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Anemia is a global public health problem, especially common among children in developing countries, which affects their physical and mental health development. However, there is currently a lack of research on the relationship between anemia and academic performance. The objective of this study was to explore the association between anemia and academic performance, and the possible factors mediating this association among Chinese children. The data for this study came from the baseline survey of the Chinese Education Panel Survey Elementary School Cohort. The cohort was conducted from September 2018 to June 2019 in 160 elementary schools, covering 20 provinces and 40 counties/districts throughout China. Paper-based questionnaires were used, completed by 4th grade students, parents, head teachers, main teachers, and principals. The data used included questionnaire responses, physical measurements, and academic performance of 17,695 students. Based on students' hemoglobin levels and school altitude data, we grouped them into anemia and nonanemia categories using WHO criteria. The anemia group had 1,154 individuals, while the nonanemia group had 16,541 individuals. An ordinary least squares regression and mediation effect analysis were conducted. Our findings found the prevalence of anemia was 6.52% among Chinese Grade 4 students. Students without anemia had a higher average test score for three academic subjects than students with anemia (P < 0.001); their test scores for Chinese, Mathematics, and English were also higher (P < 0.05). Multivariate regression analysis showed a negative association between anemia and average test scores as well as individual test scores for the three subjects. Mediation analysis found that anemia affected academic performance directly (P < 0.05), and indirectly by decreasing the cognition score (P < 0.05). The indirect effect was 19.9% of the total effect. Findings highlighted anemia affected academic performance both directly and indirectly. Nutrition-related interventions should be implemented to prevent a decrease in academic performance among students with anemia. [ABSTRACT FROM AUTHOR]

Objective. In real communication, the context is complex and changeable and the color and meaning of some words will wander in the context. The development and changes of words are more complex and multidimensional than before. Compared with the rational meaning of words, the color meaning of words can better reflect the psychological mode and way of thinking of the Han nationality but it is difficult for foreign learners to accurately grasp and misunderstandings often occur. In order to solve this problem, it is necessary to summarize and explain the words whose color meanings are easily shifted, so as to help the students accurately grasp the color meanings of the words and better help Chinese learners to realize the communicative function of the language. Method. This paper takes the scope of emotional words as the starting point and proposes that emotional words are words with emotional colors. The four aspects of whether words belong to emotional words define the concept of emotional words and introduce the specific methods of judging and extracting emotional words from the two aspects of dictionary definition and word collocation. This paper takes foreign students whose native language is English as the research object, through questionnaire survey and corpus analysis, to investigate the use of foreign students' emotional colors and to explore the influence of native language factors on emotional color acquisition. Based on the research of modern Chinese ontology and the existing research results in the field of teaching Chinese as a foreign language, this paper takes the theory of interlanguage and transfer theory as the theoretical basis and mainly uses the methods of comparative analysis and error analysis to try to find out the relationship between emotional color teaching and acquisition. Results/Discussion. The basic pattern and quantity distribution of lexical emotion correction for beginners, intermediate, and advanced learners of Chinese as a second language were analyzed, and the restrictive factors and characteristics were explained. Similarities and differences and the rationale behind them were explored. In the process of international Chinese teaching, teachers mostly pay attention to the rational meaning of words, while ignoring the teaching of the emotional meaning of words. The lack of vocabulary emotion and meaning teaching is prone to errors in students' understanding and use. With the increase of the vocabulary of intermediate and advanced learners, many words with similar colors and meanings appear, which brings a lot of difficulties for students to distinguish between synonyms. If the use of words with emotional meanings is not accurate, it is easy to cause communication barriers. [ABSTRACT FROM AUTHOR]

To explore the effects of social support on the mental health of older adults in different age groups in China, and to provide reference for the development of social support policies to promote the mental health of older adults in China. This paper uses a random sampling method to conduct a questionnaire survey of 3,000 older adults aged 60 years or older in Nanjing and a dichotomous logistic regression model for empirical analysis. The two dimensions of mental health and social adjustment were used to measure the mental health status of the elderly. The results showed that the overall mental health status of the elderly in Nanjing city was more optimistic, and the nonempty nesters with male gender, higher education level, and partners were generally healthier; objective and subjective support had significant positive effects on the mental health of middle and high aged elderly, while the utilization of support had more significant effects on the health of low-aged elderly. This paper proposes that government departments should develop a localized elderly support system and social support policies adapted to the actual situation in Nanjing according to the quantitative distribution and demand characteristics of the mental health of elderly people in different age groups. The study is structured as follows: the second part contains data sources and statistical methods. The third part is the analysis of empirical results. The fourth part is the discussion and conclusion part of the article. [ABSTRACT FROM AUTHOR]

In order to supplement and improve the landscape evaluation system of traditional villages and play a positive guiding role in the specific protection and development of village landscape, this paper proposes the ecological landscape environment evaluation of traditional villages in Guanzhong from the perspective of rural revitalization. First of all, the relevant national and provincial evaluation standards are deeply studied, and the comprehensive evaluation system of the traditional village landscape in the Guanzhong region is constructed by using expert scoring and an analytic hierarchy process, which includes 6 criteria and 25 indicators. Three typical villages of different types and different development stages, namely, village A, village B, and Village C, were selected for landscape investigation and comprehensive evaluation. The results show that the weight of village location and landscape pattern is the largest, that is, the most important. The second is architectural landscape, with a weight of 0.236, accounting for a high proportion. Then, it is the natural landscape and street landscape, with a weight of 0.1-0.2. Finally, it is the intangible cultural landscape and landscape style protection, with a weight of less than 0.1. The alpha value of the comprehensive evaluation questionnaire of the village A is 0.984. The alpha value of the comprehensive evaluation questionnaire of village B is 0.941. The alpha value of the comprehensive evaluation questionnaire for the landscape of village C is 0.986, which is greater than 0.8. Conclusion. This study makes a comprehensive evaluation of the landscape of typical traditional villages. [ABSTRACT FROM AUTHOR]

Aim: This paper aimed to investigate the relationship between social support and quality of life for nurses in infectious disease departments in China, as well as the function of psychological resilience in mediating this relationship. Background: Nurses in infectious disease departments play a critical role in the prevention and control of infectious diseases and in public health care services in general, and their quality of life can affect the quality of clinical nursing work they do. However, there are few studies on the relationship between nurses' social support networks and their quality of life. Methods: A cross‐sectional study was conducted using a sample of 866 clinical nurses from the infectious disease departments of 10 general hospitals in China. Data were collected using a questionnaire survey from January to May 2021. The mediating influence of psychological resilience on social support and quality of life was investigated using structural equation modelling. Results: The score of quality of life was (36.36 ± 7.64). Quality of life was positively correlated with social support and psychological resilience (r1 = 0.521, r2 = 0.583; p <.01), and psychological resilience was positively correlated with social support (r = 0.426; p <.01) as well. The mediating effect of psychological resilience between social support and quality of life was 0.233, accounting for 37% of the total effect. Conclusion: The quality of life of nurses working in infectious disease departments is in the middle level. Psychological resilience is a mediating variable between social support and quality of life. Implications for Nursing Management: Managers can improve the quality of life of nurses by both increasing social support and strengthening psychological resilience. Managers should pay attention to the degree of social support provided to nurses and take proactive measures to build psychological resilience so that nurses can effectively manage stress and negative emotions from work and life in order improve their quality of life. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to understand the current situation and multiple factors affecting the core competence specializing in the maternal, neonatal and under‐five nursing in China. Background: Highly skilled nurses and midwives are essential worldwide for achieving the Sustainable Development Goals, especially in low‐ and middle‐income countries like China, due to the overwhelming COVID‐19 crisis. Method: The 890 nurses and midwives from 12 hospitals were investigated in this cross‐sectional study, with two questionnaires: the sociodemographic information and competency inventory for the registered nurses. Results: The participants reported a mean total score of 193.78 (±42.19) out of 220 and lowest in critical thinking and research ability (3.01 ± 0.82). The professional title, level, marital status, relationship quality, highest qualification, experience in specialist nurse training, participation in scientific research projects and publishing papers were the influencing factors (P <.05). Conclusions: The respondents' core competence needs improvement, especially critical regarding thinking and research ability. In addition, marriage and good or excellent relationship quality are factors that can potentially improve competence. Implications for Nursing Management: Targeted interventions for higher core nursing competence need to be implemented, especially focusing on nurses' marital status and emotional support from partners. [ABSTRACT FROM AUTHOR]

Social determinants of public health have gained increasing attention. This paper studied whether social support from online communities related to maternal mental health. We focused on online maternity communities that group users with a similar prenatal status to facilitate their exchange of personal experiences and knowledge about maternal caring during pregnancy. Such online maternity communities are getting increasingly popular and can be found across countries and societies. We invited users—currently pregnant and gave birth within 1 year at the time of the study—from one such community in China to participate in a survey. The survey measured their perceived social support (PSS) exclusively from the peer group in the online community, their mental health and newborns' birth outcomes (N = 500). Users reported high score in PSS from the online peer group which was comparable to the ones from family, significant other and friends in other studies. We used linear regression models to examine the effects of PSS on mental health and birth outcomes. We found that a one‐point increase in the PSS score was associated with a 0.19‐point (p < 0.1) decrease in the prenatal depression and a 0.26‐point (p < 0.01) decrease in the postnatal depression, which was equivalent to 3% and 4.5% of the average respectively. Moreover, a one‐point increase in the PSS score was associated with a 14.49‐gram increase in a newborn's weight (p < 0.01). [ABSTRACT FROM AUTHOR]

