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New graduate nurses experience substantial stress during the transition from student to professional practice, which may compromise their well-being and professional practice capabilities. While resilience has been identified as a protective psychological resource, limited longitudinal research has examined how resilience influences professional performance over time or whether well-being functions as a mediating mechanism. Understanding these dynamic relationships is critical for informing evidence-based strategies to support early-career nurses.
This study aimed to (1) examine temporal changes in resilience, well-being, and professional practice capabilities during the first 3 months of employment among new graduate nurses; (2) investigate associations among these variables; and (3) test whether well-being mediates the relationship between resilience and professional practice capabilities.
A three-month longitudinal study was conducted with 72 newly graduated nurses. Measures of resilience, well-being, and five domains of professional practice capabilities (patient-centered care, interdisciplinary teamwork, evidence-based practice, quality improvement, and technology application) were collected at baseline, 2 weeks, and 3 months. Pearson's r correlations, generalized estimating equations (GEEs), and Monte Carlo simulations were performed to examine temporal associations and indirect effects.
Resilience was significantly associated with well-being (B = 1.285, p < 0.001) and all domains of professional practice capabilities. Both resilience and well-being independently predicted patient-centered care, interdisciplinary teamwork, evidence-based practice, quality improvement, and technology application. Monte Carlo simulations confirmed that well-being significantly mediated the relationship between resilience and all five performance domains. Improvements in well-being and several domains of professional practice capabilities were observed at 3 months.
Resilience serves as a foundational psychological resource that supports new graduate nurses' professional practice capabilities. Well-being serves as a key mechanism translating resilience into evidence-based nursing behaviors. Early-career interventions that strengthen resilience and promote well-being may enhance professional practice capabilities and improve workforce retention during the critical transition period.
by Hung-Chih Yeh, Chia-An Ho, En-Yu Chang, Hei-Tung Lau, Chih-Wen Hsu, Hsin-Yu Tu, Pei-Hsuan Wang, Chin-Shan Ho
The isometric mid-thigh pull (IMTP) is a reliable method for assessing whole-body maximal isometric strength; however, the influence of lifting straps on IMTP performance remains unclear, particularly in sports such as judo that rely heavily on grip strength. This study recruited 30 male participants, including 15 judo athletes and 15 recreationally resistance-trained undergraduates, who completed IMTP tests under strapped and non-strapped conditions in a randomized order. Peak force (PF), rate of force development (RFD), and impulse (IP) were measured using a 1000 Hz force plate, and a two-way mixed ANOVA was used to examine the effects of group and strap condition. The results showed no significant interaction between group and condition. However, significant main effects of both group and strap condition were observed for most variables (p < 0.05), with higher PF, RFD, and IP recorded under the strapped condition. Judo athletes also demonstrated greater grip strength (51.3 ± 3.4 kg) than the resistance-trained group (44.7 ± 3.3 kg, p < 0.01). These findings suggest that the use of lifting straps enhances IMTP performance and may reduce the influence of grip strength limitations on maximal force expression. Therefore, when the purpose of IMTP testing is to assess maximal force production, the use of lifting straps may be considered to minimize the potential influence of grip-related limitations and to standardize testing procedures across athletes.by Chia-En Hsieh, Li-Hua Huang, Ya-Lan Hsu, Tzu-Jung Wu, Hsiang-Chu Pai
ObjectivesThis study explored the association between work stress and professional commitment among clinical nurses, focusing on the serial multiple mediating effects of resilience and coping. Clinical nurses experience high levels of work stress that may negatively impact their professional commitment. However, the mechanisms underlying this relationship, particularly the mediating roles of resilience and coping, remain unclear.
Materials and MethodsThis cross-sectional study was conducted at a single medical center and involved 345 clinical nurses recruited from internal medical and surgical wards, obstetric and pediatric wards, and emergency and critical care units. The valid response rate was 97.2%. All participants were recruited from inpatient units within the same medical center, ensuring a consistent clinical setting across all departments. Descriptive, univariate, and Pearson correlation analyses were performed, and mediation effects were tested using PROCESS Model 6.
ResultsNurse stress was significantly negatively associated with professional commitment (total association: c = −0.0808, p Conclusion
Higher nurse stress was significantly associated with lower professional commitment. Resilience and coping were significantly associated with this relationship as serial mediating factors. Given the cross-sectional design, these findings should be interpreted as associations rather than causal effects. Strengthening resilience and adaptive coping may help support nurses’ professional commitment.
Cancer registries remain the gold standard for global cancer monitoring, yet complementing them with electronic health records and claims can significantly enhance the understanding of the cancer burden by providing a more complete picture of the patient journey. The main aim of this project is to serve as a proof of concept for using real-world data mapped to the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) to monitor cancer epidemiology over time and characterise patients’ clinical history and outcomes.
