BackgroundEmergency department (ED) nurses work in high-stress environments and face multiple role pressures simultaneously, making occupational stress and work-family conflict increasingly prominent occupational health concerns in this population. However, the prevalence and correlates of these two constructs have not been systematically examined in the Chinese ED nursing context.ObjectivesThis study aimed to describe the current status of occupational stress and work-family conflict among emergency department nurses, and to examine the association between the two constructs and identify potential influencing factors.MethodsA cross-sectional design was adopted. From December 26, 2023, to January 18, 2024, a total of 1,540 emergency department (ED) nurses from 30 tertiary hospitals across 20 provinces, autonomous regions, and municipalities in China were recruited using a stratified cluster sampling method. Occupational stress and work-family conflict were assessed using a self-designed general information questionnaire, the occupational stress questionnaire, and the Work-Family Behavioral Role Conflict Scale. Data were analyzed using SPSS 25.0, employing descriptive statistics, Pearson correlation analysis, and multiple linear regression to examine the associations between occupational stress and work-family conflict.ResultsA total of 1,540 valid questionnaires were included in the final analysis. The majority of participants were female, aged 30–39 years, held a bachelor's degree, were married with children, and had a junior professional title. The mean total occupational stress score was 55.55 ± 16.78, with dimension scores of 19.22 ± 5.35 for effort, 23.72 ± 9.10 for reward, and 12.60 ± 4.74 for overcommitment. The mean total work-family conflict score was 42.48 ± 16.21, with subscale scores of 18.27 ± 6.88 for work-to-family conflict and 24.21 ± 10.75 for family-to-work conflict. Pearson correlation analysis revealed that the total work-family conflict score and both of its dimensions were positively correlated with the total occupational stress score and all three dimensions, with correlation coefficients ranging from 0.462 to 0.664 (all P < 0.001), indicating moderate-to-strong associations between work-family conflict and occupational stress. Multiple linear regression identified the following factors as independently associated with occupational stress: bachelor's degree or above (B = 1.928, 95% CI: 0.021–3.835, P = 0.048), senior professional title (B = 4.744, 95% CI: 1.046–8.441, P = 0.012), weekly working hours of 41–48 h (B = 1.585, 95% CI: 0.292–2.877, P = 0.016), 49–58 h (B = 5.419, 95% CI: 3.073–7.765, P < 0.001), and ≥59 h (B = 7.353, 95% CI: 4.144–10.562, P < 0.001), monthly night shift frequency >8 times/month (B = 2.975, 95% CI: 0.689–5.261, P = 0.011), work-to-family conflict (B = 1.244, 95% CI: 1.123–1.365, P < 0.001), and family-to-work conflict (B = 0.319, 95% CI: 0.243–0.395, P < 0.001).ConclusionsWork-family conflict is significantly associated with elevated occupational stress among emergency department nurses. Nurses with higher education levels, senior professional titles, longer working hours, and higher monthly night shift frequency tend to report higher levels of occupational stress. These findings suggest that nursing managers may consider controlling working hours, monitoring night shift frequency (>8 shifts per month) and fostering a family-supportive organizational culture as potential strategies to alleviate occupational stress in this population. However, given the cross-sectional design of this study, these associations should not be interpreted as causal, and the proposed strategies should be validated through future longitudinal research.

Objective:To develop and compare three machine learning models for identifying factors associated with workplace violence (WPV) among emergency department nurses. Methods:A total of 1540 emergency department nurses from various regions of China were examined between December 2023 and January 2024. Data were collected using scales measuring WPV, work-family conflict, occupational stress, occupational burnout, nursing practice environment, and self-rated sleep quality. Three analytical models (logistic regression, decision tree, and random forest) were developed and compared to classify nurses with and without WPV experiences among emergency department nurses. Model performance was evaluated using sensitivity, specificity, PPV, NPV, F1-score, balanced accuracy, and area under the receiver operating characteristic curve (AUC). Results:Among the 1540 nurses, 1309 individuals (85.0%) had experienced WPV in the past year. All three models indicated that work-family conflict, occupational burnout, and occupational stress were significantly associated with WPV experiences among emergency department nurses (p < 0.05). In the random forest and decision tree models, sleep disorders and the nursing practice environment were also identified as significant associated factors. The accuracy of the logistic regression, decision tree, and random forest models was 0.829, 0.851, and 0.859; the specificity was 0.667, 0.605, and 0.593; the sensitivity was 0.864, 0.903, and 0.916; and the F1 score was 0.893, 0.909, and 0.915, respectively, with AUC values of 0.832 (95% CI: 0.781-0.883), 0.768 (95% CI: 0.711-0.826), and 0.834 (95% CI: 0.783-0.885). Conclusions:Work-family conflict, burnout, occupational stress, the nursing practice environment, and sleep disorders were consistently associated with WPV experiences among emergency department nurses. Random forest achieved the highest sensitivity, F1-score, and overall accuracy, whereas logistic regression showed the highest specificity and balanced accuracy. Logistic regression and random forest demonstrated similar discrimination.

