Moral courage level of nurses: a systematic review and meta-analysis.

BACKGROUND: Moral distress occurs in daily nursing work and plagues nurses. Improving the level of moral courage is one of the main strategies to reduce moral distress, and low levels of moral courage may lead to nurse burnout, increased turnover, and reduced quality of care. METHODS: Nine electronic databases in Chinese and English were searched for the level of moral courage among nurses, including PubMed, Web of Science, EMBASE, CINAHL, CNKI, Wan fang, Wei pu, CBM and Cochrane Library, for the period from the date of database creation to April 5, 2023. The Agency for Healthcare Research and Quality (AHRQ) was used to assess the methodological quality of the included studies, followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Meta-analysis and Systematic Reviews of Observational Studies guidelines, and data from the included studies were meta-analyzed in STATA version 15 using a fixed-effects model. RESULTS: Seventeen cross-sectional studies of moderate or high quality met the eligibility criteria and involved 7718 nurses, and the Nurses' Moral Courage Scale (NMCS) was used to measure the self-assessed moral courage level of nurses. Eleven of these studies reported total scores for nurses' moral courage, and the meta-analysis results showed a pooled mean score of 78.94 (95% CI: 72.17, 85.72); Fourteen studies reported mean entry scores for nurses' moral courage, and the meta-analysis results showed a pooled mean score of 3.93 (95% CI: 3.64, 4.23). CONCLUSION: The results of the meta-analysis showed that nurses' moral courage levels were in the medium to high range, among the nurses who seemed to be male, non-nursing managers, high school education, had not experienced ethical issues, and considering resignation had lower levels of moral courage. The results of the meta-analysis may provide some reference for nursing managers and even hospital administrators to develop strategies to optimize nursing quality.

Experiences of the Older Adults After Being Abused: A Qualitative Meta-synthesis.

Elder abuse is a global public health problem with severe social costs. Research on elder abuse has gradually increased; however, less attention has been paid to older adults' perceptions and experiences of abuse. This review aimed to integrate older adults' perceptions and experiences of abuse to provide a theoretical basis for developing interventions that meet their authentic needs. Six electronic databases were searched to include qualitative studies examining perceptions and experiences of abuse among adults aged 60 years or older, and 22 studies were included. This study used the Joanna Briggs Institute meta-aggregation approach to integrate the qualitative findings, which identified four themes: (a) changes resulting from elder abuse, (b) causes of abuse, (c) barrier factors and facilitating factors to the disclosure of abusive behavior, and (d) adopting different response strategies. The findings revealed that older adults experience persistent physical and psychological burdens and financial stress following abuse. Multiple factors influence the emergence of abuse and older adults search for help from the outside world, especially social support and perceptions of abuse. Older adults can deal with abuse by accepting the status quo or taking steps to change it. These findings have important implications for helping older adults prevent and cope with abuse experiences.

Factors influencing thirst in ICU patients: A mixed methods systematic review.

OBJECTIVE: To systematically review the factors influencing thirst in ICU patients, providing a reference for effective management of thirst in ICU patients and the formulation of intervention measures. METHODS: A total of 12 electronic databases were searched from inception to July 2023. The synthesis method of JBI mixed methods research systematic review was used. The quantitative studies were analyzed by Stata17.0 and RevMan 5.3 software, and the qualitative studies by meta-aggregation. RESULTS: A total of 13 studies were included, including 2 qualitative studies and 11 quantitative studies. The quantitative study was carried out by meta-aggregation, extracting seven categories to form two synthesized findings. Quantitative meta-analysis revealed that 11 factors, including marital status, whether to use mechanical ventilation for the first time, air leakage, mechanical ventilation mode, simplified acute physiology score, respiratory rate, mask comfort, serum sodium concentration, breathing pattern, diuretics, and vasoactive drugs, were all associated with the occurrence of thirst in ICU patients. The qualitative and quantitative results were integrated into 5 categories, namely personal characteristics and lifestyle, disease factors, treatment factors, psychological factors, and nurse factors. CONCLUSIONS: Thirst is a prevalent and severe issue among ICU patients, and effective interventions are required to address it. Considering its various causes, managing thirst in ICU patients should involve multiple levels of intervention. Treatment-related factors contribute significantly to thirst, and these factors should be taken into consideration when developing a thirst management strategy. Personal characteristics and lifestyle, psychological factors, drug-related factors, and nursing factors should be identified and optimized as soon as possible. IMPLICATIONS FOR CLINICAL PRACTICE: Healthcare professionals should pay attention to thirst symptoms in ICU patients and promptly take effective preventive or intervention measures based on the influencing factors.

