Effects of Tactile Massage in Improving Older Residents' Psychological Health in Long-Term Care Facilities: A Randomised Controlled Trial.

BACKGROUND: Loneliness, anxiety and depressive symptoms are common among older residents in long-term care facilities (LTCFs), which can negatively impact their quality of life and increase mortality rates. Addressing these psychological health issues is an important task for nursing staff. There is a need for easy and accessible interventions to improve older residents' negative emotions. Tactile massage (TM) is a form of touch therapy that induces oxytocin, which can help individuals feel relaxed, experience pleasure and reduce anxiety. TM can also provide a sense of security and care for individuals. OBJECTIVE: This study aimed to evaluate the effects of TM in improving older residents' psychological health in LTCFs. DESIGN: In this study, we applied a two-arm randomised controlled trial research design. METHODS: We used convenience sampling to enrol 55 older residents in three long-term care facilities who were randomly assigned to an intervention group and a comparison group. The intervention group received TM by research assistants on both hands for 15 min per time, twice a week for 4 weeks and the comparison group received regular care. Data were collected before and after the intervention. Generalised estimating equations (GEEs) were used to evaluate the effectiveness of the intervention. RESULTS: There were no significant differences in loneliness, anxiety, depressive symptoms, happiness, ear temperature, heart rate or diastolic blood pressure between the two groups after the intervention. However, the intervention group had significant improvements in comfort (B = 0.86, p < 0.001), relaxation (B = 1.00, p < 0.001), respiratory rate (B = -0.16, p = 0.021) and systolic blood pressure (B = - 4.17, p = 0.002) compared to the control group. CONCLUSIONS: TM can help older residents who live in LTCFs feel relaxed and comfortable. IMPLICATIONS FOR PRACTICE: TM can be easily implemented as it requires no tools. We recommend that nursing staff and healthcare professionals incorporate TM as part of their care routines. They also can encourage family members to perform TM on residents during their visits to enhance residents' comfort and relaxation. REPORTING METHOD: The Consolidated Standards of Reporting Trials (CONSORT) checklist was used for this paper. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05052138).

Correction: Structural validity of the Rosenberg self-esteem scale in patients with schizophrenia in Indonesia.

[This corrects the article DOI: 10.1371/journal.pone.0300184.].

Mediating roles of perceived stigma and mental health literacy in the relationship between school climate and help-seeking behavior in Indonesian adolescents.

OBJECTIVE: This study aimed to investigate whether perceived stigma and mental health literacy play mediating roles in the correlation between school climate and help-seeking behavior in Indonesian adolescents. METHODS: We used cross-sectional study design that recruited 760 Indonesian adolescents of age 16-19 years. We used convenience sampling from July to September 2019. Bivariate analysis was used to investigate the association of demographic characteristics with help-seeking behavior. Mediation analysis was employed to explore the mediating roles of mental health literacy and perceived stigma on the relationship between school climate and help-seeking behavior. RESULTS: Findings indicated that ethnicity, family income, and father's educational level were significantly associated (p < 0.05) with help-seeking behavior in Indonesian adolescents. Furthermore, perceived stigma and mental health literacy sequentially showed partial mediating roles in the relationship between school climate and help-seeking behavior (indirect effect: 0.004; 95% CI: 0.001, 0.010). Our mediating model indicated that a high level of school climate was associated with low perceived stigma (b = -0.11, p < 0.001) and high mental health literacy (b = 0.28, p < 0.001) and higher help-seeking behavior (b = 0.14, p < 0.001). CONCLUSION: Our study discovered novel insight of help-seeking behavior mechanism among adolescent by serial mediation test. Supportive school climate is necessary to achieve adequate help-seeking behavior. In addition, taking into account of student's perceived stigma and mental health literacy in promoting help-seeking behavior is also important.

Structural validity of the Rosenberg self-esteem scale in patients with schizophrenia in Indonesia.

