Background Patient safety is a fundamental objective for healthcare systems worldwide and a prerequisite for high-quality nursing care. Growing evidence indicates that organisational silence among nurses not only undermines job satisfaction and performance but also stifles innovation and impedes decision-making within healthcare organisations, thereby jeopardising patient safety. In China, Generation Z emergency nurses exhibit distinct characteristics compared to previous generations, which may shape their experiences of organisational silence. However, the precise influence of these generational traits on their propensity for silence remains unclear. Objectives This study aimed to explore the organisational silence experiences of Generation Z emergency nurses within China's distinctive sociocultural context. Methods A phenomenological qualitative approach was adopted for this study. Semi-structured, in-depth face-to-face interviews were conducted with 21 Generation Z emergency nurses from a tertiary hospital in Shanghai between January and February 2025. The collected data were analysed using Colaizzi's seven-step phenomenological analysis method. Results The analysis revealed three primary themes with twelve associated subthemes: (a) competency limitations among those maintaining silence, (b) underlying reasons for organisational silence, and (c) outcomes of silence. Conclusion While moderate silence may yield certain benefits, prolonged organisational silence can have detrimental effects on employees, teams and organisations. As different types of organisational silence operate through distinct mechanisms, healthcare managers should develop targeted intervention strategies based on careful assessment of both the motivations behind silence and its extent. The ultimate objectives are to reduce organisational silence among Generation Z emergency nurses, enhance staff retention, and improve patient safety outcomes.

ObjectivesSleep disturbance, cancer-related fatigue, emotional distress (anxiety and depression), and pain, collectively known as psychoneurological symptom cluster (PNSC), were common during and after anti-cancer treatment in breast cancer patients. This study aimed to explore the relationship among PNSC to identify potential intervention targets.MethodsIn this cross-sectional study, 304 breast cancer patients who received treatment in the Breast Surgery Department from June 2025 to January 2026 were recruited. Self-report data were collected using the Cancer Fatigue Scale, the Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, and Visual Analog Scale for Pain. Static symptom interrelationships were examined using Gaussian network model, and putative directional associations were explored using Bayesian network analysis. The dynamic correspondence between symptoms was explored through computer-simulated interventions, and simulation-derived candidate symptom targets were identified.ResultsThe network analysis identified physical fatigue, sleep latency, and depression as core symptoms, with expected influence (EI) values of 1.883, 0.940, and 0.794, respectively; furthermore, the study identified physical fatigue, pain, and daytime dysfunction as bridging symptoms, with bridge expected influence (bEI) values of 1.824, 1.558, and 1.331, respectively. The estimated Bayesian network also suggested that physical fatigue occupied as a key node within the network. The results of computer-simulated interventions showed that depression produced the largest reduction, with sum scores declining from 5.98 to 4.67; this was followed by the affective fatigue and physical fatigue. Meanwhile, poor sleep efficiency was associated with an increase in the total sum score, from 5.99 to 6.04.ConclusionsOur findings suggest that physical fatigue and depression may be prioritized as intervention targets to break the vicious cycle of symptom interactions within the PNSC. The integration of computer-simulated interventions and traditional network analysis allowed for prioritizing the effects of individual symptoms at both static and dynamic levels, thereby improving the accuracy and effectiveness of targeted interventions. Further research is needed to verify whether targeting these symptoms can improve clinical outcomes.

ObjectiveTo summarize the best available evidence regarding fertility preservation decision⁃making for breast cancer patients of reproductive age,so as to provide a reference for supporting these patients making decisions.MethodsThe databases and websites including UpToDate,BMJ Best Practice,Cochrane Library,JBI Evidence⁃Based Healthcare Center database,the UK National Institute for Health and Care Excellence(NICE),PubMed,Web of Science,and EMbase for evidence related to fertility preservation decision⁃making for breast cancer patients of reproductive age were systematically searched.The types of evidence sought included clinical decision support tools,guidelines,systematic reviews,evidence summaries,and expert consensus documents.The search period was from the inception of each database to Februry 18,2025.Two researchers with a background in evidence⁃based nursing independently conducted the literature quality assessment.Evidence meeting quality standards was then extracted and summarized,incorporating input from relevant professionals.ResultsA total of 15 articles were included,comprising 2 clinical decision support documents,4 guidelines,3 expert consensuses,2 evidence summaries,and 4 systematic reviews.The summarized best evidence covers four key aspects:the fertility preservation decision⁃making team,pre⁃decision assessment,decision⁃making methods,and decision content,resulting in a total of 30 best evidence statements.ConclusionsThe summarized best evidence provides an evidence⁃based foundation for clinical healthcare professionals to support fertility preservation decision⁃making in breast cancer patients of reproductive age.In clinical application,healthcare providers need to respect patients' reproductive intentions,continuously advance the decision⁃making process,and protect the fertility potential of breast cancer patients as much as possible.