Evidence-based practice attitudes, knowledge and skills of nursing students and nurses, a systematic review and meta-analysis.

AIM/OBJECTIVE: This study aims to carry out a meta-analysis of attitudes, knowledge, and skills level of nursing students and nurses in EBP, providing a reference for optimizing EBP education strategies. BACKGROUND: At present, no meta-analysis has been performed to quantitatively synthesize the attitudes, knowledge and skill levels of nursing students and nurses toward EBP. This makes it difficult to precisely identify the true level of EBP among nurses, implying that there is no evidence to support the adoption of EBP teaching strategies approaches. DESIGN: A total of 9 Chinese and English databases including CNKI, Wan fang, VIP, CBM, PubMed, Embase, Web of Science, Cochrane Library and CINAHL were used to search cross-sectional quantitative articles on EBP attitudes, knowledge and skills level of nurses and nursing students. The search time limit was from the inception of the database to September 2023. METHODS: Two researchers independently screened the literature and extracted the data. The Agency for Healthcare Research and Quality (AHRQ) was used to assess the quality of the included studies. Stata15.0 software was used for statistical analysis to summarize the scores of EBP attitude, knowledge and skills level of nursing students and nurses included in the study. RESULTS: A total of 25 cross-sectional studies from 13 countries were included, involving 11363 nursing students and nurses. The meta-analysis results revealed that nursing students and nurses lacked evidence-based practical knowledge and skills, with pooled mean scores of 3.06 (95 % CI: 2.72, 3.39), 2.91 (95 % CI: 2.60, 3.22), 4.31 (95 % CI: 4.08, 4.54) and 4.45 (95 % CI: 4.20, 4.70). In contrast, nursing students and nurses revealed a positive attitude towards EBP, with pooled mean scores of 3.57 (95 % CI: 3.28, 3.86) and 5.11 (95 % CI: 4.80, 5.42). Subgroup analysis revealed that senior nursing students and nurses with master's degree or above had higher attitudes, knowledge and skills. CONCLUSIONS: In summary, nursing students and nurses have a positive attitude towards EBP. However, they seem to lack the necessary knowledge and skills. Therefore, nursing educators should consider this as an opportunity to strengthen the teaching of their evidence-based practical knowledge and skills. This will lay a reference for developing nursing discipline.

Effect of Exercise on Fatigue in Patients Receiving Maintenance Hemodialysis Treatment: A Systematic Review and Network Meta-analysis.

OBJECTIVE: This study aimed to evaluate the effect of different exercises for improving fatigue in maintenance hemodialysis patients. DESIGN: PubMed, Embase, Web of Science, Cochrane, PEDro, CNKI, VIP, Wanfang data, CBM, and CINAHL were conducted from the establishment of the database to July 2023. We independently screened the literature, evaluated the quality, analyzed the data using Stata 15.0, and performed subgroup analysis on intervention time and exercise intervention adherence. RESULTS: Twenty-three studies were analyzed, with 1867 patients and nine interventions. Based on the surface under cumulative ranking curves and pairwise comparisons effects, overall long-term, short-term, and exercise intervention adherence >90% effects have all presented that during dialysis aerobic-resistance combined exercise was ranked as the most effective compared with routine care (surface under cumulative ranking curves = 83.9%, standardized mean difference = -1.45, 95% CI = -2.23 to -0.67; surface under cumulative ranking curves = 85.9%, standardized mean difference = -1.38, 95% CI = -2.24 to -0.52; surface under cumulative ranking curves = 86.6%, standardized mean difference = -1.54, 95% CI = -2.58 to -0.49; surface under cumulative ranking curves = 83.6%, standardized mean difference = -1.45, 95% CI = -2.25 to -0.66, respectively), followed by interdialytic period muscle relaxation exercise, interdialytic period aerobic-resistance combined exercise, interdialytic period aerobic exercise, and interdialytic period Baduanjin. CONCLUSIONS: Dialysis aerobic-resistance combined exercise may be considered in practice when resources allow. However, high-quality, multicenter, and large-sample randomized control trials must further verify this conclusion.

Prevalence, associated factors, and nursing practice-related outcomes of workplace violence towards nursing students in clinical practice: A systematic review and meta-analysis.