This study will be conducted as an observational cohort study using a multinational network of large real-world data sources mapped to the OMOP CDM. Electronic health records (EHR) from primary and secondary care, health insurance claims and cancer registry data will be included. To date, 20 databases from 16 countries, mainly from Europe but also North America and Asia, have committed to participate in the project.
We will investigate the temporal trends in incidence, prevalence and survival of 36 cancers across haematopoietic and solid tumours from 2000 (or the start of accurate data if later) to the last year with complete data. Data from all individuals registered in each of the participating data sources will be eligible for inclusion in the study. For primary care EHR and claims, individuals will be required to have at least 1 year of prior observation to ensure the identification of incident cases and adequate capture of patient characteristics. We will estimate crude and age-standardised incidence and 5-year partial prevalence. Additionally, we will estimate crude and age-standardised overall survival at 1, 5 and 10 years for the total study period and by diagnosis year groups defined according to data availability. All study objectives will be investigated at the database level, with results stratified by age and sex. For incidence and survival analyses, additional stratifications will be performed by clinical conditions and smoking status (where available). We will use the National Cancer Institute (NCI) Joinpoint Regression Programme to model overall trends in cancer incidence and the NCI JPSurv software to estimate trends in survival. Finally, we will characterise individuals diagnosed with an incident cancer based on demographics, clinical conditions and medication use at different time windows.
Findings will be presented separately for each database and further summarised through descriptive aggregation by country and data source type.
Each data partner will obtain study approval from their local institutional review boards prior to study execution. Distributed queries will be employed, whereby standardised analytical code is shared and run at each site locally. Deidentified, aggregated results will be returned from all participating sites. A minimum cell count of five will be used when reporting results, depending on each collaborator’s data governance requirements.
All study code will be publicly available, and findings will be submitted to open science journals to promote transparency and reproducibility.
Falls among older adults are a major public health issue and the leading cause of injury-related deaths. They affect older adults' physical, social, and psychological well-being. Although CBT-based interventions show promise for fall prevention, they have not yet been specifically applied to this population.
To evaluate and synthesize the effects of cognitive behavioral therapy (CBT) on older adults' fear of falling, perceived consequences of falls, physical performance, and balance:
A systematic search of Academic Search Complete, CINAHL Plus with Full Text, Cochrane Library, Embase, Medline, PubMed, and Web of Science was performed, from database inception to March 8, 2025, to find randomized trials applying CBT to prevent falls among older adults. The Cochrane risk-of-bias tool for randomized trials was used to assess the risk of bias of the studies included. A random-effects DerSimonian–Laird model with a 95% confidence interval was used to estimate the pooled standardized mean differences (SMDs) of outcomes.
Seventeen studies were included in the final analysis. CBT in combination with exercise was found to reduce fear of falling (pooled SMD = −0.25; 95% CI = −0.41 to −0.09; I 2 = 22.22%) and improve balance (pooled SMD = 0.79; 95% CI = 0.56–1.01; I 2 = 0.00%; p < 0.001) in older adults. The findings of this study can guide future research on developing CBT-based interventions to maximize the benefits of this modality for preventing falls among older adults. This study suggests that CBT in combination with exercise is effective for preventing falls among older adults. CBT also appears to benefit older adults by reducing their fear of falling and improving balance. The intervention duration should be considered to achieve a meaningful effect on fall prevention for this population.
To evaluate the effectiveness of multidisciplinary offloading versus standard care on one-year diabetic foot ulcer recurrence, amputation, mortality, and functional recovery. In this prospective cohort study, 232 patients with healed diabetic foot ulcers were stratified into a control group (76 patients) or an intervention group (156 patients) receiving offloading modalities ranging from felt padding to custom-made therapeutic footwear. Assignment was based on shared decision-making considering biomechanical needs and economic feasibility. Primary outcomes included recurrence, amputation, and mortality. Secondary outcomes assessed quality of life, working ability, and ankle function. The intervention group demonstrated significantly lower recurrence (10.9% vs. 25.0%; p = 0.007) and mortality (3.2% vs. 14.5%; p = 0.004). Multivariable analysis identified offloading as independently protective against recurrence (odds ratio 0.35) and mortality (odds ratio 0.24). Amputation rates did not differ significantly after adjustment. Functionally, the intervention group achieved superior recovery in quality of life, working ability, and ankle scores (p < 0.001). Subgroup analysis indicated that customized therapeutic footwear yielded the lowest complication rates and highest patient satisfaction. Multidisciplinary offloading significantly reduces recurrence and mortality while restoring physical function. Although financial barriers influence device selection, customized therapeutic footwear offers the optimal balance of biomechanical protection and functional outcomes.
