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To evaluate the feasibility, effectiveness, and acceptability of a spherical video-based virtual reality training programme aimed at helping nurses manage workplace violence.
A convergent mixed-methods study.
This study included nurses from a tertiary medical centre in Taiwan. The training programme involved four interactive 360° scenarios focused on recognising, de-escalating, and responding to workplace violence. Quantitative measures included risk perception, confidence in coping with aggression, and technology acceptance. Qualitative measures included the participants' learning experiences. Quantitative and qualitative findings were integrated through joint displays.
The programme was feasible, with all participants completing the training. Nurses reported high levels of perceived usefulness and ease of use. Quantitative data revealed considerable improvements in risk awareness and confidence in responding to incidents of violence. Qualitative data revealed that immersion and emotional resonance enhanced engagement, fostered self-reflection, and reinforced learning. Technical challenges included subtitle placement and speech recognition accuracy.
Spherical video-based virtual reality is a feasible, acceptable, and effective training approach that improves nurses' preparedness for managing workplace violence by enhancing situational awareness and confidence in addressing high-risk situations.
Integrating spherical video-based virtual reality into continual education may strengthen nurses' workplace safety competencies, prevent harm from incidents of violence, and improve patient care in stressful environments.
Workplace violence undermines nurse safety and patient care. Current training modules often lack contextual realism. Our programme improved nurses' awareness, confidence, and reflective learning and was feasible and well accepted. The findings are relevant to nursing educators, hospital administrators, and policymakers seeking sustainable strategies for addressing workplace violence.
This study adhered to the Revised Standards for Quality Improvement Reporting Excellence.
Patients or the public were not involved in the design, conduct, or reporting of this study.
To identify the latent frailty trajectory and explore corresponding predictors among older adults living with frailty who experience hip fracture surgery within 3 months after discharge.
From December 2022 to November 2024, 178 individuals were consecutively enrolled in a longitudinal observational study conducted at a tertiary hospital in Zhejiang Province, China.
The Reported Edmonton Frail Scale measured the frailty level at 5 points, which included baseline (pre-fracture), at discharge, 2 weeks, 1 and 3 months after discharge. Latent class growth models were set up for the frailty trajectory. Multinomial logistic regression was performed to explore the predictors of frailty trajectory classes.
One hundred fifty-three participants completed the full follow-up. Latent class growth models identified 3 frailty trajectories. Class 1: moderate frailty transformed to severe frailty (n = 27; 17.65%); Class 2: mild frailty transformed to moderate frailty (n = 86; 56.20%); Class 3: pre-frailty transformed to mild frailty (n = 40; 26.15%). A higher-level D-Dimer at admission and the five-item version of the Geriatric Depression Scale increased the incidence of Class 2 compared to Class 3. The higher scores of the Abbreviated Mental Test decreased the incidence of Class 2 compared to Class 3. Longer surgical waiting time, a higher-level five-item version of the Geriatric Depression Scale and the Age-Adjusted Charlson Comorbidity Index increased the incidence of Class 1 compared to Class 3. The higher scores of the Abbreviated Mental Test and Mini Nutritional Assessment Short Form decreased the incidence of Class 1 compared to Class 3.
Three frailty trajectory classes were identified among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories.
Modifiable factors such as improving nutrition and cognitive status and managing depression, comorbidities and preoperative evaluations provide methods for future interventions to prevent or mitigate frailty among this population.
What problem did the study address? Frailty is an inherent dynamic among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. Some factors affect the mitigated frailty process in this population. What were the main findings? Three frailty trajectory classes were identified in this study. And the level of their frailty worsens 3 months after surgery compared to pre-fracture. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories. Where and on whom will the research have an impact? The findings of this study provide screening, intervention and discharge plan evidence for healthcare workers in orthopaedics and geriatrics Departments. Helping community healthcare workers and primary caregivers set the theoretical basis for home-based intervention programs.
We have adhered to relevant EQUATOR guidelines using the STROBE reporting method.
No patient or public contribution.
This study aimed to investigate the network structural characteristics of self-efficacy and professional resilience among emergency nurses, identify core nodes within the network, and elucidate the key interactive mechanisms between these constructs.
Descriptive cross-sectional study.