BackgroundJob burnout and work-family conflict have become prevalent occupational health issues in the healthcare industry. Emergency department (ED) nurses face dual pressures from high-intensity work environments and multiple role responsibilities, making them highly susceptible to job burnout. This study aimed to describe the current status of job burnout and work-family conflict among ED nurses, and explore their correlation as well as the associated factors of job burnout, so as to provide empirical evidence for formulating targeted occupational health intervention measures for ED nurses.ObjectiveBased on the Job Demands-Resources (JD-R) model, this study investigated the current status of job burnout and work-family conflict among ED nurses, and analyzed the correlational relationship between work-family conflict and job burnout, intending to provide evidence-based references for improving the occupational health status of emergency nursing staff.MethodsA cross-sectional survey was conducted from December 26, 2023–January 18, 2024. A total of 1,540 ED nurses from 30 hospitals were enrolled in the study. Data were collected via a self-designed sociodemographic questionnaire and two standardized scales for assessing job burnout and work-family conflict. Descriptive statistics, Pearson correlation analysis, and multiple linear regression analysis were performed using SPSS 26.0 (IBM Corporation, Armonk, New York, United States) to analyze the correlational relationships among variables.ResultsAll 1,540 distributed questionnaires were valid for analysis. Most participants were female, held a bachelor's degree, and had children. The average total score of job burnout was 4.77 (SD = 6.16), with subscale scores of 11.30 (SD = 7.76) for emotional exhaustion, 8.61 (SD = 7.58) for cynicism, and 13.79 (SD = 10.04) for professional efficacy. The average total score of work-family conflict was 42.48 (SD = 16.21), including 18.27 (SD = 6.88) for work-to-family conflict and 24.21 (SD = 10.75) for family-to-work conflict. Correlation analysis showed that the total score and the scores of the two dimensions of work-family conflict were positively correlated with the total score and the scores of all three dimensions of job burnout (r = 0.493, 0.553, 0.389; all P < 0.001). Multiple linear regression analysis identified significant associated factors of job burnout, including parental status (B = −1.126, 95% CI: −2.041 to −0.211, P = 0.016), weekly working hours of 49–58 h (B = 1.010, 95% CI: 0.005–2.015, P = 0.049), weekly working hours of ≥ 59 h (B = 2.503, 95% CI: 1.128–3.878, P < 0.001), monthly night shift frequency of ≥ 9 times (B = 1.324, 95% CI: 0.344–2.303, P = 0.008), and work-to-family conflict (B = 0.449, 95% CI: 0.397–0.501, P < 0.001).ConclusionsLong working hours and frequent night shifts are closely correlated with aggravated emotional exhaustion, and work-family role conflict is significantly associated with higher job burnout levels among ED nurses. Hospital administrators should formulate targeted intervention strategies, including reasonably regulating working hours, reducing excessive night shifts, and building a family-supportive organizational atmosphere, to alleviate job burnout and stabilize the emergency nursing workforce.

