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AnteayerInternacionales

Beyond Autonomy? Understanding Patient Participation in Contemporary Nursing Care: A Focused Ethnography of Chronic Illness Contexts

ABSTRACT

Aim

To explore how chronically ill patients, family members and nurses perceive and experience patient participation in nursing care within a Chinese hospital context.

Design

Focused ethnography.

Methods

The study was conducted in a Chinese public hospital over 8 months between February and September 2021. Data were generated through 90 h of participant observation and 30 semi-structured interviews, including individual and dyadic interviews with 10 nurses, 17 patients and 7 family members. Data were analysed using reflexive thematic analysis through an inductive and iterative process.

Results

An overarching theme ‘participation as relational, holistic and dynamic’ was developed, comprising three themes: (1) participation as fulfilling individual responsibility, (2) family members as co-participants and (3) participation as an evolving multidimensional practice. These themes suggest that participation was understood as a relational responsibility enacted through everyday interactions. Family members were actively involved in care processes, and participation extended across physical, intellectual and emotional dimensions. Digital information and technologies further reshaped participation, creating new opportunities and tensions in everyday care.

Conclusion

Patient participation in nursing care extends beyond autonomy-based models and is shaped by relational responsibilities, family involvement and evolving digital healthcare contexts.

Implications for the Profession and/or Patient Care

To promote patient participation, policies and practices should recognise relational and family-based dimensions of care. Healthcare organisations should foster environments that support collaborative participation among patients, families and nurses. Training and education should be developed to promote nurses' digital literacy, cultural competence, ethical sensitivity and relational communication to support participation in contemporary care contexts.

Impact

This study broadens prevailing autonomy-centred understandings of patient participation by demonstrating how participation is co-constructed through relational responsibilities and family involvement. The findings offer insights for nursing practice and policy in culturally diverse and increasingly digital healthcare environments.

Reporting Methods

COREQ.

Patient or Public Contribution

No Patient or Public Contribution.

Systematic Review and Meta‐Analysis of Post‐Stroke Delirium Risk Prediction Models

ABSTRACT

Aim

To systematically review published studies on the post stroke delirium risk prediction models; and to provide the evidence for developing and updating the clinically available prediction models.

Design

Systematic review.

Data Sources

Systematically searched studies on 10 databases, which were conducted from inception to 9 January 2025. The studies of post-stroke delirium risk prediction models were included.

Methods

Extracted the data from the selected studies. The Prediction Model Risk of Bias Assessment Tool checklist was used to evaluate the risk of bias of the models. The meta-analysis of model performance and common predictors was performed by Revman 5.4 and Medcalc.

Results

A total of 12 studies were included, and 21 risk prediction models for post-stroke delirium were constructed. The combined effect size of area under the receiver operating characteristic curve was 0.84. All studies were found to have a high risk of bias and good applicability. Meta-analysis showed: National Institutes of Health Stroke Scale score, age, neutrophil-to-lymphocyte ratio, neglect, visual impairment and atrial fibrillation were independent predictors of post-stroke delirium.

Conclusion

The included studies all found to have a high risk of bias; future studies should focus on adopting more scientifically rigorous study designs and following the standardised reporting guidelines to enhance extrapolation and facilitate its clinical application.

Implications for the Profession

This review may promote clinical healthcare workers to develop and update clinically available prediction models, thereby establishing risk prediction models with strong clinical utility.

Impact

This study presents the first systematic evaluation of delirium risk prediction models in stroke patients, thereby facilitating the choice, use and develop of the clinical usable post stroke delirium risk prediction models.

Reporting Method

This review adhered to the PRISMA guidelines.

Patient or Public Contribution

No patient or public contribution.

Review Registration

RD42024620360 (PROSPERO According to JAN Guidelines).

How to Implement Advance Care Planning for People With Dementia: A Scoping Review

ABSTRACT

Background

Advance care planning for people with dementia is an important process to ensure that patient preferences are respected throughout disease progression. However, the complexity of advance care planning and the challenges in effective communication hinder its implementation. The lack of clear procedural guidance for health care teams and the limited research on practical issues such as building trust and resolving conflicts further complicate this process.

Objective

To explore the key components of and processes for advance care planning for people with dementia.

Methods

The authors conducted a comprehensive search of databases, including PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, NICE, Open Grey, CNKI, and Wanfang. The inclusion criteria focused on studies reporting advance care planning practices and stakeholder perspectives related to dementia.