BACKGROUND: The Rosenberg self-esteem scale (RSES) is a commonly employed instrument for measuring self-esteem in the general population and those with mental illness. However, confirmatory factor analyses (CFA) to determine the structural validity of the RSES for schizophrenia patients in Indonesia are limited. OBJECTIVES: We examined the structural validity of the RSES as a measurement for patients with schizophrenia in Indonesia through confirmatory factor analyses (CFA), as well as assessing internal consistency and reliability. METHODS: The sample comprised 260 participants. Over two weeks, 30 subjects were added to investigate test-retest reliability. The structural validity analyzed was based on a CFA to determine the model fit. We used internal consistency (Ordinal alpha) to evaluate the reliability evidence. RESULTS: Four different models were analyzed in this study. Considering the single-factor model (Model 1a), the overall fit criteria were inadequate. However, after some modification indices, all fit criteria were significantly adequate (Model 1b). The adequacy of all fit standards remained satisfactory when the two-factor model (Model 2) and hierarchical model (Model 3) were applied. The RSES had an ordinal alpha coefficient of 0.75. While 0.89 and 0.88 for the positive and negative self-esteem subscale, respectively. Test-retest reliability yielded adequate results with an interclass correlation score ranging from 0.87 to 0.93. CONCLUSIONS: The current investigation provided evidence supporting the structural validity, internal consistency, and reliability of the RSES, indicating that the RSES can be considered a valid and reliable measurement. A two-factor model of RSES was an appropriate model to measure self-esteem in our study. This finding suggests that the use of the RSES is beneficial and applicable in assessing levels of self-esteem in individuals diagnosed with schizophrenia in Indonesia.

Nursing students' attitudes towards mental illness: A multi-national comparison.

Accessible Summary What is known on the subject Health professionals, including nurses, are shown to have stigmatizing attitudes towards mental illness. For nursing students who are in their formative years of professional development, mental illness stigma can severely impact the care they provide. Little research has investigated multi-national comparisons of nursing students' attitudes towards mental illness. What this paper adds to existing knowledge This study shows that between countries, there were substantial differences amongst nursing students in stigmatizing attitudes towards mental illness. Cultural perspectives may explain some of these differences. What are the implications for practice Regardless of location, stigmatizing attitudes are present at varying levels. Each nation can take steps to reduce these by acknowledging the presence of stigmatizing attitudes amongst nurses, educating nurses regarding the negative impacts of stigma on patient outcomes, and decrease stigmatizing attitudes by facilitating opportunities for nurses (particularly student nurses) to have direct contact with people with lived experiences of mental illness. ABSTRACT: INTRODUCTION: Stigmatizing attitudes perpetuated by nursing professionals are a pervasive problem for people experiencing mental health issues. This global issue has detrimental consequences; inhibiting one's life chances and help-seeking behaviours. To date, few studies have compared nursing students' attitudes towards mental illness from a multi-national perspective. AIM: To compare undergraduate nursing students' attitudes towards mental illness across six countries: Australia, India, Jordan, Saudi Arabia, Taiwan and USA. METHOD: In a cross-sectional design, data were collected from undergraduate nursing students (N = 426) using the Social Distance Scale. A one-way analysis of variance was used to compare differences between countries. RESULTS: Nursing students' attitudes to mental illness differed between countries. Social Distance Scores were highest amongst nursing students from Jordan and Saudi Arabia. Students from Taiwan and India possessed moderate stigma scores. Social Distance Scores from the USA and Australia were lowest. DISCUSSION: Clear differences in stigmatizing attitudes emerged between countries; these are discussed in relation to possible cultural influences. IMPLICATIONS FOR PRACTICE: It is suggested that educating nurses, combined with direct contact with people with lived experiences of mental illness, can reduce stigmatizing attitudes regardless of country, location or educational institution.

Correlation between hemoglobin levels and depression in late-stage cancer patients with irritability as mediating variable.

