We present a novel AI-powered “gut–brain–sleep” digital-twin nursing ecosystem (G-B-S DT-N) that translates microbiome and neuroimmune signals into precision interventions for sleep and mood disorders. The ecosystem integrates four key layers: Microbiome Dynamics, Neuro-immune Interface, Sleep-Cognition-Emotion Circuits, and Person-Nurse-Environment Triad. These layers leverage multi-omics data, EEG sleep microstructure, real-time sensors, and EMR feeds to create a dynamic, patient-specific architecture. Uncertainty-aware explainable AI (XAI) modules ensure privacy and interpretability, enabling causal inference through advanced machine learning techniques. Adaptive care pathways, including precision pre-/post-biotic delivery and circadian light prescriptions, are optimized via nurse-in-the-loop reinforcement learning. The digital twin is operationalized through a five-step closed-loop workflow in hospital and community settings. Quantum-accelerated simulations and a proposed RCT (D-TWIN-RCT) will assess efficacy compared to standard care. Social, legal, and ethical frameworks protect data sovereignty and autonomy. This ecosystem offers a scalable solution for managing complex comorbidities, positioning nursing as a key driver of microbiome-precision medicine.

PURPOSE:Gallbladder polyps pose a health concern among nurses, and early identification is essential for timely intervention and risk management. This study aimed to identify key risk factors and validate an early warning model for GBP specifically tailored to nurses using a retrospective cohort design. METHODS:A cohort of 3,507 nurses was recruited from a tertiary care hospital in northern China, with 3,181 participants after exclusions. The cohort was divided into training (2,407 cases) and validation (774 cases) subsets. Logistic regression analysis of demographic, lifestyle, and biochemical factors was used to develop a prediction model for GBP. Model performance was assessed using sensitivity, specificity, ROC curves, calibration curves, and the Hosmer-Lemeshow test. RESULTS:The prevalence of GBP increased from 1.45% in 2013 to 12.7% in 2022. Key predictors included age, gender, walking time, fried food consumption, and total bilirubin levels. The model demonstrated moderate accuracy with an area under the curve of 0.64 in the training cohort and 0.65 in the validation cohort. Sensitivity reached 60%, specificity was 64-65%, and the negative predictive rate was 92%. Internal validation using bootstrap resampling confirmed model stability. CONCLUSIONS:The early warning model for GBP among nurses demonstrated fair discriminative performance and reliable calibration, indicating potential clinical utility. The model can facilitate early intervention and strengthen occupational health management. Further research should aim to refine the model and validate it across diverse populations to enhance generalizability and accuracy.

Background Due to the unique challenges of their work environment and job demands, nurses often work even when ill. Nurses' presenteeism, defined as working while ill impairs performance or engagement, poses a significant threat to both the quality of care and patient safety. Previous studies have primarily measured nurses' presenteeism using scale scores or thresholds, an approach that focuses solely on the study variable while neglecting inter-individual differences. Recognising individual differences is the key to conducting personalised analyses and subsequently developing targeted intervention strategies.Aim This study aimed to employ latent profile analysis to identify distinct subgroups and characteristics of nurses' presenteeism within the Chinese cultural context, and incorporate the effort-reward imbalance model to explore factors associated with presenteeism.Methods A cross-sectional online study involving 2,871 eligible nurses conducted through the questionnaire platform named "Wen Juan Xing". The general information questionnaire, the McCloskey/Mueller Satisfaction Scale, the Stanford Presenteeism Scale and the Effort-Reward Imbalance Questionnaire were used as the measurement instruments. SPSS (version 25.0) was used for the descriptive statistics and multicollinearity analysis. Mplus (version 8.0) was used to conduct the common method bias test, latent profile analysis and covariate analysis.Results Nurses' presenteeism was classified into three profiles, namely, the "Low presenteeism-Dual Stability Group" (29.5%), the "Medium Presenteeism-Restricted Concentration Group" (20.5%), and the "High Presenteeism-Impaired Task Execution Group" (50.0%). These subgroups demonstrated divergent patterns across the effort-reward imbalance perspective (effort, reward, and overcommitment), individual characteristics (age and gender), and occupational information (years of working experience and job satisfaction).Conclusions The three subgroups of nurses' presenteeism in this study exhibited significant heterogeneity. Different subgroups exhibited distinct characteristics. The significant heterogeneity in the three potential profiles can help nursing managers develop individualised and targeted interventions. This study provides a new direction for reducing nurse presenteeism from an effort-reward imbalance perspective.Clinical trial number Not applicable.

