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☐ ☆ ✇ Journal of Clinical Nursing

Workplace Trust, Interpersonal Trust, and Nurses' Physical and Mental Health: The Mediating Role of Resilience

Por: Zhihui Zheng · Ting Du · Shiyi Li · Zhe Shen · Bixia Huang · Yubei Chen · Xia Li — Febrero 26th 2026 at 04:45

ABSTRACT

Aims

Examine the relationships between workplace trust, interpersonal trust, and nurses' physical and mental health, and specifically investigate the mediating role of resilience.

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Patient or Public Contribution

No patient or public contribution.

Implications for Nursing and Health Policy

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.

☐ ☆ ✇ Worldviews on Evidence-Based Nursing

Evidence‐Based CKD Prevention Strategies for Healthcare Professionals: Focusing on Primary and Secondary Prevention in Conservative Care

Por: Fatema Ahmed · Qingyuan Ye · Li Li · Waleed Ksebe · Chen Wu · Kefang Wang — Febrero 21st 2026 at 06:28

ABSTRACT

Background

Chronic kidney disease (CKD) is a significant public health problem that requires effective preventive and conservative methods to limit morbidity and death.

Aim

This study aims to give clinical practice an evidence-based basis for the clinical practice of healthcare professionals by methodically looking for the best available data on conservative strategies and CKD prevention in high-risk and early-stage patients.

Methods

The 6S evidence resource model was followed and states that evidence retrieval was done top-down, gathering necessary studies from January 2014 to July 30, 2024. Databases searched included BMJ Best Practice, DynaMed, NICE, GIN, SIGN, JBI Evidence Synthesis, JBI Evidence Implementation, Cochrane Library, and PubMed. Following the JBI grade of evidence and recommendation methodology, two reviewers independently examined and assessed the literature, extracting and summarizing evidence.

Results

Seventy-nine publications were identified: 18 guidelines, 1 randomized controlled trial, 2 expert consensus statements, 36 evidence summaries, and 22 systematic reviews and meta-analyses. Key findings were summarized across eight aspects: risk assessment and early detection, risk factors and prevention of genetic factors, management of diabetic nephrology, impact of bariatric surgery on preventing CKD, screening and diagnosis, treatment and prevention strategies, lifestyle modifications, and CKD prevention.

Linking Evidence to Action

This study summarized the best evidence for preventing CKD from eight aspects, which can help clinical or community medical professionals develop and apply CKD preventive strategies for high-risk groups and early-stage patients. By using these evidence-based strategies, healthcare professionals can reduce the incidence and progression of CKD, leading to fewer hospitalizations, improved kidney function preservation, and enhanced long-term survival and quality of life for patients. Future research should address identified gaps and explore the implementation of these strategies in diverse clinical settings.

☐ ☆ ✇ Worldviews on Evidence-Based Nursing

Effects of Peer‐Led Walking With mHealth Technology on Exercise Behavior of Women With Overweight and Obesity From Pregnancy to Early Postpartum: A Randomized Controlled Trial

Por: Jian‐Pei Huang · Hung Hui Chen · Ching‐Fang Lee · Li‐Kang Chi · Jung‐ Mei Tsai · Pao‐Jen Chen — Febrero 20th 2026 at 06:19

ABSTRACT

Background

Women with overweight or obesity tend to engage in low levels of exercise and face challenges in initiating and maintaining exercise throughout pregnancy.

Aims

This study aimed to evaluate the effectiveness of a peer-led walking and mobile health (mHealth) app intervention on self-efficacy and change in exercise behavior stage, based on the transtheoretical model (TTM), of women with overweight or obesity from pregnancy to one month postpartum.

Methods

The study was a randomized controlled trial with an experimental design. A total of 114 pregnant women (BMI ≥ 24 kg/m2 and gestation < 16 weeks) were recruited from prenatal clinics in Taiwan from July 2021 to May 2022. The intervention group (IG) received the peer-led walking program with mHealth support, while the control group (CG) received standard antenatal care. Follow-ups were conducted at 24–28 weeks (T2), 36–40 weeks (T3), and one month postpartum (T4).

Results

The IG had significantly higher exercise self-efficacy scores from T1 to T3 compared to the CG. IG participants showed notable progress in exercise behavior stages, transitioning from the contemplation stage at T1 to preparation and action stages at T2 (χ 2 = 13.208, p < 0.01), with some reaching the maintenance stage by T3 (20.9%, χ 2 = 9.49, p < 0.05). In contrast, most of the CG participants remained at the contemplation stage throughout pregnancy to early postpartum.

