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This study aimed to examine the level of vicarious posttraumatic growth among intensive care unit nurses in China and explore the mediating role of death coping ability in the relationship between moral resilience and vicarious posttraumatic growth.
A multicentre, cross-sectional study was conducted in accordance with the STROBE guidelines.
Between January and March 2025, a questionnaire survey was conducted among 666 intensive care unit nurses from nine tertiary Grade A hospitals across five provinces in China. Participants completed three standardised instruments: the Rushton Moral Resilience Scale, the Coping with Death Scale–Short Version, and the Vicarious Posttraumatic Growth Inventory. We used IBM SPSS 27.0 for descriptive statistics, univariate analyses, and correlation analyses, and employed AMOS 27.0 to perform structural equation modelling for testing mediation effects.
Intensive care unit nurses demonstrated a moderate level of vicarious posttraumatic growth. Moral resilience was positively associated with both death coping ability and vicarious posttraumatic growth. Death coping ability was found to play a partial mediating role in the relationship between moral resilience and vicarious posttraumatic growth.
Moral resilience and death coping ability are key factors associated with vicarious posttraumatic growth among intensive care unit nurses. Nurses with stronger moral resilience are more likely to cope constructively with death-related stress, which may support psychological growth in trauma-intensive environments.
This study highlights the need to enhance intensive care unit nurses' moral and emotional capacities through ethics education, emotional coping training, and institutional support strategies. Strengthening these competencies may foster professional development and mental wellbeing in critical care settings.
To translate the Supportive and Palliative Care Indicators Tool (SPICT) into Chinese and conduct preliminarily tests of its performance in hospitalized patients with cancer.
A cross-sectional validation study conducted from January to March 2024.
SPICT 2022 was translated in both directions, following the Brislin translation model, and the Chinese version culturally debugged through expert consultation and pre-testing. Content validity was evaluated by expert scoring. Tool internal consistency was evaluated using KR-20 coefficient, and retest reliability was evaluated using kappa coefficient. The screening performance was evaluated by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
Of 388 hospitalized cancer patients included, approximately one-quarter had potential palliative care needs. Content validity of the Chinese version of SPICT was good, as were internal consistency and test–retest reliability. Accuracy (0.905), sensitivity (0.806), specificity (0.943), PPV (0.845), and NPV (0.926) for the Chinese version of SPICT indicated that it is an acceptable instrument.
The Chinese version of SPICT can be applied for screening of palliative care needs in hospitalized patients with cancer in China.
The Chinese version of SPICT had been adapted to assist clinicians or nurses in quickly identifying hospitalized patients with cancer who may have palliative care needs. This is conducive to help clinical team to start palliative care consultation, care goal discussion and (or) referral for patients in clinical practice. And it probably helps to advance integration between palliative care assessment and routine oncology care assessment.
This study provided a screening tool for palliative care, with good validity and reliability, as well as excellent screening performance to facilitate palliative care need screening in clinical practice, promote palliative care referrals and improve patient quality of life.
This study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.
No patient or public contribution.
Preventing skin tears (STs) in older adults is an urgent public health concern, especially in long-term care (LTC) facilities. However, limited research on ST prevention among care workers exists due to a lack of suitable assessment tools. This study aims to develop and psychometrically evaluate the Knowledge, Attitude and Practice instrument for care workers in preventing Skin Tears (KAP-ST) in older adults.
The KAP-ST was developed and validated in four phases during May–October 2024. First, an item pool was generated through a comprehensive literature review. Second, a preliminary instrument was developed through a Delphi expert consultation and pilot testing. Third, the items and the final instrument were optimised through a cross-sectional survey involving 317 care workers from 29 LTC facilities in China. Finally, a psychometric evaluation was conducted in another cross-sectional survey involving 373 care workers from 18 LTC facilities.
