Dilemmas for nurses in China

The impact of stretch service goals on unethical behaviors of nurses: A three-wave cross-sectional study

BACKGROUND

Stretch service goals strive to motivate healthcare practitioners to maintain high quality in service provision. However, little is known about how stretch service goals trigger nurses' unethical behavior.

RESEARCH AIM

This study aimed to investigate the influence of stretch service goals on nurses' unethical behavior, as well as the mediating effects of patient entitlement and nurses' emotional dissonance.

RESEARCH DESIGN

A quantitative cross-sectional study is designed.

PARTICIPANTS AND RESEARCH CONTEXT

We sourced data by conducting a time-lagged three-wave survey study from March to September 2020. Random sampling was used, and data were collected from 422 nurse-patient pairs in Chinese hospitals. Bootstrapping method and structural equation modeling were employed to verify the conceptual model.

ETHICAL CONSIDERATIONS

The study was approved by the designated authority within hospitals and ethical committees.

RESULTS

Stretch service goals are not directly related to nurses' unethical behavior. Stretch service goals can trigger nurses' unethical behavior via patient entitlement. Patient entitlement and nurses' emotional dissonance play a chain-mediating role between stretch service goals and nurses' unethical behavior.

CONCLUSIONS

In the context of the healthcare industry, nurses may engage in unethical behavior due to the pressure of achieving stretch service goals. This study contributes to opening the "black box" of stretch service goals and nurses' unethical behavior by exploring the chain-mediating effect of patient entitlement and nurses' emotional dissonance.

Exploring the influence of the spiritual climate on psychological empowerment among nurses in China: a cross-sectional study

BACKGROUND

Psychological empowerment notably impacts nurses' work engagement and high-quality care. A spiritual climate is a work environment that respects individuals and encourages them to express personal views. Previous studies have shown that a spiritual climate enhances psychological empowerment, however, the relationship between them among the nursing population remains unclear. This study aimed to explore the effect of a spiritual climate on nurses' psychological empowerment and provide a scientific basis for improving psychological empowerment among nurses.

METHODS

A cross-sectional survey of 837 nurses from five hospitals in Sichuan Province, Southwest China, was conducted using a convenience sampling method; this survey included nurses' demographic characteristics, the Psychological Empowerment Scale (PES), and the Chinese version of the Spiritual Climate Scale (C-SCS). The data were analysed using one-way analysis of variance (ANOVA), correlation analysis, and multiple linear regression.

RESULTS

The sample of 837 nurses attained a psychological empowerment score of (45.49 ± 6.42) and a spiritual climate score of (75.25 ± 16.75). The one-way ANOVA revealed that psychological empowerment scores among nurses varied based on differences in age, department, years of work experience, professional title, level of work intensity, and children (yes/no). Pearson's correlation analyses revealed a significant positive correlation between the spiritual climate and nurses' psychological empowerment (r = 0.564, P < 0.001), and multiple linear regression analysis showed that working in the intensive care unit (ICU), work intensity, and the four items pertaining to spiritual climate influenced nurses' psychological empowerment, explaining 32.6% of the total variance in psychological empowerment.

CONCLUSION

The findings suggested that the spiritual climate perceived by nurses and psychological empowerment are moderately high. Working in the ICU, work intensity, and the four items pertaining to spiritual climate influence nurses' psychological empowerment. Nursing managers should pay attention to the daily work intensity of nurses, especially ICU nurses, organize work tasks reasonably, promote dynamic and balanced nurse human resource deployment based on patients' conditions and nurses' workloads, and implement scientific scheduling plans to establish a positive spiritual climate in the workplace. Additionally, group workshops and systematic training programs can effectively enhance psychological empowerment among nurses.

Organizational support enhances nurses' work-family enrichment: a person-context interactionist perspective

Introduction

Attaining a favorable work-life balance is a complex and ongoing challenge in the nursing profession. According to a person-context interactionist perspective and the two-factor theory, this study investigated the underlying mechanism by which organizational support impacts work-family enrichment via protective factors (i.e., decent work) and depleting factors (i.e., burnout) among Chinese nurses.

Methods

A descriptive cross-sectional research design was utilized in this study, employing an online questionnaire as the primary method for data collection. The study included 355 nurses who completed a self-reported questionnaire designed to measure variables such as organizational support, decent work, burnout, work-family enrichment, and demographic information. The collected data were analyzed using a chain mediation model in PROCESS macro (Model 6).

Results

The findings of the analysis revealed that nurses reporting higher levels of organizational support also exhibited a greater sense of work-family enrichment. Moreover, the study identified indirect effects of organizational support on work-family enrichment, mediated by decent work and burnout.

Discussion

These findings suggest that targeted interventions aimed at promoting organizational support can contribute to the overall well-being and work-life balance of nurses.

Male Students' Perceptions of the Nursing Profession: A Qualitative Study

Introduction

This study aims to explore the thought, feelings and perceptions of male nursing students and male nursing professionals in the nursing profession.

Methods

This present study used a qualitative research design to explore the feelings, thoughts, and opinions of male nursing students (first to fourth years) and male nursing professionals about their perception of the nursing profession. The study recruited 11 male nursing students and 11 male nursing professionals using a purposive sampling method. Data were collected via semi-structured individual interviews using qualitative open-ended inquiries consisting of seven questions. The data were analysed using thematic perspectives.

Results

The analysis revealed three themes: (a) perceiving gender varieties, (b) taking apparent advantage of masculine characteristics, and (c) taking an equal perspective. Male students' replies to their professional gender attitudes were that there was no distinct line among the gender-related advantages and disadvantages according to whether they were first to fourth-year students.

