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Lo Iacono C, Amodio E, Vella G, Caruso M, D’Anna G, Gambera A, Soresi M, Intravaia G, Latina R. Self-Perceived Competencies and Attitudes on Palliative Care in Undergraduate Nursing Students: A Multicenter Descriptive Study. NURSING REPORTS 2024; 14:2550-2564. [PMID: 39330742 PMCID: PMC11435199 DOI: 10.3390/nursrep14030188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 09/16/2024] [Accepted: 09/19/2024] [Indexed: 09/28/2024] Open
Abstract
Introduction: Caring for the dying can generate anxiety and emotional distress, particularly in nursing students, and perceived competence could play a crucial role in enabling nurses to perform their duties with greater confidence. Unfortunately, few studies describe the relationship between students' nursing attitudes and perceived self-efficacy in palliative care (PC). To overcome this gap, this survey aimed to assess the attitudes towards dying patients and the perceived competence of nursing students in palliative care at different universities in the south of Italy. Methods: A cross-sectional study was conducted from September 2022 to March 2023 involving nursing students from the three major Sicilian universities (Italy). The study included a survey investigating socio-demographic characteristics, palliative care training, knowledge about pain management, and previous experience with dying. Moreover, the Professional Competence of the Core Curriculum in Palliative Care Nursing (CCPCN) questionnaire and the Frommelt Attitudes Toward Care of the Dying-B Italian version (FATCOD-B-I) assessed competencies and emotional attitudes. Results: A total of 1913 nursing students were recruited, of which 71.3% were females, and 53.9% were in the age range of 18 to 21 years. In the multivariable analysis, practical PC training was a substantial factor in enhancing competencies (Adj-OR 2.78 [95% CI = 2.12-3.65]). Male students had higher competence odds (Adj-OR 1.38 [95% CI = 1.14-1.66]), and perceived knowledge strongly correlated with self-assessed competence. Advancement in academic years also positively influenced competence self-assessment (Adj-OR 1.98 [95% CI = 1.75-2.24]). Regarding emotional attitudes, a per-quartile increase in competence score was found to improve the attitude score (Adj-OR 1.24 [95% CI = 1.13-1.35]). Conclusions: Nursing students gain valuable experience during clinical experience. PC training and perceived knowledge of PC significantly increase nurses' competencies, and the latter seem to be strongly associated with attitudes. Thus, introducing palliative care education into nurses' core curricula could be a way to reduce anxiety and emotional distress in young students.
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Affiliation(s)
- Cinzia Lo Iacono
- Terminal Cancer Patient Assistance Society (SAMOT Onlus), Via della Libertà 193, 90143 Palermo, Italy; (C.L.I.); (G.I.)
| | - Emanuele Amodio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90143 Palermo, Italy; (E.A.); (M.S.); (R.L.)
| | - Giuseppe Vella
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90143 Palermo, Italy; (E.A.); (M.S.); (R.L.)
| | - Maria Caruso
- Azienda Ospedaliera Universitaria Policlinico “G Martino”, University of Messina, 98124 Messina, Italy;
| | - Giuseppe D’Anna
- Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, University of Palermo, 90143 Palermo, Italy;
| | - Angelo Gambera
- Azienda Ospedaliero Universitaria Policlinico “G. Rodolico—San Marco”, University of Catania, 95124 Catania, Italy;
| | - Maurizio Soresi
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90143 Palermo, Italy; (E.A.); (M.S.); (R.L.)
| | - Giuseppe Intravaia
- Terminal Cancer Patient Assistance Society (SAMOT Onlus), Via della Libertà 193, 90143 Palermo, Italy; (C.L.I.); (G.I.)
| | - Roberto Latina
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90143 Palermo, Italy; (E.A.); (M.S.); (R.L.)