The final KAP-ST contains 35 items across knowledge, attitude and practice dimensions. Exploratory factor analysis (EFA) revealed a nine-factor structure (factor loadings ranging from 0.451 to 0.799, accounting for 61.35% of total variance). The Item-Level Content Validity Index (I-CVI) values ranged from 0.926 to 1.000, and the Scale-Level Content Validity Index (S-CVI/Ave) was 0.991. The instrument's Cronbach's α, split-half, and test–retest reliability coefficients were 0.887, 0.744, and 0.934, respectively. The CFA analysis revealed an ideal absolute fit validity (RMSEA = 0.068; RMR = 0.029) and parsimony fit validity (PGFI = 0.684).
The KAP-ST demonstrates strong reliability, structural validity and content validity. It is well-suited for assessing care workers' knowledge, attitudes and practices in preventing STs among older adults. Further research is required to enhance and confirm its validity.
STs in the spotlight recently necessitate the use of appropriate investigative tools to facilitate in-depth research, especially for care workers, who should prioritise access to specialised knowledge. Introducing professional guidance in LTC facilities is recommended to enhance the knowledge, attitude and practice of care workers.
Standardised Guidelines for Scale Construction and COSMIN checklist.
No patient or public contributions.
To understand the social representations of bedside milk expression (BME) among mothers of preterm newborns in neonatal intensive care units (NICUs).
Qualitative descriptive study.
The study was conducted from July to August 2024 in two NICUs of a referral maternity hospital in Fortaleza, Brazil. Nineteen mothers of hospitalised premature newborns participated. Semi-structured interviews were conducted and subjected to thematic content analysis.
Mothers perceived BME as a meaningful act of protection and bonding, though some were unfamiliar with the practice. Emotional ambivalence was common, shaped by prior breastfeeding experiences and the context of prematurity. Discomfort related to privacy and shared spaces was noted. Support from healthcare professionals was essential to promote understanding and adherence.
Social representations of BME are shaped by emotional, social and institutional experiences. Anchored in prior breastfeeding experiences and cultural meanings of maternal care, the practice is objectified through both gestures of affection and tangible barriers.
Healthcare professionals, particularly nurses, should receive training to support mothers in BME. Structural improvements, privacy and emotional support are essential for fostering maternal autonomy and confidence.
This study highlights the barriers to BME, emphasising the role of healthcare support and the need for better infrastructure, privacy and training to enhance maternal confidence and breastfeeding.
The study followed the Consolidated Criteria for Reporting Qualitative Research checklist.
None.
This paper highlights the pivotal role of healthcare professional support in overcoming barriers to BME and promoting breastfeeding practices.
Fresh breast milk is considered the gold standard for reducing complications and improving survival in preterm infants. BME is recommended as an effective strategy to ensure the availability of fresh breast milk. Mothers' social representations of this practice remain underexplored within the neonatal intensive care context.
Explores mothers' social representations of BME in NICUs, addressing a significant gap in qualitative research. Reveals how emotional, social and institutional factors shape mothers' perceptions, motivations and challenges related to BME. Highlights the need for targeted professional support, improved infrastructure and privacy to enhance maternal autonomy and adherence to milk expression practices.
Healthcare professionals, particularly nurses, should receive specialised training to provide technical guidance and emotional support, enhancing mothers' confidence and autonomy in BME. Improving infrastructure and ensuring privacy in NICUs are crucial to creating supportive environments that facilitate milk expression and strengthen maternal–infant bonding. Institutional policies should integrate maternal-centred strategies to support breastfeeding continuity and promote humanised neonatal care.
To explore the experiences, perceptions, and role adaptation of nursing PhDs in hospital settings in China.
A descriptive phenomenological qualitative study.
Individual in-depth interviews were conducted with eight female nursing PhD holders from eight tertiary hospitals across five provinces between November 2024 and February 2025. Data were concurrently collected and analysed using NVivo 11.0, guided by Colaizzi's seven-step analysis.
Four main themes were identified: (1) Multidimensional motivations for choosing hospital work; (2) professional challenges; (3) perceived professional value and benefits; and (4) career expectations and developmental recommendations. Fifteen subthemes further detailed these dynamics.
This study offers a nuanced understanding of the career development of nursing PhDs within hospital settings. The findings reveal the complex interplay of factors influencing their decisions to enter clinical practice. Moreover, it underscores the dual challenges of role ambiguity and limited resources, while also illustrating the transformative potential of applying academic training to drive clinical innovation among nursing PhDs in hospital environments.