Aim: This study aims to design a 100‐h training programme for nursing innovation teams and to evaluate the effect of this training programme using Kirkpatrick's model. Background: The innovative capability of nurses is a powerful driver for the development of the nursing discipline, and it is currently at a low to medium level in China. Innovation competency development has become a research trend in nurses' in‐service education, but only changes in nursing innovation behaviours before and after training have been evaluated. The cascading, continuous assessment tools are rarely used. Methods: This is a quasi‐experimental research design: pretest and posttest design. Totally, 61 clinical nurses from Hangzhou Hospital of Traditional Chinese Medicine were enrolled for innovation training. This innovation team training programme consisted of a 36‐h theoretical training phase and a 64‐h collaborative training phase. The four levels of Kirkpatrick's model, that is, reaction, learning, behaviour, and result, were applied for the evaluation together with questionnaires. Results: At reaction level, the nurses' attendance was over 85% in two phases. The differences between nurse organizational innovation climate scores of tested nurses before and after training were statistically significant (t = −22.559, P <.001). At learning level, there were statistically significant differences between nurses' innovation self‐efficacy scale scores of tested nurses before and after training (t = −16.832, P <.001). At behaviour level, the nursing innovation behaviour scale scores of tested nurses were significantly higher after training (t = −18.950, P <.001) than before the training. At result level, the clinical nurse innovation ability of tested nurses after the training were higher than before the training (t = −26.275, P <.001). The numbers of patent applications, granted patents, application for scientific research projects, sponsored scientific research projects, and papers published by team members after the training were larger than those before training (Z = −2.032, P =.042). Conclusion: Kirkpatrick's model can evaluate the effectiveness of nursing innovation training for clinical nurses. The nursing innovation training is beneficial to improve nurses' innovation capacity, organizational innovation climate and innovation self‐efficacy, and nursing innovation behaviour and promote the output of research and innovation projects. Implications for Nursing Management: Managers can flexibly develop training modules with regional characteristics based on this programme to effectively improve the innovation ability of clinical nurses, thus meeting the urgent demand for innovative nursing talents and the rapid development of nursing disciplines. [ABSTRACT FROM AUTHOR]

Most road crashes are caused by human factors. Risky behaviors and lack of driving skills are two human factors that contribute to crashes. Considering the existing evidence, risky driving behaviors and driving skills have been regarded as potential decisive factors explaining and preventing crashes. Nighttime accidents are relatively frequent and serious compared with daytime accidents. Therefore, it is important to focus on driving behaviors and skills to reduce traffic accidents and enhance safe driving in low illumination conditions. In this paper, we examined the relation between drivers' risk perception and propensity for risky driving behavior and conducted a comparative analysis of the associations between risk perception, propensity for risky driving behavior, and other factors in the presence and absence of streetlights. Participants in Hefei city, China, were asked to complete a demographic questionnaire, the Driver Behavior Questionnaire (DBQ), and the Driver Skill Inventory (DSI). Multiple linear regression analyses identified some predictors of driver behavior. The results indicated that both the DBQ and DSI are valuable instruments in traffic safety analysis in low illumination conditions and indicated that errors, lapses, and risk perception were significantly different between with and without streetlight conditions. Pearson's correlation test found that elderly and experienced drivers had a lower likelihood of risky driving behaviors when driving in low illumination conditions, and crash involvement was positively related to risky driving behaviors. Regarding the relationship between study variables and driving skills, the research suggested that age, driving experience, and annual distance were positively associated with driving skills, while myopia, penalty points, and driving self-assessment were negatively related to driving skills. Furthermore, the differences across age groups in errors, lapses, violations, and risk perception in the presence of streetlights were remarkable, and the driving performance of drivers aged 45–55 years was superior to that of drivers in other age groups. Finally, multiple linear regression analyses showed that education background and crash involvement had a positive influence on error, whereas risk perception had a negative effect on errors; crash involvement had a positive influence, while risk perception had a negative effect on lapse; driving experience and crash involvement had a positive influence on violation; and age had a negative influence on it. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the relationship between work engagement and inclusive leadership in Chinese hospital head nurses. Besides, it explored the effect of the mediating role of inclusive leadership in the relationship between work engagement and innovative behaviour among Chinese hospital head nurses. Background: Head nurses are essential in the group of registered nurses who are to pass the Chinese licensure examination for nurses. Their work engagement and innovative behaviour are beneficial to improve the quality, efficiency and competitiveness of nursing services. However, little is known about the mediating role of inclusive leadership in the relationship between work engagement and innovative behaviour. Methods: In April 2018, a total of 374 Chinese head nurses were surveyed with a Work Engagement Scale, an Inclusive Leadership Scale and an Innovative Behavior Scale. Because the data were normally distributed in our study, Pearson's correlation coefficient (r) was used to conduct the correlation analysis of study variables. Multiple linear regression analysis was used to explore the factors of innovative behaviour. Model 4 of Hayes's (2013) PROCESS macro and Bootstrap method was used to examine the mediating role of inclusive leadership. Result: Inclusive leadership was significantly and positively correlated to innovative behaviour and work engagement (p < 0.01). Moreover, work engagement was correlated with innovative behaviour (p < 0.01). In addition, hospital level, publishing papers, work engagement and inclusive leadership were the factors of head nurses' innovative behaviour (p < 0.01). Inclusive leadership partially mediated the relationship between work engagement and innovative behaviour, accordingly. Conclusion: Work engagement affects innovative behaviour among Chinese head nurses, and inclusive leadership is a mediator in the relationship. We should take measures to improve the leaders' level of inclusive leadership, in order to strengthen head nurses' innovative behaviour. Implications for nursing management: According to the results of the study, the leaders of head nurses should pay attention to improve head nurses' innovative behaviour, inclusive leadership, work engagement, and the quality and competitiveness of nursing. [ABSTRACT FROM AUTHOR]

Background. Diabetic cognitive impairment (DCI), a serious complication of diabetes mellitus (DM), is gaining more acceptance and attention. The learning and memory function of diabetics always decreases. Traditional Chinese medicine (TCM) has been demonstrated to be effective in treating the symptoms in China, and thereinto Chinese medicinal herbs (CMH) are the most widely used. The objective of the present study was to review and analyze the existing data about reducing the symptoms in CMH treatment for DCI. Methods. Electronic literature databases (PubMed, EMBASE, CNKI, SinoMed, and Wan fang) were searched for randomized controlled trials conducted in China, comparing CMH with western medicines in the treatment of DCI, up to April 1, 2018. We applied standard meta-analytic techniques to analyze data from papers that reached acceptable criteria. Result. Nine randomized controlled trials (n = 576) on CMH were included. We found moderate evidence that CMH used alone or in combination with western medicines was more effective than western medicines alone in reliving the symptoms for DCI (total effective rate, odds radio (OR) = 4.64 (2.60, 8.29), and 95% confidence interval, P<0.00001). Besides, CMH along or in combination with western medicines showed more beneficial effects on Montreal Cognitive Assessment (MoCA) scale (mean difference (MD) = 1.31(0.75, 1.87), P<0.00001), Mini-Mental State Examination (MMSE) scale (MD = 2.07 (0.86, 3.28), P<0.00001, and TCM symptom score (TCMSS) (MD = -4.89 (-8.44, -1.34), P = 0.007). Most of the included studies showed that there was not a significant difference in the adverse events. Conclusions. These findings demonstrated that CMH used alone or in combination with western medicines were apparently better than western medicines alone in the treatment of DCI. Because of the poor quality of the studies that were available for the present meta-analysis, further researches are still needed to support these early findings. [ABSTRACT FROM AUTHOR]

Aims. To develop an evidence-based practice (EBP) facilitating strategy informed by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and evaluates the strategy's effectiveness on promoting EBP. Background. Nurses are increasingly expected to use research evidence in practice to improve patients' outcomes, but the application of such evidence is still unsatisfactory. The facilitation of EBP in nursing needs the organization and the individual levels. Methods. Based on an analysis of EBP-promoting strategies and expert consultation, the core team of the nursing department developed an EBP group-based and project-oriented strategy under the guidance of the i-PARIHS framework. The strategy was implemented for six years and evaluated by a longitudinal design. The validated Chinese version of the self-reported Evidence Based Practice Questionnaire (EBPQ) was used to assess the attitudes, knowledge, and practice of the nurses. Results. The mean score of the total EBPQ was 4.46 (SD = 0.92) after one year of the EBP strategy, and the scores for knowledge, attitudes, and practice of EBP members were higher than those of general nurses p < 0.05 . After four years, EBP members' scores continued to increase. EBP groups conducted 51 EBP projects in the areas of emergency nursing, surgical and medical nursing, critical care, and so forth. Of these, 33 projects improved nursing practice by changing nursing procedures, upgrading nursing tools, and developing nursing standards, resulting in improved patient outcomes. Conclusion. The EBP group-based and project-oriented strategy can promote EBP. The composition of the EBP group, the annual audit of EBP projects, and the roles of internal and external facilitators were key components of this EBP-facilitating strategy. Implications for Nursing Management. The strategy is an organizational-level EBP-facilitation approach which can improve nurses' academic preparation for EBP through ongoing training and sustained EBP behavior that involves annual projects. [ABSTRACT FROM AUTHOR]