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Jiang J, Zhou J, Chen X, Zhu X, Zhang H, Zhang Q, Zhang J. The impact of clinical internship experience on nursing students' attitudes towards death and choices of end-of-life care: A self-control study. Nurs Open 2024; 11:e2214. [PMID: 38943259 PMCID: PMC11213817 DOI: 10.1002/nop2.2214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/30/2024] [Accepted: 06/05/2024] [Indexed: 07/01/2024] Open
Abstract
AIM This study aims to explore the impact of emergency department internships on the attitudes towards death among undergraduate nursing students and their preferences for end-of-life care settings. Additionally, the study analyzes the reasons behind nursing students' choices of end-of-life care settings and provides insights for improving undergraduate education on attitudes towards death and end-of-life care, and provide reference for the development of emergency hospice care. DESIGN This study adopts an observational design with a self-controlled before-and-after approach. METHODS A questionnaire survey was conducted with 96 nursing interns between July 2021 to June 2022. Demographic information and data on attitudes towards death, and preferences for end-oflife care location were collected by online questionnaire. Paired test were conducted to compare differences between groups. RESULTS The study included a total of 96 nursing students with an average age of 21.11 years. The scores for the avoidance-acceptance dimension of death attitudes before and after the internship were 2.40 (1.80, 3.00) and 2.20 (1.60, 3.00), respectively, showing a significant difference (Z = -2.084, p = 0.037). Factors such as gender, experience in caring for critically ill or dying patients, knowledge of death education, and discussions about death at home were found to influence nursing students' attitudes towards death. Nursing students expressed a preference for receiving end-of-life care and treatment in their homes or in hospice/palliative care wards, while the intensive care unit, emergency department, and nursing homes were the least preferred settings. There were significant differences in nursing students' preferences for end-of-life care settings before and after the internship (p = 0.000). Importantly, the number of nursing students expressing a desire to receive end-of-life care in the emergency department increased from 2 to 7 after the internship, while the number of students not wanting end-of-life care in the emergency department decreased by 5.
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Affiliation(s)
- Jingyuan Jiang
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
- Disaster Medical CenterSichuan UniversityChengduChina
- Nursing Key Laboratory of Sichuan ProvinceChengduChina
| | - Jing Zhou
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
- Disaster Medical CenterSichuan UniversityChengduChina
- Nursing Key Laboratory of Sichuan ProvinceChengduChina
| | - Xiaoli Chen
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
- Disaster Medical CenterSichuan UniversityChengduChina
- Nursing Key Laboratory of Sichuan ProvinceChengduChina
| | - Xiaolin Zhu
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
- Disaster Medical CenterSichuan UniversityChengduChina
- Nursing Key Laboratory of Sichuan ProvinceChengduChina
| | - Hao Zhang
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
- Disaster Medical CenterSichuan UniversityChengduChina
- Nursing Key Laboratory of Sichuan ProvinceChengduChina
| | - Qin Zhang
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
- Disaster Medical CenterSichuan UniversityChengduChina
- Nursing Key Laboratory of Sichuan ProvinceChengduChina
| | - Jianna Zhang
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
- Disaster Medical CenterSichuan UniversityChengduChina
- Nursing Key Laboratory of Sichuan ProvinceChengduChina
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Xu GR, Yu WY. Mediating effect of meaning in life on death anxiety and attitude toward palliative care among undergraduate nursing students. BMC Palliat Care 2024; 23:139. [PMID: 38840188 PMCID: PMC11151652 DOI: 10.1186/s12904-024-01472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND This study investigates the mediating effect of meaning in life between death anxiety and attitude toward palliative care among nursing students. METHODS We enrolled 363 undergraduate nursing students using a convenience sampling method as the respondents and conducted a survey using general information about nursing students, the Chinese version of the FATCOD-B Scale, the Chinese version of the Death Anxiety Scale, and the Chinese version of the Meaning in Life Questionnaire. The SPSS25.0 statistical software was used to analyze the mediating effect. RESULTS The mean total attitude score toward palliative care was (104.72 ± 10.62). Death anxiety had a significant negative predictive effect on the attitude toward palliative care (β = -0.520, P < 0.01). When the mediating variable of the presence of meaning in life was included, the negative predictive effect of death anxiety on attitude toward palliative care remained significant (β = -0.379, P = 0.036); the mediating effect (-0.141) accounted for 27.12% of the total impact (-0.520). CONCLUSIONS The presence of meaning in life mediates the relationship between death anxiety and attitude toward palliative care. This implies that nursing educators, through their role in educating nursing students about the meaning of life, can significantly influence the development of a positive attitude toward palliative care.
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Affiliation(s)
- Gui-Ru Xu
- School of Nursing, Fujian Medical University, No. 1, Xuefu North Road, Minhou County, Fuzhou City, 350122, Fujian Province, China.
| | - Wen-Ying Yu
- School of Nursing, Fujian Medical University, No. 1, Xuefu North Road, Minhou County, Fuzhou City, 350122, Fujian Province, China
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Tong J, Liu Q, Liu Y, Li J, Zhang Q, Shi H. Factors influencing death attitudes of medical students: a scoping review. Front Public Health 2024; 12:1342800. [PMID: 38651123 PMCID: PMC11033510 DOI: 10.3389/fpubh.2024.1342800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Aim To summarize factors influencing death attitudes of medical students, help identify intervention targets, and design precision interventions for improving death attitudes of medical students. Methods Web of Science, PubMed, Embase, OVID, China National Knowledge Infrastructure, and Wanfang databases were searched. Retrieval time was from January 2012 to September 2023. Studies on factors influencing death attitudes of medical students were included. Results Thirty-five studies were included in the final review. A total of 28 factors influencing death attitudes of medical students were summarized and divided into three categories comprising personal factors, social factors, and psychological factors. More than 15 studies confirmed that gender, religion, and discussing death with families were factors that influenced medical students' death attitudes. Conclusion Results indicate that there are many types of factors that influence death attitudes of medical students. It is necessary for universities to implement death education based individual characteristics and guide medical students to cultivate generally optimistic death attitudes and appropriate life values.
