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Within the context of limited childcare resources and a high prevalence of multigenerational co-residence in China, grandparents play a pivotal role in the caregiving of infants and toddlers. However, discrepancies in parenting philosophies across generations may lead to conflict, thereby impacting maternal psychological well-being and parenting experiences. Identifying the typologies of intergenerational co-parenting relationships is therefore essential for informing targeted health interventions.
This study aimed to identify latent profiles of mother–grandparent intergenerational co-parenting relationships in families with infants and toddlers in Shenzhen, China, using the Grandparent-Parent Co-parenting Relationship Scale (GPCRS) dimensions. It further sought to examine how maternal psychosocial factors (parenting stress, perceived stress, depressive symptoms, sleep quality), the quality of spousal co-parenting relationships and intergenerational caregiving role arrangements are associated with profile membership.
A cross-sectional survey study.
A total of 366 mothers with children aged 0–3 years was recruited from maternity and child healthcare institutions in Shenzhen, China, between January 2023 and May 2024. Validated scales were used to assess intergenerational and spousal co-parenting, parenting stress, parenting sense of competence, perceived stress and depressive symptoms. Latent profile analysis was employed to identify patterns of intergenerational co-parenting relationships, and multinomial logistic regression was conducted to examine the associated predictors.
Three distinct intergenerational co-parenting profiles were identified: the Discordant Group (29.2%), the Balanced Group (46.7%) and the Harmonious Group (24.0%). Higher spousal co-parenting scores were positively associated with more harmonious profiles. Lower levels of parenting stress, perceived stress and depressive symptoms, as well as higher sleep quality and grandparental involvement in caregiving were all associated with more positive relationship profiles. However, higher maternal parenting competence was paradoxically linked to greater intergenerational conflict.
Mothers in the Discordant Group, marked by low agreement/support and high conflict, reported the highest stress and depressive symptoms, whereas those in the Harmonious Group showed the most favourable psychosocial outcomes, with the Balanced Group in between. Stronger spousal co-parenting, better sleep quality and grandparental caregiving were associated with membership in the Harmonious class. These findings underscore the importance of fostering harmonious co-parenting across spousal and intergenerational subsystems to enhance maternal well-being and family functioning in early childhood.
Nurses and healthcare professionals could implement family-based interventions tailored to identified profile characteristics, thereby more effectively supporting maternal mental health and fostering greater harmony in intergenerational co-parenting families.
To investigate the status of social isolation among middle-aged and elderly breast cancer patients and identify its influencing factors. Additionally, to explore the mediating role of self-perception of aging between frailty and social isolation, as well as the moderating effect of menopausal symptoms.
A cross-sectional study guided by the Strengthening the Reporting of Observational Studies in Epidemiology.
This study was conducted on middle-aged and elderly breast cancer patients from September 2022 to February 2023 in Guangzhou, China. Related data were assessed by structural questionnaires. Correlation analysis and regression analysis were performed by SPSS 26.0 while PROCESS macro v4.0 was used to test the moderated mediation model.
Breast cancer patients aged 45–82 years experienced moderate social isolation. It was influenced by educational level, residence, menopause symptoms, self-perception of aging, and frailty. The moderated mediation model involving self-perception of aging and menopausal symptoms for explaining how frailty causes social isolation was supported. The mediating role of self-perception of aging gradually strengthens as menopausal symptoms become severe.
Social isolation resulting from frailty in middle-aged and elderly breast cancer patients is mediated by self-perception of aging, with menopausal symptoms amplifying this effect. Interventions focused on improving self-perception of aging and managing menopausal symptoms may help reduce social isolation by mitigating the impact of frailty.
This study highlights the importance of addressing frailty, self-perception of aging, and menopausal symptoms in clinical nursing practice, which may help reduce social isolation among breast cancer patients.
Patients contributed by completing the questionnaire, ensuring the accuracy and completeness of the information with assistance from the research team.
To identify and reach consensus on dimensions and criteria of a competence assessment instrument for health professionals in relation to the process of evidence-based healthcare.
A two-round Delphi survey was carried out from April to June 2023.
Consensus was sought from an expert panel on the instrument preliminarily established based on the JBI Model of Evidence-Based Healthcare and a rapid review of systematic reviews of relevant literature. The level of consensus was reflected by the concentration and coordination of experts' opinions and percentage of agreement. The instrument was revised significantly based on the combination of data analysis, the experts' comments and research group discussions.