These findings offer critical insights for hospital administrators and educational policymakers. By elucidating the career development challenges and opportunities for nursing PhDs, the study underscores the need for tailored talent management frameworks and targeted educational reforms. The findings have important implications for hospital settings in China and offer guidance for global strategies in talent management and clinical education reform, ultimately contributing to improved patient care and healthcare outcomes.
Adhered to COREQ guidelines for qualitative research.
None.
Death preparedness is an important prerequisite for improving the quality of life and the quality of death in advanced cancer patients. However, research on the level of death preparedness in patients is insufficient, and there is little understanding of the current status and influencing factors of death preparedness in advanced cancer patients.
This study aims to assess the current status of death preparedness and its influencing factors in advanced cancer patients.
Based on the PRECEDE-PROCEED model, a structured survey questionnaire was designed to collect data on personal factors (such as gender, age and residence area), interpersonal factors (such as social support, caregiver readiness and healthcare worker readiness) and social factors (such as care resources, policy support and information supply). Through multiple linear regression and BP neural network analysis, the study explores the impact and significance of these influencing factors on death preparedness in advanced cancer patients.
A total of 930 valid questionnaires were collected in this study. The death preparedness score in advanced cancer patients was 72.18 ± 22.82, indicating a moderate level, with the highest score being the ‘reflexive care’ dimension and the lowest score being the ‘hospice programme’ dimension. Multivariate analysis revealed that meaning in life and social support were the most significant predictors of death preparedness in advanced cancer patients. In addition, personal factors such as dignity, household income and coping style, also played an important role. Interpersonal factors like social support, as well as social factors such as care resources and policy support, also had an impact on patients' death preparedness to some extent.
Death preparedness in advanced cancer patients is generally at a moderate level, and death preparedness is influenced by a combination of personal factors, interpersonal factors and social factors.
This study is based on the PRECEDE-PROCEED model to comprehensively explore the influencing factors of death preparedness in advanced cancer patients. It provides theoretical support for improving life services for advanced cancer patients. It offers valuable practical experience and insights for societal attention and reform in end-of-life care.
No Patient or Public Contributions were included in this paper.
This study explored the factors associated with oncology nurses' behaviour and intention to provide cancer care to lesbian, gay, bisexual, and transgender (LGBT) individuals in Taiwan.
A qualitative descriptive study.
Semi-structured interviews were conducted with 25 oncology nurses between August and October 2023. The interview data were analysed using the framework method (the socio-ecological model) and constant comparative techniques.
Factors associated with oncology nurses' behaviour and intentions to provide cancer care for LGBT individuals were categorised and presented by the levels of the social-ecological model: (1) intrapersonal level: oncology nurses' attitudes toward LGBT populations and their experiences, confidence, and beliefs in providing cancer care for LGBT individuals; (2) interpersonal level: concerns or interactions with oncology nurses' colleagues, other heterosexual cancer patients, and managers; (3) community and organisation levels: organisational climate and related training courses; and (4) societal and policy level: policy regarding sexual orientation, gender identity collection, and social atmosphere.
Multilevel barriers associated with oncology nurses' behaviours and intentions to provide cancer care to LGBT individuals were identified. The study findings emphasised the importance of related training courses offered by organisations to reduce cancer care disparities among LGBT individuals. These courses also aim to enhance oncology nurses' confidence and comfort in delivering holistic and patient-centred cancer care for this population.
The study findings can be employed to assist in developing related training courses and understand the challenges oncology nurses face when providing cancer care to LGBT individuals.
No patient or public contributions.
This study aimed to determine the mediating roles of perceived control and resilience in the association between mutuality and quality of life (QoL) in caregivers of adults with heart failure.
A multi-centre cross-sectional study.
We recruited 268 patient-caregiver dyads with heart failure using convenience sample enrolled from four hospitals in Henan Province, China from March to December 2023. Caregivers' mutuality, perceived control, resilience and QoL were assessed. A multiple-mediation model was tested using the PROCESS macro in SPSS.