A multi-center cross-sectional study was conducted from January to February 2025, involving 612 emergency nurses from 20 hospitals in Sichuan, China. Data were collected using a self-administered demographic questionnaire, the General Self-Efficacy Scale, and the Chinese Emergency Nurse Professional Resilience Tool. An adjacent network integrating professional resilience and self-efficacy was developed. Key covariates—including title, position, tenure in the hospital or emergency department, education, and exposure to workplace violence—were included as control variables. Network precision and stability were evaluated using the correlation stability coefficient and confidence intervals for edge weights. To further test the robustness of the network model, sensitivity analyses were performed by adding each significant covariate to the original model. The Network Comparison Test was then used to compare the covariate-adjusted and unadjusted networks, assessing differences in network structure, overall strength, and edge weights.
The analysis identified S9 as the central node in the network. The overall network showed satisfactory stability and precision. The Network Comparison Test showed no significant differences in network structure or global strength between the adjusted and unadjusted models, indicating that the network was stable and robust to covariate adjustment.
This network analysis revealed the interaction mechanisms between self-efficacy and professional resilience among emergency nurses through contemporaneous network modelling and identified S9 as the core node, suggesting that this coping strategy plays a key role in regulating psychological resources. The overall network demonstrated good stability and precision, with no statistically significant differences between the adjusted and unadjusted models according to the Network Comparison Test. These findings indicate that the network structure was robust to covariate adjustment and provide a reference for developing and optimising intervention strategies to enhance professional resilience among emergency nurses.
For Emergency Nurses and the Management of Emergency Nursing Practice: What problem does this study address?
This study addresses the gap in understanding how self-efficacy and occupational resilience interact in emergency nurses under high-stress conditions.
A contemporaneous network analysis revealed a central node linking self-efficacy and resilience, highlighting key pathways in their mutual influence.
The findings offer practical guidance for emergency nursing management, supporting the development of targeted strategies to strengthen nurses' resilience, enhance professional competence, and improve the quality of emergency care.
This study is reported using the STROBE guidelines.
No Patient or Public Involvement: This study did not include patient or public involvement in its design, conduct, or reporting.
To systematically review published studies on fall risk prediction models for inpatients.
A systematic review and meta-analysis of prognostic model studies.
A literature search was carried out in Web of Science, the Cochrane Library, PubMed, Embase, CINAHL, SinoMed, VIP Database, CNKI and Wanfang Database. The search covered studies on risk prediction models for falls in inpatients from inception to March 9, 2024.
The research question was formulated using the PICOTS framework. Data extraction was performed following the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). The quality of studies related to risk prediction models was evaluated with the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was conducted using STATA 18.0 software.
A total of 15 studies were included, with 13 eligible for meta-analysis. Only 2 of these 15 studies had external validation. The reported AUC values ranged from 0.681 to 0.900. The overall risk of bias was high, mainly attributed to inappropriate data sources and improper processing in the analysis domain. The pooled AUC from the meta-analysis was 0.799. After reviewing the predictors included in various models, FRIDs, fall history, age, gait, mental status, gender and incontinence were relatively common.
The fall risk prediction model for inpatients performs well overall, but it has a high risk of bias. Future development of risk prediction models should strictly adhere to the PROBAST, combine clinical reality, optimise study design and improve methodological quality.
This study provides medical professionals with a clear overview of constructing fall risk prediction models for inpatients. The fall-related predictors in these models help healthcare providers identify high-risk patients and implement preventive strategies. It also offers valuable insights for the development of future prediction models.
This study did not include patient or public involvement in its design, conduct, or reporting.
We aimed to identify the barriers and facilitators to participation in interventions aimed at improving cognitive function among older adults with type 2 diabetes mellitus (T2DM) and mild cognitive impairment (MCI) in rural areas.
This study is the qualitative phase of a larger randomised controlled trial and employs a descriptive approach.
We conducted in-depth, semi-structured face-to-face interviews with older adults diagnosed with T2DM and MCI in rural areas of China in November 2023. The interviews were guided by the Capability, Opportunity, Motivation, and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). The interview recordings were transcribed and analysed using NVivo V.11 software. Two research assistants independently coded the transcriptions, and the identified barriers and facilitators were mapped to the corresponding domains within the COM-B model and TDF.
A total of 26 older adults, aged 60–87, participated in the interviews. Nine themes were identified, including disease awareness, disease attitude, social interaction, responsibility and health, emotion guidance, organisational management, expertise and benefits, self-perception and role identity crisis. These themes mapped onto the three core components of the COM-B model as well as the nine domains of the TDF, which include: knowledge, environmental context and resources, social influences, intentions, emotions, reinforcement, beliefs about consequences, beliefs about capabilities and social identity.