Conclusion

Male nursing students and professionals believe that nursing is equally appropriate for both men and women, and they could employ masculine characteristics to thrive in their professional development.

N, Rojas Cadena M, Naranjo-Lara P, Mendoza AP, Jima-Sanmartín J, Casanova DA, García B, Giraldo NC. Assessment of preparedness and proficiency in basic and advanced life support among nursing professionals: a cross-sectional study

Background

Cardiac diseases are among the leading causes of death worldwide, including sudden cardiac arrest in particular. Nursing professionals are often the first to encounter these scenarios in various settings. Adequate preparation and competent knowledge among nurses significantly impact survival rates positively.

Aim

To describe the state of knowledge about Basic and Advanced Life Support guidelines among Ecuadorian nursing professionals.

Methodology

A nationwide, descriptive, cross-sectional study was conducted from February to April 2023 among Ecuadorian nursing professionals. Participants were invited through official social media groups such as WhatsApp and Facebook. The study utilized a self-administered online questionnaire to evaluate theoretical knowledge of Basic Life Support (BLS) and Advanced Life Support (ALS). Knowledge scores were assigned based on the number of correct answers on the tests. T-tests and one-way ANOVA were used to examine relationships between knowledge scores and demographic and academic training variables.

Results

A total of 217 nursing professionals participated in the study. The majority of the participants were female (77.4%) and held a university degree (79.9%). Among them, only 44.7% claimed to have obtained a BLS training certificate at least once, and 19.4% had ALS certification. The overall BLS knowledge score (4.8/10 ± 1.8 points) was higher than the ALS score (4.3/10 ± 1.8 points). Participants who had obtained BLS certification and those who used evidence-based summaries as a source of extracurricular training achieved higher BLS and ALS knowledge scores.

Conclusion

Ecuadorian nursing professionals in this study exhibited a significant deficiency in theoretical knowledge of BLS and ALS. Formal training and preparation positively impact life support knowledge. Support and inclusion of Ecuadorian nurses in training and academic preparation programs beginning at the undergraduate level are essential for promoting life support knowledge and improving outcomes.

A qualitative study on the willingness and influencing factors of master of geriatric nursing specialist postgraduates to volunteer for home respite care for disabled elderly families

BACKGROUND

As China's population ages, the demand for care for the disabled elderly is increasing, and family caregivers find it challenging to meet the comprehensive care needs of the disabled elderly. Through home respite services, families of the disabled elderly can receive help and support from specialized nursing professionals to ease the burden on family caregivers and provide high-quality services. This study explores the willingness and influencing factors of Master of Geriatric Nursing Specialist postgraduates in China to volunteer to provide home respite services for disabled elderly individuals.

METHODS

A qualitative study based on Grounded Theory used Strauss and Corbin's programmatic version. A purposive sampling method was employed to conduct semi-structured interviews with 12 Master of Geriatric Nursing Specialist postgraduates from a tertiary hospital in Changsha, Hunan Province, China.

RESULTS

The willingness of Master of Geriatric Nursing Specialist postgraduates to volunteer to provide home respite services for the disabled elderly was established as a core category, which was influenced by three main categories: personal factors, service object factors, and social factors, and nine categories formed from 39 initial concepts were included under the main category.

CONCLUSIONS

Influenced by China's traditional cultural background, Master of Geriatric Nursing Specialist postgraduates in China have shown high motivation in volunteering to provide home respite services for the families of the disabled elderly but have been challenged by several challenges from China's healthcare environment and education system. Relevant departments need to adopt a series of policies and measures to increase volunteers' willingness to participate in respite care and promote its development.

Development and evaluation of a scale to measure nurses' unsafe driving behaviour while commuting

Driving is the most prevalent form of commuting for most workers but is also perhaps the most hazardous mode of travel with unsafe driving contributing significantly to road traffic accidents. Despite nurses having been reported as being at higher risk of commuter-related accidents over the last three decades, little is known about unsafe driving behaviours among nurses while commuting, which is unique from other driving routines. Additionally, the lack of appropriate tools to measure such behaviours is apparent. This study aims i) to identify unsafe driving behaviours among nurses while commuting and ii) to develop a scale to assess nurses' unsafe commuting driving behaviours. The study employed a multiphase and multimethod approach to develop the scale, which was subject to stringent validation and evaluation. Themes were specified via the Nominal Group Technique (NGT). Six themes were identified namely: i) violations and reckless driving, ii) negative emotions, iii) drowsy driving iv) mind wandering, v) error and vi) carelessness. Content and face validity were sought through expert review. A total of 442 nurses' data were collected across multisite hospitals for evaluation. Exploratory factor analysis (EFA) resulted in recovered structure and was confirmed through Confirmatory Factor Analysis (CFA) with structural equation analyses being conducted to test predictive validity. All constructs met adequate validity and reliability. Nurses' unsafe driving behaviours while commuting were identified with a novel scale to assess them being both developed and validated. The resulting MyUDWC scale is a suitable tool for measuring nurses' unsafe driving behaviours while commuting.

Why do male nurses choose to work in foreign countries? A qualitative study on Chinese male nurses working in Japan

Aim

This study aimed to examine foreign-educated male nurses' motivation to emigrate for work, as well as explore the contextual factors that shape their career trajectories.

Background

To that end, we interviewed Chinese male nurses working in Japan. No previous study has examined why male nurses seek employment abroad or the problems they face.

