Objectives Existential distress at the end of life constitutes a profound crisis of fractured personhood that transcends biomedical suffering. Most models of personhood remain primarily descriptive, static taxonomies and have not been translated into an actionable clinical roadmap. This study aims to address three systemic barriers in conventional palliative psychotherapy—the “somatic-reflective disconnect,” compressed terminal timelines, and Western individualistic biases. By synthesizing and complementing Eastern philosophical concepts with Western clinical frameworks, we derive a novel, secular clinical model (the Personhood Pentadigm [PP]) to map and systematically disrupt end-of-life existential suffering. Methods We employ a dual-stage qualitative design. First, we develop the conceptual framework through transcultural translation of the Eastern psychology of the five aggregates, integrating five secular dimensions—Physical Image, Somatosensory Tone, Role/Narrative, Volitional Behavior, and Consciousness—with Western clinical humanities (including modern grief theories and existentialism). Second, we operationalize the model using a purposive qualitative case vignette methodology based on detailed bedside clinical documentation of contrasting terminal trajectories. Each case is analyzed via a three-phase interpretive analytic procedure: 1) domain-specific qualitative coding, 2) causal pathway mapping, and 3) interdisciplinary care alignment. Results The analysis reveals that existential distress is a dynamic, multi-nodal systemic collapse of personhood rather than a static symptom. Importantly, the selected vignettes demonstrate two coincidental, non-disease specific configurations of suffering: 1) a trajectory (Case A, oncology) that illustrates a sequential, downstream linear cascade where physical and somatosensory fractures systematically dismantle the patient’s global macro-narrative; and 2) a trajectory (Case B, chronic organ failure) that illustrates a complex, non-linear recursive loop where somatic distress and loss of roles feedback to drive death anxiety and fear of sleep. Operationally, the findings prove that establishing a “somatic runway” via physical stabilization is a strict prerequisite for downstream reflective therapies. Additionally, the PP successfully sequences and aligns clinical actions across multidisciplinary specialties. Conclusions By establishing a shared, translational lexicon and clear interdisciplinary role demarcation, the PP empowers front-line multidisciplinary teams to systematically disrupt cascading loops of distress. It serves as an operational care-planning roadmap that democratizes existential care, allowing clinicians to routinely integrate holistic psychospiritual support into bedside palliative care.
Objectives This study aimed to identify core and bridge symptoms within symptom clusters in patients with acute exacerbation of chronic heart failure (ACHF) using network analysis. Methods We conducted a cross-sectional survey using convenience sampling of 268 ADHF patients hospitalized in the cardiology department of a tertiary hospital from September 2023 to September 2024. Data were collected using a general information questionnaire and the Memorial Symptom Assessment Scale of Heart Failure. We used principal component analysis to identify symptom clusters and network analysis to analyze them. Core symptoms were determined based on strength centrality, and bridge symptoms were identified using the bridge centrality index. Results Factor analysis revealed four symptom clusters: fluid retention, dyspnea-fatigue, emotional-psychological, and digestive-metabolic. Network analysis showed that abdominal distension was the core symptom of the fluid retention cluster, while sadness was the core symptom of the emotional-psychological cluster. Abdominal distension, sadness, and dry mouth were identified as bridge symptoms across the symptom clusters. Conclusions In patients with ACHF, there are strong correlations between abdominal distension and weight gain, shortness of breath and difficulty breathing when lying flat, and sadness and anxiety. Abdominal distension, sadness, and dry mouth serve as bridging symptoms within the symptom clusters, highlighting their pivotal role. Early identification of these clusters and key symptoms can aid in timely symptom management and prevent delays in medical intervention.