AIM:The objective of this study is to examine the association between moral courage, psychological resilience, and the occurrence of workplace violence among emergency department nurses. BACKGROUND:Workplace violence represents a major occupational hazard in healthcare institutions worldwide. Moral courage refers to nurses' ability to make principled decisions when facing ethical conflicts, thereby avoiding moral distress. Psychological resilience is defined as an individual's positive internal capacity to cope with adversity and stress. Such violent incidents severely undermine nurses' physical and mental well-being, while moral courage plays a pivotal role in enhancing nurses' psychological resilience and improving their mental health. However, the underlying mechanism through which moral courage influences nurses' experiences of workplace violence remains unexplored. METHODS:This study surveyed 325 emergency nurses in Liaoning Province, China, using the Nurses' General Information Form, the Nurses' Moral Courage Scale, the Psychological Resilience Scale, and the Workplace Violence Scale. Descriptive analysis, correlation analysis, and analysis of influencing factors were conducted using SPSS 27.0, while AMOS 27.0 was employed for the verification and analysis of structural equation modeling. RESULTS:The final model explained 35.0% of the total variance in workplace violence among emergency department nurses. Moral courage had a positive impact on psychological resilience, with a path coefficient β = 0.710 (t = 15.347, p < 0.001). Psychological resilience negatively predicted workplace violence, with a path coefficient β = -0.210 (t = -2.466, p = 0.014). Similarly, moral courage negatively predicted workplace violence, with a path coefficient β = -0.231 (t = -2.709, p = 0.007). Psychological resilience played a partial mediating role between moral courage and workplace violence, accounting for 35.89% of the mediating effect. CONCLUSIONS:This study employed structural equation modeling and found a significant negative correlation between moral courage and workplace violence, as well as a partial mediating effect of psychological resilience in the relationship between moral courage and workplace violence. IMPLICATIONS FOR NURSING MANAGEMENT:In the future, training measures can be developed from enhancing nurses' moral courage and psychological resilience, and constantly optimize and improve the existing interventions. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

INTRODUCTION:The purpose of this systematic review and meta-analysis is to evaluate the global risk of preterm birth associated with passive smoking. Specifically, the study aims to examine whether passive smoking continues to impact preterm birth rates, with particular attention to the potential effects following the implementation of stricter smoking bans in recent years. MATERIAL AND METHODS:This systematic review and meta-analysis followed PRISMA guidelines and was preregistered in PROSPERO. A comprehensive literature search was conducted in PubMed, Embase, CINAHL, and Web of Science up to February 17, 2024, using keywords related to passive smoking and preterm birth. Eligible observational studies were selected, and data were independently extracted and assessed for quality by two authors. Statistical analysis used odds ratios (ORs) and the I2 statistic for heterogeneity. Subgroup analyses and publication bias assessments were conducted. Review Manager and Stata were used for the analysis, with significance set at p < 0.05. RESULTS:Meta-analysis showed a 21% increase in the odds of preterm birth in women exposed to environmental tobacco smoke (ETS) (OR, 1.21; 95% CI, 1.10-1.32) with significant heterogeneity (I2 = 76.2%). Stronger associations were found in cohort and cross-sectional studies, studies in Asia, larger sample sizes, and recent publications. Findings were robust across various analyses. CONCLUSIONS:Prenatal environmental tobacco smoke exposure significantly increases preterm birth risk. Effective public health interventions, including stringent smoke-free policies, public education, and awareness campaigns, are needed to reduce environmental tobacco smoke exposure and improve maternal and infant health outcomes.

Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prominent cause of chronic liver disease, and occupational stress may serve as a potential risk factor. This study aims to assess the association between occupational stress trajectories and incident MASLD among Chinese female nurses. Methods We conducted a prospective longitudinal study using data from the Nurse' Health Cohort Study, involving 1,113 female nurses, free of MASLD at baseline (2018). Occupational stress was measured using the Chinese Nurse Job Stress Scale at four time points. Group-based trajectory modeling was used to identify distinct stress trajectories. Through doctors' diagnoses, we assessed incident MASLD over a subsequent 6-year period from 2019 to 2024. Cox proportional hazards regression models evaluated the association of stress trajectories and MASLD risk, adjusting for demographics, work-related factors, and medical conditions. Results During follow-up, 256 nurses reported incident physician-diagnosed MASLD. Three occupational stress trajectories were identified: moderate decreasing (36.4%), moderate stable (55.9%), and moderate increasing (7.7%). Participants in the moderate increasing stress trajectory had a significantly higher risk of developing MASLD (adjusted HR: 3.14, 95% CI: 2.19-4.49, p < .001) compared to those in the moderate stable trajectory. This association between stress trajectory and MASLD risk was not modified by age or BMI (p(interaction)>0.50). Conclusions and relevance The study concludes that increasing stress levels over time are associated with a higher incidence of MASLD. These findings underscore the importance of stress management interventions in reducing the risk of MASLD progression. Further research is needed to explore the underlying mechanisms and to develop targeted strategies for stress reduction in clinical settings.