PURPOSE: In late-stage cancer, the cancer itself or the side effects of cancer treatment are known to affect the hemoglobin (Hgb) levels or emotions of patients. We to investigate the relationship between Hgb levels and depression in late-stage cancer patients and verified whether irritability has a mediating effect on this relationship. METHOD: The research tools included a patient basic information form, the Irritability Scale-Initial Version (TISi), and the Hamilton Depression Rating Scale (HAMD). We first compared the Hgb levels, HAMD scores, and TISi scores of the cancer patients with different attributes, performed multiple hierarchical regression analysis, and then analyzed the mediating effects of TISi scores using the Sobel test. RESULTS: In the 117 late-stage cancer patients, Hgb levels of patients with a BMI<18.5 kg/m2 were lower than those of the patients with a BMI 24.0 kg/m2. Hgb levels had a negative influence on both TISi scores (B = -2.74, p = .001) and HAMD scores (B = -0.75, p = .010). TISi scores mediated the relationship between Hgb levels and HAMD scores (Z = 2.06, p = .040). CONCLUSIONS: Irritability is a mediating variable of the influence of Hgb levels on depression, meaning that lower Hgb levels in late-stage cancer patients may be detrimental to emotional stability, induce irritability, and thereby cause depression. Thus, in the psychological care of late-stage cancer patients, medical teams should be more vigilant in monitoring Hgb levels and anemia treatment.

Sleep quality and internet addiction among junior college students; The mediating role of depression: A cross-sectional study.

This study investigated the mediating effect of depression on the relationship between sleep quality and internet addiction in Taiwanese junior college students. We recruited 590 (53 males, 537 females) students, aged from 15 to 22 years from a day school of a junior college in northern Taiwan. We used a cross-sectional study design. The Chen Internet Addiction Scale, Chinese Version of the Pittsburgh Sleep Quality Index, and Adolescent Depression Scale were used as measurement instruments. Using the IBM SPSS Statistics 26 software package, descriptive statistics, reliability analysis, correlation analysis, and inferential statistics were used to evaluate the participants' demographics and relationships between the study variables. The mediation model was tested using the Z test. The prevalence of internet addiction in junior college students was 21.2 %. The indirect effects were determined using Sobel's test and bootstrapping confirming that depression completely mediated the relationship between sleep quality and internet addiction. The findings would help to build holistic and comprehensive prevention and intervention programs that should be developed to reduce the addictive behaviors of adolescents.

Antenatal depression across trimesters as a risk for postpartum depression and estimation of the fraction of postpartum depression attributable to antenatal depression: A systematic review and meta-analysis of cohort studies.

OBJECTIVE: This meta-analysis aimed at estimating the prevalence of postpartum depression (PPD) at different postpartum timepoints in women with antenatal depression (AD) in the three trimesters. We also examined the association between AD and PPD, and estimated the population attributable fraction of PPD to AD. METHODS: This systematic review and meta-analysis identified cohort studies that determined the prevalence of PPD in women who had AD, and those that examined the association between AD and PPD from PubMed, Embase, MEDLINE, CINAHL and PsycINFO. Articles were appraised using the modified Newcastle Ottawa Scale and data were analyzed using Comprehensive Meta-Analysis. RESULTS: Eighty-eight (88) cohort studies with a combined sample size of 1,042,448 perinatal women contributed to the meta-analysis. About 37% pregnant women who had AD, later had PPD. Those with AD had four times higher odds of developing PPD (OR: 4.58; 95% CI = 3.52-5.96). The odds of having PPD were higher when AD was observed in the first or third trimester compared to the second trimester. About 12.8% of PPD cases were attributable to AD. CONCLUSION: The findings should inform future clinical guidelines on the screening, the frequency of screening, and follow-up care in maternal-mental health.

Machine learning-based speech recognition system for nursing documentation - A pilot study.