ObjectivesThe purpose of this study is to discover how occupational burnout influences the health status of emergency nurses and to investigate the mediation effect of work–family behavior role conflict.DesignA multi-center cross-sectional study.Setting and participantsA questionnaire survey of 1,540 emergency nurses from 30 tertiary hospitals in China was conducted between December 26, 2023, and January 18, 2024.MethodsUsing an online questionnaire, we performed a cross-sectional survey to collect demographic data and information about occupational burnout, work environment, work–family behavior, role conflict, and emergency nurses’ health status. The PROCESS macro for SPSS 26.0 was used to analyze the moderated mediation model, and the bootstrap approach was used to investigate the mediating effects.ResultsThe findings revealed that 57.3% of the nurses had experienced occupational burnout. A substantial positive association was identified between professional burnout, work–family behavior role conflict, and somatic symptoms (r = 0.493, 0.534; p < 0.001). Occupational burnout was found to be a significant predictor of somatic symptoms, with work–family conflict serving as a mediator (β = 0.616, t = 13.295, R2 = 0.488, p < 0.01). Our research found that nurses’ work environment mediated the association between burnout and work–family behavior role conflict (β = 0.007, t = 3.647, p < 0.01), indicating that a positive work environment may reduce the impact of burnout on family role conflict.ConclusionWork–family behavioral role conflict and the nursing work environment were found to partially mediate the association between occupational burnout and the health outcomes of emergency nurses. These findings suggest that, while interventions aimed at mitigating work–family role conflict and improving the work environment are essential, they may not be sufficient on their own to safeguard nurses’ health. Additional strategies are needed to comprehensively address the health risks associated with occupational burnout. Moreover, the interplay among burnout, work–family conflict, and environmental factors underscores the necessity of integrated and multifaceted intervention approaches to alleviate the health burden experienced by emergency nurses effectively.

BackgroundThe identification and management of depression during pregnancy is an important public health issue. Although many existing psychological intervention programs are effective, their implementation is plagued by issues, such as insufficient professional resources and lengthy intervention cycles. Studies have suggested that internet-based problem management plus (IPM+) can effectively address the aforementioned challenges in the management of general depression. However, its application in the pregnant population remains to be verified. ObjectiveThe objective of our study was to explore the effect of IPM+ on depressive symptoms in pregnant women. MethodsFrom April to October 2024, 80 pregnant women were recruited from the Hubei General Hospital and randomly assigned to the intervention group (n=40) and the control group (n=40). The control group received routine care, while the intervention group received a 5-week IPM+ intervention (1.5 hours per week) in addition to routine care. The primary outcome measure is depressive mood, and the secondary outcome measures include anxiety symptoms, perceived stress, and sleep quality. The data were collected using the Edinburgh Postnatal Depression Scale, Pregnancy Anxiety Questionnaire, 4-item Perceived Stress Scale, and Insomnia Severity Index at baseline (T1), immediately after the intervention (T2), and at 3 months (T3). ResultsCompared with the control group, the intervention group showed statistically greater improvements in depressive symptoms (between-group effect size: Hedges g=0.74, 95% CI 0.23-1.24 at T2; Hedges g=0.76, 95% CI 0.25-1.28 at T3), anxiety symptoms (between-group effect size: Hedges g=0.51, 95% CI 0.03-0.98 at T2; Hedges g=0.52, 95% CI 0.04-0.99 at T3), and perceived stress (between-group effect size: Hedges g=0.71, 95% CI 0.23-1.18 at T2; Hedges g=0.62, 95% CI 0.15-1.11 at T3) at both T2 and T3. In terms of sleep quality, the intervention group demonstrated statistically greater improvement compared with the control group only at T3 (between-group effect size: Hedges g=0.68, 95% CI 0.19-1.17). ConclusionsIPM+ effectively alleviates depression and anxiety symptoms, reduces perceived stress, and improves sleep quality in pregnant women with antenatal depression. The intervention effects are sustained for up to 3 months postintervention. Trial RegistrationChictr.org.cn ChiCTR2400083324; https://www.chictr.org.cn/showprojEN.html?proj=222789

To explore the dose-response associations of physical activity (PA) during pregnancy with antenatal depression (AD) and postpartum depression (PPD). Thirteen electronic databases were searched from inception to April 8, 2026 and additionally screened references manually. Interventional and longitudinal observational studies in pregnant populations were eligible if they reported dose-response associations for PA during pregnancy in relation to AD or PPD; cross-sectional studies were excluded. Linear and nonlinear dose-response meta-analyses were conducted. Twenty-three studies from 10 countries involving 122,847 participants were included, comprising 5 randomized clinical trials and 18 cohort studies. In the linear dose–response meta-analysis, each 300 MET-min/wk increase in PA was associated with a 6