Linking Evidence to Action

The peer-led walking intervention with mHealth has the potential to enhance self-efficacy and promote sustained exercise behavior of women with overweight or obesity during and after pregnancy and is a valuable approach to establishing long-term exercise behavior.

Trial Registration

ClinicalTrials.gov: NCT 05022680

☐ ☆ ✇ Worldviews on Evidence-Based Nursing

The Effectiveness of Non‐Pharmacological Interventions on Preoperative and Postoperative Anxiety Among Patients Undergoing Abdominal Surgery: A Systematic Review and Meta‐Analysis

Por: Wai Lin William Tse · Po Yan Sin · Kai Chow Choi · Ho Yu Cheng — Febrero 19th 2026 at 06:35

ABSTRACT

Background

Patients undergoing abdominal surgeries have a chance to experience surgical-related anxiety. But the most effective non-pharmacological interventions in managing this anxiety have not yet been identified.

Aim(s)

To examine the effectiveness of different types of non-pharmacological interventions, and identify the effective components on pre- and postoperative anxiety management among patients undergoing abdominal surgeries.

Methods

A systematic search of randomized control trials (RCTs) examined the effects of non-pharmacological interventions on preoperative and/or postoperative anxiety (Primary outcomes) among patients undergoing abdominal surgery was conducted across MEDLINE, Ovid Nursing, AMED, PsycINFO, CINAHL, EMBASE, Cochrane Library, HyRead, and WANFANG DATA from 1987 to March 1, 2024. Secondary outcomes including postoperative pain, postoperative analgesics consumption, resumption of postoperative bowel movements, and length of hospital stay were also examined. Cochrane Risk of Bias Tool (version 2.0) was used for quality assessment. Meta-analysis was performed to synthesize the findings. Narrative summaries were provided for the studies that could not be included in the meta-analysis.

Results

This review included 35 RCTs. The interventions of included studies were categorized as prehabilitation, sensory stimulation, preoperative counseling, information provision, and psychological interventions. Meta-analysis revealed that preoperative counseling was beneficial in managing preoperative anxiety (SMD = −1.36; 95% CI = −1.96, −0.76), postoperative anxiety (SMD = −1.30; 95% CI = −1.62, −0.98), and postoperative pain (SMD = −0.84; 95% CI = −1.21, −0.47). Meanwhile, psychological interventions adopting relaxation exercises had potential effects in reducing postoperative opioid consumption and shortening time to postoperative bowel movement.

Linking Evidence to Action

Adopting preoperative counseling is suggested for the management of pre- and postoperative anxiety and postoperative pain among patients undergoing elective abdominal surgeries. A one-off lasting for 20–45 min preoperative counseling including individualized information about the coming surgery and perioperative process, and a discussion addressing patients' concerns is recommended. Future research is needed to explore the effects of relaxation exercise on important patients' outcomes such as postoperative analgesics consumption and time to resume bowel movement among patients undergoing abdominal surgery.

Trial Registration

PROSPERO registration number: CRD42023359484

☐ ☆ ✇ Journal of Advanced Nursing

Model Predicting Positive Aspects of Caregiving Among Family Cares of Persons With Dementia: A Longitudinal Cohort Study

Por: Doris Sau Fung Yu · Sheung‐Tak Cheng · Kevin Shuang Zhou Chen — Febrero 16th 2026 at 06:39

ABSTRACT

Aim

Positive aspects of caregiving among family carers of persons living with dementia not only benefit the carers' health, but also enhance the quality and sustainability of invaluable informal care resources. To better inform the development of carer support intervention to optimise positive aspects of caregiving, this paper tested the integrative theoretical model based on stress coping and meaning-making paradigms.

Design

Longitudinal exploratory study.

Methods

From January 2018 to August 2021, 390 Chinese family carers of persons living with dementia were recruited from the geriatric clinics in Hong Kong. The criterion variable was measured by the Positive Aspect of Caregiving Scale at baseline and 6 months thereafter. The predictors were measured using the Dementia Management Strategies Scale, the Caregiving Self-Efficacy Scale, the Meaning-Focused Coping Scale, the Medical Outcome Study Social Support Survey, the Duke University Religion Index, the Positive Affect Index and the Intrinsic Motivations to Care. Path analysis tested the hypothesised model.