Objective This review aimed to summarize the characteristics of both physical robots and health education interventions, identify the educational and relational strategies robots used, and summarize the available evidence on the reported effectiveness of these interventions. Methods Comprehensive searches were conducted up to March 2026 across seven databases. Based on the PICOS framework, intervention studies that examined the effect of physical robot-based health education on targeted outcomes were eligible. Study characteristics, samples, physical robots, and interventions, along with intervention outcomes, were extracted and synthesized. Educational strategies were coded using the Behavior Change Techniques Taxonomy v1.0, and relational strategies were coded based on the framework for building long-term human-computer relationships. This review was registered on Open Science Framework (https://osf.io/b5c4d). Results Forty-two studies were included. Thirteen theoretical frameworks were identified to guide the design of physical robots and interventions. Physical robots utilized twenty-six unique behavior change techniques (BCTs) to provide health information, illustrate and demonstrate health behaviors, facilitate goal setting, and offer timely feedback. Ten relational strategies were employed to build human-robot relationships, such as showing empathy, continuity, politeness, and nonverbal immediacy behaviors. Intervention topics covered chronic disease management, hospitalization and medical procedure education, disease prevention, and general health promotion. The majority of studies indicated that both children and adults showed statistically significant increases in health-related knowledge (21/22) and enhanced self-efficacy (7/9) following health education intervention. However, evidence regarding the impact on behavioral and physical outcomes remains limited and heterogeneous. Conclusion Physical robot-based health education shows a promising effect on increasing individuals’ health-related knowledge and attitudes. Future research could conduct randomized controlled trials to examine the effectiveness of physical robot-based health education compared with interventions delivered by human professionals or non-embodied virtual agents, targeting both short-term knowledge and attitude outcomes and long-term behavioral and physical outcomes.
Objectives This study aimed to systematically synthesize qualitative evidence on stroke survivors’ experiences and perceptions of sedentary behavior, with a focus on the factors influencing sedentary behavior, the meanings and values associated with it, and their needs and preferences for interventions. Methods A literature search was conducted in PubMed, CINAHL, Embase (Ovid), PsycINFO, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and WanFang. Searches were conducted from inception to November 2024, with an update in February 2026. Two independent reviewers screened titles, abstracts, and full texts against predetermined eligibility criteria, and resolved discrepancies by consulting a third reviewer. Quality was appraised using the Joanna Briggs Institute’s Critical Appraisal Checklist for Qualitative Research, and data synthesis was conducted through a meta-aggregative approach. The ConQual ranking system was used to establish confidence in the synthesized findings. Results Five studies were included. Quality appraisal resulted in two studies receiving Grade A and three receiving Grade B. Sixty unequivocal or equivocal findings were extracted and aggregated into 12 categories, yielding four synthesized findings. Synthesized finding 1 (driving factors for sedentary behavior): including dysfunction and activity limitations, mental and emotional disorders, habits and daily patterns, absence of social support, and environmental restrictions. Synthesized finding 2 (cognition and experience of sedentary behavior): which is characterized by insufficient cognitive awareness and profound negative psychological experiences. Synthesized finding 3 (individual response to sedentary behavior): behavioral confrontation and psychological adaptation, characterized either by proactive behavioral disruptions through structured support, routine integration, and digital self-monitoring, or by psychological rationalization and entitlement that reframe sedentariness as a justified coping mechanism. Synthesized finding 4 (preference for sedentary behavioral interventions): including education and information provision, support from significant others, and technology assistance and behavioral reminders. According to the ConQual approach, confidence was rated as moderate for synthesized finding 3, and low for synthesized findings 1, 2, and 4. Conclusions This review uncovers several key issues about sedentary behavior in stroke survivors. Multiple internal and external factors interact to create a complex pathway of influence. The lack of awareness among stroke survivors, caregivers, and healthcare professionals highlights the marginalization of sedentary behavior in stroke rehabilitation. Psychological adaptation to sedentary behavior may benefit stroke survivors, suggesting future interventions should address psychological needs. Proactive response and intervention preferences from stroke survivors offer specific guidance for future approaches.
