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Examine the relationships between workplace trust, interpersonal trust, and nurses' physical and mental health, and specifically investigate the mediating role of resilience.
Nurses are central to healthcare delivery but frequently experience workplace violence, adversely affecting their well-being. Trust represents a higher-order mechanism that fosters positive attitudes and professional growth, potentially safeguarding nurses' resilience in coping with adversity. However, research elucidating how trust influences nurses' health via resilience remains limited.
A cross-sectional study was conducted using convenience sampling. A total of 2855 clinical nurses from general hospitals in Fujian Province, China, were surveyed between August and October 2022. Workplace trust and interpersonal trust were served as independent variables, Physical Component Summary and Mental Component Summary scores as dependent variables, and resilience as a mediator. Mediation analysis was performed using Mplus 8.3. The study was prepared and reported according to the STROBE checklist.
Mean scores were Physical Component Summary: 51.12 ± 8.90, and Mental Component Summary: 48.20 ± 10.18. Workplace trust had significant direct effects on both Physical Component Summary and Mental Component Summary. Interpersonal trust had no significant direct effects on Physical Component Summary or Mental Component Summary. Resilience demonstrated significant mediating effects: for workplace trust on Physical Component Summary and on Mental Component Summary; and for interpersonal trust on Physical Component Summary and on Mental Component Summary.
Workplace trust directly enhances nurses' physical and mental health. While interpersonal trust lacks a direct link to health outcomes, both workplace and interpersonal trust significantly improve nurses' health indirectly by bolstering resilience. Resilience serves as a critical pathway through which trust fosters well-being.
No patient or public contribution.
Nurse managers and healthcare administrators should prioritise interventions to cultivate workplace trust (e.g., fostering trust among colleagues, and between nurses and the organisation/management) and strengthen interpersonal trust and psychological resilience. Enhancing these protective factors will better equip nurses to manage occupational and personal stressors, ultimately safeguarding and improving their physical and mental health.
To investigate diabetes family involvement, including supportive and nonsupportive family behaviours in China, and explore the relationships among opposite forms of family involvement, diabetes self-management and glycaemic control.
A cross-sectional study.
Type 2 diabetes patients were recruited from hospitals in Nanjing, Shanghai and Jinan, and communities across China, between April 2023 and August 2023. A total of 1648 patients completed questionnaires regarding diabetes family involvement, diabetes self-management, perceived glycaemic control and patient characteristics. Data analysis was conducted using SPSS 26.0 and PROCESS macro.
The mean scores for supportive and nonsupportive family behaviours were 19.14 out of 40 and 12.47 out of 30, respectively, resulting in an overall family involvement score of 6.67. Overall family involvement, especially supportive family behaviours, was positively related to diabetes self-management and perceived glycaemic control, whereas nonsupportive family behaviours were not. Diabetes self-management partially mediated the relationships between both overall family involvement and supportive family behaviours with perceived glycaemic control.
Diabetes family involvement was suboptimal. Overall family involvement, especially supportive family behaviours, could not only directly improve glycaemic control but also indirectly enhance it through promoting diabetes self-management.
The findings highlight the importance of promoting supportive family involvement and patient self-management in diabetes management.
This study endorses the necessity for healthcare professionals to integrate the family unit into diabetes management and implement interventions at the family unit level, to address the neglect of families in current interventions. It also advocates for promoting supportive family involvement rather than all family involvement in future interventions. Promoting supportive family involvement and patient self-management can better improve patients' glycaemic control and alleviate the burden on medical and social systems.
This study adheres to the STROBE guideline of reporting.
No Patient or Public Contribution.
Symptom networks offer a new approach to explore the relationships among various symptoms and provide information for optimising precise symptom management strategies. However, no previous studies have identified the central symptoms of multidimensional frailty.
A cross-sectional study was conducted from December 2023 to March 2024 in China.
A total of 933 community-dwelling older adults (aged 60 years or older) in China were recruited via convenience sampling.
Sociodemographic variables, clinical variables and scores on the Tilburg Frailty Indicator were assessed in all participants. The qgraph package and IsingFit package of R software were applied to construct the symptom network. Three node centrality indices (strength, betweenness and closeness) and the expected influence were calculated to identify the central symptoms of the multidimensional frailty network. All statistical analyses were performed in R.