Results

The carers aged 56.2 (SD = 12.2); about two-thirds being female and adult-child caregivers. The hypothesised model showed an unsatisfactory model fit. The model was optimised by modification index with consideration of the theoretical plausibility in making the changes (CFI = 0.971, RMSEA = 0.057, SRMR = 0.027). After adjusting the baseline PAC, the 6-month PAC was predicted by self-efficacy in controlling upsetting thoughts and obtaining respite as well as meaning-focused coping. Various contextual factors strengthened the self-efficacy and meaning-focused coping, indirectly increasing PAC. Whereas carers' intrinsic motivation towards care and good dyadic relationships increased the carer's self-efficacy in emotional regulation, social support and religiosity played indispensable roles to facilitate meaning-focused coping.

Conclusion

PAC in dementia context is evolved from an integration of stress coping and existential meaning-making paradigms. Enhancing emotion and role regulation as well as meaning-focused coping are crucial to enhance the positive experience of the family carers.

Implications for the Profession and/or Patient Care

This project has generated a theory-driven and evidence-based predictive model to explain the manifestation of positive aspects of caregiving in dementia caregiving. The findings provide precise directions on how to empower family caregivers to create a fulfilling and meaningful caregiving adventure.

Impact

Substantial evidence indicates the role of positive aspects of caregiving in enhancing the carers' health outcomes in the context of dementia. However, inadequate theorization of this phenomenon delimits the momentum to develop proactive strategies to optimise such a positive caregiving experience. This longitudinal study indicated that positive aspects of caregiving are evolved from an integrative stress coping and existential meaning-making paradigm. More specifically, a sense of self-efficacy in emotional and role regulation as well as the use of meaning-making coping predict a higher level of positive aspects of caregiving. A context, which is characterised by high religiosity, good intrinsic motivation of care and a good dyadic relationship, also favours the cultivation of this positive experience during life adversity. This study facilitates a paradigm shift in supporting family carers in a dementia context and advances the theorization of positive human experience in facing life adversity.

Reporting Method

The reporting method complies with the STROBE, stands for observational study.

Patient or Public Contribution

Family carers of persons with dementia actively shared their experience in family caregiving.

☐ ☆ ✇ Journal of Advanced Nursing

Relationship Between Sleep and Cognitive Frailty in Older Adults: A Systematic Review and Meta‐Analysis

Por: Xuehan Ma · Gengxin Yao · Xinyu Wan · Yiran Xu · Yali Yang · Lishuang Zheng · Xin Li · Yiming Qiu · Li Chen · Xinxin Wang · Guichen Li — Febrero 16th 2026 at 06:39

ABSTRACT

Aim

To explore the relationship between sleep and cognitive frailty in older adults.

Design

A systematic review and meta-analysis.

Data Sources

The Web of Science, Cochrane Library, CINAHL, Embase, PsycINFO and PubMed databases were searched from inception to October 28, 2024.

Methods

Two investigators independently conducted literature screening, data extraction and quality assessment. The Joanna Briggs Institute Critical Appraisal Tool and Newcastle–Ottawa Scale were used to evaluate methodological quality. This review followed PRISMA guidelines.

Results

This review included 13 articles involving 14,223 individuals, and 10 studies included in the meta-analysis. Across 13 studies, the overall prevalence of cognitive frailty was 25%. Sleep problems were categorised into four categories; the results reported that poor sleep quality, long sleep time and insomnia were correlated with the presence of cognitive frailty. However, the relationship between short sleep time and cognitive frailty was not significant.

Conclusions

This review quantitatively suggested that sleep parameters such as long sleep time, insomnia and poor sleep quality were correlated with the presence of cognitive frailty. Future research should adopt longitudinal designs and use validated instruments to measure both quantitative and qualitative aspects of sleep, thereby facilitating a thorough examination of the strength of the relationship between sleep and cognitive frailty, as well as the direction of causality.

Impact

The review highlights the need to integrate comprehensive sleep assessments and targeted interventions into nursing care plans for older adults to enhance their sleep health. The findings will provide support for the development of effective interventions to prevent and manage cognitive frailty in the older population.

Patient or Public Contribution

No patient or public contribution.

