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Type 2 diabetes remission is an achievable, evidence-based therapeutic goal, yet its integration into routine care remains at an early stage. In China, where leading institutions are pioneering remission-oriented practice, healthcare professionals play a pivotal role in shaping its clinical implementation. Nevertheless, how healthcare professionals perceive, interpret, and enact remission-oriented care remains understudied.
To explore healthcare professionals' perceptions and experiences regarding type 2 diabetes remission implementation and to develop a constructivist grounded theory explaining how remission-oriented care is supported and advanced in clinical practice.
A grounded theory study.
Using constructivist grounded theory methodology, we conducted semi-structured interviews between March and November 2025. Participants were recruited from healthcare settings that implemented type 2 diabetes remission services in Hunan Province, China, including tertiary hospitals, community hospitals, and healthcare companies. Coding proceeded through three iterative phases: initial coding, focused coding, and theoretical coding, combined with constant comparative methods and reflective memo-writing.
We recruited 23 healthcare professionals, including physicians, nurses, dietitians, and healthcare service managers. The core category of the substantive theory, ‘sustaining development towards remission’, captured the process of remission-oriented care from its conceptual introduction to clinical implementation. This process comprised four interrelated phases: germination, emergence, branching, and flourishing. The theory illustrates how healthcare professionals navigate cognitive adaptation and behavioural transformation in implementing remission-oriented care, highlighting the developmental trajectory of type 2 diabetes remission within routine diabetes management.
The findings emphasise that achieving type 2 diabetes remission holds significant practical implications for promoting proactive health globally, while also representing a challenging process. It advocates that this approach be incorporated into routine diabetes care pathways to support remission-oriented management of type 2 diabetes, improve patient health outcomes, and optimise the professional contribution of nurses in sustainable diabetes management.
This study contributes to global understanding of remission-oriented diabetes care by illustrating healthcare professionals' implementation experiences and highlighting the contribution of nurses in supporting remission-oriented management of type 2 diabetes.
The COREQ guidelines for qualitative research reporting were followed.
No patient or public contribution.
The global nursing shortage poses a critical challenge to healthcare systems. Emergency department (ED) nurses face high occupational stress due to demanding environments and strained patient-family interactions. Chronic stress impairs resilience and health, contributing to burnout and attrition. Understanding ED nurses' stressors and resilience is vital for workforce stability.
To identify core elements and interrelationships of occupational stressors and resilience among ED nurses in Zhejiang Province, China, using network analysis, and to explore intervention strategies.
Cross-sectional study.
From November 2024 to January 2025, data were collected from 990 ED nurses in 26 hospitals across 11 cities. Measures included a demographic questionnaire, the Chinese version of the Stressor Scale of Emergency Nurses, and the Resilience Structure Scale for Healthcare Professionals. Network analysis was conducted to illustrate the interconnections between stressors and resilience factors, while accounting for significant sociodemographic covariates.
A total of 990 nurses participated in the study. Violence-related stressors, such as physical assault and witnessing aggression, were the most prominent nodes in the stressor network. Key resilience elements included reframing patient or family criticism positively and timely emotional regulation. Bridge analysis highlighted ‘viewing criticism as encouragement’ as a crucial link connecting stress and resilience.
ED nurses work under intense stress from violence and scrutiny, which undermines resilience. Strengthening key resilience factors—especially cognitive reframing and emotional regulation—may buffer stress and enhance coping. Bridge nodes offer targeted points for intervention.
None.
This study clarifies the network of occupational stressors and resilience in ED nurses, identifying key intervention targets. It supports interventions focusing on cognitive adjustment, emotional regulation and interpersonal support to build resilience and reduce stress.
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