Results

The review included 45 studies and identified key components and processes for successfully implementing advance care planning in dementia care. These components include enhancing readiness, capturing patient wishes, and executing those wishes. The implementation processes cover assessing participation capacity, selecting surrogate decision-makers, and identifying healthcare providers who implement advance care planning. As the condition of people with dementia progresses, the role of healthcare providers who implement advance care planning becomes increasingly important in advance care planning practices.

Conclusions

The success of advance care planning depends on the interconnection of multiple components, and the findings offer practical insights for improving the advance care planning process to ensure that the care preferences of people with dementia are respected throughout the progression of the disease.

Reporting Method

PRISMA-ScR.

No Patient or Public Contribution

This is a review without patient and public contribution.

Classifying and Characterising Unmet Integrated Care Needs of Older Adults With Multimorbidity: A Latent Profile Analysis

ABSTRACT

Aims

To classify the unmet integrated care needs of older adults with multimorbidity and to explore the factors associated with different categories of unmet integrated care needs among the target population.

Design

A cross-sectional survey using the statistical method of latent profile analysis.

Methods

From July 2022 to March 2023, 397 older adults with multimorbidity, aged 60 years or older, were recruited from one primary healthcare setting and from four secondary and tertiary hospitals to participate in face-to-face questionnaire surveys. The questionnaire used in this study to assess unmet integrated care needs among older adults with multimorbidity was self-designed through a series of steps, including a scoping review, expert consultation and cognitive interviews. Latent profile analysis was applied to uncover distinct profiles of unmet integrated care needs, and multinomial logistic regression was employed to explore whether the profiles were further distinguished by participants' sociodemographic and health-related covariates. The data were analysed using IBM SPSS v.29.0 and Mplus v.8.0.

Results

The optimal solution was a four-profile model, characterised by high unmet integration needs, high unmet system integration needs, low unmet system integration needs and low unmet integration needs, respectively. Multinomial logistic regression results indicated that profile differences were associated with place of residence, number of coresidents and the presence or absence of complex multimorbidity.

Conclusion

The integrated care needs of older adults with multimorbidity have not yet been fully met. Classifying and characterising unmet integrated care needs profiles is a crucial step in the rational allocation of integrated care resources.

Reporting Method

This study was reported based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for cross-sectional studies.

Patient or Public Contribution

All participants were older adults with multimorbidity, and they were informed that they could withdraw from the study at any time.

Perspectives and Requirements of Patients with Prostate Cancer on Mobile Health Interventions During Androgen Deprivation Therapy: A Descriptive Qualitative Study

ABSTRACT

Aim

To explore the perceptions of patients with prostate cancer undergoing androgen deprivation therapy towards mobile health interventions.

Design

The study employed a qualitative descriptive design.

Methods

Seventeen participants were recruited from tertiary care hospitals from November 2022 to June 2023. The collected data were subsequently analysed using a content analysis approach.

Results

The main themes were facilitators, barriers, information needs, emotional and social needs, and self-management needs. Facilitators for using mobile health included support from healthcare professionals and family, competitive design features and user-friendly interfaces. Barriers included negative past experiences with technology and a satisfactory current state of health. Informational support included those patients who expressed a desire for timely, accurate information integrated with traditional Chinese medical principles. Regarding emotional support, patients emphasised their independence, preferring not to burden family and friends, showing disinterest in mindfulness and relaxation therapies, and generally disliking online interactions with fellow patients. For self-management, medication reminders and rehabilitation guidance were seen as vital tools to enhance supportive care.

Conclusion

The study highlights the importance of customising mobile healthcare applications to meet unique needs among patients with prostate cancer and enhance their engagement and satisfaction. Understanding their specific preferences enables the development of more effective mobile healthcare applications.

Reporting Method

The COREQ checklist.

Influencing factors of inter‐nursing lateral violence: A qualitative systematic review

Abstract

Background

Lateral violence is a global social problem that has attracted considerable attention in the field of public health. This has seriously affected the quality of care, the safety of patients' lives and the career development of nurses.

Objective

To systematically evaluate the factors influencing of nursing lateral violence and provide evidence for preventing and reducing inter-nursing lateral violence.