Objectives To identify and synthesize empirical research on how nurses and nursing assistants in nursing homes experience patient safety culture, and to determine the factors that shape their commitment to safety. Methods We used an integrative review approach following the PRISMA 2020 guidelines. A systematic search of five databases, CINAHL, MEDLINE (Ovid), Embase, Scopus, and Web of Science, was conducted to retrieve peer-reviewed studies published from inception to 26 May 2026. The constant comparative analysis approach groups findings into themes. Results 21 studies were included in this review. Four themes emerged following data analysis: 1) Perspectives of patient safety realities through different lenses; 2) Idealistic safety intentions versus realistic safety practices; 3) Perceptions of relational and structural working conditions shaping patient safety culture and commitment to patient safety; 4) Perceptions of organizational and management structures shaping patient safety culture and commitment to patient safety. This review found that while nurses’ and nursing assistants’ beliefs and attitudes toward patient safety were positive, their perceptions of safety culture and their commitment to patient safety efforts were influenced by various organizational conditions and ongoing systemic issues in the nursing home. Perceptions of safety culture were less positive among registered nurses than among other nursing professionals. Conclusions Nursing professionals hold moderately positive perceptions of the safety culture, suggesting that certain safety areas still require improvement. Nonetheless, their inability to translate positive safety intentions into actual safety actions reflects a critical concern for patient safety. Nursing leaders must drive reforms in existing organizational safety policies and practices to address systemic gaps that compromise patient safety. This will improve nursing professionals’ commitment to patient safety and the overall nursing home’s patient safety culture.
Objectives This study aimed to examine whether Asian American dementia caregivers’ affiliate stigma and loneliness sequentially account for the associations of social network and social support with positive aspects of caregiving (PAC). Methods The sample included 162 Korean and 176 Chinese American caregivers enrolled in a randomized clinical trial and recruited from New York, US (March 2023 to September 2025). We measured social network using the Lubben Social Network Scale-6, social support using the NIH Toolbox Social Support scales, affiliate stigma using the modified Affiliate Stigma Scale, loneliness using the University of California, Los Angeles Loneliness Scale (UCLA), and PAC using the 9-item PAC scale. We tested sequential mediation models while adjusting for sociodemographics, health status, and caregiving context. We tested indirect effects and the proportion mediated using bias-corrected bootstrap confidence intervals (CIs; 5,000 resamples). Results Both social network (β = 0.137, 95 % CI: 0.018 to 0.254) and support (β = 0.265, 95 %CI: 0.166 to 0.360) were significantly associated with higher PAC. Total indirect effects through affiliate stigma and loneliness accounted for 38.2 % and 27.8 % of the total effects, respectively. Loneliness was the only single mediator that reached significance (social network β = 0.036, 95 %CI: 0.012 to 0.076; social support β = 0.048, 95 %CI: 0.011 to 0.098). The sequential pathway, lower stigma followed by lower loneliness, was significant for social support (β = 0.012, 95 %CI: 0.003 to 0.029) but not for social network (β = 0.008, 95 % CI: −0.000 to 0.024). Conclusions In this study, social resources were associated with more positive caregiving appraisals, and loneliness was the principal intervening variable. Because all measures were obtained at a single time point, these indirect effects are correlational and cannot establish causal ordering. Culturally tailored interventions should strengthen social ties and incorporate loneliness-targeted strategies, with anti-stigma components requiring further evaluation in adequately powered studies.
Objectives This scoping review aimed to map the theoretical frameworks used in health education strategies for breast cancer-related lymphedema (BCRL), identify their “active ingredients”, namely behavior change techniques (BCTs), and explore the structural relationships among these elements using social network analysis (SNA). Methods A systematic electronic search was conducted in the Cochrane Library, CINAHL, Embase, PubMed, Web of Science, CNKI, Wanfang, CBM, and VIP databases from inception to May 2024. Intervention components were extracted and coded according to the Michie Behavior Change Technique Taxonomy (v1). SNA was used to calculate descriptive metrics, including degree centrality and network density, to identify core techniques and their patterns of co-occurrence. Results A total of 18 studies were included. Regarding theoretical frameworks, eight studies explicitly applied formal frameworks, including the Health Belief Model, Empowerment Theory, Knowledge-Attitude-Practice Theory, the Stress and Coping Model, Problem-Based Learning, and Solution-Focused Nursing. The remaining studies mainly adopted clinical nursing models or structured health education programs. Regarding behavior change techniques, 42 distinct BCTs were identified, with an average of 15.39 BCTs per study. The most commonly used BCT categories were “goals and planning,” “repetition and substitution,” “feedback and monitoring,” and “shaping knowledge.” SNA identified “instruction on how to perform the behavior,” “action planning,” and “demonstration of the behavior” as the techniques with the highest degree centrality, constituting the core structure of the intervention network. Three functional communities were identified: “skill acquisition & execution,” “self-regulation & monitoring,” and “social support & knowledge.”Overall, existing interventions generally showed positive trends in subjective outcomes, including quality of life, disease-related knowledge, and self-care ability. In contrast, findings for some objective physiological outcomes, such as lymphedema incidence, remained inconsistent. Conclusions Current health education for BCRL primarily relies on a set of techniques focused on skill development and action planning, yet generally lacks rigorous theoretical integration. Future research should prioritize developing precision, theory-driven interventions aligned with patients’ survivorship trajectories and integrating these core BCTs with digital technologies to promote long-term patient adherence.
