation analysis was performed to explore the mechanisms of health belief model constructs on CDC screening behaviour. The study methods were compliant with the STROBE checklist. Results: Knowledge had a significant indirect effect on CDC screening behaviour through perceived susceptibility, perceived benefits, perceived barriers and self‐efficiency. Cues to action exerted both significant direct and indirect effects on CDC screening behaviour. The indirect effects of cues to action were exerted through perceived susceptibility, perceived barriers and self‐efficiency. Conclusion: Health beliefs played vital roles in mediating the effects of knowledge and cues to action on patients' CDC screening behaviour. Health beliefs should be assessed and modified through creative educational methods. Strategies aimed at increasing cues to action are also expected to facilitate patients' CDC screening behaviour. Relevance to clinical practices: The study contributes to the exploration of how health beliefs affect patients' CDC screening behaviour. The results could be used to inspire future community‐based intervention programmes. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To construct a path model addressing influences of diabetes distress, self‐efficacy of injecting insulin, resilience and decisional balance of injecting insulin to quality of life (QoL) in insulin‐treated patients with type 2 diabetes (T2DM). Background: Insulin regimens more negatively impact QoL than oral medication treatments in patients with T2DM. Understanding the factors and influencing pathways associated with subsequent QoL will help nurses design timely interventions to improve QoL of insulin‐treated T2DM patients. Design: A 9‐month prospective design was employed in this study. Methods: Self‐reported questionnaires were used to collect data from 185 insulin‐treated T2DM patients. At baseline, diabetes distress and self‐efficacy of injecting insulin were collected, while QoL, resilience and decisional balance of injecting insulin were collected 9 months later. Data were collected from February 2017 to February 2018. Structural equation modelling was used for analysis. This study was conducted based on the STROBE. Results: Low baseline diabetes distress and high 9‐month decisional balance of injecting insulin directly associated with high 9‐month QoL. High baseline self‐efficacy of injecting insulin and high 9‐month resilience directly associated with high 9‐month decisional balance of insulin injection and indirectly associated with high 9‐month QoL. High baseline diabetes distress directly and indirectly associated with poor 9‐month QoL. Conclusions: Diabetes distress, self‐efficacy of injecting insulin, resilience and decisional balance of injecting insulin play different roles in associating with QoL in insulin‐treated T2DM patients. Relevance to clinical practice: Nurses could provide educational programs focusing on enhancing decisional balance of injecting insulin to improve QoL in insulin‐treated patients. Improving self‐efficacy of injecting insulin and resilience could be promising strategies to improve the decisional balance of injecting insulin. More timely assessment of diabetes distress and intervention might be powerful strategies to improve subsequent QoL in these patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To observe the psychological status of pregnant women during COVID‐19 pandemic, and to test a hypothetical model that estimates the influence of psychological response to COVID‐19 and security sense on pregnancy stress. Background: COVID‐19 advanced rapidly and then spread worldwide. Pregnant women were more susceptible to the COVID‐19 infection. Furthermore, it is not clear whether this infection will increase the risk of congenital monstrosity, foetal growth restriction, premature delivery or cause other long‐term adverse effects. Design: A descriptive, cross‐sectional survey. Methods: A total of 331 pregnant women participated in this study. And this research adhered to the STROBE guideline. The psychological questionnaire for emergent events of public health, pregnancy stress scale and security questionnaire were used to collect data. The hypothetical path model was tested using the SPSS version 25.0 software and AMOS version 26.0 software. Results: Fear and depression were the most common psychological responses among pregnant women during the COVID‐19 pandemic. The hypothesis model of this study fitted the data well, and the results showed that psychological response positively affected pregnancy stress, while security sense negatively affected pregnancy stress; security sense mediated between psychological response and pregnancy stress. Conclusion: Nurses and midwives can help reduce the stress in pregnant women by alleviating their psychological response to the COVID‐19 pandemic and by improving their security sense. Relevance to clinical practice: It is essential for the health staff to build trust with pregnant women and their families, and communicate accurate information to them. Nurses should promptly conduct a psychological response evaluation and psychological guidance for pregnant women to alleviate their fears and hypochondria related to COVID‐19. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed to address the interrelationships among neurocognition, self‐efficacy, motivation and self‐management in individuals with schizophrenia. Background: Self‐management performance of individuals with schizophrenia is relatively poor. The effect of neurocognitive impairment on self‐management in schizophrenia remains inconsistent, which may be attributed to the neglect of possible mediating factors. Little attention has been given to the role of motivation and self‐efficacy for linking neurocognition to self‐management. Design: A cross‐sectional study. Methods: Three hundred and twenty patients were recruited with convenience sampling in this study. Patients' neurocognitive function, self‐efficacy, motivation and self‐management behaviours were measured. Pearson or Spearman correlation analysis and path analysis were performed to examine the interrelationships. This study followed STROBE checklist for cross‐sectional studies (see Appendix S1). Results: The final model, with good fit indices, revealed that (1) neurocognition, self‐efficacy and motivation were directly associated with self‐management, (2) self‐efficacy and motivation partly mediated the impact of neurocognition on self‐management and (3) motivation additionally mediated the association of self‐efficacy and self‐management. Conclusions: Our study extends the current findings, indicating that self‐efficacy and motivation may act as mediators in the relationship between neurocognition and self‐management in schizophrenia. Relevance to clinical practice: Mental health professionals should pay attention to interventions targeting both cognitive and psychosocial components to enhance self‐management in individuals with schizophrenia. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To explore the effects of hospital‐family holistic care model based on 'Timing It Right' on the health outcome of patients with permanent colostomy. Background: Colorectal cancer is a common malignant tumour of digestive system, which seriously threatens human life and health. Colostomy is one of the main treatments for colorectal cancer, which effectively improves the 5‐year survival rate of patients. However, the postoperative psychological and physiological rehabilitation nursing is still faced with great challenges due to the change of body image and defecation pathway caused by colostomy. Methods: A randomised controlled trial was conducted, and 119 patients with permanent enterostomy were randomly divided into two groups, with 60 cases in the intervention group and 59 cases in the control group. The intervention group received routine care follow‐up and hospital‐family holistic care intervention based on 'Timing It Right', while the control group received routine care and follow‐up. The resilience, self‐care ability, complications and life quality of patients with permanent enterostomy were compared between two groups before intervention, at discharge, 3 months and 6 months after discharge. CONSORT checklist was applied as the reporting guideline for this study (see Appendix S1). Results: A total of 108 patients with permanent enterostomy completed the study (90.76%). At 3 months and 6 months after discharge, the resilience and quality of life in the intervention group were significantly better than those in the control group (t = 4.158 vs. 7.406, t = 4.933 vs. 8.611, p <.05), while the complications in the intervention group were significantly lower than that in the control group (25.5% vs. 41.51%, 14.45% vs. 30.19%; p <.05). The self‐care ability of the intervention group was significantly better than that in the control group (t = 1.543 vs. 3.656 vs. 6.273, p <.05) at discharge, 3 months and 6 months after discharge. The interaction between time and grouping showed that the effect of time factor varied with the grouping. After intervention, there were significant differences in psychological resilience, self‐care ability, complications and quality of life between the two groups at different observation points (p <.01). The three evaluation indices of intervention group increased with the migration of observation time points and were significantly better than those of control group, especially the quality of life (84.35 ± 4.25 vs. 60.45 ± 8.42, p <.01). Conclusions: The hospital‐family holistic care model based on 'Timing It Right' can effectively improve the psychological resilience, self‐care ability and quality of life; reduce complications; and improve the health outcomes of patients with permanent enterostomy. Relevance to clinical practice: Patients with permanent enterostomy have different needs for nursing care at different stages of the disease, and they are dynamically changing. The hospital‐family holistic care model based on 'Timing It Right' can effectively improve the health outcomes of patients with permanent enterostomy, which is worthy of clinical application. [ABSTRACT FROM AUTHOR]

Aim and objective: To describe factors associated with father involvement in the neonatal intensive care unit using the Heuristic model of the dynamic of parental behaviour and influence on children over time. Background: Research shows that infants with involved fathers have better cognitive development, fewer crying episodes after caesarean birth, improved breastfeeding exclusivity and duration, and more regular sleep patterns. Preterm infants with involved fathers have improved cognitive development. Design: This cross‐sectional exploratory study used survey methodology to explore factors associated with father involvement in the neonatal intensive care unit. Methods: The STROBE checklist for cross‐sectional studies was used (see Appendix S2). Biological fathers of infants in a 97‐bed neonatal intensive care unit in the southern USA completed a survey which asked about their involvement with their hospitalised infants and factors which affected that involvement. Eighty fathers completed the survey. Results: Age ranged between 20–53 with 43% first‐time fathers. Compared to less involved fathers, fathers who were more involved were younger, married or living with the mother, performed kangaroo care or fathers of multiple gestation. Fathers who had attended the delivery were more likely to bathe their infants than those who had not attended the delivery and fathers who performed kangaroo care felt more confident than those who did not. Compared to fathers who visited less often, fathers who visited more often were younger, had infants with a shorter hospitalisation time and lower acuity, and had fewer children in the family. Conclusions: Fathers are involved with their neonatal intensive care unit infants in many ways. Factors were identified that affect involvement in the neonatal intensive care unit. Relevance to clinical practice: Results can help nurses in neonatal intensive care units worldwide facilitate father–infant interaction, identify fathers at risk for decreased involvement and advocate for institutional policy development for supporting neonatal intensive care unit father involvement. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To generate a theoretical explanation of nurse‐to‐nurse mentoring in the clinical setting. Background: Despite an abundance of mentoring literature, the processes involved between nurses in mentoring relationships have yet to be studied. Nursing literature has focused on mentor attributes and relationship outcomes rather than focusing on theoretical discovery. Design: Classical grounded theory (CGT). Methods: CGT procedures (constant comparative method, coding and memoing) were used to analyse interview data exploring fifteen nurse protégés' experiences of mentoring. Results: Confidencing, the protégés' need to become confident in the professional role, emerged as the main concern of study participants. Three dimensions are threaded throughout nurse‐to‐nurse mentoring: earnest intentions, filial bond and trust‐worthiness. Earnest intentions are the sincere attitude that protégés and mentors demonstrate regarding their mentoring relationship. An exclusive, familial‐type connection, filial bond, attends to the affective needs of protégés and mentors. Trust‐worthiness, the explicit feeling of trust between protégés and mentors, strengthens as each demonstrates being worthy of the other's trust. Mentoring Up theory explains five phases of mentoring: seeding, opening, laddering, equalising and reframing. The initial phases are periods of relationship discovery (seeding) and testing (opening). Laddering is an intense period of reciprocal interactions between mentors and protégés. Equalising begins as protégés perceive themselves to be equal to their mentors in terms of their professional capability. Protégés reflect on the meaning of the relationship in the reframing phase. Conclusions: Mentoring Up is a dense theory that reveals insights, explanations and predictions for initiating, developing and engaging in mentoring relationships. Mentoring Up fills a gap in the existing literature and provides a framework for future mentoring research. Relevance to clinical practice: The theory has implications for healthcare organisations, nursing education and individual nurses. Mentoring Up expounds on the interpersonal connections and reciprocal interactions vital for successful nurse‐to‐nurse mentoring. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the components of the Amalgamation of Marginal Gains (AMG) performance system to identify a set of principles that can be built into an innovative fundamental nursing care protocol. Background: Nursing is urged to refocus on its fundamental care activities, but little evidence exists to guide practising nurses. Fundamental care is a combination of many small behaviours aimed at meeting a person's care needs. AMG is a successful system of performance management that focusses on small (or marginal) gains, and might provide a new delivery framework for fundamental nursing care. Design: Qualitative interview study. Methods: We undertook in‐depth interviews with healthcare and sports professionals experienced in AMG. We analysed data using open coding in a framework analysis, and then interrogated the data using Normalisation Process Theory (NPT). We triangulated findings with AMG literature to develop an intervention logic model. Results: We interviewed 20 AMG practitioners. AMG processes were as follows: focusing on many details to optimise performance, identification of marginal gains using different sources, understanding current versus optimum performance, monitoring at micro and macro level and strong leadership. Elements of normalisation were as follows: whole team belief in AMG to improve performance, a collective desire for excellence using evidence‐based actions, whole team engagement to identify choose and implement changes, and individual and group responsibility for monitoring performance. Conclusions: We have elicited the processes described by AMG innovators in health care and sport and have mapped the normalisation potential and work required to embed such a system into nursing practice. Relevance to clinical practice: The development of our logic model based on AMG and NPT may provide a practical framework for improving fundamental nursing care and is ripe for further development and testing in clinical trials. [ABSTRACT FROM AUTHOR]

Aims and objectives To improve the understanding of district nurses' experiences of encountering women exposed to intimate partner violence. Background Intimate partner violence is a public health issue that influences all aspects of affected women's lives; it is thus of great relevance to identify intimate partner violence. District nurses in primary health care in Sweden encounter women of all ages and are therefore in a unique position to identify intimate partner violence and provide nursing care. However, studies indicate that several barriers have kept nurses from identifying intimate partner violence. Consequently deeper understanding of district nurses' encounters with women exposed to intimate partner violence is needed. Design A qualitative study using grounded theory method. Methods Interviews with 11 district nurses in primary health care in Sweden. Results The hesitation process is central in these encounters. Several barriers to asking and factors that facilitated asking impacted the hesitation process. Under the influence of these factors, district nurses moved from being unaware that identifying intimate partner violence was their professional responsibility, to becoming ambivalent about asking, to starting to prepare themselves to ask about intimate partner violence. The presence of factors that facilitated asking finally made district nurses feel prepared, and then they decided to ask women about intimate partner violence. Conclusions The concept of managing the hesitation process could be used to be incorporated in continuing education and training. Barriers and facilitators concerning organisational factors found in this study may be specific to the Swedish health care system, but the concept of the hesitation process is applicable in similar contexts and perhaps to other issues about which it is difficult to ask. Relevance to clinical practice This study illuminates the importance of a supportive work environment in reducing district nurses' hesitation to ask about intimate partner violence and to propose continuing education, training and supervision for district nurses regarding intimate partner violence. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess the acceptability and usability of a standardised communication tool for nurses. Background and significance Communication is key in health care. On a daily, if not hourly, basis, nursing staff is inundated with new information regarding tools and resources, practice changes and the work environment. However, there is currently no standardised messaging or delivery method to effectively communicate new information. Even with a plethora of communication tools such as flyers, posters, emails, unit huddles and unit meetings, there is no means to guarantee attendance to crucial information. Design Descriptive, cross-sectional online survey, implemented at a nonacademic, suburban hospital with 280 nurses. Methods The Clinical Chatter, an online tool developed by nursing leadership to standardise messages regarding the organisation, new tools and resources, professional development, recognition and unit updates, was delivered to each nurse on a weekly basis followed by administration of Acceptability and Usability scales. Results The Clinical Chatter tool has adequate acceptability and usability as a method of communication among nurses in a hospital organisation. Sociodemographic variables of age and years of experience had no statistically significant association with perceived acceptance and usefulness of the tool. Conclusion The findings indicate that the Clinical Chatter tool can be used as a standardised communication tool to deliver key information among nurses working in a hospital organisation. Nursing leadership must establish and support a clear communication system to enhance patient care and outcomes and improve nursing job satisfaction. Relevance to clinical practice Communication is vital to advancing health care. Lack of communication among nursing has been linked to unsafe patient care: medication errors, unhealthy work environments and decreased nurse retention rates. Clinical Chatter is an effective communication tool for presentation of institutional information to nursing personnel. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to gain insight into the process of patient enablement in general practice nursing consultations. Background Enhanced roles for general practice nurses may benefit patients through a range of mechanisms, one of which may be increasing patient enablement. In studies with general practitioners enhanced patient enablement has been associated with increases in self-efficacy and skill development. Design This study used a constructivist grounded theory design. Methods In-depth interviews were conducted with 16 general practice nurses and 23 patients from 21 general practices between September 2013 - March 2014. Data generation and analysis were conducted concurrently using constant comparative analysis and theoretical sampling focussing on the process and outcomes of patient enablement. Use of the storyline technique supported theoretical coding and integration of the data into a theoretical model. Findings A clearly defined social process that fostered and optimised patient enablement was constructed. The theory of 'developing enabling healthcare partnerships between nurses and patients in general practice' incorporates three stages: triggering enabling healthcare partnerships, tailoring care and the manifestation of patient enablement. Patient enablement was evidenced through: 1. Patients' understanding of their unique healthcare requirements informing their health seeking behaviours and choices; 2. Patients taking an increased lead in their partnership with a nurse and seeking choices in their care and 3. Patients getting health care that reflected their needs, preferences and goals. Conclusions This theoretical model is in line with a patient-centred model of health care and is particularly suited to patients with chronic disease. [ABSTRACT FROM AUTHOR]