Objective: To analyze the risk factors associated with unscheduled transfers to the resuscitation unit in emergency observation patients and to develop a predictive model based on nursing risk scores. Methods: This prospective study analyzed the clinical data of 1166 patients admitted to the emergency observation unit of West China Hospital, Sichuan University, from 1 December 2020, to 28 February 2021. Patients were categorized into groups based on the occurrence of unscheduled transfers to the resuscitation unit. Fall risk scores, pressure ulcer risk scores, and self-care ability assessments were conducted for all patients. Multivariate logistic regression was used to identify risk factors and construct a predictive model. Results: Among the patients, 110 (9.4%) experienced unscheduled transfers to the resuscitation unit. Multivariate logistic regression analysis identified high fall risk, high pressure ulcer risk and impaired self-care ability as independent risk factors for unscheduled transfers. A nomogram was constructed incorporating these factors along with age and sex, achieving an area under the receiver operating characteristic curve of 0.823 (95% confidence interval: 0.786-0.859). Conclusions: High fall risk, high pressure ulcer risk, and impaired self-care ability are independent risk factors for unscheduled transfers to the resuscitation unit in emergency observation patients. The developed predictive model demonstrates provides valuable evidence to guide clinical decision-making and support proactive nursing interventions.

Background:Emergency department nurses work in environments with high stress and irregular shifts, which poses a high risk of work-family behavior role conflict (WFBRC). Conflicts have a negative impact on health, including psychological symptoms like anxiety and depression, along with physical symptoms like fatigue, and sleep disorders. The scores of different dimensions of WFBRC vary among different genders, and it is unknown whether there are differences in terms of the impact of different dimensions of WFBRC on health problems among nurses of different genders. Aim:To investigate the impact of WFBRC on the emergency department nurses' health outcomes by comparing different gender. Study design:Secondary analysis of a cross-sectional study. A stratified cluster group sampling method was employed to survey emergency department nurses from 30 hospitals in China. Data from the Work-Family Behavioral Role Conflict Scale (WFBRC-S), the Self-assessment scale of somatization symptoms (SSS-CN), and a self-administered sleep questionnaire (SSQ) were collected via electronic questionnaire format, and propensity score matching (PSM) was employed to balance sociodemographic factors, and then a linear regression analysis was performed to clarify gender differences. Results:A total of 1,540 emergency department nurses were surveyed, and dataset of 329 male and female emergency department nurse pairs were successfully generated. The study showed male emergency department nurses report higher family-to-work conflict (FWC) scores (25.93 ± 11.85) than females (23.36 ± 10.55). Work-to-family conflict (WFC) has a greater impact on the physical and psychological symptoms of female emergency department nurses (β = 0.607) than male nurses (β = 0.392), while FWC shows the opposite pattern [female (β = 0.165) VS male (β = 0.351)]. Regarding sleep disorders, WFC affects female nurses (β = 0.460) is close to that of male nurses (β = 0.467). Conclusion:Male emergency department nurses report higher FWC scores than females. WFC has a greater impact on the physical and psychological symptoms of female emergency department nurses than male nurses, while FWC shows the opposite pattern.

Background: Patients with infection by multi-drug-resistant organisms (MDROs) are often complicated, difficult to cure, require advanced antimicrobial drugs for treatment, and are susceptible to bacterial colonization. This places a heavy economic burden on patients, which can even lead to death, and also increases the economic burden on healthcare services. Aim: We aimed to systematically assess the risk factors for infection by MDROs in patients in the intensive care unit (ICU). Methods: PubMed, Embase, MEDLINE, and the Cochrane Library were queried from database inception to 21st September 2023, for literature on risk factors for MDRO infection in patients in the ICU. Two researchers independently performed the screening, data extraction, and quality assessment of the retrieved articles. Data were statistically analysed using Stata 16.0. Findings: This meta-analysis included 29 articles involving 18,063 patients, of whom 2955 had contracted MDRO infections. The results of the meta-analysis revealed that diabetes mellitus, cardiovascular disease, history of hospitalization within the previous year, abnormal liver function, history of MDRO infection, injury severity score, length of ICU stay, nasogastric tube, parenteral nutrition, colonization pressure, multiple traumas, mechanical ventilation, tracheostomy, central venous catheter, previous antibiotic treatment, immunosuppressive agents, piperacillin-tazobactam, multi-antibiotic treatment, glycopeptide antibiotics, carbapenems, imipenem, and nitroimidazoles were risk factors for MDRO infection in patients in the ICU. Conclusions: The ICU is a high-risk area for MDRO infection. Healthcare professionals should adopt prevention and control measures based on these risk factors to reduce the occurrence of MDRO infections. 2025 The Healthcare Infection Society. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BackgroundEmergency department (ED) nurses suffer from workplace violence (WPV) and occupational stress (OS) due to the working environment. However, a relatively small number of studies on the relationship between WPV and OS among ED nurses have been conducted and its impact on nurse health or nursing quality.MethodsA cross-sectional study was conducted in 30 hospitals in China from December 26, 2023, to January 18, 2024 through questionnaire survey and stratified cluster sampling.ResultsA total of 1,540 ED nurses were surveyed, 1,309 of whom had experienced WPV. OS score of these ED nurses was (55.55 ± 16.78). Correlation between WPV and OS was significant (rs = 0.577, P < 0.01), and multivariate regression analysis revealed that an education level of bachelor's degree or higher; weekly working hours of 41–48, 49–58, and ≥59 h; physical violence experience; and psychological WPV were key influencing factors of OS among ED nurses.ConclusionA high proportion of ED nurses had experienced WPV, they had moderate to severe levels of OS, and WPV was a direct predictor of OS among them. This may be reduced by strengthening the management of violence in their workplace.