BACKGROUND:Clinical evidence guiding the fertility decisions of reproductive-age patients with breast cancer remains limited. No study has reported the impact of fertility preservation interventions on the decision-making process of patients with breast cancer. Fertility preservation interventions reduce fertility decision-making conflicts and address psychological issues in patients with breast cancer. AIMS:We evaluated the effectiveness of fertility preservation interventions, including educational materials, decision aids, and counseling models in facilitating informed fertility-related decision-making among reproductive-age patients newly diagnosed with breast cancer. Additionally, we examined the influence of these interventions on patients' psychological state. METHODS:We searched PubMed, Embase, ClinicalTrials.gov, and the Cochrane Library from inception to February 20, 2025. Randomized controlled trials and non-randomized controlled trials that reported the effects of fertility preservation interventions on fertility decision making among patients with breast cancer were included. Two authors independently screened the studies, assessed their quality, and extracted the data. Bias risk was assessed using the Cochrane risk-of-bias tool for randomized trials. RESULTS:The interventions were categorized as decision aids, educational interventions, and psychological interventions. CONCLUSIONS:Fertility preservation interventions significantly enhanced the fertility knowledge of patients with breast cancer, particularly interventions such as decision aids. However, no single intervention demonstrated distinct superiority specifically in terms of mitigating decisional conflict and alleviating patients' psychological distress. Fertility preservation interventions, when combined with specialist consultation, enhanced fertility-related knowledge and had a positive impact on fertility decision making. High-quality research is recommended to enrich fertility preservation interventions and encourage multidisciplinary teamwork to enhance fertility decision-making. TRIAL REGISTRATION:The protocol was registered on PROSPERO (Registration number: CRD420251007625).

PurposeFrailty is a significant factor influencing the prognosis of patients with gynecological malignancies. Surgery and chemotherapy are key components of cancer treatment; however, limited research has addressed frailty and its associated risk factors in this patient population. This study aimed to determine the prevalence of frailty and identify its associated factors in patients with gynecological malignancies following surgery and chemotherapy.MethodThis cross-sectional study was conducted at two tertiary hospitals in Shanghai between January and September 2024. Patients completed five assessment scales, including the Demographic Information Scale, Vulnerable Elders Survey-13 (VES-13), Athens Insomnia Scale (AIS), Depression Anxiety Stress Scale-21 (DASS-21), and Perceived Social Support Scale (PSSS), to screen for frailty and related factors. Multivariate logistic regression analysis was used to identify risk factors for frailty, with 95% confidence intervals (CIs) used to estimate the strength of the associations.ResultA total of 211 eligible inpatients with gynecological malignancies who had undergone surgery and chemotherapy were recruited. The prevalence of frailty in these patients was 64.9%. Multivariate logistic regression analysis identified several risk factors for frailty: older age, underweight status, stress, insomnia, married status, high white blood cell count, and low albumin levels.ConclusionThis study highlights the relatively high prevalence of frailty among patients with gynecological malignancies after surgery and chemotherapy. Understanding the factors associated with frailty is crucial for implementing timely interventions that can improve health-related quality of life and treatment outcomes in this patient population.

To explore symptom clusters, symptom experiences, and self-management strategies in patients with cervical cancer undergoing concurrent chemoradiotherapy. A qualitative descriptive approach was used. Semi-structured interviews were conducted with patients with cervical cancer using an interview guide. The audio recording of the interviews was transcribed. Thematic analysis was conducted using Colaizzi’s seven-step framework. Thirteen participants were interviewed. The mean age of the participants was 47 years. Three themes were identified: (a) Struggle for survival among patients reintegrating into society; (b) Overcoming self-management challenges; and (c) Resilience and adaptation in the face of adversity. Individuals diagnosed with cervical cancer who undergo concurrent chemoradiotherapy often experience various clusters of symptoms. Despite facing challenges in self-management, these patients maintain a positive attitude and persistently strive to coexist harmoniously with their health conditions.