Caregivers' mental QoL positively correlated with mutuality, perceived control, and resilience. Caregivers' physical QoL was correlated with mutuality. Conversely, perceived control and resilience showed no significant correlation with physical QoL. Moreover, the association between mutuality and mental QoL was mediated by perceived control and resilience, respectively, and together in series, accounting for 32.3%, 14.1% and 28.2% of the total effect, respectively.
Perceived control and resilience mediated the link between mutuality and mental QoL in caregivers of adults with heart failure. Interventions targeted at strengthening perceived control and resilience may improve caregivers' mental QoL. Additionally, the mental QoL may be improved by indirectly enhancing mutuality among caregivers of adults with heart failure.
It is important to develop multimodal intervention strategies that combine perceived control and resilience to amplify the positive impact of mutuality on the mental QoL of caregivers in individuals with heart failure.
The STROBE guideline was adopted to report this study.
No patient or public contribution.
To investigate the impacts of social support and psychological detachment on nurses' job burnout, as well as to validate psychological detachment's mediating effect.
The study was conducted using a questionnaire-based cross-sectional design.
From October 2023 to March 2024, convenience sampling was used to distribute electronic questionnaires (including a general information questionnaire, the Maslach Burnout Inventory, the Psychological Detachment Scale, and the Social Support Scale) to investigate the current state of job burnout, psychological detachment, and social support among nurses. A total of 325 nurses were included in the study. The statistical analysis was performed using SPSS 29.0 software and the SPSS Process 4.1 plug-in.
Results showed that both social support and psychological detachment were negatively correlated with job burnout. Excluding general demographic characteristics, social support was negatively associated with job burnout through psychological detachment, where psychological detachment mediated social support and emotionally exhausting job burnout with a mediating effect of 8.93%.
Nurses' job burnout can be mitigated by both social support and psychological detachment, with psychological detachment acting as a mediation of the effect of social support.
Nursing managers should take measures to enhance the social support of nurses appropriately. At the same time, it is necessary to arrange work reasonably and establish a solid communication mechanism to improve nurses' psychological detachment and reduce nurses' job burnout.
No patient or public involvement.
To explore the stability of resilience among frontline nurses and to analyse the predictive role of internal and external factors on the patterns of resilience transformation in China during public health emergencies.
The study used a longitudinal design and surveyed 258 frontline nurses at three different time points: February–March 2020 (T1), May–June 2020 (T2) and May–June 2022 (T3). The survey included the 10-item Connor–Davidson resilience scale, the Emotion Regulation Questionnaire and the Simple Coping Style Questionnaire. Latent profile analysis and latent transition analysis were used to examine the potential classes and changes. Multivariate logistic regression analysis was applied to evaluate the predictors of resilience transitions.
The resilience of frontline nurses was divided into three categories: fragile group, general group and high resilience group. From T1 to T2, the general group exhibited the least stability, with a probability of maintaining its original latent state at 72.9%. Marriage and positive coping styles significantly impacted the transition between resilience categories. From T2 to T3, the fragile group showed the lowest stability, with a 74.9% likelihood of retaining its initial latent state. In this context, supportive hospital management (including psychological counselling, restful environments, and both spiritual and material incentives) and individuals' emotional regulation and sleep quality significantly affected the transition between resilience categories.
These findings emphasise the necessity for early intervention. For frontline nurses, conducting initial assessments of resilience coupled with sustained hospital support is crucial for maintaining mental health and improving the quality of nursing care in public health emergencies.
This study offers a fresh perspective for understanding the resilience of frontline nurses during public health emergencies. At the same time, it reveals the factors that promote or hinder the change in resilience among frontline nurses at both individual and organisational levels. This provides a theoretical basis for future resilience interventions and helps us formulate effective crisis management strategies to respond to future public health emergencies. For frontline nurses with diverse resilience characteristics and relevant transformation factors, a personalised multi-mode resilience improvement plan can be developed to mitigate public health emergencies' potential adverse psychological impact on frontline nurses, especially those in the fragile group.
No patient or public contribution.
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