OBJECTIVES: To estimate the prevalence of Workplace violence (WPV) among nursing students in clinical practice, and examine the associated factors and nursing practice-related outcomes. DESIGN: A systematic review and meta-analysis. REVIEW METHODS AND DATA SOURCES: A comprehensive literature search was performed in nine databases from inception to Mar 2023. Two researchers independently screened studies, extracted data and assessed the quality of included studies. The random-effects model was used to estimate the pooled prevalence of WPV. Separate analyses were conducted by WPV type and source. RESULTS: 57 studies involving 23,451 nursing students were identified. The overall prevalence of WPV experienced and witnessed by nursing students was 45.37 % and 53.76 %, respectively, and 13.73 % were unsure if they had WPV. Psychological violence was the most prevalent form of WPV, but the prevalence of WPV also varied by setting and source, with obstetrics and gynaecology (41.25 %) being the most common settings and patients and their relatives (50.80 %) being the most common sources. When exposed to WPV, 65 % of nursing students did nothing except keep quiet, and 74 % did not report it. Concerning the associated factors of WPV, there were few reports on patient-related factors, and the selected studies focused primarily on nursing student- and occupational-related factors. Regarding nursing practice-related outcomes, WPV had a predominantly negative impact on nursing students' professional practice, but it also had a certain motivating effect. CONCLUSIONS: This meta-analysis estimates the global prevalence, associated factors, and nursing practice-related outcomes of WPV among nursing students. The findings confirm the high prevalence of WPV; therefore, schools and institutions should prioritize WPV education and training. The hospital should then formulate WPV laws and regulations, enhance the WPV reporting procedure, and protect the rights and interests of nursing students. Finally, hospital administrators should employ individualized intervention strategies for nursing students based on the variables that affect them.

Reliability and validity of the Chinese version of the trauma-specific frailty index (TSFI) for geriatric trauma patients.

BACKGROUND: Pre-traumatic frailty in geriatric trauma patients has caught attention from emergency medical workers and the assessment of it thus become one of the important aspects of risk management. Several tools are available to identify frailty, but limited tools have been validated for geriatric trauma patients in China to assess pre-traumatic frailty.The aim of this study is to translate the Trauma-Specific Frailty Index(TSFI) into Chinese, and to evaluate the reliability and validity of the translated version in geriatric trauma patients. METHODS: A cross-sectional study was conducted. The TSFI was translated with using the Brislin model, that included forward and backward translation. A total of 184 geriatric trauma patients were recruited by a convenience sampling between October and December 2020 in Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan. Using reliability or internal consistency tests assessed with Cronbach's alpha coefficient, split-half reliability and test-retest reliability. Content validity and construct validity analysis were both performed. Sensitivity, specificity and maximum Youden index(YI) were used to determine the optimal cut-off value. The screening performance was examined by Kappa value. RESULTS: The total study population included 184 subjects, of which 8 participants were excluded, resulting in a study sample size of 176 elderly trauma patients (the completion rate was 95.7%). The Chinese version of Trauma-Specific Frailty Index(C-TSFI) have 15 items with 5 dimensions. Cronbach's alpha coefficient of the C-TSFI was 0.861, Cronbach's alpha coefficient of dimensions ranged from 0.837 to 0.875, the split-half reliability of the C-TSFI were 0.894 and 0.880 respectively, test-retest reliability ranged from 0.692 to 0.862. The correlation coefficient between items and the C-TSFI ranged from 0.439 to 0.761. The content validity index for items (I-CVI) of the C-TSFI scale was 0.86~1.00, and the scale of content validity index (S-CVI) was 0.93. The area under curve (AUC) of the C-TSFI was 0.932 (95%CI 0.904-0.96, P < 0.05), the maximum YI was 0.725, the sensitivity was 80.2%, the specificity was 92.3%, and the critical value was 0.31. Kappa value was 0.682 (P < 0.05). CONCLUSIONS: The Chinese version of TSFI could be used as a general assessment tool in geriatric trauma patients, and both its reliability and validity have been demonstrated.

Instruments for assessing the spiritual needs of cancer patients: A systematic review of psychometric properties.