A total of 933 individuals were surveyed in this study, including 472 (50.6%) females. The median age of all participants was 71.0 years. A total of 408 subjects were assessed as multidimensional frailty. The prevalence of multidimensional frailty was 43.7%. The centrality indices revealed that ‘difficulty in walking’, ‘difficulty in maintaining balance’, and ‘feeling down’ were the symptoms with the largest strength and expected influence values.
This study primarily utilised network analysis to construct a symptom network of multidimensional frailty among community-dwelling older adults. The findings revealed that difficulty in walking, difficulty in maintaining balance, and feeling down were the most central symptoms.
This study identified the central symptoms of multidimensional frailty in older adults, which may serve as primary intervention targets. Nursing staff could incorporate targeted physical and psychological interventions into person-centred care plans.
This study was reported in accordance with the STROBE guidelines.
No patient or public contribution was involved in this study.
To identify and describe instruments used to assess obstetric violence and evaluate their methodological quality and psychometric properties.
A scoping review.
Ten databases [Medline (via PubMed), Web of Science, the Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SinoMed, Wanfang Database, China National Knowledge Infrastructure (CNKI), VIP Database and China Medical Journal Full-text Database] were searched from inception to June 2025.
Studies focusing on the development or validation of obstetric violence measurement tools were eligible for this review. Methodological quality and psychometric properties were evaluated using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and criteria.
A total of 19 studies encompassing 25 obstetric violence measurement tools were included. These studies were conducted in 15 countries between 2018 and 2025. The tools targeted postnatal and pregnant women, healthcare providers, students and other populations. Most studies reported data on content validity, structural validity and internal consistency. Limited information was available on cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity and responsiveness.
This review identified multiple obstetric violence instruments used across diverse populations and settings. Whilst the methodological quality and measurement properties of the included tools were sub-optimal, they nevertheless provide a foundation for the timely assessment of obstetric violence and subsequent research.
Future research should prioritise the establishment of a unified definition of obstetric violence, alongside the development, adaptation and rigorous validation of measurement instruments to enhance their reliability and validity.
This review underscores the need for maternity care professionals and educators to critically evaluate existing tools for measuring obstetric violence, given their current methodological limitations.
The PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist.
No patient or public contribution.
Loneliness and social isolation are prevalent and persistent in cancer patients, affecting their psychosocial adjustment. Non-pharmacological interventions have been shown to be effective in previous studies; however, the most effective types of non-pharmacological interventions for this population remain unclear.
The aim of this systematic review and network meta-analysis (NMA) was to synthesize the existing evidence and compare the effectiveness of different types of non-pharmacological interventions in treating loneliness and social isolation among cancer patients.
A systematic search was conducted in PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE databases from their inception to December 2024. Randomized controlled trials (RCTs) evaluating non-pharmacological interventions targeting loneliness and social isolation in cancer patients were included. NMA was performed using Stata 17.0 software under a frequentist framework.
A total of 13 RCTs were included, including 9 non-pharmacological interventions and 1151 cancer patients. In order of probability, group logotherapy (SUCRA: 99.9%, SMD: −1.62, 95% CI: −2.23 to −1.01) was the most effective intervention for alleviating loneliness and social isolation, followed by psychoeducational therapy (SUCRA: 76.9%, SMD: −0.62, 95% CI: −1.16 to −0.07) and supportive expressive group therapy (SUCRA: 65.7%, SMD: −0.40, 95% CI: −0.75 to −0.05).
The NMA suggests that, in terms of short-term efficacy, group logotherapy may be considered the optimal choice for reducing loneliness and social isolation levels in cancer patients. Healthcare professionals could regularly conduct group logotherapy among cancer patients to promote their psychosocial adaptation.
PROSPERO Registration Number: CRD42024616937
At-risk mothers experience disproportionately higher rates of antenatal depression and anxiety, which can hinder mother–infant bonding and adversely affect infant socioemotional development. Despite growing evidence on postpartum mental health, antenatal risk factors among psychosocially vulnerable mothers remain underexplored, particularly in multi-ethnic Asian settings.