Background:Somatic symptom disorder is influenced by various factors, with increasing evidence highlighting its close association with burnout. This study aimed to investigate the correlation between somatization symptoms and burnout levels among emergency nurses, focusing on the impact of burnout on somatization. Methods:A cross-sectional study was conducted involving 1,540 emergency nurses working in tertiary hospitals in China. Data collection occurred between December 26, 2023, and January 18, 2024, using the Chinese versions of the Maslach burnout inventory-general survey (MBI-GS) and the somatic symptom disorder self-rating scale (SSD-CN). Statistical analyses were performed using SPSS version 25.0. Results:The mean SSD score was 39.58 ± 13.61, with 53.4% of participants exhibiting moderate to severe somatization symptoms. The mean burnout score was 4.77 ± 6.16, with a burnout incidence of 57.3%. A positive correlation was identified between the composite burnout score and the total SSD score (Pearson correlation coefficient = 0.534, p < 0.01). Emotional exhaustion and depersonalization scores were also positively correlated with individual SSD domain scores and the total SSD score (p < 0.01), Multivariate linear regression analysis revealed significant factors influencing somatization symptoms, including 6-10 and 11-15 years of work experience, weekly working hours of 41-48 or 49-58, 5-8 or >9 night shifts per week, monthly incomes ≥10,000 RMB and the composite burnout score (p < 0.05). Conclusion:Emergency nurses in this study exhibited severe somatization symptoms, with burnout identified as a significant contributing factor. To address this issue, healthcare management should consider implementing alternative shift patterns, optimizing workforce allocation, and revising compensation systems to ensure equitable labor distribution. These measures would support the healthy development of emergency nurses. Furthermore, nurses should prioritize self-care by engaging in activities such as psychological interventions, positive thinking training, and yoga to reduce burnout and enhance overall health.

BACKGROUND:Patients in the intensive care unit (ICU) require complex care with rapidly changing conditions, and missed nursing care (MNC) can lead to severe consequences. Investigating the current status and influencing factors of MNC in the ICU is essential to enhance patient safety, optimise care quality and improve nurse job satisfaction, providing evidence-based strategies for ICU nursing management. AIMS:The aims of this study were to investigate the current status of MNC in ICU and to analyse its causes, providing insights to reduce missed care and improve the quality of nursing for critically ill patients. STUDY DESIGN:This is a cross-sectional study, using convenience sampling, 191 ICU nurses from five tertiary hospitals in Sichuan Province were selected as participants from 1 June 2024 to 30 June 2024. Data were collected through a general information questionnaire and the Missed Nursing Care in Intensive Care Units Scale. RESULTS:A total of 191 questionnaires were sent out in this survey, and finally, 185 were included for data analysis. The score for MNC in ICU was 72.14 ± 15.61 points. All nurses reported experiencing at least one instance of missed care during their shifts. The most frequently missed care items were as follows: assisting and guiding patients in early rehabilitation, analgesia and sedation management and psychosocial assessment of critically ill patients. Statistical analysis revealed that MNC in ICU was significantly influenced by nurses' gender, education level, professional title, ICU type and patient load (p < 0.05). The score for reasons behind MNC was 63.24 ± 18.53 points. The primary contributing factors were as follows: heavy nurse workload, excessive patient transfers, high frequency of patient condition changes and emergency events. ICU type (Internal Medicine ICU/comprehensive ICU), patients load (≥ 4 patients/nurse) and characteristics (master's degree and above, intermediate nurse) emerged as modifiable risk factors for MNC. CONCLUSION:Missed nursing care occurs frequently in ICU and is influenced by multiple factors. These findings suggest that nursing administrators should ensure adequate nurse staffing levels and enhance training programmes on MNC awareness, and improve nurses' understanding of this phenomenon. These measures would effectively reduce missed care occurrences and subsequently improve ICU nursing quality. RELEVANCE TO CLINICAL PRACTICE:This study identifies missed nursing care (MNC) in intensive care units (ICUs), particularly in rehabilitation, pain management and psychosocial support. KEY FINDINGS:Staffing/workload (≥ 4 patients/nurse) and unit type (medical/general ICUs) significantly increase MNC. Non-urgent but critical care (e.g., psychological support) is often deprioritised. SOLUTIONS:Implement safe staffing ratios, train nurses on MNC consequences and optimise workflows (e.g., standardised handoffs).