Background. There was a remarkable downgrade in China's COVID-19 response strategies in January 2023. The COVID-19 infection rate grew rapidly in the early stages following the management policy shift. This study attempted to explore the associations between SARS-CoV-2 infection and mental or physical health status in pregnant and postpartum women and the role of perceived health risks and family members' SARS-CoV-2 infection status on these associations by capturing the impact of policy shifts in a short period of time. Methods. This cross-sectional study with a random sample from a convenience sample of hospitals was conducted in pregnant and postpartum women in January 2023. Standardized assessment tools were employed to assess anxiety, depressive and physical symptoms, and feelings of hopelessness. Hierarchical multiple logistic regressions were conducted to examine the mechanisms of associations of interests by including a range of sociodemographic factors, self-perceived health, SARS-CoV-2 infection status, and perceived health risks as covariates. Results. Of the 1,013 pregnant and postpartum women aged 32.0 ± 0.3 years, 58.2% (n = 590) were diagnosed with COVID-19, and 49.4% (n = 500) had family members who were infected with SARS-CoV-2. Nearly 98% of the included participants took measures to prevent SARS-CoV-2 infection. A COVID-19 diagnosis was positively associated with feelings of hopelessness (OR = 1.68, 95% CI: 1.20–2.35), probable anxiety (OR = 6.42, 95% CI: 2.18–24.61), possible depression (OR = 2.56, 95% CI: 1.07–6.70), and physical symptoms (OR = 6.28, 95% CI: 1.63–42.03) after adjusting for sociodemographic and health characteristics, while the associations presented no statistical significance when family members' SARS-CoV-2 infection status and perceived health risks were introduced into the models. Conclusions. Our results suggested that pregnant and postpartum women may experience physical and mental health challenges when they or their family members contracted COVID-19 in the context of a considerable shift in COVID-19 management. Early detection of poor health status and its risk factors for vulnerable groups during shifts in health policy and administrative practice is very necessary, and health services, including easy access to psychosocial support and obstetric counselling, should be prioritized. [ABSTRACT FROM AUTHOR]

Objective. Perceived control refers to an individual's subjective perception, affective experience, or cognitive beliefs regarding their level of control. The objective of this study was to examine the relationship between perceived control and quality of life (QoL) among breast cancer (BC) patients using a structural equation model. Method. Participants (N = 80) completed questionnaire surveys on perceived control and QoL using the Cancer Experience and Efficacy Scale (CEES) and the Quality of Life Questionnaire Core 30 (EORTC QLQ-C30 V3.0), respectively. Structural equation modeling was employed to examine the associations between perceived control factors, including cancer experience and control efficacy, and QoL. Results. The QoL in BC patients was found to be significantly negatively correlated with physical symptoms, accounting for 51.6%. This indicates that the QoL of patients decreased by 51.6% with each unit increase in physical symptoms. In terms of perceived control among BC patients, socioeconomic strain exerted the greatest influence on cancer experience, accounting for 44.3%, followed by emotional strain and personal strain at 40.08% and 34.6%, respectively. Group efficacy had the highest impact on control efficacy at 43.0%, followed by individual efficacy and medical efficacy at 41.8% and 29.7%, respectively. QoL in BC patients decreased by 4.2% with every unit increase in cancer experience but improved by 3.5% with every unit increase in control efficacy. Conclusion. The structural equation model facilitates a comprehensive understanding of the interrelationships among various variables in perceived control and QoL among BC patients. The cancer experience in perceived control is negatively correlated with the QoL, whereas control efficiency demonstrates a positive correlation with QoL. Consequently, healthcare professionals should implement appropriate interventions to alleviate physical symptoms and enhance control efficiency, thereby improving both perceived control and QoL levels among BC patients. This trial is registered with ChiCTR2300069476. [ABSTRACT FROM AUTHOR]

Aims. This study was designed to investigate the impact of inclusive leadership on challenge-oriented citizenship behaviors and examine the mediating role of organizational justice on the relationship between inclusive leadership and challenge-oriented citizenship behaviors among nurses. Background. Leaders exhibiting an inclusive leadership style have the potential to create a positive work climate and motivate members of the organization. However, the mechanisms by which organizational justice contributes to this process remain to be explored, particularly in terms of how it motivates challenge-oriented organizational citizenship behaviors. Method. A cross-sectional questionnaire survey was conducted among nurses in China at the end period of the COVID-19 pandemic. A total of 527 registered nurses were enrolled and completed the self-report questionnaires including inclusive leadership scale, organizational justice scale, and challenge-oriented citizenship behavior scale. The hypotheses were tested using hierarchical multiple regression analyses and structural equation modelling. Results. The results of empirical tests revealed that nurse leader's inclusive leadership had a positive relationship on nurses' challenge-oriented organizational citizenship behaviors (β = 0.823, p < 0.001) after controlling several demographic covariates. Meanwhile, inclusive leadership was positively linked to organizational justice (β = 0.747, p < 0.001), and the indirect effect of inclusive leadership on nurses' challenge-oriented citizenship behaviors through organizational justice was statistically significant (β = 0.641, p < 0.001). Furthermore, the model fit indices were χ2/df = 1.952, RMSEA = 0.043, CFI = 0.979, and TLI = 0.977, indicating that the model had high quality. Conclusion. This study could help nurse leaders with inclusive leadership style have a better understanding and taking the advantages of the influence mechanism of organizational justice in inspiring nurses' challenge-oriented citizenship behaviors. While nurse managers can inspire challenge-oriented organizational citizenship behaviors through inclusive leadership, they should also emphasize the evaluative and behavioral-shaping effects of organizational justice. Both leadership and organizational justice are essential to motivate challenge-oriented organizational citizenship behaviors and to foster organizational development. Moreover, managers should focus on the process and conditions of implementing organizational justice to ensure fairness within the organization and to create a conducive environment for challenge-oriented organizational citizenship behaviors. [ABSTRACT FROM AUTHOR]

Taking care of people with dementia is stressful for informal caregivers. Respite care can provide a break for them. But it is often underused, and its acceptability can be low in China. One reason is that it fails to meet their needs. This study aimed to explore the preference of caregivers of people with dementia for respite care services. A discrete choice experiment was used. Attributes and levels of respite care were informed by a literature review and expert consultations. A fractional factorial design was used to reduce the number of choice sets. A questionnaire survey was conducted in Tianjin, China. A mixed logit model was used to compute coefficients for attributes and levels. Respite care packages differed in five attributes, which were content, provider, duration, frequency, and cost. 322 caregivers completed valid discrete choice experiment questionnaires. All five attributes were statistically significant. Two most preferred attributes were "providers" (coefficient 1.297, p < 0.001) and "frequency" (coefficient 1.169, p < 0.001). Caregivers prefer highly qualified service providers and frequent respite care. The desirable respite care for caregivers would be assistance with personal care for people with dementia which was provided by an experienced worker with attitudes of understanding and respect towards people with dementia more than 3 times per week regularly and more than 4 h every time with a lower cost. This study offered new information on Chinese dementia caregivers' preferences for respite care. Policymakers should pay attention to the frequency and quality of providers when designing respite care to improve service uptake and ultimately lighten the burden on caregivers of people with dementia. [ABSTRACT FROM AUTHOR]

Aim: To explore the impact mechanism of transformational leadership and clan culture on the willingness to stay of nursing staff in the aged care industry. Background: Previous researchers had paid much attention to the leadership and culture, yet it was unclear how the transformational leadership and clan culture influence the willingness to stay of nursing staff, especially those in the aged care industry. Methods: A questionnaire was conducted in an aged care agency in Anhui Province, with a total of 217 valid questionnaires collected for empirical analysis. Results: (a) Transformational leadership indirectly affects willingness to stay by affecting organisational commitment and job satisfaction. (b) Clan culture also affects the willingness to stay by affecting their organisational commitment and job satisfaction. (c) Professional identity also has a significant positive impact on the willingness to stay. Conclusions: The findings of the study emphasize the importance of transformational leadership and clan culture in enhancing the willingness to stay of nursing staff in the aged care industry, and clarify the specific impact mechanism. Implications for Nursing Management: Nurse leaders in the aged care agencies should improve transformational leadership, and strive to build clan culture to help retain nursing staff better. [ABSTRACT FROM AUTHOR]

Background. Adherence to complete decongestion therapy (CDT) is of utmost importance for patients with breast cancer-related lymphedema (BCRL). However, past studies have demonstrated that adherence to CDT in BCRL patients is less than satisfactory. Our study aimed to describe the level of adherence to CDT among BCRL patients and utilize the Health Belief Model to analyse the key factors that influence adherence. Methods. We employed a convenient sampling method to select 158 patients with BCRL who were in the maintenance stage of CDT in a grade A tertiary tumour hospital in Guangzhou. A questionnaire survey was used to investigate patients' adherence to CDT, as well as their sociodemographic characteristics, medical history characteristics, disease knowledge, and health beliefs. Results. The CDT adherence score of BCRL patients was 96.46 ± 18.46 points, with an average score of 2.61 ± 0.50 points per item. The adherence rate was 65.18 ± 12.47%, indicating a moderate level of adherence. Factors that significantly influenced CDT adherence in BCRL patients included age under 45 years, having 0 or 1 child, experiencing 9 lymphedema symptoms, and having low levels of disease knowledge and health beliefs (p < 0.05). Conclusions. The level of adherence to CDT in BCRL patients is moderate and requires improvement. To enhance adherence to CDT, medical professionals should focus on patients who are younger, have fewer children, exhibit fewer symptoms of lymphedema, possess limited disease knowledge, and have weak health beliefs. [ABSTRACT FROM AUTHOR]