To identify factors associated with antenatal depression, anxiety, and maternal–fetal bonding among at-risk mothers.
This cross-sectional observational study was nested within an ongoing randomised controlled trial. Two hundred at-risk mothers, defined as single, of low socioeconomic status, referred for psychosocial support, at risk of depression, with adverse childhood experiences, or with a fetus with a congenital malformation, were recruited from outpatient obstetric clinics between February and September 2024. Participants completed online self-administered questionnaires assessing antenatal depression, anxiety, perceived stress, social support, parenting self-efficacy, and maternal–fetal bonding. General Linear Models were used to analyse data and identify factors associated with depression, anxiety, and bonding.
Higher perceived stress was associated with increased depression (β = 0.28, p < 0.001) and anxiety (β = 1.28, p < 0.001) and poorer bonding (β = 0.08, p = 0.02), while greater social support predicted lower anxiety (β = −0.31, p < 0.001). Higher parenting self-efficacy was linked to stronger bonding (β = −0.09, p = 0.06). Younger mothers (β = −2.68, p = 0.025) and Indian mothers (β = 7.46, p = 0.017) were particularly vulnerable to anxiety, whereas post-secondary education was protective against depression (β = −1.44, p = 0.02). Model fit ranged from 0.14 to 0.65.
Perceived stress, social support, and parenting self-efficacy significantly influenced antenatal mental health and bonding in at-risk mothers. These findings underscore the need for culturally sensitive, nurse/midwife-led interventions that integrate early screening, stress reduction, and empowerment strategies within routine antenatal care to strengthen maternal mental health and early bonding outcomes.
(1) Nurses and midwives play a critical role in screening for antenatal depression and anxiety in mothers with risk profiles highlighted in this study. (2) Culturally responsive nursing practice that demonstrates sensitivity towards sociocultural pressures is needed to provide individualised care. (3) Integration of digital and community-based antenatal education programs could provide more equitable access to care for at-risk mothers who may face barriers to in-person care.
(1) Despite having a higher susceptibility for antenatal mental health conditions, risk factors for antenatal depression, anxiety, and maternal–infant bonding have been underexplored in at-risk mothers. (2) Antenatal stress and anxiety are universally associated with depression across risk groups, while maternal self-efficacy and perceived social support serve as key protective factors. (3) The findings from this study suggest the need for early screening and nurse-led interventions that support maternal parenting self-efficacy and stress management to improve maternal mental health outcomes among at-risk mothers.
STROBE reporting checklist.
No patient or public contribution.
To investigate how leadership support influences nurses' innovation behaviour through the chain mediation of creativity, role identity and knowledge sharing.
Despite the recognised role of leadership in fostering innovation, the mechanisms linking leadership support to nurses' innovative behaviours remain under explored. Clarifying how creativity, role identity and knowledge sharing mediate this relationship is critical for optimising nursing practices.
This was a quantitative cross-sectional study.
A cross-sectional survey was conducted in March 2024 to collect data using the Leadership Innovation Support Scale, Creativity Role Identity Scale, Knowledge Sharing Scale and Nurses' Innovative Behavior Scale. Descriptive analysis, correlation analysis and chain-mediated effect analysis were performed using SPSS 26.0.
We found a positive relationship between leadership support and nurses' innovation behaviour; creativity role identity and knowledge sharing played a mediating role in this relationship. Moreover, there was a significant chain mediating effect of creativity role identity and knowledge sharing on the relationship between leader support and nurses' innovation behaviour.
Creativity role identity and knowledge sharing act as a chain-mediated mechanism between leadership support and nurses' innovative behaviours. Therefore, hospital managers should focus on the level of leadership support for innovation among nurses and implement targeted measures focusing on creativity role identity and knowledge sharing to improve nurses' innovation.
To promote the development of innovation in healthcare institutions, motivating nurses' innovative behaviour has become a key focus. Based on role identity theory and social exchange theory, this study explores the chain mediation effects of innovative role identity and knowledge sharing between leadership support and nurses' innovative behaviour. This suggests that supervisors can enhance support to help nurses better recognise their role in the innovation process, promoting the exchange of experiences and sharing of innovative outcomes, thereby further stimulating the overall innovation ability of the team.