Background:Chemotherapy causes physiological, psychological, and social impairments in patients with cancer. Frailty reduces the effectiveness of chemotherapy and increases the toxicity associated with radiotherapy and chemotherapy, the possibility of chemotherapy failure, and adverse outcomes. However, factors affecting chemotherapy-related frailty in patients with cancer remain unclarified. Objective:This systematic review aimed to identify risk factors driving frailty progression during chemotherapy in patients with cancer. Methods:A comprehensive systematic search was conducted on PubMed, Web of Science, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database (VIP), and SinoMed for observational studies (cohort, cross-sectional, or case-control) on factors affecting the debility-of-chemotherapy stage in patients with cancers between the inception of the database and February 2025, with an updated search executed in May 2025. Literature screening, quality evaluation using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality checklist, and data extraction were conducted independently by 2 authors. Meta-analysis, effect size combination, sensitivity analysis, and publication bias analysis were performed using RevMan (version 5.4; The Cochrane Collaboration) and R (version 4.4.3; R Foundation). Results:The analysis comprised 14 studies (8 cross-sectional, 2 repeated cross-sectional, 3 cohort, and 1 mixed-design), including 3879 patients with cancer and 23 influencing factors. Methodological quality assessment using Agency for Healthcare Research and Quality (mean 8.8, SD 1.3, 95% CI 7.9-9.7; SE 0.4) and Newcastle-Ottawa Scale (mean 8.0, SD 1.0, 95% CI 6.7-9.3; SE 0.6) revealed 73% (8/11) of cross-sectional studies as high-quality. The meta-analysis showed a 35% (95% CI 22%-50%) prevalence of frailty during chemotherapy in these patients. Cancer stage (odds ratio 1.99, 95% CI 1.64-2.42), chemotherapy frequency (odds ratio 2.60, 95% CI 1.83-3.70), transfer (odds ratio 2.18, 95% CI 1.50-3.17), hemoglobin (odds ratio 0.29, 95% CI 0.18-0.47), white blood cell (odds ratio 0.37, 95% CI 0.21-0.65), comorbidity (odds ratio 1.93, 95% CI 1.30-2.86), and hypoproteinemia (odds ratio 1.74, 95% CI 1.31-2.30) were risk factors for frailty in patients at the chemotherapy stage. Conclusions:Frailty during chemotherapy was strongly associated with advanced cancer stage, frequent treatment cycles, metastasis, anemia, leukopenia, comorbidities, and hypoproteinemia. Clinically actionable findings emphasized hemoglobin and albumin monitoring as preventive targets, while heterogeneity in assessment tools and population bias limited generalizability. The integration of frailty screening into chemotherapy workflows is urgent to mitigate treatment-related functional decline.

With the increasing incidence of stroke among young and middle-aged individuals, addressing their psychological well-being has become a critical concern. Negative emotional states such as depression, anxiety, and conditions like post-traumatic stress disorder (PTSD) can hinder recovery and increase the risk of recurrence. Therefore, this study aims to conduct a meta-synthesis of qualitative research on post-traumatic growth (PTG) in this population, examining the factors that contribute to PTG, its developmental trajectory, and the coping mechanisms involved. A systematic search of 14 databases was conducted, with reference tracking, to ensure comprehensive literature retrieval. A total of 1,753 articles were initially identified. After removing duplicates and excluding articles that did not meet the criteria, 11 studies were included, involving 156 participants in total, with 5 studies conducted in China and the remaining from other regions. The review followed the Joanna Briggs Institute (JBI) approach: systematic search with predefined criteria, critical appraisal of study quality using the JBI Checklist (assessing rigor in data collection/analysis), and meta-synthesis via iterative theme development (coding, categorizing findings) and validation (cross-checking by reviewers) to derive integrated results. A total of 42 research findings were synthesized into 9 new categories, further grouped into 3 integrated results: (1) trauma and stress period, which includes physical, psychological, and social stress; (2) adjustment and reconstruction period, involving seeking support, cognitive processing, self-mobilization, and life reorganization; and (3) growth period, characterized by new possibilities and self-actualization. The limited time frame of the studies and the predominance of research from China (5 out of 11 included studies) may restrict the generalizability of the findings. Excluding non-English and non-Chinese studies introduces a potential language bias. Furthermore, as the review only included qualitative studies with generally small sample sizes (total 156 participants), the findings should be interpreted with caution. This meta-synthesis is the first to systematically synthesize qualitative evidence on PTG in young and middle-aged stroke patients, offering a novel three-stage framework (trauma and stress, adjustment and reconstruction, growth) that integrates physical, psychological, and social dimensions of recovery. By clarifying distinct emotional, cognitive, and behavioral features at each stage, this study advances existing research—previously fragmented in exploring PTG elements—by providing a holistic developmental trajectory. In clinical practice, this framework informs targeted interventions (e.g., stage-specific emotional support, cognitive guidance, and social reintegration strategies) to facilitate PTG and enhance patients’ reintegration into society.