PURPOSE: Considering the significant workload of nursing tasks, enhancing the efficiency of nursing documentation is imperative. This study aimed to evaluate the effectiveness of a machine learning-based speech recognition (SR) system in reducing the clinical workload associated with typing nursing records, implemented in a psychiatry ward. METHODS: The study was conducted between July 15, 2020, and June 30, 2021, at Cheng Hsin General Hospital in Taiwan. The language corpus was based on the existing records from the hospital nursing information system. The participating ward's nursing activities, clinical conversation, and accent data were also collected for deep learning-based SR-engine training. A total of 21 nurses participated in the evaluation of the SR system. Documentation time and recognition error rate were evaluated in parallel between SR-generated records and keyboard entry over 4 sessions. Any differences between SR and keyboard transcriptions were regarded as SR errors. FINDINGS: A total of 200 data were obtained from four evaluation sessions, 10 participants were asked to use SR and keyboard entry in parallel at each session and 5 entries were collected from each participant. Overall, the SR system processed 30,112 words in 32,456 s (0.928 words per second). The mean accuracy of the SR system improved after each session, from 87.06% in 1st session to 95.07% in 4th session. CONCLUSION: This pilot study demonstrated our machine learning-based SR system has an acceptable recognition accuracy and may reduce the burden of documentation for nurses. However, the potential error with the SR transcription should continually be recognized and improved. Further studies are needed to improve the integration of SR in digital documentation of nursing records, in terms of both productivity and accuracy across different clinical specialties.

Prevalence of sleep disturbance among adolescents with substance use: a systematic review and meta-analysis.

PURPOSE: Sleep disturbance has become a major challenge among adolescents worldwide. Substance use is among the most common factors contributing to sleep disturbance. This systematic review and meta-analysis examined the prevalence and categories of sleep disturbance among adolescents with substance use. METHODS: We comprehensively searched for relevant studies published in the following databases from inception to August 2022: CINHAL (via EBSCOhost), PubMed, Scopus, Ovid Medline, Embase, ProQuest, and Web of Science. Data analysis was performed using Comprehensive Meta-Analysis version 3 software. We used a random-effects model to pool prevalence rates with 95% confidence intervals (CIs). Forest plots and p values for the Cochran Q statistic were used to evaluate heterogeneity among studies. Subgroup and meta-regression analyses were performed to compare the groups and identify the sources of heterogeneity. RESULTS: We examined 18 studies that reported insomnia, hypersomnolence, sleep-related breathing disorders as sleep disturbances among adolescents with the use of alcohol, smoking, marijuana, and coffee. The total sample was 124,554. The overall prevalence rate of sleep disturbance was 29% (95% CI: 0.201-0.403). Subgroup analysis revealed that the prevalence rates of insomnia and hypersomnolence were higher among alcohol users (31%; 95% CI: 0.100-0.654) and smokers (46%; 95% CI: 0.232-0.700). The study design and method of assessment groups were the significant moderators that showed the source of variation in the included studies. CONCLUSION: Sleep disturbance is highly prevalent among adolescents with substance use. Insomnia and hypersomnolence are more prevalent among alcohol users and smokers, respectively. On the basis of our findings, health-care providers can develop effective targeted interventions to reduce substance use, prevent sleep disturbance, and promote healthy sleep habits among adolescents.

Comparison of nursing diagnostic accuracy when aided by Knowledge-Based Clinical Decision Support Systems with Clinical Diagnostic Validity and Bayesian Decision Models for psychiatric care plan formulation among nursing students: a quasi-experimental study.

BACKGROUND: The most suitable and reliable inference engines for Clinical Decision Support Systems in nursing clinical practice have rarely been explored. PURPOSE: This study examined the effect of Clinical Diagnostic Validity-based and Bayesian Decision-based Knowledge-Based Clinical Decision Support Systems on the diagnostic accuracy of nursing students during psychiatric or mental health nursing practicums. METHODS: A single-blinded, non-equivalent control group pretest-posttest design was adopted. The participants were 607 nursing students. In the quasi-experimental design, two intervention groups used either a Knowledge-Based Clinical Decision Support System with the Clinical Diagnostic Validity or a Knowledge-Based Clinical Decision Support System with the Bayesian Decision inference engine to complete their practicum tasks. Additionally, a control group used the psychiatric care planning system without guidance indicators to support their decision-making. SPSS, version 20.0 (IBM, Armonk, NY, USA) was used for data analysis. chi-square (χ2) test and one-way analysis of variance (ANOVA) used for categorical and continuous variables, respectively. Analysis of covariance was done to examine the PPV and sensitivity in the three groups. RESULTS: Results for the positive predictive value and sensitivity variables indicated that decision-making competency was highest in the Clinical Diagnostic Validity group, followed by the Bayesian and control groups. The Clinical Diagnostic Validity and Bayesian Decision groups significantly outperformed the control group in terms of scores on a 3Q model questionnaire and the modified Technology Acceptance Model 3. In terms of perceived usefulness and behavioral intention, the Clinical Diagnostic Validity group had significantly higher 3Q model and modified Technology Acceptance Model 3 scores than the Bayesian Decision group, which had significantly higher scores than the control group. CONCLUSION: Knowledge-Based Clinical Decision Support Systems can be adopted to provide patient-oriented information and assist nursing student in the rapid management of patient information and formulation of patient-centered care plans.