Methods

This study employed a qualitative and inductive research design. Sixteen Chinese male nurses working in Eastern and Western Japan were recruited using convenience and snowball sampling methods and were interviewed via video calls. Co-researchers of both genders from different occupational and cultural backgrounds coded the findings and identified common themes in participants' responses. We analysed our findings vis-à-vis various theoretical perspectives and developed an explanatory model.

Results

Participants' experience as nurses in Japan ranged from six months to eight years. The findings confirmed that factors identified in earlier reports influenced nurses' motivation and work. Two new factors emerged: influence by others and social reasons. Moreover, two factors that affected male nurses' motivation to work abroad, namely, external factors and the influence of others, were identified. Social reasons were identified as a pull factor.

Conclusion

Our study provides valuable insights into recruiting and retaining foreign male nurses in developed countries facing issues such as ageing populations and nursing shortages.

Implications for nursing policy

This study has important implications for nursing management. Our findings highlight the importance of orienting foreign-educated nurses regarding the local work culture to increase the recruitment and retention of foreign talent. Moreover, enhanced salary packages and benefits to improve motivation can lead to improved job performance, which can positively impact patient and safety outcomes.

Barriers to community healthcare delivery in urban China: a nurse perspective

PURPOSE

There is considerable research on China's community healthcare, but little examining its delivery from a nurse perspective. This article, set in the context of Shenzhen, elicits community nurses' views on barriers to healthcare delivery, providing an initial evidence framework to improve community nursing practice at organizational and policy levels.

METHODS

We used qualitative methods. Data from semi-structured interviews with 42 community nurses in Shenzhen underwent inductive content analysis. Consolidated criteria for reporting qualitative research were consulted to structure our reporting.

RESULTS

Our analysis suggests four elements discouraging community nurses in care delivery: lack of equipment, stressful work environments, staff incompetence, and patient distrust. Centralized means of procurement, management indifference to nurses' well-being, unsystematic training and reluctance to enter the community healthcare sector, and public prejudices against nursing contributed to these constraints, preventing community nurses from performing patient-centred care, devoting energy to caring, freeing themselves from heavy workloads, and building trust-based care relationships.

CONCLUSIONS

Delivery barriers devalued community health services systematically and undermined nurses' professional advancement and psychological well-being. Targeted management and policy inputs are necessary to reduce caring barriers and enhance the ability of community nursing to safeguard population health.

Perception and experience of altruism in graduate nursing students

BACKGROUND

Altruism is the core of nursing professionalism. Graduate nursing education in China started late and is still developing, exploring the current state of altruistic behavior and the perceived experience of altruism among graduate nursing students may have important implications for nursing education.

OBJECTIVE

Explore the current state of altruistic behavior and the perceived experience of altruism among graduate nursing students in China.

RESEARCH DESIGN

This is a descriptive phenomenological qualitative research study, semi-structured in-depth interviews were conducted. Seventeen graduate nursing students from three schools were selected to participate in the study. Colaizzi's analysis method was performed with NVivo software to develop common themes from the data.

ETHICAL CONSIDERATIONS

The research proposal was approved by the Research Ethic Committee of Yangzhou University, China.

RESULTS

Four themes emerged from the analysis of the interviews of the 17 participants: "Definition of altruism," "Altruism in the nursing profession," "Altruism applied in practice," and "Factors influencing altruistic behavior."

CONCLUSIONS

Although participants indicated that the concept of "altruism" was relatively new to them, altruistic behavior is common in both their work and life. Many factors influence the altruistic behavior of graduate nursing students, including the environment, personal factors, education, recipient factors, occupational factors, and gains and losses. Families, schools, and hospitals should create favorable environments to foster altruistic tendencies in students.

Relationships between depression, self-efficacy, and professional values among Chinese oncology nurses: a multicenter cross-sectional study

OBJECTIVES

Many factors are related to oncology nurses' professional values. However, the evidence on the relevance of professional values among oncology nurses in China remains sparse. This study aims to investigate the relationship between depression, self-efficacy, and professional values among Chinese oncology nurses and analyze the mediating effect of self-efficacy on this association.

METHODS

It was a multicenter cross-sectional study designed with the STROBE guidelines. An anonymous online questionnaire recruited 2530 oncology nurses from 55 hospitals in six provinces of China between March and June 2021. Measures included self-designed sociodemographic and fully validated instruments. Pearson correlation analysis was employed to explore the associations between depression, self-efficacy, and professional values. Bootstrapping analysis by the PROCESS macro was used to examine the mediating effect of self-efficacy.

RESULTS

The total scores of depression, self-efficacy, and professional values of Chinese oncology nurses were 52.75 ± 12.62, 28.39 ± 6.33, and 101.55 ± 20.43, respectively. About 55.2% of Chinese oncology nurses were depressed. Chinese oncology nurses' professional values were generally intermediate. Their professional values were negatively related to depression and positively correlated with self-efficacy, while depression was negatively related to self-efficacy. Moreover, self-efficacy partially mediated the relationship between depression and professional values, accounting for 24.8% of the total effect.

CONCLUSIONS

Depression negatively predicts self-efficacy and professional values, and self-efficacy positively predicts professional values. Meanwhile, depression in Chinese oncology nurses has an indirect effect on their professional values through self-efficacy. Nursing managers and oncology nurses themselves should develop strategies aimed at relieving depression and improving self-efficacy to strengthen their positive professional values.