Objective This study aimed to identify factors influencing nurses’ attitudes toward life-sustaining treatment (LST) in the Republic of Korea and to explore how perceptions of a good death and contextual factors shape these attitudes. Methods An explanatory sequential mixed-methods study was conducted at two tertiary hospitals from July to November 2024. In the quantitative phase, 104 nurses completed a cross-sectional survey, and multiple linear regression was used to identify factors associated with LST attitudes. In the qualitative phase, eight purposively sampled nurses participated in semi-structured interviews, which were analyzed using conventional content analysis. Findings were integrated through a joint display. Results Quantitative findings showed moderate good death perceptions (mean = 2.91) and negative LST attitudes (mean = 3.52). Male gender (β = 0.32, P < 0.001) and stronger good death perceptions (β = 0.26, P = 0.005) were associated with more negative LST attitudes. Qualitative findings identified seven domains: experiences of close others’ deaths, direct patient care experience, depth of LST knowledge, patient age, prognosis and recovery potential, family economic burden, traditional Korean cultural values, and social acceptance and legal liability concerns. Integrated findings showed that traditional cultural values and gender roles contextualized the association between gender and gender roles. At the same time, experiences of death and end-of-life care explained the association between good death perceptions and LST attitudes. Conclusion Nurses’ LST attitudes are shaped by good death perceptions as well as personal, clinical, and sociocultural factors. These findings provide an empirical basis for developing competency-based LST education, standardized case-based protocols, and culturally sensitive practice guidelines to support nurses in end-of-life decision-making.
Objectives This study aimed to explore Hong Kong healthcare professionals’ (HCPs’) perceptions of and needs for a Home-based Artificial Intelligence Pain Management System (HAIPMS) for cancer pain. Methods A qualitative study was conducted using semi-structured interviews with 14 HCPs from Jockey Club Home for Hospice (JCHH) in Hong Kong between March and June 2025. Data were analyzed using thematic analysis. Results A total of 14 participants (mean age 37.5, SD 9.5 years; 3 males [21%], 11 females [79%]) were included. Their professional experience ranged from 3 to 33 years. Thematic analysis generated three themes and ten subthemes. The themes were: 1) valued but under-supported home-based cancer pain management, including family-dependent and intermittent professional support; comfort, affordability, and system relief in home-based care; and subjective assessment, medication non-adherence, and delayed support; 2) cautious optimism toward AI integration, including expectations for visible, measurable, and continuous pain monitoring; concern of risks resulted from AI implementation; and heterogeneous attitudes shaped by professional and generational divides; and 3) practical requirements for HAIPMS implementation, including essential functional modules; user-centered design and adaptability; safety and ethical assurance requirements; and training and sustained support. Conclusions HCPs viewed HAIPMS as a potentially useful supportive tool for home-based cancer pain management, provided that it preserves professional autonomy, fits local care contexts, and incorporates ethical safeguards, user-friendly design, and sustained support. These findings offer practical guidance for developing AI-assisted pain management systems in home-based cancer pain.