AIMS AND OBJECTIVES: To identify available instruments for assessing cancer patients' spiritual needs and to examine their psychometric properties using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology. BACKGROUND: Cancer patients frequently have significant spiritual needs. The nurse plays an integral role in assessing the patient's spiritual needs as part of providing holistic care. It is crucial to assess these needs using appropriate and reliable instruments. DESIGN: A systematic review based on COSMIN methodology. METHODS: Seven electronic databases (PubMed, EMBASE, CINAHL, Web of Science, ProQuest, CNKI and WANFANG) were systematically searched from inception until 14 February 2023. Two authors independently screened eligible literature, extracted data and evaluated methodological and psychometric quality. This systematic review was conducted following the PRISMA checklist. RESULTS: Sixteen studies have reported 16 different versions of the instruments. None of the instruments were properly assessed for all psychometric properties, nor were measurement error, responsiveness and cross-cultural validity/measurement invariance reported. All of the instruments failed to meet the COSMIN quality criteria for content validity. The quality of evidence for structural validity and/or internal consistency in five instruments did not meet the COSMIN criteria. Eventually, five instruments were not recommended, and 11 were only weakly recommended. CONCLUSION: Instruments to assess spiritual needs exhibited limited reliability and validity. The Spiritual Care Needs Scale is provisionally recommended for research and clinical settings, but its limitations regarding content validity and cross-cultural application must be considered in practice. Future research should further revise the content of available instruments and comprehensively and correctly test their psychometric properties. RELEVANCE TO CLINICAL PRACTICE: The review findings will provide evidence for healthcare professionals to select instruments for recognising spiritual needs in cancer patients. NO PATIENT OR PUBLIC CONTRIBUTION: This study is a systematic review with no patient or public participation.

The effect of psychological contract on turnover intention among nurses: a meta-analytic review.

BACKGROUND: The turnover intention (TI) of nurses is common, posing a threat to modern healthcare organizations. Psychological contract (PC) is a predictor of TI, affecting significantly nurse's TI. However, the extent of the association between PC and nurse's TI is unknown. We performed a meta-analysis to quantitatively analyze the relationship between PC and nurse's TI. METHODS: We searched nine electronic databases from inception to July 2023. Observational studies were included using a retrieval strategy related to PC and TI. Meta-analyses of common effect and random effect models were performed using R software with Spearman or Pearson correlation coefficients. Meta-regression, subgroup analysis, publication bias, and sensitivity analysis were also carried out . RESULTS: Eighteen studies including 8,908 nurses were identified. Based on various PC-related perspectives, 16 studies explored nurses' TI in terms of the content and three-dimensional structure of PC. Of these, 9 studies reported the negative direction of the correlation between PC and TI (r ranged from - 0.20 to -0.45), whereas 7 studies reported the positive direction of the correlation between PC and TI (r ranged from 0.32 to 0.50). The PC total and its dimensions were found to have moderately significant associations with TI, with the exception of the PCE and PCE-I. Additional, 2 studies reported the relationship between the outcome of PC and TI, the PCF, PCB, and PCV were powerful predictors of nurses' TI. Meta-regression and subgroup analysis found that only nurses working in specialized departments might be the source of heterogeneity. CONCLUSIONS: To our knowledge, this was the first meta-analysis to quantitatively examine the relationship between PC and TI among nurses. The findings reaffirmed the necessity for healthcare administrators and the medical profession to valued nurse' good interpersonal, social support, humanistic environment, and meet nurses' psychological and spiritual needs in addition to their material demands. Moderators of the connection between PC and TI, based on meta-regression and subgroup analyses, should be carefully explored as they may aid in identifying nurses' TI. Additional, longitudinal research, as well as mixed research, should be conducted to more comprehensively explore the relationship between PC and TI.

Relationship between social support and fear of cancer recurrence among Chinese cancer patients: A systematic review and meta-analysis.

Background: To quantitatively analyze the association between social support (SS) and fear of cancer recurrence (FCR) by reviewing current evidence from observational studies. Methods: A comprehensive literature search was performed in nine databases from inception to May 2022. Observational studies that used both SS and FCR as study variables were included. Regression coefficient (ß') and correlation coefficient (r) were calculated with R software. Subgroup analysis was utilized to investigate the degree of the relationship between SS and FCR as well as the impact of various forms of SS on FCR in cancer patients. Results: Thirty-seven studies involving 8,190 participants were identified. SS significantly reduced FCR risk [pooled ß' = -0.27, 95% confidence interval (CI) = -0.364 to -0.172], with moderate negative correlations (summary r = -0.52, 95% CI = -0.592 to -0.438). Meta-regression and subgroup analysis showed that types of cancer and study type were the source of heterogeneity. However, types of SS [actual SS, perceived social support (PSS), and others], source of actual SS, and source of PSS were not significant moderators. Conclusion: To the best of our knowledge, this is the first systematic review and meta-analysis to quantitatively investigate the association between SS and FCR in Chinese cancer patients using ß' and r coefficients. The results re-emphasized that social workers should enhance the use of SS by cancer patients and establish a sound SS system by either implementing more relevant research or developing targeted policies. Based on meta-regression and subgroup analyses, moderators of the association between SS and FCR should also be studied closely as they may help identify patients in need. In addition, longitudinal research, as well as mixed research, should be conducted to more comprehensively explore the relationship between SS and FCR. Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier CRD42022332718.