Community nursing delivery in urban China: A social power perspective

Community nurses remain understudied in research on interactional power, especially in China where community healthcare is an emerging practice. Grounded in French & Raven's typology of social power, this article conceptualises the power of community nurses in a Chinese urban context. Through thematic analysis of textual data from 26 semi-structured interviews and two additional focus group discussions with community nurses in Shenzhen, we identified six power varieties, i.e. indirect reward, indirect coercion, legitimate position, peer reference, field expertise, and caring information. We classified these powers trichotomously, as nurse-to-doctor, nurse-to-nurse, and nurse-to-patient, to show the potential influences nurses bring to healthcare relationships. Our analysis indicated nurses' exercise of some powers was constrained by two elements, i.e. doctor-nurse power polarity and patient prejudices against nursing, which together contributed to nurses' adverse power loss. These power adversities permeated the community health environment, contributing to healthcare delivery dysfunctions by undermining nurses' self-improvement, self-assurance, enthusiasm, and cooperation in care. Our analysis, using the insights of social power, develops a novel reading of community nursing delivery in urban China. We argue that nurse empowerment could promote community healthcare delivery. Role enhancement and pro-nursing policy development would reduce adverse power scenarios for community nurses and help convert their potential power resources into practical powers in support of patients' needs.

Factors associated with selection of practice in primary care and rural health among medical and nursing students in China

BACKGROUND

China has a shortage of physicians and nurses in primary care and rural health. This study explores factors that influence the choices of medical and nursing students in China to select a career in primary care, or in rural health.

METHODS

A total of 3826 medical students and 1771 nursing students were surveyed in China. Data were analysed using descriptive statistics, Chi-squared tests, and logistic regression models.

RESULTS

The majority of medical and nursing students were willing to practice primary care (55% and 59%, respectively). Yet, only 16% and 5% of medical and nursing students, respectively, desired to work in a village or small city. The most common reasons cited to not practice primary care is the lack of opportunities for clinical skills improvement, academic and personal development, and networking. Medical students who were living in a rural residence between ages 1 and 15years were more likely to report a willingness to work in a rural location (OR: 2.18, 95% CI: 1.33-3.58) or in primary care (OR: 1.72, 95% CI: 1.31-2.25).

CONCLUSION

More efforts are needed to understand how preferences among medical and nursing students influence their career choices and change in choices over time. Understanding the concerns of students can help to tailor interventions in healthcare education and training to increase student satisfaction with their career choice and enrolment counts in medical and nursing fields.

Impacts of COVID-19 pandemic on professional identity development of intern nursing students in China: A scoping review

PURPOSE

Clinical experience plays a vital role in the development of the professional identity (PI) of nursing students. China has applied a strict zero- COVID health policy in combating the COVID-19 pandemic since December 2019 and studies have been conducted in different places of China to explore PI development of nursing students during the pandemic time among the intern nursing students who are on clinical practices. This review study aims to synthesize the previous studies and provide a comprehensive picture of the impacts of the pandemic on the PI development of intern nursing students.

METHODS

Arksey and O'Malley's five-stage scoping review framework was used. Combinations of keywords were used to search relevant articles in both Chinese and English databases published from inception of the articles until the final search date (10 March 2022). The initially included articles were also appraised for their quality, and those that passed the appraisal were left for data analysis. The analytic results were cross-checked among the reviewers.

RESULT

Three themes emerged from the included studies: 1) the PI levels, 2) the impacts of personal and social factors of PL, and 3) the specific impact of the COVID-19 pandemic. The levels of students' PI ranged from 66%-80% of the total scores in PI instruments, almost the same levels as in pre-pandemic time, despite the elevated social image of nurses after the COVID-19 pandemic. There is no consensus about the impacts of most personal and social factors on students' PI across the studies. The impacts of COVID-19 on PI were both positive and negative.

CONCLUSIONS

COVID-19 epidemic exerted complicated impacts on the PI of intern nursing students. While it is necessary to address the fear of the COVID-19 pandemic among intern nursing students, the pandemic may not be an opportunistic time to enhance the students' PI.

Configurational Paths to Higher Efficiency in County Hospital: Evidence From Qualitative Comparative Analysis

Background

The efficient operation of county-level medical institutions is a significant guarantee in constructing Chinese rural tertiary care service networks. However, it is still unclear how to increase the efficiency of county hospitals under the interaction of multiple factors. In this study, 35 county general hospitals in China were selected to explore the configuration paths of county hospitals' high and poor efficiency status under the Environment-Structure-Behavior (ESB) framework and provide evidence-based recommendations for measures to enhance its efficiency.

Methods

Data envelopment analysis with the bootstrapping procedure was used to estimate the technical efficiency value of case hospitals. A fuzzy-set qualitative comparative analysis approach was carried out to explore the configuration of conditions to the efficiency status.

Results

Antecedent configurations affecting the efficiency status of county hospitals were identified based on the ESB analytical framework. Three high-efficiency configuration paths can be summarized as structural optimization, capacity enhancement, and government support. Another three types of paths, namely insufficient capacity, aggressive expansion, and poor decision-making, will lead to inefficient configurations.

Conclusion

Qualitative comparative analysis is necessary when exploring complex causality. The efficiency situation of county hospitals results from a combination of influencing factors instead of the effect of a single one. There is no solitary configuration for high efficiency that applies to all healthcare units. Any measures aimed at efficiency promotion should be discussed within the framework of a case-specific analysis.

Factors influencing intention to stay of male nurses: A descriptive predictive study

Nurse shortages and nurse attrition are high in many countries, and there is also a dearth of male nurses in the profession. This study aimed to examine the level of intention to stay and ten predictors of this among male nurses in China. A descriptive, predictive study was administered to 480 registered male nurses. Eight research instruments were used to collect data. Descriptive statistics and binary logistic regression were employed to analyze the data. The overall intention to stay in the nursing profession as perceived by male nurses was at a moderate level. Binary logistic regression demonstrated that work group cohesion, transformational leadership, career growth, and job satisfaction were significant predictors, explaining 32.2% of the total variance for intention to stay. The findings of this study provide suggestions for nursing administrators and policymakers to develop appropriate strategies or interventions to increase the intention to stay for male nurses to stay in the profession, based on the four predictors.