Workplace violence (WPV) against healthcare workers (HCWs)is a global issue. Resilience, a constructive psychological resource, can help HCWs better cope with WPV. This study examined resilience levels and factors influencing HCWs exposed to WPV. Using a convenience sampling method, 180 HCWs from two tertiary hospitals in Shanghai completed a self-administered questionnaire assessing demographic characteristics, hospital WPV, social support, general self-efficacy, emotion regulation, and resilience. Data were collected using the Questionnaire Star platform and analyzed using SPSS 27.0 software. Over the past 12 months, verbal violence being the most prevalent (90.0

Seeking professional psychological help can improve outcomes for women with perinatal depression (PND). However, the use of professional psychological help-seeking behaviors for women with PND is not promising. Spouses are important sources of support and play a decision-making role in the process of seeking professional psychological help for women with PND. Exploring the factors that influence couples' intention to seek professional psychological help is important for developing effective interventions. This study aims to investigate the level and latent profiles of intention to seek professional psychological help in women with PND and their spouses, and identify influencing factors associated with different profiles. A cross-sectional study involving 267 women with PND and 267 spouses was conducted. The General Help-Seeking Questionnaire-the Intention to Seek Professional Psychological Help (GHSQ-ISPH), the Questionnaire of Stigma for Seeking Professional Psychological Help Questionnaire, the Attitude Toward Seeking Professional Psychological Help Scale, the Self-Efficacy for Seeking Mental Health Care Help Scale and the Edinburgh Postnatal Depression Scale were used. Latent profile analysis was used to identify groups with similar levels of GHSQ-ISPH. Multiple logistic regression was used to explore influencing factors associated with the intention to seek professional psychological help. The mean GHSQ-ISPH scores of women with PND and their spouses were 12.17 ± 4.06 and 12.61 ± 3.88, respectively. LPA yielded three profiles. The profiles were named based on the GHSQ-ISPH score to reflect the level to which women with PND and their spouses intend to seek professional psychological help: "Women low-Spouses high intention for help" (Profile 1), "Women high-Spouses low intention for help" (Profile 2) and "Couple high intention for help" (Profile 3). Multiple logistic regression showed that spouses with a monthly income (858-1285/USD), with lower openness to seeking treatment for emotional problems, lower knowledge competence beliefs, and negative attitudes toward seeking professional psychological help were significantly associated with Profile 2 than with Profile 3 (P < 0.05 or P < 0.001). PND women who received a university or college and with lower public stigma were more significantly related to Profile 1 than Profile 3 (P < 0.05). The findings of this study indicate a moderate level of intention to seek professional psychological help among women experiencing PND and their partners. These results offer valuable insights for perinatal nurses, suggesting the necessity for the development of targeted interventions aimed at enhancing couples' intentions to pursue professional psychological support. Identifying the factors associated with each profile outlined in this research offers the opportunity for more personalized and effective interventions. Tailored approaches like these could substantially enhance engagement with mental health resources, leading to improved outcomes for couples affected during the perinatal period.