Objective This study aimed to characterize the multidimensional self-health management needs of patients undergoing bariatric surgery, to provide a basis for optimizing the care continuum across the pre-admission, perioperative, and follow-up phases. Methods This study employed a descriptive qualitative design incorporating patient-journey mapping. Through purposive sampling, 19 patients from mainland China who underwent bariatric surgery between November 2024 and April 2025 were recruited for semi-structured interviews. Inductive thematic analysis was subsequently applied to distill core experiences and needs themes and construct the patient-journey map. Results The finalized patient-journey map employed the clinical timeline (pre-admission, perioperative, and follow-up management) as the horizontal axis and five vertical dimensions—medical/behavioral management, role management, emotional management, dietary management, and exercise management. Across these phases, 32 core experience themes were identified, capturing the dynamic evolution of needs. The pre-admission phase was marked by fragmented information, decisional delay, internalized weight stigma, and disrupted eating and activity rhythms. The perioperative phase revealed expectation–reality gaps in symptom experience, ambivalent fear–anticipation emotions, and barriers rooted in generic dietary and exercise guidance. The follow-up phase was characterized by plateau anxiety, suboptimal medication adherence, dietary misconceptions constrained by real-world contexts, and monotonous exercise patterns. Collectively, the trajectory illuminates a shift from informational empowerment and destigmatization toward expectation calibration and symptom adaptation, ultimately demanding sustained behavioral reinforcement and identity reconstruction through continuous, stage-tailored support. Conclusions This patient-journey map delineated dynamic, stage-specific self-management experiences and needs in bariatric surgery, providing a practical framework for comprehensive, patient-centered, and precision interventions aimed at optimizing recovery, adherence, and long-term quality of life.
Objective This review aimed to identify, examine, and synthesize current literature on global nursing career frameworks and identify key attributes that effectively support nurses’ career progression. Methods A scoping review guided by Arksey and O’Malley’s framework and Joanna Briggs Institute (JBI) best practice guidance for protocol development and reporting. A comprehensive search was conducted across MEDLINE (Ovid), CINAHL (EBSCOhost), Scopus, APA PsycINFO (Ovid), four online databases, grey literature, and professional nursing peak 'bodies' websites. Sources were included if they were reported in English and focused on the nursing profession and career progression, structured career planning, or career pathway frameworks. Data were synthesized using thematic analysis. Results From the 1159 identified, 12 sources were included. Key attributes of nursing career frameworks that support career progression were identified, including self-directed career planning, clear pathways and role definition, strong leadership and collaborative networks, workforce issues, and prioritizing nurse well-being. Conclusion Nursing career frameworks appear to offer strategies that complement workforce recruitment and retention. Such frameworks can provide structured guidance, promote diverse career opportunities, and foster a sustainable nursing workforce.
OBJECTIVE:This umbrella review aimed to synthesize systematic reviews and meta-analyses to evaluate the effectiveness of non-pharmacological interventions (NPIs) on agitation, depression, anxiety, cognitive function, and quality of life in individuals living with dementia, and to examine the stability and methodological quality of the evidence base. METHODS:Systematic searches of MEDLINE (via EBSCOhost), PubMed, CINAHL, PsycINFO, and Web of Science databases were conducted from inception to February 2025. Systematic reviews and meta-analyses evaluating NPIs for older adults with dementia were included. Methodological quality was assessed using A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Evidence overlap was quantified using the corrected covered area (CCA), and effect estimates reported in the included reviews were synthesized narratively. RESULTS:Twelve systematic reviews, including 147 randomized controlled trials, were included. Methodological quality varied across reviews, and all reviews had at least one non-critical weakness. Review overlap was very slight (CCA = 1.8 %). Across reviews, NPIs were associated with small but consistent reductions in agitation (standardized mean difference ([SMD] -0.25, 95 %CI: -0.36 to -0.13), depression ([SMD] -0.20, 95 %CI: -0.29 to -0.11), and anxiety ([SMD] -0.21, 95 %CI:-0.34 to -0.09). A modest improvement was observed in cognitive function ([SMD] 0.22, 95 %CI:0.11 to 0.34 ), whereas no significant effect was found for quality of life ([SMD] 0.08, 95 %CI: -0.15 to 0.32). The most consistent benefits were reported for information and communication technology-based interventions, massage and touch therapies, and physical exercise. Evidence certainty was moderate for agitation, depression, and anxiety, but low or very low for cognitive function and quality of life. CONCLUSION:NPIs were associated with small but consistent improvements in agitation, depression, anxiety, and cognitive function among older adults with dementia. Although effect sizes were modest and evidence certainty varied across outcomes, the findings support NPIs as key components of person-centered dementia care. Further high-quality research is needed to clarify optimal intervention modalities, dosage, mechanisms of action, and implementation strategies across diverse care settings.