Addressing barriers and leveraging facilitators can effectively enhance the willingness of elderly patients in rural areas to participate in interventions aimed at improving cognitive function. A multi-layered approach should be adopted, focusing on disease knowledge and attitudes, social interactions, the impact of the disease burden on both family and individuals, emotional state, organisational management, team expertise and timely assessment, individual self-efficacy and role perception.
The study adheres to the COREQ reporting guidelines.
The participants in this study were older adults with T2DM and MCI from rural areas. Participants were involved in the development of the interview guide and were subsequently interviewed regarding the facilitators and barriers to their participation in cognitive function interventions.
To explore survivors' perspectives and experiences of psychological detachment while living with a stoma.
A qualitative descriptive study was conducted. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
A total of 15 semi-structured interviews were conducted between February 2024 and May 2024. The phenomenological method proposed by Colaizzi was used to analyze the data.
Four major themes emerged from the analysis: (1) Trapped in the Persistent Impact of Dual Traumas: Struggles with Adaptation; (2) Trapped by the Unrelenting Burden of Stoma Care: A Cycle of Powerlessness; (3) Trapped by the Shackles of a Stigmatised Identity: The Dilemma of Social Reintegration; and (4) Divergent Pathways of Detachment: Navigating Between Immersion and Transcendence. Within the main themes, eight subthemes were formulated.
This study thoroughly explored and elucidated the psychological detachment experiences of colorectal cancer survivors with a stoma, revealing its key role in mental health recovery and psychosocial rehabilitation and informing clinical interventions.
The study suggests that healthcare staff should guide survivors in drawing a clear boundary between stoma care and their personal life, encourage any correction of erroneous social cognition, and promote the positive development of psychological detachment among survivors.
This study explored the challenges of psychological detachment in stoma survivors, identifying key barriers like trauma, care burden, role misconceptions, and varying detachment levels. The findings can guide healthcare providers in supporting survivors' mental well-being and inform better survivorship care strategies.
There was no patient or public contribution.
Surrogates make decisions for critically ill patients in intensive care units (ICUs). Because such decisions are critical, many surrogates experience decisional conflict, which can lead to long-term regret and psychological distress. Understanding surrogates' needs during decision-making, particularly when invasive procedures are involved, is essential to improving patient outcomes.
To identify and analyse the needs of surrogates and the decisional conflict they experience during the decision-making process for invasive procedures in ICUs.
This convergent, parallel, mixed-methods study was conducted at a tertiary medical centre in southern Taiwan. Eligible participants were surrogates aged 20 years or older. The patients represented by these surrogates had a Glasgow Coma Scale (GCS) score of < 12 and were expected to undergo at least one invasive procedure. Quantitative data were collected from 100 surrogates using a structured questionnaire assessing decisional conflict and needs, and qualitative data were obtained through in-depth interviews with 13 surrogates.
The following factors were significantly associated with decisional conflict: lower education level (β = −6.24, p = 0.042), lower family income (β = −9.91, p = 0.027), and resuscitative types of invasive procedure (β = −6.40, p = 0.045). Information needs were the most critical because information is often overwhelming without a medical background. Meeting surrogates' support needs, including the need for support from family members, can help reduce isolation in decision-making. The findings also indicate that internal resources played a key role in alleviating decisional conflict in surrogates.
The informational, support, and resource needs of surrogates play a critical role in decision-making for invasive procedures. Their informational needs primarily indicate difficulties in comprehending and integrating complex medical information within a limited timeframe. Clear, structured communication and emotional support may reduce decisional conflict and long-term regret.
This study aims to explore the trajectories and co-occurrence of perceived control and caregiver self-efficacy among patients with heart failure (HF) and their caregivers within 3 months post-discharge and identify associated risk factors.
A prospective cohort design.
A prospective cohort study was conducted from March to June 2024 in Tianjin, China. Information on perceived control and caregiver self-efficacy was collected 24 h before discharge, 2 weeks, 1 month, and 3 months after discharge. Group-Based Dual Trajectory Modelling (GBDTM) and logistic regression were used for analysis.