Background Peripherally Inserted Central Catheter (PICC) is essential in neonatal care, especially for critically ill infants. Traditional training for neonatal PICC insertion faces challenges such as high costs and limited practice opportunities. Virtual simulation technology has emerged as a potential training tool, providing a realistic, risk-free learning environment. Objectives The study aimed to assess the effectiveness of a virtual simulation teaching system in neonatal PICC care training, focusing on improving nursing students' knowledge， skills and interest in pediatric nursing. Design A quasi-experimental design was used, with assessments conducted before and after the activity. Participants The study involved 58 graduate nursing students from China Medical University, divided into experimental and control groups. Methods The System Usability Scale (SUS) was utilized to assess teachers' experiences with the PICC virtual simulation software. Students' perceptions of the software and their interest in pediatric nursing were measured using Self-Administered Questionnaires. Furthermore, Theoretical and Operational Assessments were applied to determine the extent of students' knowledge and practical skills before and after experimentation. Results Teachers and students have favorably evaluated the software system, with notable improvements in theoretical scores following testing. While the virtual simulation system does not enhance practical skills, it does increase student interest in pediatric nursing and employment. Conclusions This neonatal virtual simulation software serves as a complement to, rather than a replacement for, traditional clinical training. Its integration into educational programs significantly enhances learning outcomes.

To evaluate the effectiveness of virtual reality (VR) intervention in the management of pain, anxiety and fear in paediatric patients undergoing needle-related procedures. A systematic review and meta-analysis of randomized controlled trials (RCTs). A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI, and Wanfang databases was conducted to identify research articles in English or Chinese on RCTs up to February 28, 2022. Two researchers independently screened eligible articles. The Cochrane Handbook for Systematic Reviews was used to assess the risk of bias in the included studies. A fixed- or random-effects meta-analysis model was used to determine the pooled mean difference based on the results of the heterogeneity test. A total of 2269 articles were initially screened. The meta-analysis included data from 27 studies representing 2224 participants. Compared with the non-VR group, the VR intervention group significantly reduced pain, anxiety, and fear in paediatric patients who underwent puncture-related procedures. Subgroup analysis showed that VR has advantages over conventional and other distraction methods. Paediatric patients undergoing needle-related procedures would benefit from VR interventions for pain, anxiety and fear management. VR intervention has the potential to reduce pain, anxiety and fear in paediatric patients undergoing puncture-related procedures. Future clinical interventions could incorporate VR into puncture procedures as an effective method to reduce negative emotions in children eligible for VR distractions. Our paper is a systematic review and meta-analysis and such details don't apply to our work.

目的 探讨线上积极心理学理论学习与线下实践应用对临床护士工作压力及健康的影响.方法 将101名重度工作压力护士按照院区分为对照组50名和试验组51名.对照组实施常规心理支持,试验组在常规心理支持的基础上增加线上积极心理学课程学习与线下实践应用,干预时间为12周.干预前后对两组护士采用护士工作压力源量表和康奈尔健康问卷进行调查.结果 干预后试验组护士的工作压力总分及其各维度评分显著低于对照组,心理健康得分显著低于对照组(均P＜0.05).结论 线上积极心理学理论学习与线下实践可缓解临床护士工作压力,改善其心理健康.

BackgroundHumanistic care pertains to the abilities, attitudes, and behaviors central to patient-centered care, contributing to patients' sense of safety and wellbeing. This study aimed to assess the satisfaction of patients with humanistic nursing care in Chinese secondary and tertiary public hospitals.MethodsA national cross-sectional survey was conducted across 30 provinces and 83 hospitals in China. Patient satisfaction with humanistic care was assessed using the Methodist Health Care System Nurse Caring Instrument (NCI), which encompasses 20 items across 12 dimensions. Each item was rated on a 7-point Likert scale, yielding a total score of 140. Multiple linear regression analysis was employed to identify factors associated with patients' satisfaction.ResultsModerate satisfaction (mean score 91.26 ± 13.14) with humanistic nursing care was observed among the 17,593 participants. Factors significantly associated with patient satisfaction included age, hospital type, presence of children, educational attainment, place of residence, family monthly income, and medical insurance type.ConclusionThe study findings highlight the importance of tailored interventions, evidence-based practice guidelines, and patient-centered care in improving patients' satisfaction with humanistic nursing care. Continuous emphasis on nursing education and professional development is crucial for enhancing humanistic care and patient satisfaction.