Sixteen national and three international experts were involved in the first-round Delphi survey and 17 experts participated in the second-round survey. In both rounds, full consensus was reached on the four dimensions of the instrument, namely evidence-generation, evidence-synthesis, evidence-transfer and evidence-implementation. In round-one, the instrument was revised from 77 to 61 items. In round-two, the instrument was further revised to have 57 items under the four dimensions in the final version.
The Delphi survey achieved consensus on the instrument. The validity and reliability of the instrument needs to be tested in future research internationally.
Systematic assessment of nurses and other health professionals' competencies in different phases of evidence-based healthcare process based on this instrument provides implications for their professional development and multidisciplinary team collaboration in evidence-based practice and better care process and outcomes.
This study addresses a research gap of lacking an instrument to systematically assess interprofessional competencies in relation to the process of EBHC. The instrument covers the four phases of EBHC process with minimal criteria, highlighting essential aspects of ability to be developed. Identification of health professionals' level of competence in these aspects helps strengthen their capacity accordingly so as to promote virtuous EBHC ecosystem for the ending purpose of improving global healthcare outcomes.
This study was reported in line with the Conducting and REporting of DElphi studies (CREDES) guidance on Delphi studies.
No patient or public contribution.
To assess career satisfaction among Chinese nurses, explore influencing factors, and examine the mediating role of role breadth self-efficacy (RBSE) in the relationship between subjective age and career satisfaction.
A multi-centre, cross-sectional study.
Between June and October 2024, 2033 questionnaires were distributed to nurses across seven geographic regions in China, collecting data on demographics, subjective age, RBSE, and career satisfaction. Descriptive statistics, Pearson correlation analysis, multiple linear stepwise regression, and path analysis were used to identify determinants of career satisfaction and test the mediating effect of RBSE.
The effective response rate was 97%. Chinese nurses reported moderate-to-high career satisfaction, younger subjective age relative to chronological age, and moderate RBSE levels. Multivariate linear regression analysis identified education level, work institution, salary, weekly working hours, subjective age, and RBSE as significant predictors of career satisfaction. Path analysis revealed a significant negative association between subjective age and career satisfaction (β = −0.23, p < 0.001), which was partially mediated by RBSE (indirect effect = −0.11, 95% CI: −0.18 to −0.05).
The career satisfaction of Chinese nurses is at a moderately high level; the influencing factors include the intensity of nursing work and salary levels. There is a certain difference between the subjective age and the chronological age of Chinese nurses. RBSE partly mediates the relationship between subjective age and career satisfaction.
Valuing the breadth of nurses' roles, self-efficacy, and subjective age may help improve job satisfaction.
What problem did the study address?: This study elucidates the present level of career satisfaction among nurses in China and the variables affecting it. What were the main findings?: The subjective age of Chinese nurses influences career satisfaction, with RBSE partly mediating the connection between subjective age and career satisfaction. Where and on whom will the research have an impact?: This study presents novel variables of subjective age and RBSE in the investigation of factors influencing career satisfaction among Chinese nurses, offering new avenues for enhancing career satisfaction in this demographic in the future.
We adhered to STROBE guidelines for cross-sectional research.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore how the mentor-student relationship affects nursing graduate students' satisfaction with mentors, as well as how mentoring mode and learning motivation work together.
A multi-centre cross-sectional study.
Thirty universities and colleges in eastern, central and western China.
A total of 826 nursing graduate students from thirty universities and colleges participated in this study in April 2024.
Data were collected using the general information questionnaire, mentor-student relationship entry, mentoring mode questionnaire, graduate students' satisfaction item and learning motivation scale. Data were analysed using SPSS 25.0 software. The PROCESS macro-plugin and the bootstrap method were utilised to examine the mediating and moderating effects of learning motivation and mentoring mode.
There was a positive correlation between nursing graduate students' satisfaction with mentors and the mentor-student relationship (r = 0.377, p < 0.001), learning motivation (r = 0.600, p < 0.001), and mentoring mode (r = 0.292, p 0.001). Learning motivation exerted a partial mediation effect between the mentor-student relationship and graduate students' satisfaction with mentors (mediation effect value = 0.182, 95% CI = 0.148–0.218). Mentoring mode moderated the path of learning motivation in the mentor-student relationship (interaction term coefficient = 0.031, 95% CI = 0.005–0.056).
Mentor-student relationship positively predicted nursing graduate students' satisfaction with mentors significantly. Learning motivation played a partial mediating effect between mentor-student relationship and graduate students' satisfaction with mentors and mentoring mode moderated between mentor-student relationship and learning motivation pathways. Therefore, cultivating positive teacher/helpful friend relationship, boosting students' learning motivation and improving mentoring mode techniques can all increase nursing graduate students' satisfaction with mentors.