The study included 203 dyads of patients with HF and their caregivers (HF dyads). Perceived control identified three trajectories: low curve (15.3%), middle curve (57.1%) and high curve (27.6%). Caregiver self-efficacy demonstrated three trajectories: low curve (17.2%), middle curve (56.7%) and high stable (26.1%). GBDTM revealed nine co-occurrence patterns, with the highest proportion (36.7%) being ‘middle-curve group for perceived control and middle-curve group for caregiver self-efficacy’, and 16.7% being ‘high-curve group for perceived control and high-stable group for caregiver self-efficacy’. Age, gender, household income, NYHA class, symptom burden and psychological resilience were identified as risk factors for perceived control trajectories; marital status, regular exercise and psychological resilience were identified as risk factors for caregiver self-efficacy trajectories.
We identified distinct trajectories, co-occurrence patterns and risk factors of perceived control and caregiver self-efficacy among HF dyads. These findings help clinical nurses to better design and implement interventions, strengthening the comprehensive management and care outcomes for HF dyads.
These findings highlighted the interactive relationship between perceived control and caregiver self-efficacy trajectories, suggesting that interventions should boost both to improve personalised treatment plans and outcomes for HF dyads.
This study adhered to the STROBE checklist.
Patients and their caregivers contributed by participating in the study and completing the questionnaire.
To describe self-care behaviours and explore factors associated with self-care behaviours in older adults with multiple chronic conditions (MCCs).
The prevalence of MCCs is increasing in a rising trend. MCCs complicate the self-care behaviours of older adults. There is limited evidence regarding the factors associated with self-care behaviours in older adults with MCCs.
A cross-sectional design was adopted using the convenience sampling method.
Participants were recruited from a community health service centre. Measurements included the Self-Care of Chronic Illness Inventory, a single item for loneliness, the 6-item Lubben Social Network Scale, the 4-item Patient Health Questionnaire, the 15-item Tilburg Frailty Indicator, and a self-developed questionnaire for sociodemographic and disease-related characteristics. Descriptive statistics were used as appropriate. Multiple linear regression and multivariate logistic regression were adopted to examine the influencing factors.
A total of 223 participants were enrolled in this study. Among the 223 participants, 49.3%, 32.7% and 28.7% achieved a cut-off score of ≥ 70 in self-care maintenance, monitoring and management, respectively. The linear regression models indicated that smoking status, frailty and self-care confidence were significantly associated with self-care maintenance; education level, per capita monthly household income and self-care confidence were significantly associated with self-care monitoring; and employment status and self-care confidence were significantly associated with self-care management. In addition, multivariate logistic regression showed that living in cities or towns was significantly associated with higher odds of adequate self-care management.
Three domains of self-care behaviours were influenced by distinct factors, and self-care confidence demonstrated consistent associations with all three domains of self-care behaviours. Self-efficacy-focused interventions may have the potential to promote self-care behaviours in older adults with MCCs.
Healthcare providers need to take into account the pivotal factors influencing self-care behaviours of this cohort to deliver structured and effective education and support. Clinicians should consider adopting confidence-building strategies in routine education for this cohort.
We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
No patient or public contribution.
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.
This study aimed to evaluate and rank the effectiveness of various acupoint stimulation therapies in alleviating cancer-related fatigue (CRF), a pervasive and distressing symptom among cancer patients.
CRF severely compromises patients' quality of life across treatment and survivorship stages. Despite growing interest in nonpharmacological interventions, comparative evidence on the efficacy of acupoint stimulation therapies remains limited.
A systematic review and network meta-analysis of 28 randomized controlled trials (RCTs) involving 2370 participants was conducted. Databases searched included MEDLINE, CINAHL, Embase, Cochrane, Web of Science, and Airiti Library. Interventions included acupuncture, acupressure, oil acupressure, moxibustion, and transcutaneous electrical acupoint stimulation (TEAS). Standardized mean differences (SMDs) were calculated using a random-effects model. Surface Under the Cumulative Ranking Curve (SUCRA) was used to rank therapies.
Oil acupressure (SUCRA: 73.6%), relaxing acupressure (73.4%), and acupuncture (72.7%) were the most effective interventions. Both professionally administered and self-administered therapies significantly reduced CRF, with no major differences in efficacy. Subgroup analyses revealed consistent effectiveness across cancer types, particularly breast and lung cancer, and treatment stages.