目的 编制临床护士整体人文关怀感知量表,并检验其信效度.方法 在文献分析和半结构式访谈的基础上,通过德尔菲法构建量表初稿.2022年4月在武汉市某三级甲等医院选取20名临床护士进行预调查,检验量表可读性.2022年4月—5月选取咸宁市和泰安市2所医院的501名临床护士作为调查对象,对量表进行项目分析和信效度检验.结果 临床护士整体人文关怀感知量表包括6个维度、40个条目.探索性因子分析共提取6个公因子,累计方差贡献率为79.05％;验证性因子分析结果显示,量表结构模型的拟合指数良好.量表水平的内容效度指数为0.94,条目水平的内容效度指数为0.78～1.00;量表总的Cronbach'sα系数为0.98,重测信度为0.87.结论 临床护士整体人文关怀感知量表信效度良好,可用于测量护士感知的整体人文关怀情况.

AIM:To synthesize qualitative research on perspectives and understandings of Intensive Care Unit (ICU) patients, family members, and staff regarding respect and dignity in ICU, in order to explore the connotations and meanings of respect and dignity in ICU. DESIGN:A qualitative meta-synthesis. METHODS:The Chinese and English databases were systematically searched, including PubMed, Web of Science, CINAHL, Embase, Cochrane Library, CNKI, Wangfang Data, VIP, and CBM from each database's inception to July 22, 2023. Studies were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Qualitative data were extracted, summarized, and meta-synthesized. (PROSPERO: CRD42023447218). RESULTS:A total of 9 studies from 6 countries were included in the meta-synthesis. Thirty-six main themes and 67 sub-themes were extracted, which were eventually integrated into 9 categories and 4 themes: (1) integrity of humanity; (2) autonomy; (3) equality; (4) environmental support. CONCLUSION:To maintain patient dignity, it is necessary to create an environment of respect within the ICU where healthcare professionals uphold the concept of preserving human integrity and respect patients' autonomy and equality. Healthcare professionals need to value the dignity of ICU patients and treat them as unique individuals during treatment and care. Hospital managers should also strive to create a respectful environment to provide environmental support for dignity care implementation.

目的:构建管理者应对护士职业倦怠的培训方案,为临床管理工作提供参考依据.方法:通过访谈、文献回顾,经研究小组讨论拟定管理者应对护士职业倦怠的培训方案,运用德尔菲专家函询法对护理领域的15名专家进行咨询,形成管理者应对护士职业倦怠的培训方案.结果:管理者应对护士职业倦怠的培训方案包括培训目标、培训内容、培训时间、培训形式与培训效果评价.2轮函询过程中专家的积极系数均为100％,权威系数分别为0.850和0.837,第2轮函询的条目肯德尔和谐系数在0.120～0.203之间,均具有统计学意义(P＜0.05).结论:构建的管理者应对护士职业倦怠的培训方案具有一定的科学性和实用性,可为医院的护士管理工作提供参考.

Introduction In recent years, intracardiac electrocardiogram (IC-ECG) technology has been widely used for epicutaneo-cava catheter (ECC) placement and has shown many potential advantages. However, evidence about the quantitative changes, effectiveness, and safety of IC-ECG for lower extremity ECC is sparse. This study aimed to explore the quantitative changes in IC-ECG for lower extremity ECC and determine its effectiveness and safety. Methods A retrospective study was conducted on 303 premature infants who underwent successful IC-ECG-guided lower extremity ECC placement between January 2019 and December 2021. All patients underwent chest X-ray postoperatively to verify the position of the catheter tip. The amplitudes of the surface electrocardiogram and IC-ECG QRS waves and the difference between the two amplitudes were measured. The effectiveness (matching rate between IC-ECG and chest X-ray) and safety (incidence of catheter-related complications) of IC-ECG for lower extremity ECC were evaluated. Results The matching rate between IC-ECG and chest X-ray was 95.0%. When the catheter tip was optimally positioned, the QRS amplitude of the IC-ECG was 0.85 ± 0.56 mv higher than that of the surface electrocardiogram. The overall incidence of catheter-related complications was 10.6%. The actual ECC insertion length was associated with a noticeably increased risk of catheter-related complications. Conclusions This study suggests that IC-ECG is an effective and safe method by observing the dynamic changes in both QRS complexes and P wave to locate the tip of lower extremity ECC in preterm infants. Our findings would facilitate the application of IC-ECG for ECC localization.