None.
Nursing as a profession remains underrepresented in research leadership, funding success and scholarly authorship globally, which limits its influence on policy and practice. Within this broader context, racially minoritised nursing academics, including Black academics, face additional inequities that further hinder their visibility and progression. Evidence from the United States, Canada and Australia highlights persistent barriers to research careers and leadership opportunities for Black nurses. In the United Kingdom, these disparities are particularly evident: Black nursing academics face barriers to conducting research while in the wider National Health Service workforce, Black nurses are twice less likely than their White counterparts to be promoted. Together, these patterns constrain career progression and hinder the development of culturally competent healthcare education and practice.
To explore the barriers to conducting research among Black nursing academics working in UK universities that are not traditionally research intensive, and to co-create pragmatic, theory-informed recommendations for enabling supportive and equitable research environments.
A qualitative multi-study design underpinned by Intersectionality Theory and The Silences Framework.
Two work packages are proposed. Work Package 1 will use semi-structured interviews to explore the experiences and barriers of conducting research among up to 15 Black nursing academics based at UK universities that are not research-intensive. Work Package 2 will adopt a modified Delphi methodology, engaging key collaborators in two rounds of online codesign workshops. Findings from Work Package 1 will inform structured discussions in which collaborators will develop theory-informed, pragmatic recommendations to strengthen research capacity and engagement among Black nursing academics.
This study will address the persistent underrepresentation of Black nursing academics in research. While grounded in the UK, the anticipated outputs will have wider applicability, informing policy, shaping institutional strategies and guiding future research priorities across diverse academic and healthcare systems worldwide.
To identify factors associated with job embeddedness from the perspective of retaining new graduate nurses.
The study was cross-sectional in design.
Convenience and stratified sampling were used to recruit 415 newly graduated nurses from 12 tertiary hospitals in China. Anonymized data were collected through self-designed sociodemographic questionnaires, job embeddedness scale, feedback-seeking behaviour scale, authentic leadership perception scale and decent work scale. Appropriate indicators were used for descriptive statistics and t-tests, ANOVA, Pearson correlation analysis and multiple linear regression to examine the influencing factors.
The study showed that monthly income level, decent labour, authentic leadership and feedback-seeking behaviour were significant predictors of job embeddedness among new graduate nurses.
The job embeddedness of new graduate nurses is moderate. Nursing managers need to construct reasonable and fair compensation incentives, adopt positive leadership styles and encourage proactive feedback-seeking behaviours to improve the job embeddedness of new graduate nurses and alleviate the nursing talent shortage.
Exploring the factors influencing the job embeddedness of new graduate nurses provides a reference for establishing new graduate nurse retention strategies to help promote the career development of new graduate nurses and alleviate the nursing brain drain.
We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
No patient or public contribution.
To examine the personal characteristics, promoting factors and organisational barriers to the professional realisation of diabetes nurse practitioners in Israel.
A descriptive study using quantitative and qualitative data.
The participants self-completed an electronic questionnaire, which included questions on demographic and professional characteristics and a self-realisation questionnaire constructed by the authors. Researcher-led focus groups were conducted, guided by a semi-structured guide. The discussions were recorded, transcribed and analysed by qualitative methods.
Forty-one diabetes nurse practitioners (median age 50 years, 98% females) participated in the study. On average, the participants reported a relatively high self-realisation of their professional role, especially those who have been working in this role for many years. While some of them work independently and are supported by their organisation, their managers and other healthcare team members, specifically physicians, many feel that there are barriers to the full implementation of the role and achieving professional realisation. These include multitasking challenges and insufficient remuneration. Self-realisation was viewed by the participants as an opportunity to provide excellent care to patients as well as being professional beyond caring for patients. They wanted to expand their knowledge as well as guide and teach. Furthermore, they also associated self-realisation with the autonomy to carry out procedures and make decisions independently of physicians. Internal motivation was perceived as an important factor for personal self-realisation, which stems from personal creativity, aspiration for excellence, a subjective sense of freedom, self-guidance, desire for self-development and aspiration for personal growth at the highest levels.