Relationship between traits and sleep quality of hospitalized elderly patients and sleep quality of family caregivers.

AIM: To understand whether the sleep quality of the caregivers of elderly inpatients is associated with their own characteristics and with the characteristics or sleep quality of the elderly inpatients. DESIGN: A cross-sectional study design that recruited participants from September to December 2020 was adopted, in which 106 pairs of elderly inpatients and caregivers were recruited. METHODS: Data collected from the elderly inpatients included demographic characteristics as well as the numerical rating scale (NRS) score, Charlson Comorbidity Index (CCI), Geriatric Depression Scale Short Form (GDS-SF) score, and Pittsburgh Sleep Quality Index (PSQI). Caregiver data included demographic characteristics and PSQI. RESULTS: In the regression analysis of caregiver characteristics and caregiver sleep quality, only caregiver age and the relationship between caregiver and inpatient (other vs. spouse) were correlated with caregiver sleep quality. In the regression analysis of elderly inpatient characteristics, caregiver characteristics, and caregiver sleep quality, only the PSQI of elderly inpatients and the relationship between caregiver and inpatient (other vs. spouse) were correlated with caregiver sleep quality. PATIENT OR PUBLIC CONTRIBUTION: Poor caregiver sleep quality was more likely to manifest when the elderly inpatients had poor sleep quality, when the caregivers themselves were older, and when the caregiver was the inpatient's spouse.

Psychometric Evaluation of The Irritability Scale-Initial Version in Chinese Cancer Patients.

BACKGROUND: Irritability is a common experience of depressed Chinese patients but is understudied and poorly measured. OBJECTIVE: We aimed to assess psychometric properties of a new measure of irritability in Chinese cancer patients across the social and political spectrum. METHODS: The Irritability Scale-Initial Version (TISi) was translated into Chinese and tested in two samples of Chinese cancer patients undergoing treatments: 52 patients in Beijing, China, between 2018 and 2019 and 65 patients in Taipei, Taiwan, in 2020. RESULTS: The Chinese version of TISi demonstrated high internal consistency, high reliability based on the split-half method in the two samples, and satisfactory discriminant validity using the Chinese version of the 17-item Hamilton Rating Scale for Depression and the seven-item depression subscale of the Hospital Anxiety and Depression Scale in the Beijing sample. A confirmatory factor analysis produced factor loadings in both samples, which resembled a sample of American cancer patients. Three TISi items were loaded more highly on the physical instead of the original behavioral subscale in the Beijing sample. A possible influence of cultures was explained. CONCLUSION: The Chinese version of TISi has satisfactory psychometric properties for assessing the level of irritability in Chinese cancer patients. Future large-sample studies are needed to further determine TISi's factorial structure, test-retest reliability, sensitivity to change, and predictive validity for depression in Chinese cancer patients.

Psychometric Validation of the Indonesian Version of Children's Revised Impact of Event Scale 13.