Acupoint stimulation therapies, especially acupressure and acupuncture, effectively reduce CRF and are suitable for integration into routine cancer care. Self-administered acupressure offers a practical, low-cost alternative, especially in resource-limited settings. Standardization of protocols and long-term studies are warranted to guide clinical implementation.
The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024556455)
Fear of childbirth is common among pregnant women. Mindfulness-based interventions have been used widely in obstetrics. However, the evidence of the effects on fear of childbirth is controversial.
To evaluate the effects of mindfulness-based interventions on fear of childbirth, pain catastrophising, labour pain intensity, use of pain relief medication, mode of delivery and duration of labour among pregnant women planned for normal delivery.
In this systematic review, 10 databases were searched from inception to 7 November 2024. Randomized controlled trials implementing mindfulness-based interventions for fear of childbirth or related outcomes were included. Two reviewers assessed the methodological quality and certainty of evidence independently. Standardized mean difference (SMD), risk ratio (RR), and 95% confidence intervals (CI) were used to evaluate effect sizes.
A total of 16 studies from 15 trials were included. Based on very low to moderate certainty of evidence, mindfulness-based interventions were effective in decreasing fear of childbirth both immediately post-intervention and within 6-week postpartum (SMD: −0.72; 95% CI −0.89, −0.55; SMD: −0.63; 95% CI −0.91, −0.35, respectively), labour pain intensity (SMD: −1.22; 95% CI −2.07, −0.37), caesarean section rate (RR: 0.58; 95% CI 0.36, 0.93), and total duration of labour (SMD: −1.03; 95% CI −1.34, −0.72), and improving mindfulness level both immediately post-intervention and within six-week postpartum (SMD: 0.48; 95% CI 0.31, 0.66; SMD: 0.50; 95% CI 0.27, 0.73, respectively), but had no significant effect on pain catastrophising (SMD: −0.36; 95% CI −0.72, 0.01) and epidural analgesia use rate (RR: 0.77; 95% CI 0.57, 1.03).
Mindfulness-based interventions have potential effects on reducing fear of childbirth and promoting labour-related outcomes. These interventions might be an effective approach in obstetrics clinical practice to enhance the pregnancy and labour experiences among pregnant women.
PROSPERO registration number: CRD42024610793
To examine the relationship among leadership, clinical teaching competencies, and structural empowerment of nursing clinical instructors in China.
A cross-sectional study.
A total of 152 nurses who come from three Grade A tertiary hospitals located in Beijing, Kunming, and Liaoning Province, China, completed an online questionnaire that included general information, clinical teaching information, the Conditions of Work Effectiveness Questionnaire-II, nurse leadership, and structural empowerment. SPSS 26.0 and AMOS 26.0 were used for normality test, descriptive statistics, correlation analysis, regression analysis, and structural equation model.
The study revealed that nurse leadership (r = 0.402) and structural empowerment (r = 0.568) both positively correlated with clinical teaching competencies. Specifically, the level of nurse leadership exhibited a low but direct positive effect on these competencies (β = 0.22), while the level of structural empowerment demonstrated a moderate direct positive effect (β = 0.56).
Enhancing nurse leadership and structural empowerment positively influence the clinical teaching competencies of nursing instructors.
Constructing a structural equation model to describe the relationship between leadership, structural empowerment, and teaching ability can provide the most intuitive direction for future research, so as to better improve the teaching ability of clinical nursing teachers.
No patient or public contribution.
Nursing students are the primary reserve force for hospital nurses. With the shrinking of nurse human resources and the increase in turnover rates, understanding the job preferences of nursing students is crucial for attracting nursing students.
To systematically review published studies on discrete choice experiments involving nursing students.
Ten databases were systematically searched from their inception to January 15, 2025. Two researchers independently used the International Society for Pharmacoeconomics and Outcomes Research checklist to evaluate the quality of the included studies. Thematic analysis was used to classify the attributes into broad categories and corresponding subcategories. The frequency, significance, relative importance, and willingness-to-pay of each attribute in the included studies were analyzed.
Fifteen studies spanning 12 countries were included, with a total of 102 individual attributes extracted and divided into two broad categories and six subcategories. Non-financial attributes were the most frequently reported broad category. The subgroup analyses indicated that nursing students from high-income countries valued income and were highly concerned about the working atmosphere.
Linking Evidence to Action:
The results of this systematic review provide important evidence for developing incentive policies to attract nursing students to the nursing profession.
FreshRSS 