Emotional labor is considered an important part of the role in the nursing field. Previous studies have found inconsistencies between emotional labor and job satisfaction of nurses, this is due to the relationship between them being affected by other factors. However, the current nurse-patient relationship is tense and leads to an unsafe and unstable working environment for nurses. It has yet to be confirmed whether the nurse-patient relationship can be used as a mediating variable to further explain the association that exists between emotional labor and job satisfaction. Therefore, this study tested the mediating effect of the nurse-patient relationship between emotional labor and job satisfaction among Chinese nurses. A total of 496 nurses were included in the study. Data collection was from December 2021 to March 2022 using the convenience sampling method. SPSS 26.0 and AMOS 23.0 software were used to perform structural equation modeling and analyze the relationship between variables. The results showed surface acting negatively affected nurse-patient relationships and job satisfaction, contrary to deep acting and naturally felt emotions. The parallel mediation of nurse-patient trust and patient-centered nursing in the relationship between emotional labor and job satisfaction was found to be statistically significant. Our study highlighted the important mediation of nurse-patient trust and the importance of the positive effects of emotional labor. Future studies can use these findings as a reference to develop interventions.

调查临床护理教师团队的循证实践知识、态度、行为情况,结果显示,临床护理教师对开展循证实践的态度较为积极,但循证知识技能仍有巨大提升空间,应积极采取措施,将循证理念灵活融入护理教学实践并不断优化,更好地培养护理人才.

Objective:To understand the current situation of clinical ability, professional commitment, and academic self-efficacy of undergraduate nursing interns, explore the correlation among them, and provide theoretical basis for improving the clinical competence of undergraduate nursing students.Methods:The method of convenient sampling was adopted to select 325 nursing undergraduates who had internships in a three-A hospital from July 2018 to July 2020 as the research objects. General data questionnaire, nursing mini-clinical exercise assessment scale, college student professional commitment survey scale and academic self-efficacy scale were used to investigate and evaluate the students at the end of their practice. SPSS 19.0 was used to conduct Pearson correlation analysis and multiple stepwise regression analysis.Results:The total scores of clinical ability, professional commitment and self-efficacy were (51.46±7.64) points, (88.11±5.02) points and (74.20±7.95) points respectively. The results of correlation analysis showed that the clinical ability of nursing undergraduates was significantly positively correlated with professional commitment and academic self-efficacy ( P<0.05). The multiple stepwise regression analysis further showed that the latter two factors had a positive predictive effect on clinical ability, and professional commitment was the strongest factor. Conclusion:Clinical practice teaching should pay attention to the cultivation of the professional commitment and academic self-efficacy of nursing undergraduates and thus promote the development of their clinical ability.

IntroductionMenstrual discomfort affects women's quality of life, which is an important public health issue. Evidence confirming the link between passive smoking and menstrual discomfort is limited. Therefore, the aim of this study is to investigate the aforementioned topic on the basis of a cross-sectional study of 2,571 non-smoking Chinese nurses.MethodsDemographic information and passive smoking were assessed using a self-administered questionnaire. Menstrual discomfort was characterized as dysmenorrhea, illness or weakness, bed rest, and restlessness during menstruation, which was assessed using a modified version of the Cornell Medical Index-Health Questionnaire. Multivariate-adjusted odds ratio (OR) and 95% confidence intervals (CIs) were estimated using the logistic regression model.ResultsA total of 1:195 nurses (46.48%) were exposed to passive smoking. Compared with non-passive smoking nurses, passive smoking nurses were more likely to have menstrual discomfort symptoms (72.38 vs. 64.39%), especially symptoms of dysmenorrhea (49.54 vs. 42.08%), illnesses or weakness (48.28 vs. 42.08%), and restlessness during menstruation (53.05 vs. 46.22%). Exposure to passive smoking was significantly associated with menstrual discomfort (OR = 1.41, 95%CI: 1.19–1.67), especially symptoms of dysmenorrhea (OR = 1.32, 95%CI: 1.13–1.56), illness or weakness (OR = 1.24, 95%CI: 1.06–1.46), and restlessness (OR = 1.26, 95%CI: 1.08–1.48) during menstruation. The subgroup analyses, stratified by age, children, and marital status, agreed with the main findings.ConclusionsExposure to passive smoking was related to symptoms of dysmenorrhea and menstrual discomfort.

对国内外开发的慢性难愈性创面评估工具进行综述，概述慢性难愈性创面普适性及特异性评估工具的基本信息、主要内容、评分方法、应用效果等，分析现有评估工具的优缺点，旨在为我国慢性难愈性创面评估和管理提供理论依据，促进我国伤口管理发展。