Aim To test a hypothesized model linking new graduate nurses' perceptions of their manager's authentic leadership behaviours to structural empowerment, short-staffing and work-life interference and subsequent burnout, job satisfaction and patient care quality. Background Authentic leadership and structural empowerment have been shown to reduce early career burnout among nurses. Short-staffing and work-life interference are also linked to burnout and may help explain the impact of positive, empowering leadership on burnout, which in turn influences job satisfaction and patient care quality. Design A time-lagged study of Canadian new graduate nurses was conducted. Methods At Time 1, surveys were sent to 3,743 nurses (November 2012-March 2013) and 1,020 were returned (27·3% response rate). At Time 2 (May-July 2014), 406 nurses who responded at Time 1 completed surveys (39·8% response rate). Descriptive analysis was conducted in SPSS. Structural equation modelling in Mplus was used to test the hypothesized model. Results The hypothesized model was supported. Authentic leadership had a significant positive effect on structural empowerment, which in turn decreased both short-staffing and work-life interference. Short-staffing and work-life imbalance subsequently resulted in nurse burnout, lower job satisfaction and lower patient care quality 1 year later. Conclusion The findings suggest that short-staffing and work-life interference are important factors influencing new graduate nurse burnout. Developing nurse managers' authentic leadership behaviours and working with them to create and sustain empowering work environments may help reduce burnout, increase nurse job satisfaction and improve patient care quality. [ABSTRACT FROM AUTHOR]

Aim Sexual risk behaviour was explored and described using Social Action Theory. Background The sexual transmission of HIV is complex and multi-factorial. Social Action Theory provides a framework for viewing self-regulation of modifiable behaviour such as condom use. Condom use is viewed within the context of social interaction and interdependence. Design Cross-sectional survey. Methods Self-report questionnaire administered to adults living with HIV/ AIDS, recruited from clinics, service organizations and by active outreach, between 2010 - 2011. Findings Having multiple sex partners with inconsistent condom use during a 3-month recall period was associated with being male, younger age, having more years of education,substance use frequency and men having sex with men being a mode of acquiring HIV. In addition, lower self-efficacy for condom use scores were associated with having multiple sex partners and inconsistent condom use. Conclusion Social Action Theory provided a framework for organizing data from an international sample of seropositive persons. Interventions for sexually active, younger, HIV positive men who have sex with men, that strengthen perceived efficacy for condom use, and reduce the frequency of substance use, may contribute to reducing HIV-transmission risk. [ABSTRACT FROM AUTHOR]

Aims and objectives The purposes of this study were to measure the prevalence of, and identify factors associated with, cervical cancer screening among a sample of lesbian, bisexual and queer women, and transgender men. Background Past research has found that lesbian, bisexual and queer women underuse cervical screening service. Because deficient screening remains the most significant risk factor for cervical cancer, it is essential to understand the differences between routine and nonroutine screeners. Design A convergent-parallel mixed methods design. Methods A convenience sample of 21- to 65-year-old lesbian and bisexual women and transgender men were recruited in the USA from August-December 2014. Quantitative data were collected via a 48-item Internet questionnaire ( N = 226), and qualitative data were collected through in-depth telephone interviews ( N = 20) and open-ended questions on the Internet questionnaire. Results Seventy-three per cent of the sample was routine cervical screeners. The results showed that a constellation of factors influence the use of cervical cancer screening among lesbian, bisexual and queer women. Some of those factors overlap with the general female population, whereas others are specific to the lesbian, bisexual or queer identity. Routine screeners reported feeling more welcome in the health care setting, while nonroutine screeners reported more discrimination related to their sexual orientation and gender expression. Routine screeners were also more likely to 'out' to their provider. The quantitative and qualitative factors were also compared and contrasted. Conclusions Many of the factors identified in this study to influence cervical cancer screening relate to the health care environment and to interactions between the patient and provider. Relevance to clinical practice Nurses should be involved with creating welcoming environments for lesbian, bisexual and queer women and their partners. Moreover, nurses play a large role in patient education and should promote self-care behaviours among lesbian women and transgender men. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to examine factors impacting family presence during resuscitation practices in the acute care setting. Background Family presence during resuscitation was introduced in the 1980s, so family members/significant others could be with their loved ones during life-threatening events. Evidence demonstrates important benefits; yet despite growing support from the public and endorsement from professional groups, family presence is practiced inconsistently and rationales for poor uptake are unclear. Design Constructivist grounded theory design. Methods Twenty-five health professionals, family members and patients informed the study. In-depth interviews were undertaken between October 2013-November 2014 to interpret and explain their meanings and actions when deciding whether to practice or participate in FPDR. Findings The Social Construction of Conditional Permission explains the social processes at work when deciding to adopt or reject family presence during resuscitation. These processes included claiming ownership, prioritizing preferences and rights, assessing suitability, setting boundaries and protecting others/self. In the absence of formal policies, decision-making was influenced primarily by peoples' values, preferences and pre-existing expectations around societal roles and associated status between health professionals and consumers. As a result, practices were sporadic, inconsistent and often paternalistic rather than collaborative. Conclusion An increased awareness of the important benefits of family presence and the implementation of clinical protocols are recommended as an important starting point to address current variations and inconsistencies in practice. These measures would ensure future practice is guided by evidence and standards for health consumer safety and welfare rather than personal values and preferences of the individuals 'in charge' of permissions. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the quality of life of informal caregivers of patients with pressure ulcer; to assess their levels of burden; to analyse the variables influencing both their quality of life and burden. Background Informal caregivers of pressure ulcer patients, besides coping with the natural dependency of these patients, deal with the specificity of caring these types of wounds. This situation has an impact on not only the quality of life and burden felt by informal caregivers but also on individual and familiar dynamics. Design Descriptive and correlational study. Methods This study focused on 145 informal caregivers providing home care. Measurement instruments were: SF-36v2 and the Burden Interview Scale. Descriptive analysis of the quantitative variables was carried out according to measures of central tendency, and the qualitative variables were described using absolute and relative frequencies. The relationships or associations between variables were explored through correlational analysis and, whenever the data allowed, multivariate techniques were used. Results and discussion Informal caregivers showed low levels of quality of life and, most of them, significant burden. Quality of life decreased with overload, with the increasing number of pressure ulcer and with less experience of informal caregivers, with lack of financial remuneration, with unemployment, with patient positioning and with the direct care of the wound. The burden increased with the number of pressure ulcer in each patient and with the lack of financial remuneration. Conclusion These informal caregivers have low quality of life and are overburdened. Both situations are positively and negatively influenced by factors related to the pressure ulcer and to the patients' sociodemographic data. Relevance to clinical practice The results of this study allow more effective monitoring by health professionals of levels of burden and quality of life encountered in pressure ulcer informal caregivers, as well as direct interventions to inhibit the factors inducing burden and enhance those that improve quality of life. [ABSTRACT FROM AUTHOR]

Aims To explore the existence of symptom clusters in advanced chronic kidney disease. Background People with chronic kidney disease commonly report multiple symptoms. However, the complex relationships among these symptoms are still poorly understood. Design Cross-sectional. Methods A total of 436 people with stage 4 and 5 chronic kidney disease were recruited from three tertiary hospitals during 2013-2014. Participants completed the Chronic Kidney Disease-Symptom Burden Index that assesses four symptom dimensions (occurrence, distress, severity and frequency) of 32 symptoms. Exploratory factor analysis was used to identify symptom clusters across each symptom dimension. Core symptoms in each cluster were determined based on stability across dimensions and clinical plausibility. A high cutoff of 0·50 for factor loading was used for all analyses. Results Five symptom clusters were consistently identified across all symptom dimensions: fluid volume symptoms, neuromuscular symptoms, gastrointestinal symptoms, sexual symptoms and psychological symptoms. Overall, clusters ranged from 2-10 symptoms. Several symptoms were also interconnected with multiple clusters. Fatigue cross-loaded on all five clusters, whereas sleep disturbance and restless leg symptoms cross-loaded across three clusters. Conclusions Adopting a symptom cluster approach has the potential to significantly advance symptom assessment and nursing care for people in advanced stages of chronic kidney disease. Routine clinical assessment and management strategies targeted at the cluster level should have synergistic effects in reducing symptoms. Fatigue is a pervasive symptom in advanced chronic kidney disease that is interconnected with global symptom burden, suggesting better management of symptom clusters may also reduce fatigue. [ABSTRACT FROM AUTHOR]

Aim To explore how practising mindfulness affects people's experiences of living with a long-term condition. Background Increasing evidence suggest that mindfulness meditation-based interventions benefit people with long-term conditions, particularly in terms of psychological well-being. Most evidence, however, relates to short-term outcomes and limited information exists about how people use mindfulness in the longer term and how this affects their experience of living with their condition. Design A qualitative study using constructivist-informed grounded theory. Methods Using interviews, diaries and focus groups, data were collected between 2011 - 2012 from participants and/or trainers of Breathworks' mindfulness intervention. Phased recruitment enabled theoretical sampling, with data analysed concurrently using Charmaz's two-stage coding strategy. Findings The final sample comprised 41 adults with diverse physical and/or mental health conditions. Participants reported predominantly positive experiences, almost all identifying significant changes in thinking and behaviour. A core process of 'Starting where I am' was formulated, highlighting how people became more aware and accepting of their condition and thus able to self-care more effectively. The process was encapsulated in five themes: Getting a new perspective; Feeling equipped to cope; Doing life differently; Seeing a change; and Finding mindfulness difficult. Strong resonances were identified between participants' experiences and the process of transition through which people come to terms with challenging life events. Conclusion Mindfulness can be conceptualized as a facilitator of transition, enabling people to adapt to living with a long-term condition. Transition is associated with improved, self-directed self-management, which is significant to both people with long-term conditions and healthcare providers. [ABSTRACT FROM AUTHOR]

The purpose of the study was to explore the individual, social and environmental factors influencing regular exercise on the basis of the theoretical framework of social ecological model among adults with type 2 diabetes and peripheral neuropathy. A total of 122 participants were chosen from Tianjin Metabolic Disease Hospital from November 2013 to May 2014. Information on exercise status and influencing factors was collected. Most participants took walking as the mode of exercise and exercised alone. Only 59.8% of participants were reported to carry out regular exercise. Logistic regression analysis suggested that being male, longer duration with diabetic peripheral neuropathy, higher self-efficacy for exercise and higher objective support were associated with regular exercise. Exercise status was clearly not ideal among adults with type 2 diabetes and peripheral neuropathy. The study highlighted the need to take measures to improve self-efficacy for exercise and social support in order to promote exercise participation among adults with type 2 diabetes and peripheral neuropathy. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the quality/comprehensiveness of nursing documentation of pressure ulcers and to investigate the relationship between the nursing documentation and the incidence of pressure ulcers in four intensive care units. Background Pressure ulcer prevention requires consistent assessments and documentation to decrease pressure ulcer incidence. Currently, most research is focused on devices to prevent pressure ulcers. Studies have rarely considered the relationship among pressure ulcer risk factors, incidence and nursing documentation. Thus, a study to investigate this relationship is needed to fill this information gap. Design A retrospective, comparative, descriptive, correlational study. Method A convenience sample of 196 intensive care units patients at the selected medical centre comprised the study sample. All medical records of patients admitted to intensive care units between the time periods of September 1, 2011 through September 30, 2012 were audited. Data used in the analysis included 98 pressure ulcer patients and 98 non-pressure ulcer patients. The quality and comprehensiveness of pressure ulcer documentation were measured by the modified European Pressure Ulcer Advisory Panel Pressure Ulcers Assessment Instrument and the Comprehensiveness in Nursing Documentation instrument. Result The correlations between quality/comprehensiveness of pressure ulcer documentation and incidence of pressure ulcers were not statistically significant. Patients with pressure ulcers had longer length of stay than patients without pressure ulcers stay. There were no statistically significant differences in quality/comprehensiveness scores of pressure ulcer documentation between dayshift and nightshift. Conclusion This study revealed a lack of quality/comprehensiveness in nursing documentation of pressure ulcers. This study demonstrates that staff nurses often perform poorly on documenting pressure ulcer appearance, staging and treatment. Moreover, nursing documentation of pressure ulcers does not provide a complete picture of patients' care needs that require nursing interventions. Relevance to clinical practice The implication of this study involves pressure ulcer prevention and litigable risk of nursing documentation. [ABSTRACT FROM AUTHOR]

Aims. The aim of this study was to determine nurses' readiness for evidence-based practice at Finnish university hospitals. Background. Although systematic implementation of evidence-based practice is essential to effectively improving patient outcomes and value of care, nurses do not consistently use evidence in practice. Uptake is hampered by lack of nurses' individual and organizational readiness for evidence-based practice. Although nurses' evidence-based practice competencies have been widely studied in countries leading the evidence-based practice movement, less is known about nurses' readiness for evidence-based practice in the non-English-speaking world. Design. A cross-sectional descriptive survey design. Methods. The study was conducted in November-December 2014 in every university hospital in Finland with a convenience sample (n = 943) of practicing nurses. The electronic survey data were collected using the Stevens' Evidence-Based Practice Readiness Inventory, which was translated into Finnish according to standardized guidelines for translation of research instruments. The data were analysed using descriptive and inferential statistics. Results. Nurses reported low to moderate levels of self-efficacy and low levels of evidence-based practice knowledge. A statistically significant, direct correlation was found between nurses' self-efficacy in employing evidence-based practice and their actual evidence-based practice knowledge level. Several statistically significant differences were found between nurses' socio-demographic variables and nurses' self-efficacy in employing evidence-based practice, and actual and perceived evidence-based practice knowledge. Conclusions. Finnish nurses at university hospitals are not ready for evidence-based practice. Although nurses are familiar with the concept of evidence-based practice, they lack the evidence-based practice knowledge and self-efficacy in employing evidence-based practice required for integrating best evidence into clinical care delivery. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the association between horizontal violence and job satisfaction in hospital staff registered nurses and the degree to which peer relationships mediates the relationship. Additionally, the association between nurse and work characteristics and job satisfaction were determined. Background Horizontal violence is a major predictor of nurses' job satisfaction. Yet, not enough is known about the relationship between these variables. Job satisfaction is an important variable to study because it is a predictor of patient care quality and safety internationally. Peer relationships, a job satisfier for nurses, was identified as a potential mediator in the association between horizontal violence and job satisfaction. Design Cross-sectional mediational model testing. Methods An anonymous four-part survey of a random sample of 175 hospital staff registered nurses working in California provided the data. Data about horizontal violence, peer relationships, job satisfaction, and nurse and work characteristics were collected between March-August 2010. Results A statistically significant negative relationship was found between horizontal violence and peer relationships, job satisfaction and a statistically significant positive relationship was found between peer relationships and job satisfaction. Peer relationships mediated the association between horizontal violence and job satisfaction. Job satisfaction was reported as higher by nurses who worked in teaching hospitals. There were no statistically significant differences in job satisfaction based on gender, ethnicity, basic registered nurse education, highest degree held, size of hospital or clinical area. Conclusions The results suggest that peer relationships can attenuate the negative relationship between horizontal violence and job satisfaction. This adds to the extant literature on the relationship between horizontal violence and job satisfaction. Relevance to clinical practice The findings highlight peer relationships as an important factor when considering effective interventions that foster hospital staff registered nurses' job satisfaction in the presence of horizontal violence. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine patients' perceptions and experiences of noncardiac chest pain, within the framework of the common sense model. Background Patients with noncardiac chest pain have good physical prognosis, but frequently suffer prolonged pain and psychological distress. The common sense model may provide a good framework for examining outcomes in patients with noncardiac chest pain. Design Qualitative thematic analysis with semi-structured interviews. Methods In 2010, participants recruited from an emergency department ( N = 7) with persistent noncardiac chest pain and distress were interviewed using a semi-structured schedule, and data were analysed using thematic analysis. Results Seven themes were identified; six of which mapped onto core dimensions of the common sense model (identity, cause, timeline, consequences, personal control, treatment control). Contrary to previous research on medically unexplained symptoms, most participants perceived psychological factors to play a causal role in their chest pain. Participants' perceptions largely mapped onto the common sense model, although there was a lack of coherence across dimensions, particularly with regard to cause. Conclusion Patients with noncardiac chest pain lack understanding with regard to their condition and may be accepting of psychological causes of their pain. Relevance to clinical practice Brief psychological interventions aimed at improving understanding of the causes of noncardiac chest pain and providing techniques for managing pain and stress may be useful for patients with noncardiac chest pain. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore how communication failures occur in documents and documentations across the perioperative pathway in nurses' interactions with other nurses, surgeons and anaesthetists. Background Documents and documentation are used to communicate vital patient and procedural information among nurses, and in nurses' interactions with surgeons and anaesthetists, across the perioperative pathway. Previous research indicates that communication failure regularly occurs in the perioperative setting. Design A qualitative study was undertaken. Methods The study was conducted over three hospitals in Melbourne, Australia. One hundred and twenty-five healthcare professionals from the disciplines of surgery, anaesthesia and nursing participated in the study. Data collection commenced in January 2010 and concluded in October 2010. Data were generated through 350 hours of observation, two focus groups and 20 semi-structured interviews. A detailed thematic analysis was undertaken. Results Communication failure occurred owing to a reliance on documents and documentation to transfer information at patient transition points, poor quality documents and documentation, and problematic access to information. Institutional ruling practices of professional practice, efficiency and productivity, and fiscal constraint dominated the coordination of nurses', surgeons' and anaesthetists' communication through documents and documentation. These governing practices configured communication to be incongruous with reliably meeting safety and quality objectives. Conclusions Communication failure occurred because important information was sometimes buried in documents, insufficient, inaccurate, out-of-date or not verbally reinforced. Furthermore, busy nurses were not always able to access information they required in a timely manner. Patient safety was affected, which led to delays in treatment and at times inadequate care. Relevance to clinical practice Organisational support needs to be provided to nurses, surgeons and anaesthetists so they have sufficient time to complete, locate, and read documents and documentation. Infrastructure supporting communication technologies should be implemented to enable the rapid retrieval, entry, and dispersion of information. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine whether and how stigma influences attitudes towards seeking treatment for urinary incontinence, and whether its effect varies by symptom severity. Background Urinary incontinence is prevalent among women, but few seek treatment. Negative attitudes towards urinary incontinence treatment inhibit from seeking care. Urinary incontinence is a stigmatised attribute. However, the relationship between stigma and attitudes towards seeking treatment for urinary incontinence has not been well understood. Design This was a cross-sectional community-based study. Methods We enrolled a sample of 305 women aged 40-65 years with stress urinary incontinence from three communities in a Chinese city between May-October in 2011. Data were collected on socio-demographic characteristics, urinary incontinence symptoms, stigma and attitudes towards seeking treatment for urinary incontinence using a self-reported questionnaire. Effects of stigma were analysed using path analysis. Results Attitudes towards seeking treatment for urinary incontinence were generally negative. For the total sample, all the stigma domains of social rejection, social isolation and internalised shame had direct negative effects on treatment-seeking attitudes. The public stigma domain of social rejection also indirectly affected treatment-seeking attitudes through increasing social isolation, as well as through increasing social isolation and then internalised shame. The final model accounted for 28% of the variance of treatment-seeking attitudes. Symptom severity influenced the strength of paths: the effect of internalised shame was higher in women with more severe urinary incontinence. Conclusions Stigma enhances the formation of negative attitudes towards seeking treatment for urinary incontinence; public stigma affects treatment-seeking attitudes through internalisation of social messages. Relevance to clinical practice Stigma reduction may help incontinent women to form positive treatment-seeking attitudes and engage them in treatment. Interventions should specifically target the self-stigma domains of social isolation and internalised shame in women with urinary incontinence to most efficiently increase their use of health care. [ABSTRACT FROM AUTHOR]

Aims and objectives To compare nurses' caring expectations with their caregiving experiences and to identify factors that could potentially be included in a preliminary conceptual model of job satisfaction and compassion fatigue. Background Nurses often report emotional reward and satisfaction in their profession from compassionately caring for sick and injured patients. However, being in close proximity to trauma can eventually deplete a nurse's compassion and empathy for the patients they care for. This loss of compassion is further exacerbated by demanding work environments that involve administrative duties, attending to patients' psychosocial needs and interacting with patients' families. To date, the literature has tended to focus on pathology of compassion fatigue, rather than identifying its contributing factors. Design A grounded theory approach was used to identify emerging themes in nurses' accounts of their caregiving roles. Methods Open-ended interviews were conducted with nurses ( n = 9) who were employed by a maritime district health authority for a minimum of five years. Interviews focused on beliefs of how to provide care, perceived caregiving responsibilities and perceived challenges in the provision of care. Results Emerging from the data is a proposed model of job satisfaction. The concepts of monitoring and patient advocacy appeared to be key components in reported satisfaction or alienation. Discrepancies were found between care expectations outlined by management and nurses' perceptions of care provision. Additionally, type of nursing education was related to nurses' confidence in applying nursing skills. Conclusions These findings have implications for training programmes, hospital management and quality of patient care. Relevance to clinical practice It is important to identify factors that could explain resilience to compassion fatigue because compassion fatigue has negative consequences not only for nurses themselves but for the patients in their care. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore nursing students' experiences of death and dying in clinical practice. Background The encounter with death constitutes one of the most stressful experiences reported by nursing students during their clinical training. In particular, it can be difficult for student nurses to cope with the patient's suffering, to provide postmortem care and to communicate with the patient and his/her family as death approaches. Although some research has been carried out in relation to this phenomenon, there remains a need to identify and understand the situations and experiences that are of most concern to students, those which may affect their ability to cope and, therefore, interfere with the care they are able to offer to the dying patient and his/her family. Design Qualitative descriptive and hermeneutic study. Methods Semi-structured interviews ( n = 12) were conducted with nursing students. Data were collected in 2012-2013. Transcripts were analysed using Colaizzi's seven-step procedure. Findings The analysis identified five themes: impact, training in end-of-life care, ethical issues, coping and learning/growth/healing connections. The central theme was the enormous impact the encounter with death had, while the other themes were a response to and/or modulators of this impact. An explanatory model was derived on the basis of the relationship between all these emergent themes. Conclusions It is essential to understand nursing students' experience of death so as to minimise its impact. The explanatory model described here could be a useful tool for the design of training programmes on end-of-life care. Relevance to clinical practice Adequate training of this kind would help to ensure that future nurses offer high-quality care to patients and their families, minimising the impact of death and preventing emotional fatigue. [ABSTRACT FROM AUTHOR]

Aim To develop and examine the effectiveness of a home-based self-help psychoeducation programme on health-related quality of life, stress level, anxiety and depression symptoms, self-efficacy, cardiac risk factors and health service use of outpatients with coronary heart disease. Background Hospital-based cardiac rehabilitation programmes have been shown to improve, effectively, the quality of life of patients with coronary heart disease. However, a majority of these patients do not participate in these programmes, while those who do enrol in these programmes fail to complete the programmes. Design Randomized controlled trial with repeated measures. Methods This study was approved and received the grant in July 2013. A convenience sample of 128 coronary heart disease outpatients will be recruited from a tertiary hospital in Singapore. Participants are randomly assigned to the 4-week experimental group and will participate in the programme or the control group who will not participate in the programme. The outcome measures include the: 12-item Short Form Health Survey, Perceived Stress Scale, Hospital Anxiety and Depression Scale and General Self-Efficacy Scale. Data will be collected at baseline, then 4 and 16 weeks from baseline. At the end, a process evaluation will be conducted to assess the acceptability, strengths and weaknesses of our programme based on the participants' perspectives. Discussion Our programme offers coronary heart disease patients an additional option to the existing cardiac rehabilitative services in Singapore hospitals. It aims to help them manage their disease effectively by reducing cardiac risk factors and improve their health-related quality of life and psychological well-being. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to explore the ways that mothers' groups and playgroups support families with children aged 0-5 years and foster community connectedness in newer residential communities in Perth, Western Australia. Background The transition to parenthood is a time of increased support need. Changing community demography has resulted in a loss of traditional support structures and an increased need for local community initiatives to support families with young children. Design A qualitative descriptive design was used for this initial phase of a mixed methods sequential exploratory study. Method Data were collected between December 2011-August 2012. Interviews and focus groups conducted with 39 mothers provided insights from 16 mothers' groups and 13 playgroups. In addition, interviews were undertaken with three child health nurses and four local government early childhood staff. Findings For the participants in this study, mothers' groups and playgroups provided opportunities to learn about parenting, to build a supportive network, to forge friendships and a connectedness to the local community. The families who relocated often experienced isolation until new groups and social networks were found. In general, where participation in mothers' groups and playgroups facilitated relationships with others from the local community, connectedness to that community was reported by participants to be enhanced. Conclusion Mothers' groups and playgroups provide important community development opportunities and appear to help reduce potential isolation for mothers with young children. The findings are of interest to nurses and other health professionals working with families with young children. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore and understand medical-surgical nurses' perceived self-confidence and leadership abilities as first responders in recognising and responding to clinical deterioration prior to the arrival of an emergency response team. Background Patients are admitted to hospitals with multiple, complex health issues who are more likely to experience clinical deterioration. The majority of clinical deterioration events occur on medical-surgical units, and medical-surgical nurses are frequently the first healthcare professionals to identify signs and symptoms of clinical deterioration and initiate life-saving interventions. Design A prospective, cross-sectional, descriptive quantitative design using a survey method was used. Methods Nurses were recruited from an integrated healthcare system located in the south-east United States. Nurses completed a demographic, a self-confidence and a leadership ability questionnaire. Results One hundred and forty-eight nurses participated in the study. Nurses felt moderately self-confident in recognising, assessing and intervening during clinical deterioration events. In addition, nurses felt moderately comfortable performing leadership skills prior to the arrival of an emergency response team. A significant, positive relationship was found between perceived self-confidence and leadership abilities. Age and certification status were significant predictors of nurses' leadership ability. Conclusion Although nurses felt moderately self-confident and comfortable with executing leadership abilities, improvement is needed to ensure nurses are competent in recognising patients' deterioration cues and making sound decisions in taking appropriate, timely actions to rescue patients. Further strategies need to be developed to increase nurses' self-confidence and execution of leadership abilities in handling deterioration events for positive patient outcomes. Relevance to clinical practice Educational provisions should focus on various clinical deterioration events to build nurses' self-confidence and leadership abilities in handling clinical deterioration. Nurses should obtain national certification to increase their knowledge and clinical reasoning skills. [ABSTRACT FROM AUTHOR]