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Affiliation(s)
- Jingjing Tong
- Department of Postgraduate Students, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Qian Liu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ying Liu
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Juan Li
- Department of Postgraduate Students, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Qin Zhang
- Department of Postgraduate Students, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Huashan Shi
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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He X, Li B, Liu X, Jiao P, Zhao Y. Correlation between hospice competence and death coping ability among nursing students in China: A cross-sectional survey. NURSE EDUCATION TODAY 2024; 134:106080. [PMID: 38163389 DOI: 10.1016/j.nedt.2023.106080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Palliative care involves providing comprehensive physical, psychological, and social care to improve clinical symptoms and quality of life, as well as to ensure patients' dignity at the end of life. Nurses are important members of hospice care teams, and undergraduate nursing students are the hospice care providers of the future. The ability of undergraduate nursing students to provide hospice care will, thus, directly affect service quality. OBJECTIVE To understand the relationship between hospice competence and the death-coping abilities of nursing students and provide a theoretical basis for promoting the development of hospice education for nursing students. METHODS A convenience sample of 204 nursing students from a university in China completed the general conditions questionnaire, Hospice Competency Assessment Questionnaire, and a simplified version of the Coping with Death Scale. RESULTS The participants' overall average hospice competency score was 46 (35-52), with an average score of 3.0 (2.3-3.3) for effective caregiving skills, 2.6 (2.0-3.0) for cultural and ethical values, and 3.0 (2.2-3.4) for interprofessional teamwork. The average death-coping competency score was 92 (72-107). Multivariate logistic regression and Spearman's correlation analysis showed a positive correlation between death-coping and hospice competencies (P < 0.05). CONCLUSION Nursing students' overall hospice competency is low to moderate. Consequently, nurse educators should effectively modify the hospice education curriculum using the Dedicated Education Unit model.
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Affiliation(s)
- Xiaona He
- Nursing Department of Xinjiang Medical University, China
| | - Boya Li
- Nursing Department of Xinjiang Medical University, China
| | - Xinxin Liu
- Nursing Department of Xinjiang Medical University, China
| | - Peijuan Jiao
- Nursing Department of Xinjiang Medical University, China
| | - Yue Zhao
- Nursing Department of Xinjiang Medical University, China.
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Tian X, Zheng X, Peng Y, Zhou X, Huang B, Xie Y, Xiao W. The effects of hospice care education on first-year undergraduate nursing students in mainland China: A mixed-methods study. NURSE EDUCATION TODAY 2024; 134:106095. [PMID: 38266431 DOI: 10.1016/j.nedt.2024.106095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/18/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND With the rising number of people with end-stage chronic diseases, the demand for hospice care has increased dramatically. As the future health professionals for the implementation of hospice care, undergraduate nursing students in mainland China still lack knowledge and skills of hospice care, thus hospice care education plays a vital role in its development. OBJECTIVES To understand the effects of hospice care education on nursing students' death attitudes, end-of-life attitudes, humanistic care qualities, and their learning experiences. DESIGN This study used a mixed-methods design. SETTING A University of Chinese Medicine in mainland China. PARTICIPANTS The first-year undergraduate nursing students (n = 65). METHODS A mixed-methods study was conducted to evaluate the impact of a hospice care course from March to June 2021. The quantitative part included a quasi-experimental study designed with pre- and post-intervention measurements and the qualitative part included a descriptive qualitative study with semi-structured individual interviews. RESULTS The quantitative data revealed that after the course, nursing students experienced improvements in their death attitudes, end-of-life attitudes, and humanistic care qualities. Two categories were identified from the qualitative data. The category of "Gain from learning" included 4 themes (Confronting death and thinking about life; Understanding and agreeing with the idea of hospice care; Perceiving the humanistic spirit of medicine; Enhancing of the nursing discipline cognition and professional identity) and the category of "Course feedback" included 2 themes (Expressing recognition for the course arrangement; Making suggestions on the course optimization). CONCLUSIONS Hospice care education had a positive influence on nursing students. Students expressed satisfaction with the course arrangement. However, future hospice care courses should further optimize the curriculum designs by increasing the discussion of death-related topics, sharing more real clinical cases, recruiting students from different majors, and providing clinical practice, to provide high-quality nursing education for the development of hospice care.