Methods

A systematic review of qualitative study was performed in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. We collected qualitative studies on the factors influencing of inter-nursing lateral violence by searching PubMed, EMbase, The Cochrane Library, Web of Science, CINAHL, Science Direct, WanFang Data, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP) and Chinese Biomedical Literature Database (CBM). Data from inception to September 2023. Literature screening and data extraction were independently conducted by two reviewers. The Critical Appraisal Skills Program (CASP) scale was employed to assess the quality of the studies, including objectives, methodologies, designs, results and contributions.

Results

A total of 25 studies involving 882 participants were included. The results of the thematic analysis indicated that inter-nursing lateral violence was influenced by hospital management, perpetrators, victims and sociodemographic factors.

Conclusion

Inter-nursing lateral violence was influenced by multidimensional factors. To reduce the occurrence of horizontal violence among nurses, hospitals need to explore the establishment and improvement of a horizontal violence resolution mechanism, and schools should pay attention to the joint support and education of nursing students, create a good working environment and harmonious nursing culture, and promote mutual respect among nurses.

Relevance to Clinical Practice

This review emphasises the importance of the influencing factors of horizontal violence among nurses, analyses the importance of influencing factors from different perspectives, and proposes corresponding measures to reduce inter-nursing lateral violence.

No Patient or Public Contribution

This study was mostly a literature review; neither patients nor pertinent staff were involved in either the design or conduct of the investigation.

Spirituality Among Older Adults With Depression: An Interpretative Phenomenological Study

ABSTRACT

Introduction

Spirituality is a crucial yet complex element of holistic nursing care, particularly when providing care for older adults with depression. In Thailand, depression poses a significant mental health challenge. Thai cultural values are deeply interwoven with individuals' beliefs, making spirituality a critical factor in addressing the care of older adults with depression. This study aimed to explore how older adults with depression experience spirituality and construct meaning from it in their daily lives.

Design

An interpretative phenomenological study.

Methods

In-depth interviews of 30 older Thai adults living with depression (aged 60–85 years) from an outpatient psychiatric clinic in southern Thailand were conducted using semi-structured interview questionnaires. Interpretive phenomenological analysis was employed. Data were collected from June to August 2024.

Results

Five themes emerged from the phenomenological data analysis: (1) elusiveness of spiritual meaning, (2) holding oneself together through inner power, (3) finding acceptance through faith in a higher power, (4) family ties shaping peace and despair, and (5) being guided and cared for.

Conclusion

This study highlights that older adults with depression perceive spirituality as essential for their well-being. Personal practices, such as meditation and chanting, played a key role in strengthening spirituality and reducing the risk of relapse in depressive symptoms, which are distinct for each older adult. Understanding spirituality's role in mental health guides nurses to develop strategies for providing more empathetic spiritual care.

Clinical Relevance

Nurses must address depression in older adults through individualized practices to effectively empower their inner strength and coping mechanisms. Understanding each individual's spiritual practices is essential to help them harness their inner strength when coping with depression.

Efficacy and Safety of Silver Sulfadiazine Dressings and Nanocrystalline Silver Dressings on Burns: A Systematic Review and Meta‐Analysis

ABSTRACT

Aim

Nanocrystalline silver dressings are increasingly used as alternatives to silver sulfadiazine dressings in burn management, but comparative evidence remains inconclusive. This meta-analysis aimed to compare the efficacy and safety of nanocrystalline silver dressings versus silver sulfadiazine dressings in burn patients.

Design

Systematic review and meta-analysis following PRISMA guidelines. The review was registered with PROSPERO (CRD420251060978).

Data Sources

PubMed, Embase, Cochrane Library and Web of Science were searched from inception through April 2025.

Methods

Randomized controlled trials comparing nanocrystalline silver dressings with silver sulfadiazine dressings in burn patients were included. Primary outcomes were wound healing time and adverse events. Secondary outcomes included complete re-epithelialization rates and dressing change frequency. Risk of bias was assessed using the Cochrane risk of bias tool. Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations framework. Meta-analysis was performed using Review Manager 5.4.

Results

Eight randomized controlled trials (724 patients) were included. Nanocrystalline silver dressings significantly reduced wound healing time (mean difference [MD] = −3.29 days, 95% confidence interval [CI]: −3.82 to −2.76; p < 0.00001; I 2 = 0%) and dressing change frequency (MD = −8.76, 95% CI: −12.68 to −4.85; p < 0.00001; I 2 = 94%). No significant differences were found in re-epithelialization rates (odds ratio = 1.08, p = 0.80) or adverse events (risk difference = −0.00, p = 0.99). Evidence certainty was low to very low across all outcomes.