Aim. To evaluate the knowledge, attitudes, and practices of Chinese bedside nurses regarding antimicrobial stewardship, as well as to identify factors that influence nurses' engagement in antimicrobial stewardship. Background. Antimicrobial resistance is a pressing global health threat. Antimicrobial stewardship is crucial in combating this issue. Nurses play a key role in implementing antimicrobial stewardship. However, little is known about the involvement of Chinese nurses in antimicrobial stewardship. Methods. An explanatory sequential mixed-methods design was employed. A self-developed questionnaire was administered between March and August 2021 (N = 463), followed by semi-structured interviews with 17 nurses between March and July 2022. Descriptive statistics and qualitative content analysis were used to analyze the data. Results. The study found that nurses scored 75% in knowledge, 82.8% in attitude, and 84.1% in practice domains. There was a moderate correlation between nurses' knowledge, attitudes, and practices. It revealed that knowing local antimicrobial stewardship programmes information and the frequency of receiving antimicrobial stewardship training had a significant impact on nurses' knowledge scores. The willingness to participate in related training influenced nurses' attitude scores. Being a clinical teacher and the frequency of receiving related training influenced nurses' practice scores. The qualitative phase identified three themes: insufficient knowledge of nurses' engagement, diverse attitudes towards engagement, and limited scopes and absence of standards in nurses' participation. Conclusions. Our findings emphasize the importance of enhancing nurses' perception and involvement in antimicrobial stewardship. While nurses exhibit positive attitudes and practices, addressing the existing knowledge gap is crucial. To achieve this, it is necessary to clarify the role and responsibilities of nurses in antimicrobial stewardship, provide regular training and innovative methods, strengthen communication and collaboration, and foster a positive work environment. Additionally, actively promoting the development of guidelines and evaluation criteria will enable nurses to more effectively participate. Implications for Nursing Management. Regular training of nurses in antimicrobial stewardship needs to be enhanced. Nursing managers should strive to create positive, empowering, and supportive work environments, participate in policy formulation and implementation, and provide clear expectations for nurses' engagement in antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Aim. The aim of the study was to examine the effect of the length of working hours on missed nursing care, quality of nursing care, and perceptions of the nursing practice environment. Methods. A multicenter cross-sectional investigation using online questionnaires was conducted from April 2 to May 10, 2022, in twenty nine hospitals (13 Level-III hospitals and 16 Level-II hospitals). We collected data on the working hours of nurses and nurse-reported outcomes, including missed nursing care, quality of nursing care, and nursing practice environment. Restricted cubic spline (RCS) regression models were used to examine relationships between the hours per shift and nurse-reported outcomes. Results. We investigated 12,703 nurses with a response rate of 97.33%. Nurses worked on average 7.72 (SD = 1.16) hours on the day shift and 8.92 (SD = 2.20) hours on the night shift, respectively. On the day shift, working 7.5 hours shift showed minimal missed nursing care; meanwhile, working 7–7.5 hours were correlated with the highest satisfaction of the nursing practice environment and better quality of nursing care. On the night shift, the highest missed nursing care was found for a working duration of 12 hours to the working 7 hours, with the lowest satisfaction while better quality was observed. The percentage of nurses who reported working overtime was 30.33%. Nurses who worked overtime reported lower satisfaction and poorer quality of nursing care on all shifts; moreover, working overtime showed the positive correlation to missed nursing care on the day shift, while on night shift was not statistically significant. Conclusion. Positive outcomes were observed for nurses who reported working 7–7.75 hours on the day shift and 12 hours (no more than 15 hours) on the night shift. Implications of Nursing Management. The results reemphasized the need for managers to reduce the working hours, overtime work, and the frequency of the night shift. [ABSTRACT FROM AUTHOR]

Aims. To measure nursing clinical teachers' knowledge, attitudes, and practices about nursing students (NSs) suffering from workplace violence (WPV) in China. Background. The nursing clinical teacher is the most important person for NS during the clinical rotation. In contrast, there is a lack of investigation into the ability of nursing clinical teachers to manage NSs suffering from WPV. Method. A cross-sectional survey was conducted in Hubei province, China, between June and July 2022. Convenience sampling was employed to recruit clinical teachers in 9 tertiary hospitals who met the inclusion criteria. The survey was conducted using a self-designed questionnaire which has good reliability and validity. Questionnaires were collected through a web-based platform called Questionnaire Star in China. In July 2022, a total of 900 questionnaires were eventually distributed, and 869 valid questionnaires were returned. The software SPSS 26.0 was used to conduct descriptive and inferential statistical analyses. Result. The mean ± SD knowledge, attitudes, and practices scores of the nursing clinical teachers were 69.51 ± 12.78, 29.11 ± 4.38, and 82.84 ± 13.60, respectively. Also, the average score rate was 77.24%, 83.17%, and 87.20%, respectively. There are still deficiencies in the knowledge, attitudes, and practices index, such as knowledge about the sources of violence, perceptions about influencing factors, and behavioural practices for prevention. Factors affecting the knowledge index scores included teachers' age, highest academic degree obtained, years of work, the highest level of education that they could teach NSs, whether they had experienced WPV, whether they had witnessed NSs suffering from WPV, and whether their NSs had suffered from WPV. Factors affecting scores on the attitude index included the age, highest academic degree obtained, years of work, the highest level of education that they could teach NSs, and whether they had received training on prevention and coping with WPV. Factors influencing the score for the practice index included the working department, highest academic degree obtained, professional title, the highest level of education that they could teach NSs, and whether they had received training on prevention and coping with WPV. Conclusion. Nursing clinical teachers showed moderate levels of knowledge, attitudes, and practices about NSs suffering from WPV. The deficiencies mainly focused on the sources, manifestations, influencing factors, and preventive strategies of it. Also, nursing clinical teachers should be trained to better prevent and cope with WPV suffered by NSs. At the same time, in order to better protect and teach NSs, the selection criteria for nursing clinical teachers should be stricter, with requirements on age, education, years of working experience, and titles. Implications for Nursing Management. With nursing clinical teachers as the training target, health organizations and institutions should actively develop training related to preventing and coping with NSs suffering from WPV. Also, it should be incorporated into the preservice training system for nursing clinical teachers. The content of training could focus on the sources, manifestations, influencing factors, and prevention strategies of NSs suffering from WPV. The method could be online theoretical teaching combined with offline scenario simulation exercises. At the same time, strict admission criteria for nursing clinical teachers can be helpful in protecting the safety of NSs during the clinical rotation phase. For nursing managers, they should be kept abreast of organisational policies and adopt a zero-tolerance policy towards violence. It also can be recommended that nursing clinical teachers should be proactively involved in training to improve their own ability to protect NSs. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to evaluate conjunctival vessels in patients with dry eye disease (DED) using optical coherence tomography angiography (OCTA). Methods. This was a cross-sectional, observational clinical study. Twenty-three eyes of 18 patients with DED and 28 eyes of 23 healthy controls were included for examination in this study. The evaluation included the application of an Ocular Surface Disease Index Questionnaire, Schirmer Basic Secretion Test, and anterior OCTA targeting the temporal conjunctiva. AngioTool software was used to quantify the total vessel length and vessel density in the 3 × 3 mm temporal region of interest. Results. Blood vessel density measurements were compared across the OCTA systems. The total vessel length within the conjunctiva of the DED group (4799.34 ± 834.36) exceeded that of the control eye (3864.89 ± 1455.70) group (P < 0.05). However, the difference in vessel density between the two groups was not statistically significant. Conclusion. Measurement and analysis of conjunctival blood vessels using OCTA exhibited robust repeatability. In dry eyes, the total number of conjunctival blood vessels increased in accordance with disease severity. Hypoxia of conjunctival tissue may be an important cause of dry eye disease. [ABSTRACT FROM AUTHOR]

Background. The high turnover rate of new nurses is significantly impacted by the transition issue. Practice readiness has been identified as a key factor in ensuring a smooth transition, but there is currently a lack of specific instruments available in China to measure it. Aims. To translate and adapt the Casey-Fink Readiness for Practice Survey and validate its psychometric properties in senior nursing students in the Chinese cultural context. Methods. The descriptive cross-sectional study design was used. The English version of the Casey-Fink Readiness for Practice Survey was translated into Chinese according to Brislin's translation guidelines. A total of 590 senior nursing students from three nursing schools in China were surveyed with the Chinese version of the Readiness for Practice Instrument. Data analyses were performed to assess the reliability and validity of the instrument. The STROBE guidelines were used as the reporting method. Results. The validated Chinese version of the Casey-Fink Readiness for Practice Survey contained 18 items in the same four dimensions as the original English version. The internal consistency was satisfactory, with Cronbach's α and composite reliability values for all four dimensions above 0.70. The final confirmatory factor analysis model also demonstrated good fit indices, with the average variance extracted values for all dimensions above 0.50. Conclusion. The validated Chinese version of the Casey-Fink Readiness for Practice Survey is a reliable and effective instrument for measuring the readiness for practice among senior nursing students in China. Implications for Nursing Management. This study presents a valuable contribution to adapting an effective and reliable tool to assess readiness for practice among Chinese senior undergraduate nursing students. This will enable the development of specific strategies based on cultural context to optimize the readiness for practice for senior nursing students and smooth the transition of new nurses in China. [ABSTRACT FROM AUTHOR]