To identify subgroups with similar social determinants of health (SDOH) characteristics using latent class analysis (LCA) and examine their associations with physical and mental health, cognitive function and missed workdays at 3 and 6 months post-SARS-CoV-2 infection. We hypothesised that intersecting SDOH factors would differentially influence COVID-19-related health outcomes across subgroups.
Prospective cohort study from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), with longitudinal data collection and cross-sectional analyses at baseline, 3-month and 6-month follow-ups.
Multicentre registry across eight US academic medical centres (Chicago, Dallas, Houston, Los Angeles, New Haven, Philadelphia, San Francisco and Seattle).
Adults aged ≥18 years, fluent in English or Spanish, with self-reported acute COVID-19 symptoms and a confirmed positive SARS-CoV-2 test within 42 days before enrolment (9 December 2020 to 12 August 2022), and access to an internet-connected device. Exclusions included incarceration, inability to provide informed consent, lack of confirmed SARS-CoV-2 infection or no internet access. Of 3791 eligible participants with complete baseline data, 2897 (76.4%) completed the 3-month follow-up and 2666 (70.3%) completed the 6-month follow-up; most were aged 18–49 years (74–75%), female (66–67%), white (86.6–87.5%) and non-Hispanic (86.6–87.5%).
Prespecified primary outcomes were physical and mental health (Patient-Reported Outcomes Measurement Information System (PROMIS)-29 V.2.1 T-scores for depression, anxiety, fatigue, sleep disturbance, pain interference, physical function and social participation), cognitive function (PROMIS Cognitive Function Short Form 8 T-scores) and missed workdays due to illness (binary: >1 week vs ≤1 week, from a single-item survey). All measures were self-reported and collected at baseline, 3 months and 6 months; no changes from protocol.
LCA identified a 4-class model as optimal (lowest Bayesian Information Criterion (BIC) after evaluating 1–7 class models; significant demographic differences (2 p
In this US prospective cohort, SDOH-based subgroups showed persistent disparities in health outcomes post-SARS-CoV-2 infection. Findings highlight the urgent need for intersectional approaches to address systemic inequities in post-COVID-19 recovery.
To develop a machine learning model for predicting Taiwanese adults' intention to sign an advance directive (AD) and to identify the psychosocial, demographic, and system-level predictors relevant to culturally sensitive nursing. This study distinguishes between the reflective process of advance care planning (ACP) and the formal legal act of AD completion, addressing the need to understand cultural and system-level influences.
This was a cross-sectional quantitative study.
A survey was conducted with 1412 Taiwanese adults by using validated instruments, such as the Knowledge of Advance Care Planning Questionnaire and Advance Care Planning Attitude Scale. Data were analyzed using linear regression, random forest, and extreme gradient boosting models to predict the intention to sign an AD. A SHapley Additive exPlanations analysis was performed to interpret the model and investigate the effects of personal values and system-level barriers.
The extreme gradient boosting model outperformed the other models, with mean absolute error and root mean squared error values of 1.68 and 2.13, respectively. The SHapley Additive exPlanations analysis highlighted attitude toward ACP as the strongest predictor of signing intention. In addition to psychosocial factors, system-level factors such as procedural unfamiliarity and high consultation costs emerged as key barriers. Furthermore, older age and a higher number of children were associated with a weaker intention to sign an AD, reflecting a preference for informal family consensus over formal legal documentation.
Machine learning models effectively identify the interplay between personal attitudes, family dynamics, and institutional conditions that shape AD-related decision-making. The transition from ACP dialogue to formal AD signing is determined by both cultural values and structural factors.
Nurses should adopt a dual-track strategy—supporting advance care planning through family-inclusive dialogues and serving as “system navigators” to help patients overcome legal and financial barriers to advance directive signing. Data-driven insights from the present study may inform precise, culturally responsive interventions that honor patient autonomy.
Disparities in cancer care among lesbian, gay, bisexual and transgender (LGBT) individuals persist across healthcare systems worldwide. Nurses play an important role in delivering culturally competent cancer care; however, limited research has examined nurses' practices in caring for LGBT individuals with cancer and identified factors influencing such care, particularly in non-Western cultural contexts.
To examine nurses' experiences in providing cancer care for LGBT individuals, their cancer care behaviours, influencing factors and perceived needs regarding knowledge, skills and care settings for delivering culturally competent cancer care.
Cross-sectional survey.