ObjectiveSeeking formal help can significantly improve the outcomes of perinatal depression (PND). However, currently, women with PND are not consistently seeking formal help. Research indicated that spouses played a crucial role in helping women recognize PND and encouraging them to seek formal help. This study aimed to explore the factors that prevent spouses from supporting women with PND in seeking formal help, based on the Knowledge-Attitude-Practice (KAP) theory.MethodsThis is a qualitative study, utilizing semi-structured interviews to explore the factors that influence spouses to support women with PND to seek formal help. The interviews were conducted at a tertiary hospital in Shanghai, China from September 2023 to October 2023. Purposive sampling was used, and the sample size was determined by data saturation. Data analysis was conducted using Colaizzi’s seven-step method.ResultsTwelve spouses had a mean age of 34.92 years (SD 5.81); n = 7 (58.33%) were new fathers. The influencing factors identified in this study can be explained by KAP theory, ultimately three major themes and six sub-themes emerged: (1) individual knowledge factors: lack of proper recognition of PND, (2) individual attitude factors: negative attitude toward PND screening and treatment and (3) service provider factors: imbalance between supply and demand for perinatal mental health services.ConclusionSpouses who lacked supportive behavior were influenced by individual factors, including knowledge factors and attitude factors, as well as service provider factors. These identified factors can guide future research and the development of interventions to improve perinatal mental health services and encourage family support in seeking formal help.

ObjectiveNausea and vomiting are the distressing and debilitating side effects of chemotherapy. This study explores the relationship between the degree of nausea and vomiting and physical activity in patients with lung cancer during the first chemotherapy cycle.DesignA total of 107 patients with lung cancer who received platinum drugs during chemotherapy in a hospital in Shanghai, China, in 2023 were involved in this study. Data were collected with medical record system and self-reported questionnaires.Questionnaires included the International Physical Activity Questionnaire (IPAQ) and Index of Nausea, Vomiting, and Retching (INVR). IPAQ was used before chemotherapy; INVR was used on the second and sixth day of chemotherapy, followed by the analysis of the correlation between physical activity status and degree of nausea and vomiting during chemotherapy. The influencing factors of nausea and vomiting during chemotherapy in patients with lung cancer were analyzed using logistic regression analysis.ResultsMore than half of the patients experienced nausea, vomiting or retching related symptoms after chemotherapy, and the proportion of moderate to high physical activity was 50.5%. Univariate analysis showed that the degree of nausea and vomiting was influenced by factors such as age, gender, and history of drinking (P < 0.05). The degree of nausea and vomiting was negatively correlated with physical activity (P < 0.05). The multivariate linear analysis showed that gender, history of drinking, and moderate and high physical activity are contributing factors to nausea and vomiting during chemotherapy (P < 0.05).ConclusionModerate and high physical activity before chemotherapy is a protective factor for nausea and vomiting in patients with lung cancer. Physical activity can not only improve the degree of nausea and vomiting in patients with lung cancer but also reduce the incidence in these patients during the first chemotherapy cycle.

Objective To construct a nutrition support program for middle-aged and elderly patients with acute decompensated heart failure (ADHF) during hospitalization. Methods Based on the JBI Evidence-Based Health Care Model as the theoretical framework, the best evidence was extracted through literature analysis and a preliminary nutrition support plan for middle-aged and elderly ADHF patients during hospitalization was formed. Two rounds of expert opinion consultation were conducted using the Delphi method. The indicators were modified, supplemented and reduced according to the expert's scoring and feedback, and the expert scoring was calculated. Results The response rates of the experts in the two rounds of consultation were 86.7% and 100%, respectively, and the coefficient of variation (CV) for each round was between 0.00% and 29.67% (all < 0.25). In the first round of expert consultation, 4 items were modified, 3 items were deleted, and 3 items were added. In the second round of the expert consultation, one item was deleted and one item was modified. Through two rounds of expert consultation, expert consensus was reached and a nutrition support plan for ADHF patients was finally formed, including 4 first-level indicators, 7 s-level indicators, and 24 third-level indicators. Conclusion The nutrition support program constructed in this study for middle-aged and elderly ADHF patients during hospitalization is authoritative, scientific and practical, and provides a theoretical basis for clinical development of nutrition support program for middle-aged and elderly ADHF patients during hospitalization.