Aim. To develop a valid, reliable assessment tool to measure risk factors associated to low back pain (LBP) in intensive care unit (ICU) nurses. Background. LBP is defined as the pain extending from the 12th rib to the iliac crest and often coexists with buttock pain. Nursing has been identified among the top professions at risk of LBP. A mean of 70% prevalence per year in ICU nurses was reported, exceeding those employed in heavy industry. Environmental factors in workplace were also most important risks related to LBP in this population except factors including individual, physical, psychosocial, and lifestyle. However, there is lack of tools to assess environmental risk related to LBP for nurse managers currently. Methods. Focus group interviews, field research, and panel discussion were used to develop item pool. Two-round expert reviews and preinvestigation were carried out to form initial scale named Environmental Risk Assessing Instrument-Occupational Low Back Pain in Nurses (ERAI-N). A cross-sectional survey with 188 ICU participants in Hunan Province in China was implemented to collect data. Cronbach's alpha, split-half reliability, and test-retest reliability were used to test ERAI-N's reliability. Expert review was performed to test ERAI-N's content validity, and confirmatory factor analysis (CFA) was performed to assess its construct validity, being carried out in IBM SPSS Amos 26 Graphics. Results. Final version of ERAI-N scale had five dimensions with 18 items that were space, equipment, belief, guideline, and safe culture. ERAI-N scale's score of Cronbach's alpha, Guttman split-half, and intraclass correlation coefficient (ICC) was 0.958, 0.927, and 0.994, respectively. Item-level content validity scores ranged from 0.89 to 1.0, and scale-level content validity was 0.983. Standardized factor loadings ranged from 0.567 to 0.974. Model adjusted fit statistics were as follows: the chi-square statistic and degrees of freedom (χ2/df) = 3.943, root mean square error of approximation (RMSEA) = 0.071, incremental fit index (IFI) = 0.905, comparative fit index (CFI) = 0.904, parsimony normed fit index (PNFI) = 0.641, and parsimonious comparative fit index (PCFI) = 0.661. Conclusions. ERAI-N scale had moderate reliability, content validity, and construct validity. Implications for Nursing Management. Designers may use ERAI-N scale to plan the interior layout when design a new ICU. Nurse managers might utilize this instrument as a managing tool to assess whether there is environmental risk factors related to LBP in ICU. [ABSTRACT FROM AUTHOR]

This study aimed to explore the effect of the Wuhan lockdown on body mass index (BMI) among Wuhan residents as well as factors including food habits affected and changes in physical activity mediating the association. As a survey of the Wuhan lockdown, a random digit dialing method was used to sample residents aged 18 years and older. A computer-aided telephone interview was applied to survey 11,223 residents in Wuhan City in July 2020. Ordinary least squares (OLS) regression and mediation analysis were used to analyze the influence of the Wuhan lockdown on BMI. Demographic characteristics, lifestyle characteristics, and health status differed statistically significantly between residents living in and those who left Wuhan during the lockdown (mean BMI, 23.05 ± 0.04 kg/m2 and 22.34 ± 0.06 kg/m2, respectively). The mean BMI among residents living in Wuhan was 0.42 kg/m2 higher (P < 0.001) than that of residents who left Wuhan during the lockdown, as determined by multivariate OLS regression analysis. Residents living in Wuhan during the lockdown had higher BMI among those aged 18–29 and 30–44 years (P < 0.001), with no difference among those aged 45+ years. The association between living in Wuhan and increased BMI was the strongest among residents who were overweight/obese. The mediation analysis results showed an indirect effect path with living in Wuhan (through decreased physical activity and increasing BMI) and the direct effect of living in Wuhan during the lockdown. The lack of association between living in Wuhan and increased BMI among residents aged 45+ years was due to the indirect influence of living in Wuhan affecting food habits. The findings indicated that the lockdown in Wuhan city increased residents' BMI, especially among those who were young or overweight/obese, partly because of decreased physical activity. [ABSTRACT FROM AUTHOR]

The drifting elderly are an interprovincial floating elderly population that is mainly composed of unemployed older parents in China. They have left their usual residence and relocated to urban areas, facing challenge about social integration. As a neighborhood has played important roles in the floating population's social integration, this study was designed to investigate the influence of neighborhood-based identity and social participation on the social integration of the drifting elderly. Five rounds of data collection and analysis were conducted in a continuous crossover sequence using grounded theory. Twenty-four participants were recruited from three districts in Shanghai, China. The neighborhood was shown to play a prominent role in the drifting elderly's perceptions of social integration. Good neighborhood relations help the drifting elderly establish effective social support networks, interact with inflowing society, get in touch with more human resources, and form social relationships and networks. Neighborhood-based participants and identity were more conducive to eliminating heterogeneity and creating homogeneity for the drifting elderly. Thus, the neighborhood affects the social integration of the drifting elderly, which directly impacts their social feelings, integrations, and networks. Management of social integration among the drifting elderly should be focused on creating general opportunities for them to participate in neighborhood-based social events with a reasonable identity. [ABSTRACT FROM AUTHOR]

Participation by patients with chronic diseases under primary health care requires more attention to achieve effective disease management and better health outcomes. In 2016, China proposed accelerating the establishment of a system of family doctors (FDs) and strengthening doctor-patient communication to better meet residents' health service needs. This study aimed to describe perceived participation in primary health care among patients with chronic diseases in northeastern China and explore the impact of FD contract services and patient's trust on patients' perceived participation. A cross-sectional survey of 847 patients with chronic diseases in 16 primary healthcare institutions was conducted in Jilin Province, China. Among all participants, 453 patients reported signing up for FD contract services (62.93%). The perceived participation of patients with chronic diseases was at a low level (mean = 6.71 and SD = 3.35). After controlling for sociodemographic variables and health-related variables, FD contract services directly and indirectly influenced patients' perceived participation. The patient's trust was a mediator in the relationship between FD contract services and perceived participation. This study confirmed the valuation of family doctor contract services and provided a theoretical basis for the formulation of primary health service policies. Health organizations should continue to enhance the capacity of primary health services and attract more chronic disease patients to contract with FD teams, thereby enhancing doctor-patient trust and increasing patient's participation in primary health care. [ABSTRACT FROM AUTHOR]

Aims: To investigate the relationships between transformational leadership, psychological empowerment and innovative behaviour among nurses in China. Background: The innovative behaviour of nurses is important to adapt to the changing medical environment. However, there is currently a limited understanding of the relationship between nurses' innovative behaviour and transformational leadership and psychological empowerment during the pandemic. Methods: Convenience sampling was used to conduct an investigation involving 1317 nurses from 10 hospitals in China from January 2022 to April 2022. Data analysis was performed using correlation analysis, univariate analysis and multiple regression analysis. The STROBE checklist was followed when writing this manuscript. Results: High transformational leadership and high psychological empowerment were associated with high innovative behaviour. The results of the multiple linear regression analysis showed that physical condition, whether or not you have attended academic conferences or whether or not you have participated in fund research projects, transformational leadership and psychological empowerment were the main factors on nurses' innovative behaviour, together explaining 64.5% of the total variance. Conclusion: Promotion of transformational leadership and psychological empowerment is vital for nurses to promote innovation, thereby meeting the urgent demand for innovative nurses and the rapid development of nursing disciplines. Implications for Nursing Management: This study highlights the importance of transformational leadership in developing nurses' innovative behaviours. Understanding the role of psychological empowerment can help nurse managers formulate relevant intervention strategies and cultivate nurses' innovative behaviour. [ABSTRACT FROM AUTHOR]

Aims: We aim to determine the levels of patient safety value, safety attitude and safety competency and to explore the associations among these variables in emergency nurses in China. Background: Studies have focused on the individual characteristics of nurses as influencing factors of patient safety but not on the factors that may affect patient safety competency in the context of Chinese culture, such as safety value and safety attitude. Method: A cross‐sectional survey was conducted among emergency nurses in 22 hospitals. Results: The final model had acceptable fit indices (χ2/df = 3.512 < 5; CFI = 0.955 > 0.9; TLI = 0.942 > 0.9; IFI = 0.955 > 0.9; RMSEA = 0.068 < 0.08 [90% CI, 0.059 to 0.077]). A fully adjusted model was also tested, and the effects among variables were consistent with the hypothesized model. The SEM results showed that patient safety values had a significant direct effect on safety competency (b =.407, p <.001) and safety attitude (b =.656, p <.001). Patient safety attitude had a significant direct effect on safety competency (b =.493, p <.001). Patient safety values had an indirect effect on safety competency through safety attitude, and the total effect of safety values on safety competency was 0.730. Conclusions: Chinese nurses are at a moderate level of patient safety attitude and competency. Emergency nurses' safety value and safety attitude can be direct predictors of patient safety competency, and safety value can indirectly predict their patient safety competency through safety attitude. Implications for Nursing Management: Strengthening safety value is a critical step toward improving patient safety competency. Hospital administrators and educators should construct a patient safety culture that is guided and driven by appropriate values and ensure the development of necessary competencies in nurses. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate scheduling in COVID‐19‐designated hospitals, including working hours, rest days, adverse nursing outcomes and their relationship. Background: Hospitals are at the forefront of COVID‐19 prevention and control, and nurses are the main force on the frontline of the epidemic. Nursing shift is one of the most relevant and pressing issues for frontline nurses. However, there is a lack of national, large‐sample surveys on scheduling and adverse nursing outcomes in COVID‐19‐designated hospitals. Methods: Using a cross‐sectional online survey, we used nurse‐reported data to measure the characteristics of the work setting, samples and work schedule. A descriptive analysis was performed to assess the shift status and adverse outcomes of designated hospitals and frontline nurses. Logistic regression analysis was performed to determine the association between them. Results: Basic data were collected from 217 departments of 69 COVID‐19‐designated hospitals in 31 provinces in China. Nurses in the severe isolation ward worked mainly for 4 h per shift, whereas those in the fever clinic and observation ward worked mainly for 6–8 h. Half of the nurses had only 1 day of rest per week. Long working hours, lack of adequate rest time and overtime can seriously affect the quality and safety of nurses' work, resulting in adverse outcomes. Frontline nurses hope that scheduling guarantees the time to rest while ensuring fairness. Conclusions: The current evidence showed that frontline nurses were faced with long working hours, insufficient rest and overtime, which has a negative impact on nurse satisfaction, physical and mental health and quality of care. The government, hospitals and administrators still face many problems to overcome in their nursing schedules. Implications for Nursing Management: Governments and hospitals should take these factors, such as the work setting characteristics and demographic features of the frontline nurses, into account when selecting nurses to fight COVID‐19. Nurses have different working hours in different types of coronavirus unit; therefore, nursing managers should consider the working environment and nursing schedule needs, and in the future, we should pay attention to the fairness of nurses while ensuring their rest. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to investigate how the use of artificial intelligence is associated with the retention of elderly caregivers. Background: The turnover of elderly caregivers is high and increasing. Elderly care institutions are beginning to use artificial intelligence to support caregivers in their work, and the use of technology is critical to staff retention. Empowerment of elderly caregivers has been neglected by managers and researchers. Methods: This cross‐sectional study involved 511 elderly caregivers in 25 elderly institutions. Six validated standardized scales were used for data collection, and the software SPSS and SmartPLS were used for data analysis. Results: The quality of artificial intelligence has a significant positive effect on empowerment. Artificial intelligence psychological empowerment (β =.355, p <.001) and artificial intelligence structural empowerment (β =.375, p <.001) both had positive effects on retention intention, and the jointly explained variance (R2) was 42.6%. Conclusions: The results show that a significant relationship exists between artificial intelligence empowerment and retention intention. Elderly caregivers with more structural empowerment have higher retention intention. Implications for Nursing Management: Artificial intelligence suppliers need to pay attention to the role of product quality in elderly care services, continuously improve artificial intelligence quality, and strengthen the application and routine maintenance of artificial intelligence technologies. Elderly care institution managers should pay special attention to artificial intelligence structural empowerment (such as artificial intelligence‐related education and training, learning and development opportunities, and resource support). [ABSTRACT FROM AUTHOR]