Objectives This study aimed to develop and psychometrically evaluate the Intelligent Digital Learning Student Engagement Influencing Factor Scale for nursing and other medical students. Methods This instrumental development study was conducted in two phases. Phase 1 involved scale development through theoretical modeling, synthesizing the Pedagogy-Social Interaction-Technology Model, the Model of Student Motivation and Self-Regulated Learning, and the Three-Dimensional Model of Student Engagement, followed by qualitative interviews with 25 medical students guided by this integrated framework, a two-round Delphi expert consultation with eight experts, and pilot testing with 30 nursing students. Phase 2 involved psychometric evaluation through a cross-sectional survey of 1,499 medical students, with nursing students constituting the largest subgroup (n = 673, 44.90 %), followed by clinical medicine (n = 616, 41.09 %), medical laboratory science (n = 132, 8.81 %), and preventive medicine (n = 78, 5.20 %). The sample was randomly divided into two subsamples for exploratory (n = 750) and confirmatory (n = 749) factor analyses. Construct validity, reliability, and item discrimination were assessed. Results The final scale comprised 20 items across four factors: personal digital literacy, perceived school support, perceived technological environment, and perceived interpersonal interaction and support. These factors validated the integrated theoretical framework, reflecting learner-level psychological mechanisms, macro-level institutional support, and micro-level classroom factors encompassing technological and social interaction dimensions. Exploratory factor analysis explained 66.85 % of the total variance, with factor loadings ranging from 0.488 to 0.751. Confirmatory factor analysis demonstrated acceptable model fit (χ2/df = 4.587, CFI = 0.928, TLI = 0.968, RMSEA = 0.049, SRMR = 0.054). Average variance extracted values ranged from 0.542 to 0.608, and composite reliability ranged from 0.846 to 0.890. The scale demonstrated excellent internal consistency (Cronbach’s α = 0.920) and split-half reliability (0.918). Item discrimination analysis confirmed significant differences between the upper and lower 27 % of the sample (P < 0.01). Conclusion This theoretically grounded and validated scale, though tested across medical specialties, is particularly relevant to nursing education. It enables nurse educators to diagnose engagement deficits across institutional, technological, and interpersonal dimensions, guiding curricular improvements and providing a basis for precise interventions amid digital teaching transformation. Future studies should longitudinally examine its utility in nursing populations and its predictive validity for clinical performance.
Objective To synthesize and analyze qualitative evidence on clinical communication in oncology to identify facilitating factors and barriers from the perspective of students and healthcare professionals during their interactions with adults with cancer and their families. Methods The bibliographic search was conducted across the PubMed, Scopus, CINAHL, Web of Science, and PsycINFO databases and included studies published between January 2015 and January 2025. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT), and the protocol was registered in PROSPERO (CRD420250655592). The present meta-synthesis employs thematic synthesis and a deductive-inductive analysis, grounded in Epstein and Street’s model of person-centered communication. Results A total of 18 studies (15 qualitative and 3 mixed methods) were included. The sample encompassed 444 participants. A total of 291 units of meaning were analyzed; 16 facilitating factors and 14 barrier factors were identified, structuring the understanding of the main communication challenges and resources. Among the most relevant facilitators were empathy, trust-based relationships, adaptation of information to patients’ needs, active listening and emotional validation, communication training, and shared decision-making. The main barriers identified included lack of time and adequate spaces for communication, professionals’ emotional exhaustion, communication insecurity, fear of causing harm, difficulties addressing prognosis and end-of-life issues, and lack of interdisciplinary coordination, among others. Conclusions Improving communication in oncology requires not only communication skills training, but also organizational support, protected clinical time, interdisciplinary collaboration, and emotional support for students and healthcare professionals. These findings highlight the need for educational and institutional strategies that strengthen person-centered communication in oncology care.