Background Obstetric critical illness is an important factor that leads to an increase in maternal mortality. Early warning assessment can effectively reduce maternal and neonatal mortality and morbidity. However, there are multiple early warning systems, and the effect and applicability of each system in China still need to be explored. Objectives To elaborate on the application, effectiveness and challenges of the existing early warning systems for high-risk obstetric women in China and to provide a reference for clinical practice. Design A scoping review guided by the Arksey and O'Malley framework and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for scoping review (PRISMA-ScR) guidelines. Eligibility criteria We included original studies related to early warning and excluded those that were guidelines, consensus and reviews. The included studies were published in Chinese or English by Chinese scholars as of June 2021. Data sources CNKI, Wanfang, VIP, Cochrane, CINAHL, Embase, PubMed and Web of Science databases were searched systematically, and the reference sections of the included papers were snowballed. Results In total, 598 articles were identified. These articles were further refined using keyword searches and exclusion criteria, and 17 articles met the inclusion criteria. We extracted data related to each study's population, methods and results. Early warning tools, outcome indices, effects and challenges are discussed. Conclusions Although all studies have shown that early warning systems have good application effects, the use of early warning systems in China is still limited, with poor regional management and poor sensitivity for specific obstetric women. Future research needs to develop more targeted early warning tools for high-risk obstetric women and address the current challenges in clinical applications.

Abstract Purpose To explore the experience of symptom clusters and the current status of supportive need of cervical cancer patients after concurrent chemoradiotherapy and to provide a basis for improving symptom management and social support systems for cervical cancer patients. Methods In this phenomenological study, a total of 13 patients who had undergone concurrent chemoradiotherapy for cervical cancer were selected using a purposive sampling method. From January to October 2022, semi-structured face-to-face interviews were conducted to collect data and a seven-step Colaizzi process was used for data analysis. Results Three themes for the symptom cluster experience were found: declining quality of life, prominent negative emotions, and ineffective response to symptoms. Three themes of patient support needs were identified: mental and psychological needs, medical service needs and desired social support.The subtopics corresponded to these themes. Conclusions Patients with concurrent chemoradiotherapy of cervical cancer have a long disease course, more adverse reactions, and many cluster symptoms, which lead to a high demand for support. Medical staff should strengthen the education of patients about the disease, provide a systematic continuity of care information management platform, establish an effective emotional support system, make comprehensive efforts to reduce the financial burden on patients, promote physical and mental rehabilitation of patients, and improve their quality of life.

目的 总结乳腺癌放化疗患者癌因性疲乏(cancer related fatigue,CRF)运动干预的最佳证据,为临床护理提供循证依据.方法 检索UpToDate、BMJ Best practice、Cochrane Library、PubMed、美国国家综合癌症网络、加拿大安大略注册护士协会、苏格兰院际指南网、美国临床肿瘤协会、美国肿瘤护理协会、安大略省癌症护理中心、美国运动医学会、美国国立指南网、欧洲肿瘤内科学会、医脉通、JBI循证卫生保健国际合作中心图书馆、中国知网、万方、维普等网站和数据库中关于乳腺癌放化疗患者癌因性疲乏运动干预的临床指南、临床决策、系统评价、证据总结、专家共识、原始研究.检索时限为建库至 2021 年 11月.结果 共纳入文献 12 篇,其中临床实践指南 3 篇、临床决策 1 篇、系统评价 8 篇.总结最佳证据 21 条,包括运动前评估、运动时机、运动形式、运动强度、运动效果、运动方案制定原则、注意事项 7 个方面.结论 乳腺癌放化疗患者CRF运动干预最佳证据可为临床应用提供循证依据,护理人员可根据证据进行临床护理实践.

BackgroundSince March 2022, Shanghai, China, has experienced a severe wave of SARS-CoV-2 transmission caused by the Omicron variant strain. The pandemic has severely constrained the local healthcare system. After treating critically ill COVID-19 patients, emergency nurses may experience some positive changes due to new insights or gains in their work, even if they have had traumatic experiences. This study aimed to explore the promoting factors of emergency nurses' post-traumatic growth during the COVID-19 pandemic in Shanghai. We hoped to provide a new perspective and theoretical basis for intervening in and promoting the psychological rehabilitation of medical staff after traumatic circumstances.MethodsThis study employed a qualitative design based on the phenomenological approach. 18 participants from the emergency department of a third-level class-A hospital in Shanghai who participated in treating COVID-19 patients were enrolled using purposive sampling. Data collection was through in-depth and semi-structured interviews and continued until reaching data saturation. The seven-step Colaizzi process was used for data analysis.ResultsThe investigation uncovered two themes and six subthemes. Internal factors contained self-affirmation, deliberate rumination, and cognitive restructuring, which constituted attitudes and behaviours that participants could subjectively determine. External factors included social support, transformational leadership, and role modelling, which constituted factors influenced by others or the environment.ConclusionsThe promoting factors of PTG of emergency nurses originated from different sources such as individuals, organizations, and society. In addition to good psychological adjustment of the individual, society, hospitals, and nursing managers should focus on establishing supportive PTG strategies. The ultimate purpose is to improve the retention rate and career growth of nurses.