The public long‐term care insurance (LTCI) scheme has been implemented in a few countries. Although the hypotheses of crowding‐out, crowding‐in and specialisation can facilitate our understanding of the relationship between LTCI and informal care use, existing studies may suffer from reverse causality. Employing a quasi‐experimental design, this study examined the policy effect of LTCI on informal care use among community‐dwelling older adults in China. Based on the data from three waves of the Chinese Longitudinal Healthy Longevity Survey, a staggered difference‐in‐differences (DID) with propensity score matching (PSM) approach was used to analyse the impact of LTCI on probability and hours of informal care use. The results showed that, for disabled older adults, LTCI reduced 43.3% of the probability and 82.4% of the weekly hours of informal care. LTCI also exhibited a spillover effect among nondisabled older adults through reducing the probability and weekly hours of informal care by 5.2% and 12.2%, respectively. Therefore, we argue that policymakers can consider rolling out the scheme for the entire country. Meanwhile, measures are needed to avoid a sharp decrease in informal care provision. [ABSTRACT FROM AUTHOR]

Migration‐related stress is detrimental to children's mental health, yet little is known about the potential mechanisms behind this association. This study examines the mediating role of inflow city identity in the association between migration‐related stress and depression and the moderating role of social participation amongst Chinese migrant children. A sample of 484 migrant children aged 8–17 years is randomly recruited through a cross‐sectional survey in Kunming, China. Inflow city identity partially mediates the association between migration‐related stress and migrant children's depression. Moreover, social participation moderates the above relationship. The direct and indirect effects are significant for migrant children with low social participation but insignificant for migrant children with high social participation. This study deepens the theoretical understanding of the underlying mechanism between migration stress and psychological distress and provides practical implications for preventing mental disorders in Chinese migrant children. [ABSTRACT FROM AUTHOR]

Previous literature suggests that gratitude and mindfulness‐based intervention could effectively abate stressful life events, while the associations with cyberbullying perpetration have not been investigated. Little is known about the mechanisms of this association, especially for children who lack sufficient parental protection. The current study aimed to examine the roles of mindfulness and gratitude in the relationship between cyberbullying perpetration and depression among children and adolescents. This study employed data from a school‐based survey conducted in 2018, in which 1298 students aged 9–16 years were randomly selected from three elementary and middle schools in China. The moderated mediation effects of gratitude and mindfulness on the relationship between cyberbullying perpetration and depression were examined through PROCESS model. Results showed that mindfulness mediated the relationship between cyberbullying perpetration and depression, while gratitude moderated and weakened the relationship. The findings may offer insights into the awareness and intervention programs regarding positive psychological mechanisms to reduce cyberbullying perpetration among children and adolescents in China. [ABSTRACT FROM AUTHOR]

This study aimed to examine whether older adults' financial status moderated the association between neighbourhood environment (i.e. physical and social environment) and loneliness among older adults in urban China. A cross‐sectional survey was collected from urban communities of Shanghai in mid‐2020. The final analytic sample was 459 older adults (age range = 60–91 years; proportion of women: 55.8%). Multiple group analysis was applied to test the hypothesised model. A measurement model of community social capital (i.e. cognitive and structural dimensions of social capital), a crucial indicator of neighbourhood social environment, was first established in both high‐income and low‐income groups. Factor loading invariance was established in these two groups. The results show that structural social capital (i.e. organisation memberships, volunteering, social participation and citizenship activities) was negatively associated with loneliness among older respondents from the high‐income group only, whereas better community security was significantly associated with lower levels of loneliness among low‐income older respondents only. The findings imply that both structural social capital and household income should be considered as important indicators in needs assessment among lonely older adults. Future social policies and interventions should pay attention to enhancing the role of both social and physical neighbourhood environment among older adults. [ABSTRACT FROM AUTHOR]

The plethora of pathways leading to health problems of later life has made the causal assessment of widowhood on the health of older adults difficult. This research aimed to assess the short‐term impact of widowhood on the objective health of older adults and to the moderating role of community‐based care (CBC) in improving the health outcomes of older adults. In this study, the activities of daily living (ADLs) and number of hospitalisations of older adults were measured, and PSM‐DID models were conducted. Widowhood had a significant negative impact on the objective health of older adults. Widowed adults had higher ADL scores (B = 0.569, 95 percent CI: 0.295 to 0.844) and more hospitalisations (B = 2.551, 95 percent CI: 1.189 to 3.914) than nonwidowed adults. Meanwhile, CBC in urban areas can significantly reduce ADL scores (B = −0.154, SE = 0.082) and the number of hospitalisations (B = −1.402, SE = 0.348) in older adults, whereas CBC in rural areas can only significantly reduce ADL scores (B = −0.197, SE = 0.087). Taken together, there is an urgent need to focus on the health of widowed and older adults and to provide CBC in both urban and rural areas equally. [ABSTRACT FROM AUTHOR]

This study aims to explore the associations between personality traits and depressive symptoms among Chinese adults and analyse the gender and age differences in the associations. A national representative sample of 28,628 adults aged 18 and above were selected from the 2018 China Family Panel Studies (CFPS) data. The short version of the Big Five Inventory (CBF‐PI‐15) and the Center for Epidemiologic Studies Depression (CES‐D 8) were used to measure personality traits and depressive symptoms respectively. Binary logistic regression models were employed to analyse the associations between personality traits and depressive symptoms in the whole participants, different age groups and genders respectively. After adjustment, higher levels of conscientiousness, extraversion and agreeableness were related to lower level of depressive symptoms, while higher levels of openness and neuroticism were related to higher level of depressive symptoms (p < 0.05). A significant interaction between gender and conscientiousness on depressive symptoms was found (interaction p = 0.005), and the association between conscientiousness and depressive symptoms was stronger in males than females (p < 0.001). Significant interactions between age and conscientiousness (interaction p = 0.007), agreeableness (interaction p = 0.001) on depressive symptoms were found respectively. Moreover, the associations of conscientiousness and agreeableness with depressive symptoms were strongest among old group, followed by middle‐aged group, and then young group (p < 0.05). In conclusion, conscientiousness, extraversion and agreeableness had negative associations with depressive symptoms, while openness and neuroticism had positive associations with depressive symptoms. The negative association between conscientiousness and depressive symptoms was stronger among males than females, and the negative associations of conscientiousness and agreeableness with depressive symptoms were strongest among old group, followed by middle‐aged group, and then young group. [ABSTRACT FROM AUTHOR]

Grandparenting is known to impact psychological health in older people. However, the extent to which the effect is altered by migration‐related and sociodemographic determinants is less clear. Therefore, we conducted this cross‐sectional study to investigate whether the association between grandparenting and psychological distress differs between rural–urban migrants and local older adults from May to September 2019. A total of 373 rural–urban migrants and 602 local older adults involved in grandparenting in Hangzhou completed measurements assessing sociodemographic characteristics, childcare burden and psychological distress. In total, 22.2% of the grandparents reported psychological distress. Rural–urban migrant grandparents had a lower socioeconomic status (SES), a higher childcare burden (23.6 ± 9.2 vs. 20.7 ± 9.5, p < 0.001) and higher levels of psychological distress (29.8% vs. 17.4%, p < 0.001) than local grandparents. Childcare burden and pressure from adult children were the most significant predictors for psychological distress in both groups (ps < 0.05). Psychological distress was also significantly associated with self‐rated health status (β = −0.276, p = 0.033) and willingness to participate in grandparenting (β = −0.659, p = 0.024) in migrant grandparents but associated with female gender (β = 0.346, p = 0.022), caring for children at night (β = 0.424, p = 0.011), conflict with adult children (β = 0.432, p < 0.001) and annual income (β = −0.237, p < 0.001) in local grandparents. Migrant status showed a statistically significant moderating effect between childcare burden and psychological distress. These results may be of assistance in comprehensively understanding the social determinants of mental health of grandparents involved in grandparenting. [ABSTRACT FROM AUTHOR]