☐ ☆ ✇ Journal of Advanced Nursing

Midwives' Perception Towards Male Partners' Involvement in Labour Companionship: A Qualitative Study

Por: Tulian Chen · Yajing Wang · Zexuan Xu · Ting Wang · Tingting Fan · Guorong Jiang — Febrero 16th 2026 at 06:39

ABSTRACT

Background

Labour companionship is a recommendation by WHO that health authorities enable women to choose a companion during labour to ensure a safe and dignified labour experience for the birthing woman. However, most healthcare facilities in low- and middle-income countries do not necessarily consider this maternal need, which hampers a positive maternal experience during labour.

Objective

This study aims to examine midwives' perception towards the involvement of male partners in labour companionship.

Methods

An exploratory phenomenological approach was chosen and semi-structured interviews were used for this study.

Results

The four main themes identified in this study include ‘Understanding of male partners' involvement in labour companionship’, ‘Involvement of midwives in decision-making’, ‘Barriers to male partners' involvement in labour companionship’ and ‘Facilitators of male partners' involvement in labour companionship’.

Conclusion and Implications

This study found a lack of understanding among midwives of the significance of male partners' involvement in labour companionship; and the identification of hierarchical and authoritarian leadership as a barrier to midwives' participation in decision-making highlights the need for transformational leadership styles to empower midwives. Overall, the findings of this study can inform maternity care policy as well as resource development, education and professional training in the field of midwifery.

☐ ☆ ✇ Journal of Advanced Nursing

Identification of the Central Symptoms of Multidimensional Frailty Among Older Adults Using the Tilburg Frailty Indicator: A Network Analysis

Por: Yiming Qiu · Guichen Li · Rendong He · Wei Liu · Yali Yang · Lisheng Wang · Li Chen — Febrero 16th 2026 at 06:39

ABSTRACT

Background

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.

Design

A cross-sectional study was conducted from December 2023 to March 2024 in China.

Settings and Participants

A total of 933 community-dwelling older adults (aged 60 years or older) in China were recruited via convenience sampling.

Methods

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.

Results

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.

Conclusion

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.

Implications

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.

Reporting Methods

This study was reported in accordance with the STROBE guidelines.

Patient or Public Contribution

No patient or public contribution was involved in this study.

☐ ☆ ✇ Journal of Clinical Nursing

The Role Transition Journey of Spousal Caregivers of People Living With Dementia: A Meta‐Synthesis of Qualitative Studies

Por: Haiyan Ren · Zhuoqi Luo · Jiachen Han · Fang Zhou · Shuo Wang — Febrero 10th 2026 at 17:18

ABSTRACT

Aim

To explore the role transition journey of spousal caregivers of people living with dementia based on transition theory.

Design

A meta-synthesis.

Methods

This review employed a directed content analysis approach to systematically synthesise qualitative evidence. The findings were reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines and the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis.

Data Sources

A comprehensive search was conducted in eight electronic databases for studies published from the inception of each database to November 2024.

Results

This review ultimately included a total of 31 studies. Three themes were identified, including role stage, role transition properties and role transition conditions of spousal caregivers of people living with dementia. Role stage of spousal caregivers of people living with dementia encompassed seven sub-themes; role transition properties of spousal caregivers of people living with dementia included five sub-themes; role transition conditions of spousal caregivers of people living with dementia involved six sub-themes.

Conclusions

This review synthesises evidence to explore the role transition journey of spousal caregivers of people living with dementia. The role transition properties highlight the impact of critical points and events, as well as caregivers' awareness, engagement, change and difference and transition time span during their role transition journey. The role transition conditions emphasise that personal meanings, cultural beliefs and attitudes, socioeconomic status, preparation and knowledge, as well as community and society simultaneously influence the role transition journey of the caregivers.

Reporting Method

The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guided the reporting of the study.

Patient or Public Contribution

No patient or public contribution.

Trial Registration

PROSPERO registration number: CRD 42024623402

☐ ☆ ✇ Worldviews on Evidence-Based Nursing

Effectiveness of Health Coaching Interventions on Anxiety, Depression, Self‐Management Behaviors, Self‐Efficacy, and Quality of Life Among Older Adults: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Por: Yufan Yang · Lei Yu · Yiting Chen · Zhiwen Wang — Febrero 9th 2026 at 08:53

ABSTRACT

Background

Health coaching has emerged as a promising intervention to improve health outcomes in older adults. However, its effectiveness has not been comprehensively synthesized.

Aim

To evaluate the effectiveness of health coaching interventions on anxiety, depression, quality of life, self-management behavior, and self-efficacy among older adults.