Objectives This study aimed to investigate the prevalence of cardiovascular-kidney-metabolic (CKM) syndrome among nurses and to identify its influencing factors. Methods A cross-sectional design was adopted, involving 823 nursing personnel at a tertiary care hospital in Xiamen between January 1 and March 1, 2022. CKM stages were assigned following the 2023 American Heart Association (AHA) criteria. Variables included general demographic information, night-shift patterns, lifestyle habits, psychological health, and sleep health. Multivariate logistic regression was used to assess relationships between CKM stages and these variables. Results Among participants, the distribution of CKM stages was as follows: Stage 0, 480 (58.3%); Stage 1, 211 (25.6%); and Stages 2–4, 132 (16.0%). Using Stage 0 as the reference, multivariate logistic regression revealed that increased age (OR = 1.072, 95 %CI: 1.039–1.099), male gender (OR = 2.036, 95 %CI: 1.047–3.959), being married (OR = 2.115, 95 %CI: 1.232–3.631), and non-frequent tea consumption (OR = 0.579, 95 %CI: 0.366–0.915) were associated with Stage 1 CKM. For Stages 2–4 CKM, significant factors included increased age (OR = 1.130, 95 %CI: 1.081–1.180), male gender (OR = 2.364, 95 %CI: 1.069–5.225), evening chronotype (OR = 3.097, 95 %CI: 1.417–6.768), and insufficient daily physical activity (< 30 minutes; OR = 1.773, 95 %CI: 1.044-3.012). Night shift frequency showed no significant association in any comparison. Conclusions This study reveals that 41.7% of nurses were classified as having CKM syndrome (Stages 1-4). The findings suggested that, beyond fixed factors like age and sex, changeable factors such as chronotype and physical activity level—rather than night shift frequency itself—are significantly associated with CKM prevalence. These results underscore the need for targeted occupational health programs for nurses that integrate systematic “physical activity interventions” and “sleep-circadian rhythm management” to prevent and mitigate the progression of CKM.
Population aging, coupled with a rising burden of non-communicable diseases (NCDs) and increasing care complexity, is a global trend. China is among the fastest-aging countries, further intensifying the need for health system reform. Expanding nursing roles through advanced practice has proven an effective strategy to address growing care demands in countries such as Canada.This paper synthesizes peer-reviewed literature, policy reports, and regulatory documents from Canada and China (1965–2026). It examines the evolution of the nurse practitioner (NP) role in Canada, compares the socioeconomic and healthcare contexts shaping NP implementation in both countries, and proposes strategies to support the sustainable integration of the NP role in China. In doing so, this paper offers a policy-informed, phased roadmap to guide NP implementation and scale-up in China.
This study used text mining to explore the value of constructing a localized, practice-oriented nursing theory to advance nursing in China. Open-ended expert consultation was conducted with 135 nursing experts, followed by text mining and sentiment analysis (average sentiment score: 0.957). Four core thematic dimensions were identified: Development of Original Localized Theory; Disconnection between Theory and Clinical Practice; Continuing Education and Training of Nursing Theory; Academic Exchange Activities and External Publicity and Dissemination of Nursing Theory. Drawing on these findings, targeted pathways are proposed to optimize the development of nursing theory in China, namely strengthening the construction of localized original theories, bridging the gap between theory and clinical practice, unifying the application standards of nursing theory in educational and clinical settings, improving the dissemination and popularization of nursing theory, and establishing a systematic, context-adaptive framework for nursing theory development. The research provides evidence-based insights that promote the innovation, practical application, and sustainable development of nursing theory in China.