Ambiguous perceptions of job roles by service providers may lead to poor service quality. This study sought to examine the relationship between role ambiguity and service impact among disability support workers, and further, to compare the mediating effects of job‐based and collective psychological ownership in the role ambiguity–service impact link. Data were derived from a longitudinal survey conducted in 56 cities in mainland China in 2019. 1153 social workers working in disability and rehabilitation services sectors completed the questionnaire. Structural equation modeling analyses and bootstrapping were applied to test the proposed model. The results revealed that role ambiguity is a risk factor for disability support workers' service impact. Furthermore, psychological ownership serves mediating roles in the relationship between role ambiguity and service impact among disability support workers. Even more, job‐based psychological ownership plays a more critical buffering role than collective psychological ownership does among Chinese disability support workers experiencing role ambiguity. The main findings imply that human service organizations in China face the dilemma of insufficient organizational capacity, with employees tending to resolve problems by relying more on their own resources than organizational resources. Therefore, policymakers and human service organizations should develop the organizational capacity of human service organizations to help employees overcome role ambiguity. [ABSTRACT FROM AUTHOR]

We aimed to assess the association between change in social participation and long‐term improved cognitive function among older adults. Data were obtained from 9648 participants aged ≥60 years in the 2011, 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey, a national prospective cohort study. Cox regression models were used to calculate adjusted risk ratios (aRRs). Social participation was increased in 20.5% of the participants, decreased in 37.8% of the participants and stable in 41.7% of the participants from the 2011 wave to the 2014–2018 waves. The improved cognitive function rate was 17.9% at follow‐up. Compared to individuals with decreased social participation from the 2011 wave to the 2014–2018 waves, individuals with unchanged total social participation were 59% (aRR = 1.59, 95% CI: 1.35–1.87) more likely to have improved cognitive function in the 2014–2018 waves, and individuals with increased social participation were 61% (aRR = 1.61, 95% CI: 1.43–1.82) more likely to have improved cognitive function, regardless of the baseline social participation status. As for the three forms of social participation, compared with the participants with decreased social participation, those with increased participation in organised social activities, increased participation in group leisure‐time activities, unchanged informal social interactions and increased informal social interactions were 24% (aRR = 1.24, 95% CI: 1.02–1.51), 49% (aRR = 1.49, 95% CI: 1.21–1.84), 55% (aRR = 1.55, 95% CI: 1.37–1.76) and 57% (aRR = 1.57, 95% CI: 1.34–1.84) more likely to have improved cognitive function (all p < 0.05) respectively. The results were stable in the sensitivity analysis. Our findings highlight the importance of promoting social participation from a multidimensional perspective (duration, frequency and forms) to improve cognitive function among older adults, for policy makers and healthcare workers in the community. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore and compare stress, coping, professional identity and work locus of control of new graduate nurses among Shanghai, Hong Kong and Taipei. Background: The transition from a student to a staff nurse role is recognized as a stressful experience and can be a rough journey. Many newly graduated nurses find it challenging to cope with their new roles in their first few months. Methods: A cross‐sectional research was used in the study. This study was completed in Shanghai, Hong Kong and Taipei with newly graduated nurses working in hospitals. A total of 591 graduate nurses who had worked within 1 year in hospitals were recruited using convenient sampling. Data were collected using a structured questionnaire, including demographics, the occupational stress scale, the Chinese trait coping style questionnaire, the nurse professional identity scale and the work locus of control scale (Chinese version). Results: The newly graduated nurses in Shanghai had significantly lower (p < 0.05) work stress score (2.65 ± 0.67) compared with their counterparts in Hong Kong (2.99 ± 0.69) and Taipei (2.94 ± 0.60). Newly graduated nurses in Shanghai tended to choose positive coping to deal with stressful situations, whereas those in Hong Kong would be more likely to adopt negative attitudes (p < 0.05). The newly graduated nurses in Taipei had the lowest level of professional identity (3.25 ± 0.55, p < 0.05), and their work control tended to be external (46.13 ± 6.20). In contrast, those in Shanghai (52.75 ± 6.04) and Hong Kong (59.41 ± 7.29) tended to be controlled internally. Conclusions: The study findings revealed the differences among newly graduated nurses in Shanghai, Hong Kong and Taipei with their level of stress, coping, professional identity and work locus of control. Proper leadership, mentoring for newly graduated nurses, and emphasis on first aid nursing training, emotional management and management of stress in newly graduated nurse transition programmes were suggested. Implications for Nursing Management: By comparing the results in the three regions, we recommend that nursing managers promote the right leadership style. In addition to coaching, nursing managers can assign additional mentors to newly graduated nurses to help them supplement their clinical knowledge and skills with psychological support. These mentors can come from senior nurses or nursing managers working on less demanding tasks. In addition to the existing post transfer training programmes, new graduate nurses should also focus on emergency nursing training, emotional management training and stress management training. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate the status quo of nurses' spiritual care competency and their relationship with perceived professional benefit. Background: Spiritual care has always been considered a vitally important part of holistic nursing. Understanding the spiritual care competency of nurses during the COVID‐19 pandemic can help nursing managers understand the weak links in spiritual care practice and improve the quality of nursing service. As a positive emotional experience and cognitive evaluation of the profession, perceived professional benefit can serve to adjust work pressure, relieve job burnout and promote an individual's overall growth. However, the relationship between perceived professional benefit among nurses and spiritual care competency remains unclear. Methods: A total of 372 nurses were recruited from 15 separate Chinese hospitals. An online questionnaire was used to assess nurses' sociodemographic, spiritual care competency and perceived professional benefit. Statistical analyses were performed using Pearson's correlation analysis, t test, analysis of variance (ANOVA) and multiple stepwise linear regression analysis. Results: The total mean score of spiritual care competency (99.43 ± 21.10) among nurses was found to be moderate. Nurses' spiritual care competency was positively correlated with perceived professional benefit (P <.01). The multiple stepwise linear regression model (n = 372) had an explained variance (R2 = 0.218) and showed that perceived professional benefit and the manner of receiving spiritual training were the main influencing factors of nurses' spiritual care competency (P <.001). Conclusion: The study findings indicated that nurses need to improve their spiritual care competency by improving their perceived professional benefit. Implication for nursing managers: Our study evaluated the spiritual care competency of nurses and explored the correlation between perceived professional benefit and spiritual care competency among nurses. The results of this study can help nursing managers to carry out relevant interventions, thus improving nurses' spiritual care competency and optimizing the quality of nursing. [ABSTRACT FROM AUTHOR]