Between September and December 2024, a cross-sectional survey was conducted in Taiwan across two hospitals, ten nursing associations, five cancer-related foundations and three online nursing communities. A total of 608 nurses with experience caring for patients with cancer were recruited through purposive and snowball sampling. Nurses completed either an online or paper-based survey.
Nearly half of the nurses had no prior experience providing cancer care for LGBT individuals. Experience providing such care was associated with older age, non-heterosexual identity, longer length of service, higher LGBT-related care competencies and higher levels of job-related compassion satisfaction and stress. Affirmative cancer care behaviours were associated with a broader and more integrated set of competencies, including knowledge, attitudes, skills, affirmative beliefs and job-related compassion satisfaction. Nurses also reported unmet needs regarding knowledge, skills and care settings for delivering culturally competent cancer care to LGBT individuals.
These findings highlight the importance of education, resources and resilience support to strengthen nurses' delivery of culturally competent cancer care for LGBT individuals.
Related training courses, curricula and supporting resources are essential to enhance nurses' culturally competent cancer care practices for LGBT individuals.
STROBE checklist.
No patient or public contribution.
To examine workplace experiences, perspectives on coming out at work, organisational climate and mental health status of lesbian, gay, bisexual, transgender, queer/questioning and other sexual, and gender minority healthcare providers (LGBTQ+ HCPs) within an East Asian cultural context.
Observational, cross-sectional study.
An online cross-sectional survey was conducted among 173 Taiwanese LGBTQ+ HCPs between May and August 2024.
Most of the 173 respondents did not disclose their LGBTQ+ identities to any colleagues, and approximately two-fifths met the clinically significant threshold for depressive symptoms. Furthermore, compared to LGBTQ+ HCPs who disclosed to all, most, about half or a few colleagues, those who had not disclosed to any colleagues reported higher levels of depressive symptoms, lower self-esteem, less comfort with disclosure, greater perceived necessity to conceal their LGBTQ+ identities, lower scores for job stability or security, poorer interpersonal relations and lower agreement that an LGBTQ+-inclusive workplace climate would influence their willingness to remain in their current jobs. Although approximately 80% of the LGBTQ+ HCPs reported that they were familiar with national workplace antidiscrimination laws and that their organisations had grievance mechanisms, nearly two-fifths did not trust the grievance systems or procedures within their organisations.
Results emphasise the urgent need to create an LGBTQ+-inclusive workplace environment with clear and enforceable antidiscrimination policies and inclusive organisational practices to improve both disclosure safety and mental health outcomes for LGBTQ+ HCPs.
The study results extend existing knowledge by identifying the relationship between different levels of disclosure and mental health status among LGBTQ+ HCPs. They also highlight the importance of establishing support groups, a comprehensive mental health referral system and enforcement mechanisms that safeguard legal rights without compromising the privacy or safety of LGBTQ+ HCPs.
No patient or public contribution.
by Yi-Hua Wu, Chia-Ing Li, Chiu-Shong Liu, Chih-Hsueh Lin, Shing-Yu Yang, Cheng-Chieh Lin, Tsai-Chung Li
Glycemic variability (GV) is an emerging biomarker of glycemic control and may be a predictor for lung function impairment in persons with type 2 diabetes mellitus (T2DM). However, the associations between GV and lung function variables and lung function impairment have not been fully evaluated. The objective of this study was to assess the associations of glycemic variability (GV) with lung function impairment in persons with T2DM. A follow-up study was conducted on the data of 3,108 subjects collected from 2001 to 2020 using the diabetes care management program database in Taiwan. GV in fasting plasma glucose (FPG) was calculated using standard deviation (SD), average real variability (ARV), coefficient of variation (CV), variability independent of the mean (VIM), and slope of 1-year repeated measurements. A ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) less than 0.70 was used to define lung function impairment. Multivariable linear and logistic regression models were applied to explore the relationships of GV with lung function variables and lung function impairment. A total of 359 (11.6%) subjects were defined as having lung function impairment. After multivariable adjustment, FPG‐SD, FPG-CV, FPG-AVR, FPG-VIM and were found to be negatively linked with FEV1, % predicted FEV1, and FVC but not FEV1/FVC. Relative to those for the first tertile, the odds ratios (ORs) of lung function impairment for the second and third tertiles were 1.37 (95% confidence interval [CI]: 1.01, 1.87) and 1.51 (1.10, 2.08) for FPG-CV, respectively; 1.59 (1.16, 2.17) and 1.73 (1.24, 2.40) for FPG‐SD, respectively; and 1.57 (1.15, 2.13) and 1.69 (1.22, 2.33) for FPG-AVR, respectively. GV, measured by CV, SD, VIM, and VIM, is linked with lung function impairment and all lung function variables, except for FEV1/FVC ratio. GV may serve as a useful biomarker for assessing lung function impairment in persons with T2DM.by Ya-Chun Feng, Bo-Cheng Kuo, Wen-Yau Hsu