No patient or public contribution.
To explore the factors influencing nurses' attitudes towards seeking professional psychological help using network analysis.
A cross-sectional study design was employed.
In Shapingba District, Chongqing, China, a two-stage sampling method was used to select 717 nurses from primary healthcare institutions and secondary public hospitals. Data were collected through anonymous online self-report surveys from November to December 2023. Multiple validated scales were used to measure mental health literacy, social support, mental illness stigma and attitudes towards seeking professional psychological help. Network analysis was conducted in R software.
The ‘Confidence in Mental Health Practitioner’ was identified as a key node in the network. Social support was positively associated with the attitude of seeking help, while mental illness stigma had a negative effect.
Confidence in mental health practitioners plays a key role in shaping nurses' help-seeking attitudes. Enhancing professional credibility, reducing stigma and fostering supportive environments may promote psychological help-seeking, especially in primary and secondary care settings.
For the profession, it provides insights for developing targeted training to improve nurses' mental health. For patient care, a mentally healthy nursing workforce can enhance the quality of care.
Addressed the problem of low rates of nurses seeking professional psychological help and the complex factors involved. Main findings: Key factors influencing nurses' attitudes towards seeking help and the role of confidence in mental health practitioners. The research will impact healthcare institutions, nurses and ultimately patients, as it can guide the creation of a better working environment for nurses.
No patient or public contribution.
To investigate the relationship between self-care and quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD) and their caregivers.
A multicentre, cross-sectional study.
COPD patients and their caregivers were recruited from four tertiary hospitals in Jinan, Shandong Province, China from March to November 2022. Data collection included demographic and clinical characteristics, patients' self-care, caregivers' contribution to patient self-care, and QOL. Statistical analysis included descriptive statistics, paired t-tests, Pearson correlations and Actor–Partner Interdependence Model (APIM) analyses.
A total of 275 valid questionnaires were collected (patients: 67.6% male, mean age 70.5; caregivers: 58.5% female, mean age 54.2). APIM analyses revealed actor effects of self-care on QOL for both patients and caregivers, as well as partner effects indicating the influence of one's self-care on the partner's QOL.
This study elucidates the dyadic relationship between self-care and QOL in COPD patients and caregivers. Higher levels of self-care maintenance by both patients and caregivers were associated with improved physical and mental QOL. Conversely, increased self-care monitoring was correlated with reduced QOL for both patients and caregivers. No significant relationship was found between self-care management and QOL.
For healthcare professionals specialising in geriatric care, our research provides more valuable guidance for the nursing of COPD patients. While maintaining vigilance is essential for both COPD patients and caregivers, our study suggests that excessive monitoring may have adverse effects on QOL, though this impact may vary depending on the underlying need for monitoring. This underscores the importance of tailored interventions that balance necessary vigilance with the potential risks of over-monitoring. By carefully considering the motivations behind monitoring, professionals can better support both patients and caregivers, ultimately enhancing self-care, improving QOL and contributing to healthy ageing.
The STROBE checklist was used to report the present study.
During the research design phase, we conducted interviews with patients and caregivers to capture pertinent issues related to their daily self-care routines. This initial step allowed us to gain an understanding of the potential differences between patients' self-care levels and caregivers' contributions to patients' self-care, while also exploring the potential impact on their health. Prior to data collection, we conducted a pilot study to identify any shortcomings in the research design and made corresponding adjustments. The phrasing of questions in the questionnaire was refined based on the feedback from patients and caregivers. During the interpretation phase, we solicited feedback from a subset of patients and caregivers to further validate our findings, thereby enhancing the clarity and relevance of our results for the target audience.
To analyse how refined living arrangements, in the context of digital access, affect elderly healthcare resource utilisation and satisfaction with healthcare needs.
A prospective cohort study. The study reporting is conformed to the STROBE checklist.
This longitudinal study utilised data from the 2018–2020 waves of the United States-based Health and Retirement Study and the 2013–2015 waves of the China Health and Retirement Longitudinal Study.
Baseline living arrangement was categorised into living alone, intergenerational living, living with spouse, nuclear living and proximate residence. Unmet healthcare needs at follow-up waves (i.e., 2020 wave of Health and Retirement Study and 2015 wave of China Health and Retirement Longitudinal Study) were classified into unmet clinical care needs and unmet preventive care needs, which were measured using three measurements on whether the participant had disorders, whether the participants use any clinical care, and whether the participants use any preventive care. Digital exclusion was assessed using a single question about internet access at baseline.