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Affiliation(s)
- Xia Tian
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Xiaoting Zheng
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Yunyi Peng
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Xiaojun Zhou
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Baoxin Huang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Yaqian Xie
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Wenli Xiao
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China.
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Wang J, Qiu C, Zhou L, Huang X, Li X. The Death Café: Effectiveness of a hospice care educational program for nursing undergraduates based on LIFE experience-A qualitative study. NURSE EDUCATION TODAY 2023; 131:105981. [PMID: 37839140 DOI: 10.1016/j.nedt.2023.105981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/29/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Nursing students' knowledge of hospice care is limited to textbooks due to the inadequate education and training system in China and student's willingness to participate in hospice care. OBJECTIVES To deepen nursing students' understandings toward life and death, to improve their knowledge about hospice care, and to promote their willingness for hospice care practice. DESIGN This study used a qualitative descriptive study design. SETTINGS The study was conducted at a medical university in Sichuan province, China. PARTICIPANTS 71 nursing sophomores participated in this study. METHODS The Death Café teaching program was implemented which requires students to recall their memories about death and to imagine how they felt about dying, as if they were having a conversation in a death-themed café. During the implementation phase, a small-group interactive teaching approach was utilized. During the reflection phase, the students were asked to finish an essay answering four questions without standard right answers. The essays that students finished were used for evaluating the effectiveness of the Death Café program. The answers of the first two questions were presented as a word cloud. Graneheim and Lundman's qualitative content analysis method was used to analyze answers of the third and fourth questions. RESULTS Word cloud analysis indicated that at the beginning of the program participants showed more negative emotions (i.e., fearful). Students' attitudes toward death changed from negative to positive through imagining death when role-playing the different stages of life. The program enhanced students' understanding of life and taught the students effective ways to cope with death. Students clarified the objectives and necessary preparation for providing hospice care and gained new understandings for improving their hospice skills. CONCLUSIONS The Death Café program can address students' negative emotions and perceptions of death. Students gained personal benefits and professional benefits of coping with life and death from the program.
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Affiliation(s)
- Jingjun Wang
- West China School of Medicine/West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, China
| | - Chen Qiu
- West China School of Medicine/West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, China
| | - Lin Zhou
- West China School of Medicine/West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, China
| | - Xuehua Huang
- West China School of Medicine/West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, China
| | - Xiaolin Li
- West China School of Medicine/West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, China.
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Chen X, Su M, Arber A, Qiao C, Wu J, Sun C, Wang D, Zhou H, Zhu Z. Exploring the variations in death anxiety among oncology nurses in China: a latent class analysis. BMC Palliat Care 2023; 22:176. [PMID: 37946173 PMCID: PMC10634125 DOI: 10.1186/s12904-023-01282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Various factors have been found to be associated with high levels of death anxiety experienced by oncology nurses. The aim of this study was to use a person-oriented approach to examine the death anxiety patterns of Chinese oncology nurses and to analyze the differences in anxiety characteristics and their associated influencing factors. METHODS A cross-sectional survey regarding palliative care among registered oncology nurses was conducted in Jiangsu Province, China.Latent class analyses was applied to identify their patterns of death anxiety. The score of PCQN-C (The Chinese version of the Palliative Care Quiz for Nursing) and FATCOD-B-C (The Chinese version of the Frommelt Attitude Toward Care of the Dying scale), the demographic and working characteristics were further analyzed through covariance analysis (ANCOVA) and multivariate (or logistic) regression across the subgroups. RESULTS A two-potential-category model was selected based on the fit index. The results showed that 79% of oncology nurses belonged to the high pressure and pain group and 21% belonged to the low death anxiety group. The high pressure and pain group had significantly higher scores in the dimensions of emotion, stress and pain, time awareness, and cognition compared to the low death anxiety group. Factors influencing the high pressure and pain group included shorter working years, non-national or provincial oncology nursing specialists, non-national palliative care specialists, never discussing the topic of death with patients or family members, no palliative care related training, and PCQN and FATCOD scores. CONCLUSIONS Our study suggests that oncology nurses' death anxiety can be divided into two categories: low death anxiety and high stress pain, and certain factors, such as being female, having a short work experience, and lacking palliative care-related training, increase the likelihood of death anxiety.
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Affiliation(s)
- Xian Chen
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital), Nanjing, Nanjing, 210004, China
| | - Mengyu Su
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Anne Arber
- School of Health and Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Chengping Qiao
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital), Nanjing, Nanjing, 210004, China
| | - Jinfeng Wu
- Geriatrics Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Cuihua Sun
- Jiangsu Nursing Association, Nanjing, 210008, China
| | - Dan Wang
- Oncology Department, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Hui Zhou
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital), Nanjing, Nanjing, 210004, China.
| | - Zhu Zhu
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital), Nanjing, Nanjing, 210004, China.
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