Conclusions

Nanocrystalline silver dressings may offer advantages over silver sulfadiazine dressings in reducing wound healing time and dressing change frequency in burn patients, but the overall certainty of evidence is low to very low. Future well-powered, multicenter trials with standardized outcomes and extended follow-up are needed.

Relevance to Clinical Practice

These findings support the consideration of nanocrystalline silver dressings for burn wound management, particularly for reducing wound healing time and nursing workload associated with dressing changes. However, dressing selection should be guided by burn depth, infection risk, patient-specific factors, and resource availability.

Reporting Method

We have adhered to relevant EQUATOR guidelines, particularly the PRISMA checklist.

Patient or Public Contribution

No patient or public contribution.

Systematic Review Registration

PROSPERO CRD420251060978.

The Impact of Game‐Based Teaching on Undergraduate Nursing Students' Learning Satisfaction, Clinical Thinking, Clinical Skills and Anxiety: A Systematic Review and Meta‐Analysis

ABSTRACT

Aim

To evaluate the impact of game-based teaching on undergraduate nursing students' learning satisfaction, clinical thinking, clinical skills, and anxiety.

Design

Systematic review and meta-analysis.

Data Sources

China National Knowledge Infrastructure, Wanfang, Weipu, SinoMed, CINAHL, PubMed, Web of Science, Cochrane Library, and Embase. Our systematic literature search was conducted up to 31 October 2024 and included all studies published before this date, with no restrictions on publication year.

Methods

The study quality was appraised using version 1 of the Cochrane risk-of-bias tool and the JBI Critical Appraisal Tools for Quasi-Experimental Studies. A meta-analysis was performed using STATA version 12.

Results

1712 undergraduate nursing students from 19 studies were included. Meta-analysis showed that game-based teaching improved undergraduate nursing students' learning satisfaction, critical thinking, clinical decision-making, and clinical skills. Game-based teaching did not significantly enhance undergraduate nursing students' problem-solving skills.

Conclusions

Our research findings indicated that game-based teaching had more significant potential to enhance undergraduate nursing students' learning satisfaction, critical thinking, clinical decision-making, and clinical skills. However, game-based teaching did not show a substantial advantage in improving problem-solving skills compared to other teaching methods. Limited studies of the effects of game-based teaching on clinical reasoning and anxiety in nursing students cannot be meta-analysed. Future studies could improve how game-based learning is designed to support undergraduate nursing students' development of these competencies.

Impact

This study explores the effects of game-based teaching in nursing education and finds that it promotes learning satisfaction, critical thinking, clinical decision-making, and clinical skills in undergraduate nursing students, while having no significant effect on problem-solving skills. Game-based teaching can be a functional pedagogical approach to guide nursing educators to improve learning outcomes for undergraduate nursing students.

Patient or Public Contribution

Inapplicable.

Feasibility and Acceptability of the Smarthealth Intervention for Dementia Caregivers. A Qualitative Analysis of a Single‐Group Pilot Study

ABSTRACT

Aim(s)

To explore the feasibility and acceptability of acoustic monitoring and real-time recommendations for stress detection and management (i.e., smarthealth intervention).

Design

This qualitative study used a framework of acceptability for healthcare interventions.

Methods

From January 2021 to December 2023 in the U.S.A., we interviewed 10 family caregivers who had completed the 4-month smarthealth intervention. The caregivers shared their user experiences and feedback on the system's feasibility and acceptability. Data were analysed using abductive thematic analysis, incorporating the framework of acceptability for healthcare interventions and the collected data.

Results

Seven themes and 19 categories emerged: attitudes, burden, ethicality, intervention adherence, intervention coherence, perceived effectiveness and suggestions. Feedback on the smarthealth intervention was mixed. Some found it beneficial, citing accuracy, ease of use and increased awareness. However, others felt burdened during its use, primarily due to time constraints.

Conclusion

The smarthealth intervention can potentially improve caregivers' awareness of themselves and caregiving situations.

Implications for the Profession and/or Patient Care

Future directions should involve adapting the smarthealth intervention to consider diverse caregiving scenarios and incorporating a larger sample of caregivers.