Recognition and fostering of diabetes nurse practitioners' role contribute to nurses' self-realisation and professional growth.
Personal and organisational factors should be aligned to support diabetes nurse practitioners in delivering high-quality care to patients with diabetes.
COREQ (COnsolidated criteria for REporting Qualitative research).
No patient or public contribution.
To quantify how specific patient-level characteristics influence the actual amount of mobilisation received during ICU care, thereby identifying key predictors to support individualised mobilisation strategies.
A prospective observational study was conducted in four tertiary hospitals among a convenience sample of 141 critically ill patients from July to November 2023. Data on mobilisation and patient characteristics were collected using standardised data collection tools, including a mobilisation log and a demographic information sheet. Data were analysed using non-parametric tests, Spearman correlation analysis, and multivariate regression to examine associations between early mobilisation and patient-related factors.
Males and surgical patients engaged in more activity (p < 0.001). Muscle strength (r = 0.568, p < 0.001) and haemoglobin levels (r = 0.207, p = 0.014) were positively associated with mobilisation, while higher disease severity (r = −0.321, p < 0.001) and greater pain (r = −0.284, p < 0.001) were linked to reduced activity. Muscle strength, disease severity, surgical status, and sex were independent predictors, explaining 32.5% of the variance.
Early mobilisation in the ICU is influenced by various patient-related factors. Protocols should be tailored to individual patient profiles to enhance outcomes.
This study provides guidance for ICU clinicians to develop targeted mobilisation strategies that consider patients' specific clinical profiles. Tailored approaches may help optimise early mobilisation practices and patient outcomes.
Cognitive decline, including subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia, significantly affects social participation, leading to social isolation and reduced quality of life. Enhancing social participation through interventions may mitigate these effects, yet evidence on intervention effectiveness and mechanisms remains inconsistent.
To evaluate the effectiveness of social participation interventions for individuals with cognitive decline and identify effective behavior change techniques (BCTs) supporting social participation.
Our search using the following databases—PubMed, Web of Science, Embase, Cochrane Library, CINAHL, Scopus, CNKI, and Wanfang—was conducted until October 2024. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomized trials. Meta-analyses were conducted using Review Manager 5.4 and Stata18, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Sixteen RCTs involving 2190 participants were included. Music therapy (SMD = 0.62, 95% CI [0.15, 1.10]) and reminiscence therapy (SMD = 0.34, 95% CI [0.02, 0.66]) demonstrated significant positive effects on social participation. Group-based interventions were particularly effective (SMD = 0.23, 95% CI [0.04, 0.43]). Commonly used BCTs included goal setting, behavioral practice/rehearsal, and social support. However, substantial heterogeneity and limited data on SCD and MCI restricted generalizability.
Interventions promoting social participation may enhance engagement for individuals with cognitive decline, particularly through music therapy, reminiscence therapy, and group-based formats. The complexity and dynamic nature of social interaction require individuals to engage and integrate various cognitive functions and skills, which can present significant challenges for older adults with cognitive impairments in their daily social participation. Further research is needed to optimize intervention components and address gaps in targeting early cognitive decline stages.
Individuals with systemic lupus erythematosus (SLE) often suffer from sleep disturbance, which exhibits heterogeneity. Whether it could be grouped into different clusters remains unknown, posing challenges to the development of personalised interventions to address sleep disturbance.
To examine clusters of sleep disturbance and associated factors in people with SLE.
Cross-sectional design.
From November 2023 to January 2024, people diagnosed with SLE were recruited by a convenience sampling approach. Data were collected via an online platform Wenjuanxing. Sleep disturbance was evaluated by the Pittsburgh Sleep Quality Index (PSQI). Other information, such as disease activity, pain, fatigue, depression and anxiety was also collected using validated instruments. Latent profile analysis was performed to reveal the distinct clusters of sleep disturbance. Multiple logistic regression analysis was performed to investigate factors associated with the clusters.