Trends, composition and distribution of nurse workforce in China: a secondary analysis of national data from 2003 to 2018

OBJECTIVES

Given the increased ageing population and frequent epidemic challenges, it is vital to have the nurse workforce of sufficient quantity and quality. This study aimed to demonstrate the trends, composition and distribution of nurse workforce in China.

DESIGN

Secondary analysis using national public datasets in China from 2003 to 2018.

SETTING/PARTICIPANTS

National population, nurse workforce and physician workforce.

PRIMARY AND SECONDARY OUTCOME MEASURES

Frequency and proportion were used to demonstrate: (1) the longitudinal growth of nurse workforce; (2) the diversity of nurse workforce in gender, age, work experience and education level; and (3) the distribution of nurse workforce among provinces, rural-urban areas and hospital/community settings. The Gini coefficient and Theil L index were used to measure the inequality trends of nurse workforce.

RESULTS

The total number of nurses increased from 1.3 million to 4.1 million and the density increased from 1 to 2.94 per 1000 population over 2003-2018. The nurses to physician ratio changed from 0.65:1 to 1.14:1. The majority of the nurse workforce was female, under 35 years old, with less than 30 years of work experience, with an associate's degree and employed within hospitals. Central and eastern regions had more nurses and there were 5.08 nurses per 1000 population in urban areas while less than two in rural areas in 2018. The Gini coefficient and between-provincial Theil index experienced a consistent decline. Within-province inequality accounted for overall inequality has risen from 52.38% in 2010 to 71.43% in 2018 suggested that the differences of distribution are mainly reflected in urban and rural areas.

CONCLUSION

Chinese nurse workforce has been changed significantly in the past 15 years that may be associated with the reformations of policy, nursing education in China. Our study suggests current features in the nurse workforce and can be used to strengthen future health services.

Protocol for the National Nurse Health Study (NNHS): a web-based ambispective cohort study

INTRODUCTION

The physical and mental health of nurses may significantly impact the entire medical care group and directly affect the quality of medical services. Due to the intense emotional involvement and often problematic working conditions that characterise their profession, nurses appear to be especially susceptible to a complex set of stressors with repercussions to their health. Several landmark studies of nurses have provided an abundance of evidence on risk factors that influence the health status of nurses. However, few studies have investigated the health status of nurses who work in high-intensity work environments in China. The National Nurse Health Study (NNHS) objective is to build an ambispective cohort to gather web-based information on early-life events, daily habits, occupational and environmental risk factors, and health outcomes of a specific subset of healthcare professionals of Chinese nurses.

METHODS AND ANALYSIS

NNHS, which was developed at a tertiary hospital in Beijing, China, is a research initiative that enrolls registered nurses working at Peking University Third Hospital. A web-based self-administered system was designed to collect health-related data and link them with previous physical examination data. During the study period, participants with signed informed consent will be invited to annually repeat a similar procedure.

ETHICS AND DISSEMINATION

The NNHS research protocol was approved by the Institutional Ethics Committee and provides promising data that contribute to the understanding of pathophysiological links between early-life events, body composition, gut microbiota, and inflammatory and metabolic risk profiles. Moreover, the combination of a user-friendly tool with the innovative purposes of the NNHS offers a remarkable resource to test hypotheses about mechanisms of diseases, including work stress, and further plan preventive programmes in public health.

TRIAL REGISTRATION NUMBER

The study was registered on Clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT04572347) and the China Cohort Consortium (http://chinacohort.bjmu.edu.cn/project/102/).

"Not Just Anybody Can Do It": A Qualitative Study of the Lived Experience of Inpatient Palliative Care Professionals in China's Mainland

Background: Over the past 5 years, China has invested substantially in palliative care programs to meet the rising demand for such services. In China's mainland, most palliative care programs are embedded within an established hospital unit, but a small subset of providers practice exclusively in a stand-alone inpatient palliative care department.

Objective: To explore the lived experience of professionals at an independently operating palliative care hospital department in China's mainland.

Design: We used purposive sampling to select palliative care physicians and nurses. Semistructured in-depth interviews were conducted in person. Thematic analysis was used to elicit key themes that pertained to participants' lived experience.

Setting/Subjects: Ten palliative care physicians and seven nurses at the palliative medicine department in the West China Fourth Hospital of Sichuan University in Chengdu, Sichuan Province, participated in the interviews.

Results: Three themes related to participants' lived experience were (1) interactions with patients and families (e.g., frequent encounters with death, communication difficulties, witnessing family struggles, and developing mutually trusting relationships); (2) factors influencing their work life (e.g., supportive working environment, unmet training needs, policy restrictions, and lack of public awareness); and (3) perceived nature of work (e.g., complex and demanding, underappreciation, encroachment of work stress into personal life, deriving accomplishment from work, and personal growth).

Conclusion: This study helps fill the void in the palliative care literature regarding the lived experience of inpatient palliative care professionals in China's mainland. Our findings revealed factors influencing the well-being of palliative care professionals that are meaningful to policymakers.

Professional quality of life as potential mediators of the association between anxiety and depression among Chinese health-care clinicians

OBJECTIVE

Building upon the tripartite model of anxiety and depression, the current study aims to examine mechanisms of comorbidity between anxiety and depression using the ProQOL (Professional Quality of Life; including the constructs of burnout, secondary traumatic stress, and compassion satisfaction) in a sample of Chinese health-care clinicians.