A total of 7116 participants from the China Health and Retirement Longitudinal Study cohort (female: 48.6%, mean age: 57.4 years) and 7266 from the Health and Retirement Study cohort (female: 64.9%, mean age: 65.1 years) were included. Compared with older adults living a nuclear arrangement, those living an inter-generational arrangement with digital exclusion had higher clinical care utilisation, but not necessarily lower risk of unmet clinical needs; they also had lower preventive care utilisation in the Health and Retirement Study cohort, while living with spouse led to higher preventive care utilisation in the China Health and Retirement Longitudinal Study cohort.
Living arrangements can affect older adults' healthcare utilisation and unmet healthcare needs, which can be moderated by digital exposure.
These findings suggest that healthcare providers should tailor care strategies by considering both living situations and digital literacy. Enhancing digital access, especially for those in inter-generational households, could help address unmet healthcare needs and improve overall care satisfaction.
This study using the STROBE CHECKLIST for reporting guideline.
No patient or public contribution.
By comparing data from both the United States and China, it highlights the importance of considering family structure and digital inclusion when addressing healthcare needs globally. The findings suggest that older adults in inter-generational living arrangements without digital access face higher clinical care demands but still struggle with unmet healthcare needs. This underscores the need for healthcare systems worldwide to address digital exclusion and adapt care strategies to individual living circumstances to enhance healthcare outcomes for the elderly population.
To investigate the independent and combined effects of physical activity (PA) and depressive symptoms on the risk of frailty in community-dwelling older adults.
Older adults face a high risk of frailty which is commonly used to predict adverse health outcomes in older patients. Engaging in PA and without depressive symptoms are crucial factors to prevent frailty. It is essential to investigate the independent and combined effects of these two variables on the risk of frailty.
We included 3392 community-dwelling older adults. The FRAIL Scale was used to assess older adults' frail status (robust, prefrail and frail). Multiple logistic regression was utilized to examine the independent and combined effects of PA and depressive symptoms on the risk of prefrailty and frailty. The combined effects were visualized by marginal plots.
The prevalence of prefrailty and frailty in older adults were 42.16% and 10.58%. Compared with the group of “Light physical activity and With depressive symptoms”, “Vigorous physical activity and Without depressive symptoms” had the lowest risk of prefrailty and frailty.
Older adults who do not engage in PA or have depressive symptoms increased the risk of frailty, but older adults with depressive symptoms could lower the risk of frailty through PA.
It is effective to reduce the risk of frailty by directing older adults to do moderate physical activity, although they have depressive symptoms. The focus should also be on older adults with depressive symptoms, who have at least more than twice and fourfold risk of prefrailty and frailty compared to those without.
This study offers insights for future interventions aimed at preventing frailty in older adults.
This study adhered to the STROBE checklist.
Older adults participated in this study and completed questionnaires.
To identify latent profiles of competence and perceptions of spiritual care among clinical nurses and explore the possible influencing factors.
Understanding nurses' level of spiritual care competence and their perceptions and acceptance of such care is important, which could help devise nurse training programmes to address such competence in clinical nurses. However, research addressing interindividual variability in competence and perceptions among Chinese nurses is lacking.
Multicentre cross-sectional study.
Nurses working in departments with critically ill patients from 12 community, 5 secondary and 10 tertiary hospitals in Shanghai completed a demographic information questionnaire and the Chinese versions of the Spiritual Care Competence Scale, Spiritual Care-Giving Scale and Spiritual Perspectives Scale. The data were analysed using IBM SPSS v26.0 and Mplus version 8.3. Latent profile analysis identified subgroups with different levels of spiritual care competence.
In total, 1277 Chinese nurses were recruited. Four profiles of competence and perceptions of spiritual care were revealed: Low ability (23.8%), High ability (6.4%), High acceptance (34.9%) and Moderate (34.9%). The level of job position, spiritual care-related education, hospital grade and nurses' perceptions and perspectives of spiritual care predicted the probability of profile memberships in their competence.
There was heterogeneity in the characteristics of spiritual care competence. Nursing managers can implement individualised interventions, including relevant training, according to the influencing factors of different competence profiles to improve the level of such competence among nurses.
The results provide a new and expanded view of improving nurses' spiritual care competence. Interprofessional collaboration with clinicians, administrators, educators and spiritual leaders can contribute to the development of related education and training.
EQUATOR guidelines, STROBE checklist: cross-sectional studies.
All participants were clinical nurses. Participants were informed they could withdraw from the study at any time.
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