Impact

This is the first study to offer a voice detection system and real-time stress management recommendations to caregivers of people living with dementia. An individualised approach should be considered to improve the system's effectiveness. This includes providing personalised intervention components, considering caregivers' time and establishing a user-friendly system with high accessibility. The findings can be a cornerstone for smarthealth interventions influencing dementia caregivers' self-care and emotional regulation.

Reporting Method

Standards for Reporting Qualitative Research.

Patient or Public Contribution

Members of the public and service users from a memory clinic and social media platforms contributed to the study by reviewing recruitment materials.

Trial Registration: This trial's study protocol was registered with ClinicalTrials.gov (ID No. NCT04536701) on 3 September 2020 (https://classic.clinicaltrials.gov/ct2/show/NCT04536701)

Culturally and Linguistically Diverse Informal Carer Experiences of Older Adult Care Transitions From Hospital to Home: A Scoping Review

ABSTRACT

Aim

To review the evidence on the experiences and perceptions of culturally and linguistically diverse informal carers supporting older adults during transitions from hospital to home, including their interactions with transitional care interventions.

Design

Scoping review guided by Arksey and O'Malley's framework.

Data Sources

We searched CINAHL, MEDLINE, Embase, Emcare, AMED, PsycINFO, Global Health, Social Work Abstracts, JBI EBP, Scopus, Web of Science Core Collection, ProQuest and Informit for studies published between January 2010 and November 2024.

Methods

Two reviewers independently screened studies and extracted data. Analysis followed the Patterns, Advances, Gaps, Evidence for Practice and Research recommendations framework.

Results

Seventeen studies involving 1275 carers were included. Carer experiences were summarised into four themes: (1) cultural and communication barriers; (2) role ambiguity and practical challenges; (3) limited involvement in discharge planning and (4) barriers to accessing support and services. Perceptions of transitional care interventions were mixed. While some interventions improved carer preparedness and reduced stress, most lacked cultural tailoring and did not address carers' psychosocial and communication needs.

Conclusion

Culturally and linguistically diverse informal carers face challenges navigating transitional care. While involving them in care planning improves outcomes, implementation remains inconsistent. Emotional support and culturally tailored services are insufficient.

Implications for the Profession and/or Patient Care

There is a need for culturally and linguistically tailored transitional care programmes that prioritise carer education and communication support. Key areas for improvement include: (1) health literacy and system navigation; (2) involvement in care planning; (3) communication with providers; (4) psychosocial and emotional support and (5) culturally appropriate services. Future research should explore the unique emotional and psychosocial needs of these carers to inform targeted support strategies.

Reporting Method

This review follows the PRISMA guideline for reporting.

Patient or Public Contribution

No patient or public contribution.

Occupational Burnout in Nurses Is due to Long‐Term Work Stress Rather Than COVID‐19 Pandemic Event

ABSTRACT

Aim

This study aims to explore occupational burnout among Chinese nurses from two perspectives: first, by comparing changes in emotional exhaustion, depersonalisation and personal accomplishment before and after the COVID-19 pandemic; and second, by identifying long-term work-related stressors and structural factors contributing to burnout.

Design

A mixed-methods approach was adopted, combining a systematic review with qualitative interviews. The qualitative component involved semi-structured interviews with 53 hospital-employed nurses from various departments and regions across China, focusing on the three core dimensions of occupational burnout.

Methods

The systematic review included both Chinese and English-language studies published between 2016 and 2023 that used the Maslach Burnout Inventory to assess burnout among nurses. A total of 22 studies met the inclusion criteria, selected independently by two researchers using the JBI critical appraisal tool. In parallel, the qualitative interviews explored nurses' subjective experiences and coping strategies related to work stress, emotional fatigue and professional identity.

Results

Bayesian factor analysis indicated no significant differences in emotional exhaustion (BF01 = 2.202), depersonalisation (BF01 = 2.761) or personal accomplishment (BF01 = 2.747) before and after the pandemic. Qualitative findings revealed that burnout was primarily driven by long-standing systemic stressors, including promotion pressure, clinical workload, organisational demands and work–family conflict. Although many nurses relied on self-regulation strategies to maintain psychological stability, they continued to experience ongoing physical and emotional exhaustion. Some reported emotional numbness, but most retained empathy and a strong sense of responsibility. Their sense of personal accomplishment often stemmed from patient recovery and recognition of professional value.

Conclusion

Occupational burnout among Chinese nurses remained largely stable before and after the COVID-19 pandemic. Its root causes stem from persistent work-related stressors and systemic issues, rather than the pandemic itself. Effective mitigation requires institutional strategies, including better staffing, clear career pathways and sustained emotional support.