Objective:This study aims to explore the heterogeneity of burnout among emergency department nurses, identify the factors influencing burnout in different subtypes of emergency nurses, and provide targeted strategies and measures to reduce burnout in emergency department nurses. Methods:A cross-sectional survey was conducted from December 26, 2023, to January 18, 2024, involving 1,555 emergency nurses from 30 tertiary hospitals in China. The survey was distributed via an online questionnaire platform, which included general demographic information and the Maslach Burnout Inventory (MBI). The collected data were analyzed using latent profile analysis, Kruskal-Wallis H test, and multiple logistic regression. Results:A total of 1,555 questionnaires were sent out in this survey, and finally 1,540 were included for data analysis. The average burnout score among emergency nurses was (4.77 ± 6.16). Occupational burnout could be categorized into three subtypes: low burnout-low professional efficacy (C1), low burnout-high professional efficacy (C2), and high burnout-low professional efficacy (C3). The proportions of these subtypes were 41%, 32.3%, and 26.7%, respectively. Significant differences in the latent categories of burnout were observed for age (χ2 = 31.749, P < 0.001), education level (χ2 = 6.778, P = 0.034), professional title (χ2 = 21.928, P < 0.001), years of work (χ2 = 29.269, P < 0.001), weekly working hours (χ2 = 52.493, P < 0.001), number of night shifts (χ2 = 34.685, P < 0.001), and monthly income (χ2 = 18.994, P < 0.001). Conclusion:Occupational burnout is prevalent among emergency nurses, with significant heterogeneity in burnout types. Burnout is associated with age, education level, professional title, number of night shifts, weekly working hours, and monthly income. The heterogeneity of burnout subtypes and their influencing factors provides a basis for future personalized interventions.

Background:Emergency nurses are at the highest risk of experiencing workplace violence, which can negatively impact their physical and psychological health. However, the mechanisms by which workplace violence affects nurses' health remain unclear. Therefore, further exploration of potential moderating factors is required to understand the impact of workplace violence on nurses' health. Objectives:This study applied the effort-reward imbalance (ERI) model to investigate the mediating role of occupational stress in the relationship between workplace violence and health among emergency nurses, with the work environment serving as a moderating factor. Design:A cross-sectional study was conducted. Setting and participants:A questionnaire survey was administered to 1,540 emergency nurses from 30 tertiary hospitals in China between December 26, 2023, and January 18, 2024. Methods:An online questionnaire was used to obtain demographic information, along with data concerning workplace violence, work environment, occupational stress, and somatic symptoms. Latent moderate structural equations were employed to analyze the moderated mediation model, and the bootstrap method was used to test for mediating effects. Results:The path coefficient from workplace violence to occupational stress was significant (β = 0.526, P < 0.01), as was the coefficient from occupational stress to somatic symptom (β = 0.655, P < 0.01). Additionally, the direct effect of workplace violence on somatic symptoms was significant (β = 0.090, P < 0.01), with the mediating effect of occupational stress estimated at 0.433 (95% confidence interval [CI]: 0.374-0.493). The mediating effect of occupational stress on the relationship between workplace violence and somatic symptoms accounted for 79.2% of the total effect, indicating a significant mediation. Finally, the work environment moderated the impact of workplace violence on occupational stress (β = 0.063, P < 0.01). Conclusions:A moderated mediation model was developed, with occupational stress mediating the impact of workplace violence on the health of emergency nurses. The findings suggest the need for other measures to reduce the impact of workplace violence on emergency nurses' health, as well as interventions to reduce occupational stress. The combined effects of the work environment and occupational stress emphasize the need for comprehensive interventions to create a supportive workplace for nurses, thereby reducing the fit between emergency nurses and a poor working environment.