Methods

A systematic search of six English databases (PubMed, Scopus, CINAHL, Cochrane Library, APA PsycInfo, and ProQuest Dissertations & Theses Global) was conducted from inception to October 20, 2024. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated using meta-analysis with random or fixed effects. Sensitivity analyses, subgroup analyses, and publication bias tests were also performed.

Results

Thirty-five randomized controlled trials (RCTs) involving 20,200 older adults were included in this review. Meta-analysis results indicated that health coaching interventions could significantly improve anxiety (SMD: −0.09; 95% CI: −0.15, −0.04; I 2: 0%), quality of life (SMD: 0.22; 95% CI: 0.05, 0.39; I 2: 76%), self-management behaviors (SMD: 1.15; 95% CI: 0.45, 1.86; I 2: 95%), and self-efficacy (SMD: 0.18; 95% CI: 0.02, 0.33; I 2: 69%) among older adults, but had no significant effects on depression (SMD: −0.26; 95% CI: −0.64, 0.12; I 2: 98%).

Linking Evidence to Action

Health coaching interventions may enhance the well-being of older adults. However, the certainty of the current evidence was generally very low to moderate, and substantial heterogeneity existed across studies. Therefore, these findings should be interpreted with caution. More high-quality RCTs with extended follow-up, as well as analyses of differential effects across demographic information, are needed to provide more robust and generalizable evidence.

☐ ☆ ✇ Worldviews on Evidence-Based Nursing

Effects of Non‐Pharmacological Interventions on Loneliness and Social Isolation in Cancer Patients: A Systematic Review and Network Meta‐Analysis

Por: Linlin Zhao · Lianqi Gu · Na Li · Chen Shen · Rao Wang · Xin Yang · Zhiping Chu — Febrero 9th 2026 at 08:49

ABSTRACT

Background

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.

Aim

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.

Methods

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.

Results

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).

Linking Evidence to Action

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.

Trial Registration

PROSPERO Registration Number: CRD42024616937

☐ ☆ ✇ Journal of Clinical Nursing

Symptom Clusters and Influencing Factors in Adult Patients With Haematological Malignancies During Chemotherapy: A Cross‐Sectional Study

Por: Yuqin Luo · Xinwen Du · Meijia Chen · Mei Yang · Jiawei Luo · Fengjiao Chen — Febrero 4th 2026 at 16:11

ABSTRACT

Aims

To identify symptom clusters in haematological malignancy patients during chemotherapy and determine the factors associated with different symptom clusters.

Design

A cross-sectional study.

Method

Convenience sampling was used to investigate haematological malignancy patients hospitalised for chemotherapy at a tertiary teaching hospital in Chengdu, China, from January 2021 to December 2023. Participants completed the Chinese version of the Condensed Memorial Symptom Assessment Scale. Hierarchical cluster analysis was used to identify symptom clusters; univariate analyses and logistic regression analyses were used to determine their related factors. This study was reported following the STROBE checklist.

Results

A total of 600 participants were included in the study. We have identified the psychological, sleep, pain-fatigue, gastrointestinal-asthenia symptom clusters in haematological malignancy patients during chemotherapy. Binary logistic regression analysis indicated that being female and having lactate dehydrogenase levels of 220 IU/L or higher are associated with an increased risk for the psychological symptom cluster. The sleep symptom cluster is more likely to occur in females, those with a prognostic nutritional index < 45, lactate dehydrogenase ≥ 220 IU/L and platelet-to-lymphocyte ratio ≥ 107.85. Female, the prognostic nutritional index < 45 and age ≥ 60 years are correlated with the pain-fatigue symptom cluster. The gastrointestinal-asthenia symptom cluster is related to female, a diagnosis of acute leukaemia or lymphoma, lactate dehydrogenase ≥ 220 IU/L and prognostic nutritional index < 45.

Conclusion

Adult haematological malignancy patients undergoing chemotherapy experience multiple symptoms that can be further divided into four symptom clusters. The occurrence of symptom clusters is influenced by a combination of patient sociodemographic characteristics, disease conditions and biochemical indicators.

Relevance to Clinical Practice

The symptom burden is a major issue for haematological malignancy patients during chemotherapy. Health caregivers should focus on the connection between symptoms rather than individual symptoms when developing and providing interventions. Identifying the factors influencing symptom clusters in haematological malignancy patients should be the basis for accurate, efficient and cost-effective interventions.

Patient or Public Contribution

The patients completed the questionnaires during the data collection in this study.