In early 2022, the coronavirus disease 2019 (COVID-19) continued to spread quickly globally and broke out in some metropolitan areas. To stop the spread of infection, all colleges and universities were shifted to a closed model, and higher education was transformed into online learning (OL). These transitions posed numerous challenges for Generation Z students, especially those in the nursing profession that featured face-to-face practice courses. This study aimed to explore and understand the experiences of OL among Generation Z nursing students during COVID-19 epidemic. This qualitative phenomenological research design applied a purposive sampling approach to enroll 14 Generation Z nursing students from a college. Data were collected and analyzed using in-depth, semi-structured interviews and Colaizzi seven-step method. The analysis demonstrated four themes and eleven subthemes: challenges encountered during OL, advantages perceived during OL, experience of loneliness and stress, and developing resilience during OL. This study concluded that the sudden shift in learning styles presents challenges to Generation Z nursing students. Despite the adversity, the students showed tremendous resilience and endurance. During the pandemic, educators should provide support measures based on the characteristics of Generation Z to improve the effectiveness of OL and respond positively to stress.

BACKGROUND:This study aimed to provide insight into the training load of newly recruited nurses in grade-A tertiary hospitals in Shanghai, China. The lack of nurses in hospitals across China has resulted in newly recruited nurses in grade-A tertiary hospitals in Shanghai having to integrate into the work environment and meet the needs of the job quickly; thus, they undergo several training programs. However, an increase in the number of training programs increases the training load of these nurses, impacting the effectiveness of training. The extent of the training load that newly recruited nurses have to bear in grade-A tertiary hospitals in China remains unknown.METHODS:This qualitative study was conducted across three hospitals in Shanghai, including one general hospital and two specialized hospitals, in 2020. There were 15 newly recruited nurses who were invited to participate in semi-structured in-depth interviews with the purpose sampling method. A thematic analysis approach was used to analyze the data. The COREQ checklist was used to assess the overall study.RESULTS:Three themes emerged: external cognitive overload, internal cognitive overload, and physical and mental overload.CONCLUSION:Through qualitative interviews, this study found that the training of newly recruited nurses in Shanghai's grade-A tertiary hospitals is in a state of overload, which mainly includes external cognitive overload, internal cognitive overload, physical and mental overload, as reflected in the form of training overload, the time and frequency of training overload, the content capacity of training overload, the content difficulty of training overload, physiological load overload, and psychological load overload. The intensity and form of the training need to be reasonably adjusted. Newly recruited nurses need to not only improve their internal self-ability, but also learn to reduce internal and external load. Simultaneously, an external social support system needs to be established to alleviate their training burden and prevent burnout.

OBJECTIVES:Newly registered nurses in China are required to attend two years of standardized training programs after graduation, and an evaluation of the training program's effectiveness is critical. The objective structured clinical examination is a relatively new and objective approach to exploring the effectiveness of training programs and is increasingly being encouraged and used in clinics. However, the perspectives and experiences of newly registered nurses in obstetrics and gynecology regarding the objective structured clinical examination are unclear. Therefore, the objective of this study was to investigate newly registered nurses' perspectives and experiences of the objective structured clinical examination in an obstetrics and gynecology hospital.DESIGN:This qualitative study was conducted using a phenomenological approach.DATA SOURCES:Twenty-four newly registered nurses taking the objective structured clinical examination in a third-level obstetrics and gynecology hospital in Shanghai, China.REVIEW METHODS:Semi-structured face-to-face interviews were conducted between July and August 2021. The Colaizzi seven-step framework was applied for data analysis.RESULTS:Three main themes and six sub-themes emerged: 1) high satisfaction with the objective structured clinical examination; 2) gaining experience and growing as nurses; and 3) high pressure.CONCLUSION:The objective clinical structured examination can be used to assess the competence of newly registered nurses after training in an obstetrics and gynecology hospital. The examination not only enables an objective and comprehensive evaluation of others and self-evaluation but also leads to positive psychological experiences in newly registered nurses. However, interventions are needed to relieve examination pressure and to provide effective support for participants. The objective clinical structured examination can be incorporated into the training assessment system; this study provides a basis for improving training programs and the training of newly registered nurses.