This study assesses the prevalence of anxiety and identify its influencing factors among patients under observation in the emergency department of a large tertiary care hospital, aiming to inform targeted psychological interventions. A cross-sectional study was conducted between March and November 2023, involving 98 patients who met the inclusion criteria. Anxiety levels were measured using the Generalized Anxiety Disorder-7 scale. Univariate and multivariate logistic regression analyses were performed to determine the association between anxiety and demographic or clinical variables. Among the participants, 32 patients (32.7%) exhibited anxiety symptoms, with 18 (18.4%) classified as mild, 10 (10.2%) as moderate, and 4 (4.1%) as severe. Multivariate analysis identified age 40 to 59 years (OR = 1.861, P = .007), high school education (OR = 2.809, P = .012), musculoskeletal disorders (OR = 5.07, P = .003), and high perceived illness severity (OR = 3.785, P = .004) as independent predictors of anxiety. Anxiety is prevalent among emergency department patients, particularly those aged 40 to 59, with high school education, musculoskeletal disorders, or perceived severe illness. Routine anxiety screening and targeted psychological support for these high-risk groups are recommended to improve mental health and overall care outcomes in emergency settings.

BACKGROUND:Dietary patterns play a pivotal role in managing hypertension and preventing mortality. However, comparative studies on the effects of different dietary patterns on mortality risk in hypertensive patients remain limited. The aim of this study is to evaluate and compare the associations between six established dietary indices and mortality risk in this population. METHODS:Utilizing data from the 2005-2018 NHANES, 13,230 hypertensive adults were included in the analysis. Six standardized dietary indices were employed, and the associations between these dietary patterns and mortality were analyzed using a weighted Cox proportional hazards model. Additionally, time trend analysis was conducted to examine changes in dietary patterns, while weighted quantile regression (WQS) was used to identify key dietary components contributing to mortality risk. RESULTS:Over a median follow-up of 8.3 years, a total of 2,420 deaths were recorded, including 637 due to cardiovascular diseases. Higher scores for AHEI, DASH, HEI-2020, MED, and MEDI were significantly associated with reduced risk of all-cause mortality, whereas a proinflammatory diet, reflected by elevated DII scores, was associated with increased risk. Only higher DASH index scores were independently associated with reduced cardiovascular mortality. Time trend analysis revealed a decline in adherence to DASH over the years, whereas MEDI scores slightly increased. WQS regression identified dairy products, whole grains, and fatty acids as key dietary components influencing mortality risk. CONCLUSIONS:Healthy dietary patterns markedly reduce all-cause mortality risk in hypertensive patients, with the DASH diet offering notable cardiovascular protection. These findings support personalized dietary interventions for hypertension management.

Background:Sleep disorders severely impact the health of emergency department nurses and the quality of nursing care. Workplace violence is a significant contributing factor to the occurrence of sleep disorders among nurses. Objective:To investigate whether job burnout plays a mediating role between workplace violence and sleep disorders among emergency nurses, and to determine the degree of interaction between workplace violence, job burnout and sleep disorders. Method:A cross-sectional survey study was conducted from December 2023 to January 2024, in which 1,540 emergency department nurses in China were surveyed using workplace violence assessment, job burnout assessment and sleep disorder assessment questionnaires. Spearman correlation analysis was employed to assess the relationships among workplace violence, job burnout, and sleep disorders. Mediation structural equation modeling analysis was performed using the PROCESS macro in SPSS which is a plug-in special for mediating and moderating effect analysis. Results:Among the 1,540 emergency department nurses surveyed, 59.3% experienced sleep disorders. Workplace violence showed a positive correlation with job burnout (r = 0.529, p < 0.01) and with sleep disorders (r = 0.950, p < 0.01). Job burnout was also positively correlated with sleep disorders (r = 0.343, p < 0.01). Workplace violence significantly predicted job burnout (β = 1.658, p < 0.01) and sleep disorders (β = 0.250, p < 0.01). Job burnout significantly predicted sleep disorders (β = 0.132, p < 0.01). The overall mediating effect of job burnout between workplace violence and sleep disorders accounted for 46.7% of the total effect, and this mediating effect was statistically significant. Conclusion:Job burnout has mediated the impact of workplace violence on sleep disorders among emergency nurses. This indicates that intervening in job burnout among emergency department nurses is a key pathway to reducing the occurrence of their sleep disorders. Simultaneously, combining interventions targeting workplace violence may yield more comprehensive and efficient results. Future research should employ longitudinal designs to examine the impact trajectories of workplace violence on job burnout and sleep disorders among emergency nurses.