A psychometric evaluation of the Children's Revised Impact of Event Scale 13 (CRIES-13), which measures the posttraumatic stress disorder (PTSD) symptoms in children and adolescents caused by the coronavirus disease 2019 (COVID-19) pandemic, was conducted. We aimed to cross-culturally adapt and test the psychometric qualities of the CRIES-13 that was applied to Indonesian adolescents exposed to COVID-19 risk across gender groups. A cross-sectional study was conducted at a junior high school in Yogyakarta, Indonesia, in May 2022; 346 Indonesian adolescents aged 12 to 18 years completed the Indonesian version of the CRIES-13. The factorial validity results supported the scale's three-factor structure (intrusion, avoidance, and arousal), which satisfied all parameter index requirements and exhibited a favorable level of internal consistency reliability. Excellent results were obtained across genders for the four-level measurement of invariance (i.e., configural, metric, scalar, and full invariance), and they met the recommended criteria. Our Cronbach's alphas and composite reliability ratings were high (>0.7), indicating a strong correlation and reliability of the items for measuring each construct. We strongly support the use of the Indonesian CRIES-13, which was demonstrated to be valid and reliable for an adolescent population.

Urinary Incontinence and Sleep Quality in Older Women with Type 2 Diabetes: A Cross-Sectional Study.

BACKGROUND: Urinary incontinence (UI) and poor sleep negatively affect health-related quality of life (HRQoL). This study explored the UI-related factors and the relationships between UI, sleep quality, and HRQoL. METHODS: This cross-sectional study collected data from 237 women with type 2 diabetes. Multivariate logistic regression was conducted to identify the factors associated with UI. One-way analysis of variance was used to compare the mean sleep quality and HRQoL scores of women without UI and those who experienced UI of varying severities. Correlation coefficients were estimated, and multivariate linear regression was conducted to examine the relationships between UI severity, sleep quality, and HRQoL. RESULTS: Of the 237 women, 115 (48.52%) experienced UI and 139 (58.65%) were poor sleepers. The three factors associated with UI were advanced age, a higher body mass index, and a history of vaginal delivery. Significant associations between UI severity and sleep quality and between sleep quality and HRQoL were revealed. UI severity and night-time voiding frequency were both associated with sleep quality. CONCLUSIONS: One factor associated with UI (body mass index) is modifiable. UI severity is associated with sleep quality as the possible influence of night-time voiding frequency on sleep quality has been considered.

Comparison of the Associations between Self-Reported Sleep Quality and Sleep Duration Concerning the Risk of Depression: A Nationwide Population-Based Study in Indonesia.

There is substantial evidence that a lack of sleep quality and duration can increase the risk of depression in adults. Still, few studies have compared sleep quality and duration to the risk of depression in Indonesia. Therefore, this study aimed to compare the prevalence and risk of depression associated with both sleep quality and duration and identified those factors associated with sleep quality with sleep duration. This study was a cross-sectional study, and the data were obtained from the 2014 Indonesian Family Life Survey, with a total sample comprised of 19,675 respondents aged older than 15 years old. A self-reported questionnaire was used to assess sleep quality and duration. Depression was assessed using the Center for Epidemiologic Studies Depression (CESD-10) questionnaire. Logistic regression was used to examine the risk of depression, and multinomial logistic regression was used to examine the risk of poor sleep quality with consideration to sleep duration. The prevalence of depression was the highest in the poor sleep quality and long sleep duration groups (48.5%). After all variables associated with depression were adjusted, poor sleep quality was identified as a factor leading to a higher risk of depression (OR = 4.2; 95% CI: 3.7-4.6; p < 0.001) than long sleep duration (OR = 1.4; 95% CI: 1.2-1.6; p < 0.001). Furthermore, the interaction between poor sleep quality and long sleep duration gave the highest risk of depression (OR = 4.4; 95% CI: 3.6-5.3); p < 0.001). Multinomial logistic regression revealed that the factors leading to a significant increase in the risk of poor sleep quality, with consideration to sleep duration, in the population were age, gender, marital status, education, wealth index, physical activity, chronic illness, season, and urban area (p < 0.05). Sleep quality was found to be associated with a higher risk of depression than sleep duration. The findings of this study may be beneficial to healthcare professionals who develop health promotion strategies for reducing the incidence of depression in communities.

Genomic-Analysis-Oriented Drug Repurposing in the Search for Novel Antidepressants.