METHOD

A randomized cross-sectional survey was distributed to 1620 participants who were recruited from eight state-owned hospitals in a city in southern China between January and May 2017. A total of 1562 questionnaires were returned (a response rate of 96.4%). After the cases with more than 10% missing variables and multivariate outliers being removed, 1423 valid cases remained. Multiple mediator models were used for mediation analysis that was conducted using the PROCESS v3.1 macro for SPSS.

RESULTS

The indirect effects of anxiety upon depression through burnout (a1 = . 601 (95% confidence interval (CI): .552, .650), p < .001; b1 = .137 (95% CI: .101, .174), p < .001) and compassion satisfaction (a3= -.297 (95% CI: -.352, -.241), p < .001; b3 = -.069 (95% CI: -.100, -.039), p < .001) were significant, while there was no evidence that anxiety influenced depression by changing secondary traumatic stress. The indirect effects of depression upon anxiety through secondary traumatic stress (a2 = . 535 (95% CI: .483, .588), p < .001); b2 = .154 (95% CI: .120, .188), p < .001) were both positive and significant, while there was no evidence that depression influenced anxiety by changing burnout and compassion satisfaction.

CONCLUSIONS

In the current sample, burnout and compassion satisfaction mediated the effect of anxiety upon depression and secondary traumatic stress mediated the effect of depression upon anxiety. The findings of the current study offer support to the tripartite model.

"I am called girl, but that doesn't matter" -perspectives of male nurses regarding gender-related advantages and disadvantages in professional development

Background

Exploration of professional development experiences of male nurses can help develop evidence-based strategies to attract males into nursing. The study aims to investigate the advantages and disadvantages of being a male in nursing profession that male nurses and male nursing students experience in their professional development.

Methods

A descriptive qualitative research was designed. Purposive sampling was applied and 24 males (12 nursing students and 12 clinical nurses) participated. Semi-structured individual interviews were used in data collection. Thematic analysis was used in data analysis.

Results

Professional development of male nurses was related to three interplayed identities: a man, a nurse, and a minority. Three themes emerged relating to the professional development of the males: “feeling role strains” “taking perceived advantage of masculine traits” and “taking an egalitarian viewpoint”. There was no clear line between the gender-related advantages and disadvantages as factors influencing professional development can be turned by the males from barriers to facilitators.

Conclusions

Male nurses perceive nursing as equally suitable for males and females and make use of masculine traits to thrive in their professional development.

Development Trend of Infectious Disease Hospitals in China 2002-2018: A Longitudinal Analysis of National Survey Data

BACKGROUND

Infectious disease hospitals (IDHs) play very important roles in the battle against the infectious disease. The present study aims to systematically analyze the development trends and possible problems of IDHs in China.

METHODS

Most of the data came from the China Health Statistics Yearbook 2003-2019. Joinpoint Regression Model was used to analyze the development trends of IDHs between 2002 and 2018.

RESULTS

From 2002 to 2018, the number of IDHs in China increased from 126 to 167, with an average annual percent change (AAPC) of 1.82%. The ratio of nurses to beds increased from 0.38 to 0.46 with the AAPC of 0.88%, and average business housing area per bed increased with an AAPC of 1.97%. The percentage of liabilities to total assets increased year by year and the percentage of medical business costs to total expenditure decreased. The segmented trend of daily visits per physician from 2014 to 2018 was stable, and the segmented trend of daily inpatients per physician from 2012 to 2018 decreased significantly. In 2017, the rates of surgical inpatients leaving the hospital without the doctor's advice and surgical inpatients mortality were higher than 2016.

CONCLUSION

Although the development of IDHs was generally good in China, the scale of IDHs was generally small, the ability to respond to major emergencies was weak, the problem of irrational resource allocation was still prominent, and the operation of IDHs was facing a dilemma.

Attitudes and compliance with the WHO surgical safety checklist: a survey among surgeons and operating room staff in 138 hospitals in China

Background

Ten years after the introduction of the Chinese Ministry of Health (MoH) version of Surgical Safety Checklist (SSC) we wished to assess the ongoing influence of the World Health Organisation (WHO) SSC by observing all three checklist components during elective surgical procedures in China, as well as survey operating room staff and surgeons more widely about the WHO SSC.

Methods

A questionnaire was designed to gain authentic views on the WHO SSC. We also conducted a prospective cross-sectional study at five level 3 hospitals. Local data collectors were trained to document specific item performance. Adverse events which delayed the operation were recorded as well as the individuals leading or participating in the three SSC components.

Results

A total of 846 operating room staff and surgeons from 138 hospitals representing every mainland province responded to the survey. There was widespread acceptance of the checklist and its value in improving patient safety.

860 operations were observed for SSC compliance. Overall compliance was 79.8%. Compliance in surgeon-dependent items of the ‘time-out’ component reduced when it was nurse-led (p < 0.0001). WHO SSC interventions which are omitted from the MoH SSC continued to be discussed over half the time. Overall adverse events rate was 2.7%. One site had near 100% compliance in association with a circulating inspection team which had power of sanction.

Conclusion

The WHO SSC remains a powerful tool for surgical patient safety in China. Cultural changes in nursing assertiveness and surgeon-led teamwork and checklist ownership are the key elements for improving compliance. Standardised audits are required to monitor and ensure checklist compliance.