Impact

Short-term crisis responses alone are insufficient to address enduring burnout. Nursing leadership should prioritise systemic reforms—such as optimising shift schedules, defining promotion channels and integrating regular psychological support—to enhance nurse well-being and care quality.

Patient or Public Contribution

No patient or public contribution.

Health‐Promoting Lifestyle and Associated Factors Among Head and Neck Cancer Patients in Northeast China: A Cross‐Sectional Study

ABSTRACT

Objectives

Health-promoting lifestyle (HPL) is strongly associated with health outcomes. In clinical practice, health-promotion behaviours in patients with head and neck cancer (HNC) are not good, which seriously affects patients' prognosis. This study aims to investigate the current status and influencing factors of HPL in HNC patients.

Design

A cross-sectional study.

Methods

This study used a convenience sampling method to select 264 consecutive HNC patients who attended a tertiary hospital in northeast China from November 2023 to May 2024 for the survey. Data were collected using the Questionnaire for General Information, the Health-Promoting Lifestyle Profile Revised-II (HPLP-II R), the Health Literacy Management Scale (He LMS) and the Acceptance of Illness Scale (AIS).

Results

The HPLP-II R scores of HNC patients were generally average (93.10 ± 15.60), with the highest scores on the nutrition dimension and the lowest scores on the exercise dimension. HPL was significantly and positively correlated with health literacy and disease acceptance. Multiple linear regression analysis showed that educational level, cancer recurrence, health literacy and disease acceptance were the influencing factors of HPL among patients with HNC, which altogether explained 25.9% of the total variance.

Conclusion

The HPL of HNC patients is at an average level and still has much room for improvement. Patients with high literacy levels, cancer recurrence, high health literacy and disease acceptance levels had relatively high levels of HPL.

Implications for the Profession

HPL can enhance patients' internal motivation, enhance their self-management ability and improve their daily functional performance while reducing complications and improving their quality of life. This suggests that medical staff should give personalised health guidance according to patients' different health literacy in clinical work, improve patients' disease acceptance and pay attention to the development of HPL.

Reporting Method

STORBE guidelines.

Patient or Public Contribution

No patient or public contribution.

Reasons for Frail Older Adults in Nursing Homes Declining Participation in Exercise Interventions: A Life Course Perspective Qualitative Study

ABSTRACT

Aim

To explore how life course factors shape the exercise participation decisions of frail older adults living in nursing homes.

Design

This qualitative study is from the approach of social constructivism.

Methods

Seventeen frail older adults were purposefully recruited from a nursing home in Beijing, China. Data were collected through face-to-face semi-structured interviews between October 2024 and December 2024. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. Data collection and analysis continued until thematic saturation was achieved.

Results

Three overarching themes were identified: (1) cumulative effects of key elements in the life course; (2) deficiencies in existing support across various systemic levels; and (3) lack of individual subjective agency. These factors interact dynamically to inhibit participation in exercise interventions.

Conclusion

This study highlights the complex interplay between life course experiences, systemic barriers and individual-level limitations that collectively discourage exercise participation among frail older adults in nursing homes. Tailored and culturally sensitive strategies, strengthened institutional support, family engagement and improved policy communication are needed to address these barriers.

Impact

These findings offer practical insights for designing person-centred exercise interventions that align with frail older adults' lived experiences and promote active ageing in institutional settings.

Patient or Public Contribution

No patient or public contribution.

Reporting Method

COREQ (Consolidated criteria for Reporting Qualitative research).

Factors Influencing Patient Satisfaction With a Government‐Funded Free Treatment Programme for Severe Mental Illnesses: A Community‐Based Cross‐Sectional Study in China

ABSTRACT

Background

In China, government-funded free treatment programmes have substantially expanded access to mental healthcare for patients with severe mental illnesses (SMIs). However, the effectiveness and patient satisfaction associated with these programmes can vary significantly. Understanding the factors underlying these variations is crucial for optimising patient adherence and rehabilitation outcomes.

Aim

To identify factors influencing SMI patients' satisfaction with a government-funded free treatment programme in District S, Nanjing, China, and propose targeted measures to enhance the programme's effectiveness and improve patient outcomes.

Design

A cross-sectional study.