From inadequate prior antidepressants that targeted monoamine neurotransmitter systems emerged the discovery of alternative drugs for depression. For instance, drugs targeted interleukin 6 receptor (IL6R) in inflammatory system. Genomic analysis-based drug repurposing using single nucleotide polymorphism (SNP) inclined a promising method for several diseases. However, none of the diseases was depression. Thus, we aimed to identify drug repurposing candidates for depression treatment by adopting a genomic-analysis-based approach. The 5885 SNPs obtained from the machine learning approach were annotated using HaploReg v4.1. Five sets of functional annotations were applied to determine the depression risk genes. The STRING database was used to expand the target genes and identify drug candidates from the DrugBank database. We validated the findings using the ClinicalTrial.gov and PubMed databases. Seven genes were observed to be strongly associated with depression (functional annotation score = 4). Interestingly, IL6R was auspicious as a target gene according to the validation outcome. We identified 20 drugs that were undergoing preclinical studies or clinical trials for depression. In addition, we identified sarilumab and satralizumab as drugs that exhibit strong potential for use in the treatment of depression. Our findings indicate that a genomic-analysis-based approach can facilitate the discovery of drugs that can be repurposed for treating depression.

The Influence of Reducing Clinical Practicum Anxiety on Nursing Professional Employment in Nursing Students with Low Emotional Stability.

Nursing students experience anxiety during clinical practicum, which may interfere with their learning in clinical practice and nursing employment after graduation. This study explored: (1) the factors of the difference in anxiety levels between pre- and post-practicum in nursing students; (2) identified their anxiety events in a clinical environment; and (3) the correlation between emotional stability and 5-year nursing professional employment. The study was designed as a mixed method. A longitudinal secondary analysis method and a qualitative approach with open questionnaire were conducted. The emotional stability subscale of Lai's Personality Inventory and the Beck Anxiety Inventory, as well as open questionnaires were administered. Research data were collected through the purposive sampling of 237 nursing students (mean age was 20.96, SD = 1.29) of 4.2% male and 95.8% female in a central Taiwan hospital in 2013, and the participants were followed up in 2021 to show 70% in clinical service. Most of the nursing students exhibited significantly decreased anxiety levels in the post-practicum period. Compared to nursing students with high emotional stability, those with low emotional stability exhibited higher differences in their anxiety levels between the pre- and post-practicum periods. Low emotional stability is critical in a pre-practicum BAI score. However, the high pre-practicum BAI score would decrease to normal range after enrolling to practicum setting. So, as to their 5-year nursing professional employment after graduation. Teachers foster a positive learning atmosphere that emphasizes the importance of "we are family" to students. Teachers and advisors need to make efforts in leading the low emotional stability nursing students to learn effective coping and adapting strategies in clinical practicum.

Coping with the Experience of Bad Sleep and Fatigue Associated with the Nursing Clinical Practicum.

Nursing students experience anxiety during clinical practicum, which may interfere with their learning of clinical practice. This study explored the practicum anxiety symptom experience of clinical nursing students. The methodology was mixed research design consist of questionnaire and a qualitative research design following a grounded theory approach. Research data were gathered via theoretical sampling from 37 female college nursing students practicing in a Central Taiwan hospital and analyzed using the content analysis method. The mean age of the subjects was 20.7 ± 1.35 years old. The practicum-related anxiety symptom experience was made up of core dimensions associated with the nursing clinical practicum, such as bad sleep and fatigue, and covered six themes. Students first encountered anxiety-inducing situations in the clinical setting, and then they began coping through self-adaptation and teachers' help. In cases of coping failure, students began to have a bad sleep in the night and then felt tired and fatigued all day. These themes became a repeating cycle during the clinical practicum. This conceptual model shows that students experienced bad sleep and fatigue as a result of anxiety symptoms during the clinical practicum. Bad sleep and fatigue are critical anxiety symptoms for nursing students in clinical practice. Nursing teachers should pay attention to bad sleep and fatigue in nursing students and help students to improve their mental and physical health.