Purpose:To investigate the knowledge-belief-practice (KBP) regarding lymphedema prevention among postoperative breast cancer patients and identify its psychosocial determinants. Methods:Postoperative patients were selected using a convenience sampling method. A general information collection, questionnaires, a Chinese version of the Distress Disclosure Index (DDI), and the Hospital Anxiety and Depression Scale (HADS) were used. Multivariate linear regression was used. Results:The total scoring rate of knowledge, belief, and practice was 58.51%, with the lowest for knowledge and highest for belief. The level of knowledge, belief, and practice was positively correlated with self-representation and negatively with anxiety and depression. The multivariate linear regression showed that receiving health education on the knowledge, family income, anxiety, depression, and self-expression levels were the critical factors influencing lymphedema. Conclusion:The level of knowledge, belief, and practice is at the lower-to-middle level in China, with poor knowledge mastery, and the level of practice needs to be improved. Healthcare personnel should conduct health education to improve patients' knowledge level related to lymphedema and enhance the correct health beliefs of the patients. Meanwhile, they should also pay attention to their psychological health status to help them improve the level of self-expression and carry out personalized interventions according to the influencing factors.

Anxiety is common in emergency department (ED) patients, affecting physiological stability, treatment adherence, and clinical outcomes. Standardized quality care models may alleviate these effects, but further validation is needed. This study evaluates the impact of a standardized quality care model on anxiety, physiological parameters, and quality of life in ED patients. This retrospective cohort study included 205 ED patients treated between January 2021 and December 2023, selected using consecutive sampling. Patients were categorized into the standardized quality care group (n = 95) or the routine care group (n = 110) based on prior nursing care. Anxiety and depression were assessed using SAS, HAMA, GAD-7, and self-depression scale (SDS), and psychological distress with SCL-90. Quality of life was measured using social functioning (SF)-36v2, while physiological indicators (heart rate, blood pressure, oxygen saturation), patient satisfaction, and medical compliance were recorded. Statistical analyses were conducted using SPSS 26.0, with independent sample t -tests or Mann–Whitney U tests for continuous variables and chi-square (χ²) tests for categorical variables ( P < .05 considered significant). The standardized care group had significantly lower anxiety (SAS, HAMA, GAD-7) and depression (SDS) scores than the routine care group ( P < .05). Moderate to severe psychological distress (SCL-90) was also lower ( P = .015). Physiological indicators, including heart rate ( P = .012), systolic blood pressure ( P = .03), diastolic blood pressure ( P = .03), and oxygen saturation ( P = .03), improved significantly. At the 1-month follow-up, SF-36v2 scores, including physical component summary and mental component summary, were significantly higher in the standardized care group ( P < .05). Patient satisfaction (χ² = 13.28, P = .004) and medical compliance (χ² = 6.01, P = .049) were also improved. The standardized quality care model effectively reduces anxiety and depression, enhances physiological stability, and improves quality of life, patient satisfaction, and treatment adherence in ED patients. These findings support integrating structured nursing interventions into ED care. Larger prospective studies are needed to validate long-term benefits and explore technology-driven enhancements.

Perinatal insomnia and depression significantly impact maternal-infant health, but their co-developing trajectories are poorly understood. This study examines their heterogeneous progression, interrelationships, and predictive factors across the perinatal period. This was part of a mother-infant cohort study conducted in the obstetrics outpatient clinic of a tertiary hospital in Wuhan, Hubei Province. Pregnant women were enrolled (N = 1034) at early pregnancy (< 14 weeks) from July 2022 to September 2023. The perinatal depressive symptoms, insomnia severity, anxiety symptoms, and social capital were reassessed at 5-time points from enrollment (T0) to 6 months postpartum using the Edinburgh postnatal depression scale, the Insomnia Severity Index, the Pregnancy-related Anxiety Questionnaire, and the Personal Social Capital Scale 16, respectively. The follow-up time points were 16–20 weeks of gestation (T1), 28–36 weeks of gestation (T2), six weeks postpartum (T3) and six months postpartum (T4), respectively. Group-based trajectory modelling and binary logistic regression modelling were used to analyze the data (n = 436). We identified three trajectories for perinatal insomnia and depression symptoms. Insomnia: no insomnia (27.7