OBJECTIVES:The long-term care insurance (LTCI) system is a social security program that aims to address population aging and protect the basic living rights of individuals with disabilities. Since the pilot implementation of this system in 13 Chinese cities in 2016, the LTCI system has received increasing scholarly attention. This study aimed to explore the experiences of beneficiaries and their families with the LTCI system. METHODS:A qualitative research method was employed. From August to December 2024, the researchers interviewed 13 LTCI beneficiaries and their family members living in Hunan Province. Data were collected via semi-structured, face-to-face in-depth interviews. These interviews were audio-recorded and transcribed verbatim. RESULTS:The following five themes were identified. 1) The long-term care service application process is convenient. 2) The disability level assessment process is difficult. This theme includes three subthemes: unclear disability level assessment criteria; a cumbersome disability level assessment process; and a lack of professionalism among disability level assessors. 3) Long-term care services are imperfect. This theme encompasses three subthemes: the limited scope of care services; insufficient care resources; and uneven caregiver quality, including a lack of standardized criteria for service evaluation. 4) The economic burden of long-term care has been alleviated. 5) Expectations regarding LTCI services are positive. CONCLUSIONS:The findings of this study improve our understanding of LTCI participants and their family members. These insights can help the Chinese government develop more detailed support strategies and interventions, thereby improving the quality, professionalism, and scope of long-term care services while promoting the implementation of LTCI policies.
OBJECTIVES:This study aimed to explore barriers precluding hepatitis B virus (HBV) preventive care among the rural population. METHODS:Guided by the National Institute on Minority Health and Health Disparities framework, this qualitative study applied an interpretative phenomenological approach. Participants (n = 34) were recruited from three healthcare settings in southern China from May 2024 to January 2025. Data from semi-structured interviews were analyzed using interpretative phenomenological analysis. RESULTS:Barriers spanned four domains with 11 subthemes. 1) Behavioral: the last-resort paradigm in healthcare utilization, reliance on folk remedies, and intergenerational silence in familial HBV prevention; 2) Physical environment: remote residence from healthcare facilities and compound vulnerabilities in living and working environments; 3) Sociocultural: social marginalization stemming from HBV discrimination, fatalistic resignation towards health, and the myth of the hardy survivor; and 4) Healthcare system: misperceptions, underestimated needs, and access barriers related to labor, mobility, and misaligned healthcare insurance policy. CONCLUSIONS:These barriers perpetuate late HBV diagnosis, low vaccine uptake, and poor treatment adherence among the rural population. This highlights the need for mobile health services to overcome geographic barriers; culturally appropriate interventions to dismantle misinformation, HBV discrimination, and myths; and policies to reduce financial burden and improve insurance coverage, thereby making HBV preventive care accessible for this marginalized group.
OBJECTIVES:This systematic review and meta-analysis aimed to evaluate the effects of group reminiscence therapy (GRT) on psychosocial outcomes among nursing home residents with intact cognition and mild cognitive impairment (MCI). METHODS:PubMed, Embase, EBSCO, Web of Science, ScienceDirect, Wanfang, CNKI, SinoMed, VIP, and Google Scholar were searched from inception to September 2025. Randomized controlled trials (RCTs) and quasi-experimental studies investigating GRT among nursing home residents aged ≥60 years with intact cognition and MCI were included. Study quality was assessed using the Cochrane RoB 2 and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tools, and meta-analyses were conducted using RevMan 5.4. RESULTS:Nineteen studies involving 925 nursing home residents were included, comprising 4 RCTs and 15 quasi-experimental studies. GRT significantly reduced depression (SMD = -1.38; 95 %CI: -1.72, -1.05; P < 0.001) and death anxiety (SMD = -1.09; 95 %CI: -1.57, -0.62; P < 0.001), while significantly improving life satisfaction (SMD = 0.94; 95 %CI: 0.34, 1.54; P = 0.002), self-esteem (SMD = 1.21; 95 %CI: 0.59, 1.83; P < 0.001), and happiness (SMD = 0.91; 95 %CI: 0.32, 1.50; P = 0.002). However, the effect on loneliness was not statistically significant (SMD = -1.98; 95 %CI: -4.01, 0.06; P = 0.060). Subgroup analyses showed variations in intervention effects across studies. Sensitivity analyses indicated good stability of the pooled results, and no significant publication bias was detected for the main outcomes. CONCLUSIONS:GRT may improve psychosocial well-being among nursing home residents with intact cognition and MCI by reducing depression and death anxiety and enhancing life satisfaction, self-esteem, and happiness. However, the evidence regarding loneliness remains inconclusive. Further high-quality RCTs with larger sample sizes and longer follow-up periods are needed to confirm the long-term effectiveness of GRT among nursing home residents.