Methods

This study was conducted in 23 community healthcare centres in District S, Nanjing, China, from January to July 2022. A total of 924 SMI patients enrolled in the programme were selected using a two-stage random sampling method. Data on patients' individual characteristics, health behaviours and satisfaction with the programme were collected by a self-developed structured questionnaire. Guided by Andersen's Behavioural Model, hierarchical logistic regression analysis was employed to determine factors associated with patient satisfaction.

Results

Among the 924 valid responses, 51.3% of patients with SMIs reported low satisfaction with the programme. Factors associated with patient satisfaction included individual predisposing, enabling, need and health behaviour variables. Specifically, patients who were employed, had schizophrenia, experienced adverse drug reactions, feared program exposure of their condition and received treatment in hospital were more likely to report lower satisfaction.

Conclusion

This study revealed that satisfaction among SMI patients with the programme remains low, with patient satisfaction primarily determined by individual need and health behaviour factors. Policymakers and stakeholders should implement targeted measures to address these factors and improve patient satisfaction.

Impact

The findings offer new insights and scientific bases for policymakers seeking to improve the programme and practical recommendations for stakeholders to develop effective solutions.

Reporting Method

STROBE guidelines.

Patient or Public Contribution

No patient or public contribution.

Advance Care Planning Intention and Associated Factors Among People With Dementia: A Mixed‐Methods Study

ABSTRACT

Aim

To explore the current status and associated factors of advance care planning intentions among people living with dementia in China.

Design

An explanatory sequential mixed-methods design was adopted.

Methods

The research is guided by the knowledge-attitude-practice model and the theory of planned behaviour. Quantitative surveys were used to assess advance care planning intentions and associated factors in people living with dementia, followed by qualitative semi-structured interviews to delve into participants' perceptions and feelings about advance care planning. Quantitative data were analysed using multiple linear regression, while qualitative data were analysed using thematic analysis.

Results

The overall advance care planning behavioural intention was at a moderately high level. The quantitative results revealed that higher education level, certain religious beliefs, greater advance care planning knowledge, positive behavioural attitudes and stronger subjective norms were significantly positively associated with advance care planning intentions. Qualitative analysis identified three themes: positive attitude but limited ACP awareness, supportive relationships enable early ACP consideration and cultural norms shape willingness to engage in ACP.

Conclusion

Advance care planning intentions among people living with dementia are shaped by a combination of social, familial and individual factors. Increasing public awareness, addressing cultural challenges and establishing professional teams are crucial to promoting advance care planning practices. Future research should focus on larger, multicenter studies to enhance intervention strategies.

Implications

Although the attitude toward advance care planning is more positive, various factors need to be carefully considered in the process of constructing relative intervention strategies.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct or reporting.

Dysphagia in Head and Neck Cancer Patients: A Qualitative Meta‐Synthesis of Patient and Caregiver Experiences and Perspectives

ABSTRACT

Background

Dysphagia not only affects the nutritional intake of head and neck cancer (HNC) patients but may also lead to social avoidance, emotional fluctuations, and a decline in life confidence. Furthermore, dysphagia places an additional psychological and physical burden on caregivers, significantly altering their lifestyles.

Method

This study employed a qualitative systematic review approach to comprehensively analyse the experiences and coping strategies of HNC patients and their caregivers in relation to dysphagia. Relevant qualitative studies published from the inception of the database through September 2024 were selected. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research (2016), and a meta-aggregation method was applied to synthesise and categorise the research themes. This study standardised the presentation of results in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.

Results

A total of 14 studies were included, resulting in 63 research outcomes, which were consolidated into 12 new categories and integrated into 4 main themes: (1) the impact of dysphagia on daily life; (2) coping with the changes caused by dysphagia; (3) understanding of dysphagia and related needs; and (4) the physiological and psychological challenges faced, and the efforts to seek support.

Conclusions

The dual physiological and psychological challenges posed by dysphagia profoundly affect patients' daily lives, prompting ongoing adjustments to cope with these changes. Both patients and caregivers have a limited understanding of dysphagia but exhibit a strong need for support. These findings underscore the importance of providing comprehensive, individualised support for patients and caregivers to improve their quality of life and coping experiences.

Patient or Public Contribution

No Patient or Public Contribution. This study aims to analyse and synthesise the experiences and perspectives of patients and their caregivers reported in existing research. As no original data were collected and no direct interaction with patients or the public occurred, specific patient or public contributions are not included.

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