A total of 538 participants were included, with a response rate of 85.1% (538/632). Only those with sleep disturbance (PSQI > 5) were included in the final analyses. Participant mean age was 32.9 (SD = 8.4) years and 402 (92.6%) were females. All had sleep disturbance (PSQI > 5) and their mean PSQI was 8.8 (SD = 2.9). Three distinct clusters were identified: mild sleep disturbance with poor sleep quality, adequate sleep duration and good daytime functioning (50.7%), mild sleep disturbance with poor sleep quality, adequate sleep duration and poor daytime functioning (30.9%) and moderate sleep disturbance with poor sleep quality, inadequate sleep duration and impaired daytime functioning (18.4%). There are both overlaps and unique aspects in terms of factors associated with each cluster of sleep disturbance, including age, body mass index, cardiovascular system damage, musculoskeletal system damage, depression and anxiety.
Sleep disturbance in patients with SLE showed three distinct clusters, with each cluster having slightly different predisposing factors.
In clinical practice, nurses are recommended to prioritise assessment and interventions for those at-risk subgroups. They could also use the above information to develop and provide personalised interventions to address the unique needs of each cluster of sleep disturbance.
Checklist for reporting of survey studies.
No patient or public contribution.
We aimed to elucidate the underlying mechanisms influencing Oral nutritional supplementation (ONS) adherence in postoperative patients with gastric cancer (GC) by developing a structural equation model.
ONS represents a cost-effective nutritional intervention for postoperative patients with GC, with its efficacy largely dependent on sustained patient adherence over time. However, the interrelationships among the quality of discharge teaching (QDT), readiness for hospital discharge (RHD), medication beliefs and adherence to ONS remain inadequately understood.
A convenience sample of 505 postoperative patients with GC was recruited from January 1, 2023, to December 1, 2024, for a cross-sectional survey conducted at a tertiary-grade A specialised oncology hospital. The data of this study were subjected to descriptive analysis, Harman's one-way analysis of variance, Pearson correlation analysis and mediation effect analysis.
The STROBE checklist was employed for reporting in the study.
Pearson correlation analyses revealed that all four variables were significantly interrelated. Structural equation modelling showed that medication beliefs had the strongest correlation with ONS adherence (β = 0.589), followed by readiness for hospital discharge (RHD) (β = 0.557) and quality of discharge teaching (QDT) (β = 0.523). The structural equation model demonstrated a robust overall fit.
There was a significant chain mediation effect through RHD and medication beliefs. For the development of targeted intervention strategies to improve ONS adherence, future research should prioritise enhancing QDT, optimising RHD and strengthening patients' medication beliefs.
To help nurses and nursing managers formulate intervention measures to improve QDT, RHD, medication beliefs and ONS adherence in postoperative patients with GC.
Background
The complex work of public health nurses (PHNs) specifically related to mental health assessment, intervention, and outcomes makes it difficult to quantify and evaluate the improvement in client outcomes attributable to their interventions.
Objectives
We examined heterogeneity across parents of infants served by PHNs receiving different interventions, compared the ability of traditional propensity scoring methods versus energy-balancing weight (EBW) techniques to adjust for the complex and stark differences in baseline characteristics among those receiving different interventions, and evaluated the causal effects of the quantity and variety of PHN interventions on client health and social outcomes.
Methods
This retrospective study of 4,109 clients used existing Omaha System data generated during the routine documentation of PHN home visit data. We estimated the effects of intervention by computing and comparing weighted averages of the outcomes within the different treatment groups using two weighting methods: (a) inverse probability of treatment (propensity score) weighting and (b) EBWs.
Results
Clients served by PHNs differed in baseline characteristics with clients with more signs/symptoms. Both weighting methods reduced heterogeneity in the sample. EBWs were more effective than inverse probability of treatment weighting in adjusting for multifaceted confounding and resulted in close balance of 105 baseline characteristics. Weighting the sample changed outcome patterns, especially when using EBWs. Clients who received more PHN interventions and a wider variety of them had improved knowledge, behavior, and status outcomes with no plateau over time, whereas the unweighted sample showed plateaus in outcomes over the course of home-visiting services.
Discussion
Causal analysis of PHN-generated data demonstrated PHN intervention effectiveness for clients with mental health signs/symptoms. EBWs are a promising tool for evaluating the true causal effect of PHN home-visiting interventions. 
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