Aim: To determine the level of dignified care provided by critical care nurses, and explore the associated individual factors. Background: Dignity is a fundamental right of human beings. Critically ill patients are dependent on nurses. Their need for respect and dignity is liable to be neglected in intensive care unit settings. Both critically ill survivors and dying patients suffer mental anguish due to loss of dignity. Method: This was a cross‐sectional study of 526 critical care nurses working at intensive care units for adults in Zhejiang Province, China. Data were collected from February 2021 to May 2021 using the Intensive Care Unit Dignified Care Questionnaire, Wong and Law Emotional Intelligence Scale, Jefferson Scale of Empathy‐Health Professional and Nurses Professional Values Scale‐Revised. Results: The total score of dignified care was 67.37 (8.83), with the standard score as 74.07 (12.99). Participants who performed poorly in absolute and relative dignity accounted for 8.4% and 31.2% of the total sample, respectively. Emotional intelligence (β =.379, p <.001), empathy (β =.319, p <.001), professional values (β =.147, p <.001), age (β =.075, p =.003) and training in dignified care (β =.074, p =.010) were associated with dignified care, explaining 67.6% of the variance. Conclusion: The average level of participants' behaviours of maintaining patient dignity was medium. Critical care nurses need to improve their ability to maintain relative dignity of patients. Emotional intelligence, empathy, professional values, age level and training in dignified care were predictors of dignified care. Implications for Nursing Management: Improving emotional intelligence, empathy and professional values of critical care nurses and training them (especially less experienced nurses) will enhance their ability in dignified care. This study provides a novel perspective to help nursing managers develop interventions to promote humanized care in the intensive care unit. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate the current situation of community nurses' research competence in Shanghai, to provide a basis for curricula design for nursing schools, construction of better research environments and nurturing research talents among community nurses. Background: Nurses are expected to not only consume research findings but also produce knowledge. In China, there is more attention on cultivation of community nurses' research competence. However, the current status of it remains unclear. Methods: This study employed convenience sampling to recruit a total of 2562 community nurses in Shanghai from June to August 2021. The study questionnaire included personal and job‐related characteristics, research competence and barriers to nursing research practice. Pearson's χ2 tests (or Fisher exact probability method) and binary logistic regression analysis were used to analyse associated factors. Results: Our data showed that the overall research competence was 38.00 (28.00, 60.00) (best possible score, 120), which was at a low level. The binary logistic regression analysis results showed that nurses at the vice‐senior level and above, those without management roles or those who had research education/training experience had a higher level of research competence (p <.05). Besides, a higher level of research competence was also seen in nurses who had attended academic conferences above the municipal level in the last 5 years, those with plans to upgrade educational levels or those who had positive attitude towards research (p <.05). Our analysis demonstrated that limited English proficiency, data analysis and thesis writing, and lack of up‐to‐date research information and research mentors were the main barriers to effective community research practice. Conclusions: Our analysis showed that most of the community nurses had high demand for research training courses. Their research competence should be improved. In nursing educational and professional context, nursing administrators should pay more attention to provision of better learning, working and research environments. Implications for Nursing Management: Nursing administrators should establish a community nursing research culture, develop continuous training on research and prioritize recruitment and cultivation of scientific research talents. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to investigate the compassion satisfaction and compassion fatigue among Chinese frontline nurses during the COVID‐19 pandemic in Wuhan, China and to explore the related factors. Background: Frontline nurses undertake a huge nursing workload with a risk of infection, causing great pressure on them and making them face a risk of compassion fatigue during the pandemic. Methods: A cross‐sectional online survey was conducted from 9 March to 15 March 2020. A total of 1582 nurses caring for critical patients with COVID‐19 participated. Compassion satisfaction and compassion fatigue (comprising burnout and secondary traumatic stress) were assessed with the Professional Quality of Life Scale, and resilience was measured with the Chinese 10‐item Connor‐Davidson Resilience Scale. Results: Moderate levels of compassion satisfaction (36.99 ± 6.71), burnout (24.14 ± 5.33) and secondary traumatic stress (24.53 ± 5.24) were experienced by frontline nurses. Resilience and perceived work pressure were the main predictors. Conclusions: Frontline nurses demonstrated a moderate level of compassion satisfaction and compassion fatigue. Implications for nursing management: The compassion fatigue of frontline nurses should be considered. Strategies aiming to reduce stress and enhance resilience, such as training about psychological adjustment, developing professional skills and creating a supportive workplace environment, are several options. The trial is not registered. This study is a cross‐sectional study, and according to China's clinical trial registration standards, such studies are not required to be registered. So the trial is not registered. However, oral consent was obtained from the ethics committee of the hospital before this study was conducted. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the impact of self‐efficacy on the relationship between organizational climate and humanistic practice ability (HPA) in Chinese nurses. Background: To date, studies on the effect of organizational climate on nursing care have focused on care outcomes rather than care processes. Thus, this effect remains poorly understood. Methods: A total of 757 participants were sampled from three tertiary hospitals in Guangdong Province from November to December 2019; subsequently, they completed a structured electronic questionnaire. A structural equation model was used to explore the impact of nursing organizational climate on nurses' HPA. Results: A total of 688 valid questionnaires were collected. The nurses' average HPA score was 107.82 (SD 12.47). There was a positive correlation between organizational climate and HPA (r =.409, p <.05). Additionally, self‐efficacy mediated this relationship (p <.01). Conclusions: This study provides new insights into nursing organizational climate, self‐efficacy and nurses' HPA. Implications for Nursing Management: The significant mediating effect of self‐efficacy suggests that managers should implement nurse professional development programmes using targeted strategies to foster greater self‐efficacy, which could improve the quality of care and nurse–patient relationships. [ABSTRACT FROM AUTHOR]

Background. Cervical Carcinoma (CC) is the second most common cause of death in women, with most patients being diagnosed at an advanced stage. The conventional treatment for CC, with a long chemotherapy treatment cycle, is less than satisfactory and will cause serious damage to the patient's blood vessels. Objective. To analyze the impact of the clinical nursing pathway (CNP) on the incidence of complications and adverse prognosis in patients undergoing chemotherapy for CC via peripherally inserted central catheters (PICC). Materials and Methods. This study enrolled 157 CC patients who underwent PICC chemotherapy in the Shaanxi Provincial Cancer Hospital between March 2017 and April 2020 and assigned them between the two groups according to different nursing interventions. Ninety-three patients treated with CNP intervention were included in the research group (RG), and sixty-four cases treated with the routine nursing intervention were included in the control group (CG). The self-care ability and intervention satisfaction of patients were assessed using the self-care ability scale and the intervention satisfaction questionnaire, respectively, both developed by our hospital. The complication rate was observed in both cohorts, and the adverse prognosis of patients was statistically analyzed. Finally, an assessment was made on the patients' quality of life (QOL) using the quality of life questionnaire core 30 (QLQ-C30). Results. Higher scores of self-management information, catheter nursing ability, self-care compliance, and abnormal situation management were determined in RG after the nursing intervention. RG also outperformed CG in the overall incidence rates of complications and poor prognosis. Moreover, RG presented statistically higher nursing satisfaction and QLQ-C30 scores than CG after the nursing intervention. Conclusion. CNP has a significant nursing effect on patients with CC treated with PICC chemotherapy, which can not only reduce the incidence of postchemotherapy complications but also improve patient prognosis, satisfaction, and life quality, with the value for clinical promotion. [ABSTRACT FROM AUTHOR]

China is experiencing the rapid development of infrastructure projects throughout the country, especially in the Guangdong-Hong Kong SAR-Macao SAR Greater Bay Area. This is placing the Chinese construction industry under tremendous pressure to transition to a sustainability orientation due to the various economic, social, and environmental challenges involved. The transition to more sustainable infrastructure projects requires the involvement of more stakeholders, while the multistakeholder context is of less importance when making project decisions, and this may create an adverse effect on the sustainability level of infrastructure projects. Based on the questionnaire data collected, this study addresses this issue by comparatively analysing stakeholder perceptions of sustainable infrastructure delivery between Guangdong province, Hong Kong SAR, and Macao SAR. Through independent sample t-tests, the disparity in perceptions between paired stakeholder groups in the Greater Bay Area (as a whole) is revealed. Three pairs, i.e., government department and supervising engineers, owners and designers, and supervising engineers and operators, are found to be the most conflicting, while contractors and supervising engineers are the least. Of the 18 sustainability items analysed, shaped local identity and international reputation (SOC, social factor 8) is the most controversial, while value-for-money of the proposed project during its lifecycle (EOC, economic factor 5) and green design and construction (ENV, environmental factor 2) have the greatest consensus towards their roles in achieving project sustainability. Significantly, different stakeholder perceptions between the three are also identified, and the contractor group is found to share the least consensus geographically, while the operators have the least conflict rating of the relevant importance of various sustainability factors. The thorough analysis of sustainability-related items of economy, society, and environment contributes to understanding the attitudes of the various stakeholder groups involved, which then helps reduce their conflicts during sustainable infrastructure delivery. [ABSTRACT FROM AUTHOR]

Home quarantine due to the global coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on children. Lifestyle changes have led to an increase in precocious puberty (PP) among girls, and the underlying risk factors for this remain unclear. Thus, we aimed to assess the influence of environmental, genetic, nutritional, and other lifestyle factors on the risk of PP in girls. We evaluated the incidence of new-onset PP in girls during home quarantine for COVID-19 and analyzed the potential risk factors. This was a retrospective questionnaire and medical record-based study involving 22 representative medical units from 13 cities in Henan Province, China. Girls with new-onset PP (central precocious puberty, 58; premature thelarche, 58; age, 5–9 years) between February 2020 and May 2020 were included, along with 124 healthy, age-matched controls. The number of new-onset PP cases reported during the study period was compared with that reported between February and May in 2018 and 2019. Patients' families completed a questionnaire to assess potential risk factors. There was a 5.01- and 3.14-fold increase in the number of new-onset PP cases from 2018 to 2020 and from 2019 to 2020, respectively; the differences were statistically significant (p < 0.01). High-risk factors for PP included longer time spent using electronic devices, decreased exercise time, higher body mass index, vitamin D deficiency, young age (<12 years) of mother during menarche, consumption of fried food and processed meat, residence in rural areas, and consumption of off-season fruits. Thus, we found that lifestyle changes caused due to the COVID-19 pandemic led to a significant increase in PP in girls. Management of the risk factors identified in this study may help in PP prevention. [ABSTRACT FROM AUTHOR]

The application of Building Information Modeling (BIM) in fire protection discipline has been sufficiently proved to be useful, but has encountered many barriers in China. Among which, small- and medium-sized enterprises (SMEs), which are considered sensitive to adoption costs and external funding support, play a critical role in the BIM adoption process in fire protection discipline. Therefore, identifying and analyzing the barriers of BIM application are essential to help small- and medium-sized fire protection enterprises to overcome these barriers. In this study, semantic analysis, which includes word frequency analysis and coword analysis, based on literature review was utilized to identify the main barriers. 20 main barriers, which were classified into software, people, organization, and environment group, were obtained. Then, Interpretive Structural Modelling (ISM) approach and Cross-Impact Matrix Multiplication Applied to Classification (MICMAC) analysis were utilized to hierarchically analyze and categorize the main barriers of BIM application in Chinese SMFEs. The findings revealed that the lack of external support and the lack of BIM laws and regulations applicable to fire protection discipline are the key barriers in general for the application of BIM in SMFEs. For the barriers at the enterprise level, through further analysis and discussion based on barriers in the people and organization clusters, the lack of funding support for proper BIM training and the lack of organization culture support were concluded as the key barriers of BIM application inside the scope of SMFEs. According to 80-20 principle, more effort should be focused on the key barriers to gain maximum management effect. The research result categorizes the barriers for easy intervention of fire protection enterprises' managers and policymakers. It contributes to the nascent studies of BIM application and provides guidance for the application of BIM in fire protection discipline. [ABSTRACT FROM AUTHOR]