Previous studies have demonstrated that emotional facial expressions influence attention and perception in individuals with social anxiety. However, the relative influence of positive versus negative expressions on distinct subprocesses of attention and perception remains unclear. This event-related potential (ERP) study investigates the temporal dynamics of electrophysiological responses to emotional faces in high (HSA; N = 56) or low (LSA; N = 47) social anxiety individuals using a dot-probe task. Four face pairs (angry-neutral, happy-neutral, angry-happy, and neutral-neutral) were presented to probe the influence of positive and negative expressions. While behavioural results showed no significant group differences in attention bias, ERP results showed a reduced N170 amplitude for the HSA vs. LSA group in angry-neutral, happy-neutral, and angry-happy face pairs. Furthermore, enhanced N2pc effects to emotional expressions were found only in the HSA group when angry-neutral and happy-neutral face pairs were presented. No N2pc effect emerged when both positive and negative expressions were presented simultaneously. Finally, no significant P1 effect was found. Together, both positive and negative expressions influenced attentional deployment and face-specific processing in relation to social anxiety. Socially anxious individuals perceived less emotional facial information, yet their attention was biased by both negative and positive expressions.To investigate the clinical outcomes and predictors associated with the severity of new-onset pressure injuries in hospitalised patients with multiple comorbidities.
Retrospective cohort study.
We retrospectively collected data on hospitalized patients. The severity of pressure injury was defined as per the National Pressure Injury Advisory Panel. Outcome measures included short-term mortality and discharge to extended care facilities.
A total of 2150 hospitalised patients were screened, and 186 (8.7%) developed new-onset pressure injuries, including 84 classified as stage I and 102 as stage II. The Braden scale score and time from admission to pressure injury onset were significantly associated with new-onset stage II pressure injuries. Patients with stage II pressure injuries had a significantly higher risk of being discharged to extended care facilities compared to those with stage I pressure injuries (24% vs. 12%, p = 0.041). The short-term mortality rate was high in the total cohort (34%) but was not significantly different between the two groups. The worse Braden scale, lower body mass index, history of stroke and presence of stage II pressure injuries were significant predictors of discharge to extended care facilities.
New-onset Stage II pressure injuries significantly increased the risk of discharge to extended care facilities. Furthermore, this study expands the potential clinical utility of the Braden Scale by demonstrating its association not only with the risk of pressure injury development but also with the initial severity of injuries once they occur. These findings support its role in early risk stratification and targeted nursing interventions.
This study highlights the importance of early identification and prevention of pressure injuries and the potential role of the Braden scale in minimizing injury severity, reducing healthcare utilization, and improving quality of life.
STROBE guidelines.
None.
To describe unit leadership and climates for evidence-based practice implementation and test for differences in unit leader and staff nurses' perceptions within maternal–infant units.
A cross-sectional descriptive study.
A convenience sample of maternal–infant unit leaders and nurses (labour, postpartum, neonatal intensive care, paediatrics) from four Midwestern United States hospitals completed a survey including the Implementation Leadership Scale (ILS) and Implementation Climate Scale (ICS). Descriptive statistics described items, subscales and total scores. Independent t-tests with Bonferroni correction tested for differences in perceptions.
A total of 470 nurses and 21 unit leaders responded, representing 17 units. Ratings of unit leadership and climates for implementation were modest at best [ICS: M = 2.17 (nurses), 2.41 (leaders); ILS: M = 2.4 (nurses), 2.98 (leaders)]. Unit leader ratings were statistically significant and higher than nurse ratings.
This study is one of the first to describe unit leadership and climates for implementation in maternal–infant health. To improve outcomes and equity in maternal–infant health, attention on leadership behaviours and unit climates for evidence-based practice implementation is needed.
Nurse leaders are encouraged to evaluate their leadership behaviours and the unit climates they facilitate, and work to improve areas of concern or where staff perceptions differ. Staff nurses should work with their leaders to identify resources and rewards/recognition which support and facilitate EBP implementation.
This study addressed a gap in research examining the social dynamic factors of unit leadership and climate for evidence-based practice implementation in maternal–infant units. Leadership behaviours for implementation and unit climate were rated moderately by both staff and leaders. Unit leaders rated their implementation leadership and climates higher in almost all items. This study is relevant to unit leaders and nurses in maternal–infant units in the United States.
This study adhered to STROBE guidelines.
No patient or public contribution.
FreshRSS 