☐ ☆ ✇ Journal of Clinical Nursing

Trajectories and Co‐Occurrence of Perceived Control in Patients With Heart Failure and Self‐Efficacy in Their Caregivers: A Three‐Month Longitudinal Study of Dual Trajectories

Por: Yujun Wang · Yaqi Wang · Xia Chen · Qingyun Lv · Xueying Xu · Jingwen Liu · Yuan He · Hairong Chang · Bowen Wan · Sisi Cheng · Qingyi Wang · Mengmeng Tang · Xiaonan Zhang · Xiaoying Zang · Na Wei — Febrero 2nd 2026 at 10:42

ABSTRACT

Aim

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.

Design

A prospective cohort design.

Methods

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.

Results

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.

Conclusion

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.

Impact

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.

Reporting Method

This study adhered to the STROBE checklist.

Patient or Public Contribution

Patients and their caregivers contributed by participating in the study and completing the questionnaire.

☐ ☆ ✇ Journal of Clinical Nursing

Self‐Care Behaviours and Associated Factors in Older Adults With Multiple Chronic Conditions: A Cross‐Sectional Study

Por: Wei Liang · Xiaoying Ni · Huihua Zhao · Sha Li · Jie Zhong · Danni Zuo · Haiying Chen — Febrero 2nd 2026 at 10:42

ABSTRACT

Aims

To describe self-care behaviours and explore factors associated with self-care behaviours in older adults with multiple chronic conditions (MCCs).

Background

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.

Design

A cross-sectional design was adopted using the convenience sampling method.

Methods

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.

Results

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.

Conclusion

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.

Implications for the Profession and/or Patient Care

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.

Reporting Method

We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Patient or Public Contribution

No patient or public contribution.

☐ ☆ ✇ Journal of Clinical Nursing

Effectiveness of E‐Health Interventions on Improving Physical Activity in Pregnant Women: A Systematic Review and Meta‐Analysis

Por: Rong‐rong Han · Lei Zeng · Jia‐rui Lin · Qian Xu · Jia‐yuan Ma · Xin Chen · Yu Ding · Li Cheng · Ling‐ling Gao — Febrero 2nd 2026 at 10:42

ABSTRACT

Aims

This study aimed to (1) evaluate the effectiveness of e-health interventions in improving physical activity and associated health outcomes during pregnancy, (2) compare the e-health functions employed across interventions and (3) systematically identify the behaviour change techniques (BCTs) used and examine their interrelationships.

Design

A systematic review and meta-analysis following the PRISMA 2020 guidelines.

Methods

Randomised controlled trials were included. Meta-analyses and subgroup analyses were performed using RevMan 5.3. Social network analysis was conducted to determine the most central BCTs within the intervention landscape.

Data Sources

Ten databases were searched, including PubMed, Embase, Web of Science, Cochrane Library, ProQuest, Scopus, SinoMed, China National Knowledge Infrastructure, WanFang and the China Science and Technology Journal Database, from inception to April 22, 2024.

Results

Thirty-five studies were included. Pooled analyses indicated that e-health interventions significantly improved both total (SMD: 0.19; 95% CI: 0.10 to 0.27; I 2 = 55%) and moderate-to-vigorous physical activity (SMD: 0.16, 95% CI: 0.06 to 0.26; I 2 = 53%) in pregnant women. Subgroup analyses revealed that interventions based on theoretical frameworks and those not specifically targeting overweight or obese women demonstrated greater effectiveness. Additionally, e-health interventions were associated with significant reductions in both total and weekly gestational weight gain. Six of the twelve e-health functions were utilised, with ‘client education and behaviour change communication’ being the most prevalent. Thirty unique BCTs were identified; among them, ‘instruction on how to perform the behaviour’, ‘self-monitoring’, ‘problem solving’, and ‘goal setting’ showed the highest degree of interconnectedness.

Conclusion

E-health interventions are effective in enhancing physical activity and reducing gestational weight gain during pregnancy. Incorporating theoretical frameworks and well-integrated BCTs is recommended to optimise intervention outcomes.

Relevant to the Clinical Practice

Integrating e-health interventions into existing perinatal care models holds promise for enhancing physical activity among pregnant women and improving maternal health outcomes.

Reporting Method

This study adhered to the PRISMA checklist.

Patient or Public Contribution

No patient or public involvement.

Trial Registration

The study protocol was preregistered in the International Prospective Register of Systematic Reviews (CRD42024518740)

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