Development of Disaster Nursing in China: From the Spirit of Nightingale to COVID-19

As an emerging discipline, disaster nursing is very important in disaster emergency management, but there are few mature practice models and theoretical discussions. In particular, the contribution of nursing staff in disaster emergency has not yet received widespread attention and recognition. After more than 10 y of rapid development, China's disaster nursing has gradually formed a Chinese model and Chinese experience. During the global fight against coronavirus disease 2019 (COVID-19), this article takes the nursing work in disaster emergency rescue as the perspective and briefly describes the development process of disaster nursing in China to introduce the practice and theoretical development of disaster nursing in China to nursing workers around the world. Analyzing the role of Chinese nurses in national disaster emergency response provides a reference for global disaster nursing talent capacity building. By sharing the Nightingale spirit of Chinese nurses in disaster emergency, we will show people all over the world the professional value of disaster nursing practitioners and pay tribute to the nursing staff engaged in disaster emergency work.

Assessing the changes in childbirth care practices and neonatal outcomes in Western China: pre-comparison and post-comparison study on early essential newborn care interventions

OBJECTIVE

To explore the changes in childbirth care practices and health outcomes of newborns after the introduction of early essential newborn care (EENC).

DESIGN

A pre-comparison and post-comparison study.

SETTING

The study was conducted in December 2016 and December 2018 in 18 counties in four western provinces of China.

PARTICIPANTS

46 hospitals that provide delivery services participated in the study.

INTERVENTIONS

EENC practices were introduced and implemented in the 46 hospitals.

OUTCOME MEASURES

The changes of hospital indicators such as incidence of birth asphyxia and neonatal mortality were compared in 2016 and 2018. EENC coverage indicators, such as skin-to-skin (STS) contact, and time of first breast feeding were also compared before and after the intervention via interview with 524 randomly selected postpartum mothers (320 in 2016 and 204 in 2018).

RESULTS

54 335 newborns were delivered in the pre-EENC period (2016) and 58 057 delivered in the post-EENC period (2018). According to hospital records, the proportion of newborns receiving immediate STS contact increased from 32.6% to 51.2% (Risk Ratio (RR)=1.57,95% CI 1.55 to 1.59) and the percentage of newborns receiving prolonged STS contact for more than 90 min increased from 8.1% to 26.8% (RR=3.31, 95% CI 3.21 to 3.41). No statistically significant changes were found in neonatal mortality, although slight decreases in birth asphyxiate and neonatal intensive care unit admission rates were detected. Among the mothers interviewed, the proportion of newborns receiving immediate STS contact increased from 34.6% to 80.0% (RR=2.31, 95% CI 1.69 to 3.17). The exclusive breastfeeding rate increased from 43% to 73.4% (RR=1.71, 95% CI 1.43 to 2.04). The average length of the first breast feeding increased from 15.8 min to 17.1 min.

CONCLUSIONS

The introduction of EENC has yielded significant improvements in newborn care services at the pilot hospitals, including enhanced maternal and newborn care practices, improved STS contact quality and early breastfeeding performance. Further studies are needed to evaluate the long-term impact of EENC on newborn health outcomes.

Burnout in nurses working in China: A national questionnaire survey

AIM

This study aimed to assess the overall status of burnout in nurses in China on a national scale and investigate the demographic characteristics related to burnout and the relationships between demographics, job satisfaction and burnout.

METHODS

This was a national cross-sectional study conducted by the Chinese Nursing Association between July 2016 and July 2017. Data were collected using a structured, self-administered questionnaire.

RESULTS

A total of 51 406 registered nurses in 311 Chinese cities completed the questionnaire. Fifty per cent of the participants suffered burnout, and 33.8% of nurses had high scores on emotional exhaustion, 66.6% had high scores on depersonalization and 93.5% had low scores on personal accomplishment; 16.2% reported a high level of job satisfaction, only 0.4% was satisfied with their jobs and 70.7% intended to leave their jobs. Marital status, educational level, income and years of working experience affected job burnout. Nurses with a high level of burnout were more likely to have a high degree of job dissatisfaction and intend to leave their jobs.

CONCLUSION

We found a high prevalence of burnout among nurses in China. Nursing managers need to pay more attention to job burnout and its influencing factors. Interventions to reduce nurse burnout should be implemented.

Dementia-Free Life Expectancy among People over 60 Years Old by Sex, Urban and Rural Areas in Jiangxi Province, China

Objective: To estimate and compare the dementia-free life expectancy (DemFLE) and age trends of the population over 60 in 2018 in Jiangxi Province, China, by sex and urban–rural areas. Methods: Based on the Summary of Health Statistics of Jiangxi Province in 2018 and the Sixth National Health Service survey of Jiangxi Province, the model life table is used to estimate the age-specific mortality rate by sex and urban–rural areas. DemFLE and its ratio to life expectancy (LE) were calculated using the Sullivan method. Results: In 2018, the DemFLE at age 60 was 18.48 years for men and 21.31 years for women, accounting for 96.62% and 96.67% of their LE. LE and DemFLE were higher for those in urban areas than in rural areas, except for men aged 90 and above; higher in women than in men, except for people in rural areas aged 90 and above. In urban areas, DemFLE/LE was higher for women than for men; the opposite was observed in rural areas. Urban women had a higher DemFLE/LE than rural women did, urban men had a lower DemFLE/LE than rural men did. Conclusions: With increased LE, DemFLE also increases, but with older age and over time, DemFLE/LE gradually decreases. The effect of dementia on elderly adults becomes more serious. It is necessary for the government to implement a series of prevention strategies to improve the quality of life and health awareness of the elderly. Elderly urban men and elderly rural women need more attention and health care.

Psychometric evaluation of the Chinese version of the Person-Centred Care Assessment Tool

OBJECTIVE

This study aims to test a Chinese cross-cultural adaptation of the English version of the Person-Centred Care Assessment Tool (P-CAT) and evaluate its psychometric properties.

DESIGN

P-CAT was translated/back-translated using established procedures before the psychometric evaluation of the Chinese version was made.

SETTING

Two hospitals covering urban and suburban areas of Kunming in the Yunnan province of China.

PARTICIPANTS

152 female hospital staff completed the survey.

MAIN OUTCOME MEASURES

Construct validity and reliability, including internal consistency and test-retest reliability, were assessed among a sample of hospital staff.

RESULTS

The factor analysis resulted in a two-component solution that consisted of two subscales. The corrected item-total correlations for all of the items ranged from 0.14 to 0.44, with six items not meeting the cut-off level for item-total correlation (>0.3). The Chinese P-CAT demonstrated strong reliability, with a Cronbach's alpha of 0.91-0.94 for the scales and a test-retest reliability coefficient of 0.88 for the overall scale scores. The intraclass correlation was 0.92 (95% CI 0.90 to 0.95).

CONCLUSION

P-CAT appears to be a promising measure for evaluating staff perceptions of person-centredness in Chinese hospital environments. The results show that P-CAT can be a useful tool for improving the quality of healthcare in terms of person-centred care in the Chinese context.

Does ethical leadership boost nurses' patient-oriented organizational citizenship behaviours? A cross-sectional study

AIMS

To examine the relationships between perceived ethical leadership, perceived interactional justice climate, and patient-oriented organizational citizenship behaviour.

DESIGN

A cross-sectional non-experimental design was employed.

METHODS

The convenience sampling was adopted. Data were collected in July and August 2018. A total of 738 nurses were recruited from eight Chinese hospitals. The survey included instrument scales of ethical leadership, interactional justice climate, and patient-oriented organizational citizenship behaviour. SPSS version 22 was used to compute means, standard deviations, and intercorrelations. The partial least squares structural equation modelling was chosen to estimate the path coefficients of the relationships.

RESULTS

Relationships among perceived ethical leadership, perceived interactional justice climate, and organizational citizenship behaviours were statistically significant. Perceived interactional justice climate mediated the relationship between perceived ethical leadership and nurses' organizational citizenship behaviours.

CONCLUSIONS

Ethical leadership is related to interactional justice climate, which, in turn, increases nurses' organizational citizenship behaviour. Nurse leaders are encouraged to exhibit ethical behaviours and to create justice climate. Ethical leadership scale can be used to select, train, and evaluate the nurse supervisors and managers.

IMPACT

Hospital administrators are encouraged to recruit and promote those with both moral compass and leadership potential to nursing leadership positions. Nursing managers should create a justice climate in their hospitals. Hospital administrators could use ethical leadership scale to develop ethical leadership training programmes.

Perinatal women's satisfaction with nurses caring behaviours in teaching hospitals in China

BACKGROUND

Adequate caring behaviours provided by nurses can increase patients' satisfaction of care. Yet few researchers have examined women's satisfaction in nurses' caring behaviours in China and then published the study in English.

AIM

The aim of this study was to identify the level of women's satisfaction with nurses' caring behaviours during the antenatal, childbirth and postnatal periods.

METHODS

A descriptive, cross-sectional study was performed using a sample of 422 postpartum women of two teaching hospitals in Wuhan, China. A structured questionnaire on socio-demographic information was completed, and a satisfaction scale of 60 items concerning nurses' caring behaviours was measured.

RESULTS

The findings showed that participants reported a good satisfaction score for nurses' caring behaviours during all three periods. Behaviours on the 'Monitor' subscale obtained the highest score (a mean score of 4.46 for the antenatal period, 4.64 for the childbirth period and 4.31 for the postnatal period). The subscale with the second highest score was 'Human respect' (4.53, 4.27 and 4.56, respectively), while the subscale with the lowest score was 'Trust' (3.78 and 3.98). The statistical significances of the demographics of the women were shown concerning their perceived satisfaction of five subscales of caring behaviours.

CONCLUSION

The study revealed no statistically significant differences in the perceived satisfaction in nurses' caring behaviours between the antenatal, childbirth and postnatal periods. However, nursing administration development projects that focus on caring are still needed. Additionally, more studies that reflect Watson's theory of human caring on the maternity population should be conducted with a larger sample size.

Effect of Patient Participation on Nurse and Patient Outcomes in Inpatient Healthcare

Using service-dominant logic as a theoretical lens, this study investigated the co-production of healthcare service and service value co-creation between nurses and patients. The main objective of this study was to: (1) examine the effect of patient participation on patient satisfaction and nurses' attitudes and behaviors; (2) examine boundary conditions of the effect of patient participation on patients and nurses. We proposed that patient participation positively impacted patient satisfaction and nurse job satisfaction, work engagement, and helping behaviors. We further proposed that first inpatient stay and length of stay moderated the effect of patient participation on patient satisfaction, and nurses' sociodemographic characteristics moderated the effect of patient participation on nurse job satisfaction, work engagement, and helping behaviors. Using survey data from 282 nurses and 522 inpatients from a public hospital in China, we found that the effect of patient participation on patient satisfaction was contingent upon first inpatient stay and length of stay. We also found that patient participation improved nurse job satisfaction, work engagement, and helping behaviors. Furthermore, nurses' sociodemographic characteristics, namely age and organizational tenure, moderated the effect of patient participation on nurse job satisfaction, but not on work engagement and helping behaviors. Theoretical and practical implications of our findings were discussed.