Risk factors for pulmonary infection in elderly patients with acute stroke: A meta-analysis.

Objective: The study aims to systematically evaluate the risk factors of pulmonary infection in elderly patients with acute stroke. Methods: PubMed, CENTRAL, CINAHL, Web of Science, Embase, and four Chinese databases (CNKI, SinoMed, VIP, and Wanfang databases) for studies involving risk factors of pulmonary infection in elderly patients with acute stroke were searched. Then, two researchers independently read the article titles and abstracts to screen the literature, extracted relevant research data, and evaluated the methodological quality. Finally, a meta-analysis was performed. Results: In total, fifteen studies were included, with medium and high-grade quality. Meta-analysis results showed: age [OR = 1.70, 95% CI (1.27, 2.29), P = 0.0004], type of stroke [OR = 1.30, 95% CI (1.21, 1.40), P < 0.00001], conscious disturbance [OR = 2.27, 95% CI (1.44, 3.58), P = 0.0004], dysphagia [OR = 3.24, 95% CI (2.06, 5.12), P < 0.00001], diabetes mellitus [OR = 2.35, 95% CI (1.23, 4.48), P = 0.010], hypertension [OR = 2.05, 95% CI (1.83, 2.31), P < 0.0001], chronic obstructive pulmonary disease (COPD) [OR = 2.69, 95% CI (1.90, 3.81), P < 0.00001], hyperlipidemia [OR = 1.29, 95% CI (1.19, 1.39), P < 0.00001], invasive procedure [OR = 3.37, 95% CI (2.30, 4.94), P < 0.00001], hospital stays [OR = 1.41, 95% CI (1.22, 1.62), P < 0.00001], bedridden time [OR = 1.51, 95% CI (1.36, 1.68), P < 0.00001], and National Institute of Health Stroke Scale (NIHSS) score [OR = 1.67, 95% CI (1.02, 2.75), P = 0.04] were independent risk factors. Glasgow Coma Scale (GCS) score was not a risk factor. However, the relationship between atrial fibrillation, smoking history, and pulmonary infection in elderly patients with acute stroke needs further proof. Conclusions: Age, type of stroke, conscious disturbance, dysphagia, diabetes mellitus, hypertension, COPD, hyperlipidemia, invasive procedure, hospital stays, bedridden time, and NIHSS score were risk factors for pulmonary infection in elderly patients with acute stroke.

Prevalence and Risk Factors of Postdialysis Fatigue in Patients Under Maintenance Hemodialysis: A Systematic Review and Meta-Analysis.

PURPOSE: Despite the high prevalence of postdialysis fatigue (PDF) in maintenance hemodialysis patients, no meta-analysis on the prevalence and risk factors of PDF has yet been published. This study aimed to identify the prevalence of PDF and explore its related factors. METHODS: PubMed, Embase, CENTRAL, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the four Chinese databases (National Knowledge Infrastructure [CNKI], Chinese Biomedical Literature database [SinoMed], Wanfang Digital Periodicals [WANFANG], and Chinese Science and Technology Periodicals [VIP] database) were searched from inception up to July 2022. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The articles were independently searched by two reviewers, and the relevant data were extracted. The Agency for Healthcare Research and Quality was used to assess the quality of the included studies. RESULTS: Thirteen articles with 2,118 participants were included. The pooled prevalence was 60.0%. The meta-analysis results revealed that the ultrafiltration volume, mean arterial pressure after dialysis, and good sleep quality were potentially associated with PDF, whereas only good sleep quality (odds ratio 0.24, 95% confidence interval 0.19-0.30) was significantly associated with PDF. CONCLUSION: PDF is common in maintenance hemodialysis patients, which is related to the ultrafiltration volume, sleep quality, and mean arterial pressure after dialysis. However, the mechanism underlying the risk factors and PDF remains unknown. Further research is warranted to investigate the risk factors, intervention, treatment, and mechanism in maintenance hemodialysis patients.

Status of work alienation among nurses in China: A systematic review.

Background: Work alienation is a common feeling of estrangement from the work and its context. Nurses are prone to feel alienated due to the high risk of infection, heavy workload, and the persistence of stress at high levels. Work alienation has serious negative outcomes, organizationally as well as personally. In recent years, the issue of work alienation among nurses has received considerable attention in China, but no systematic reviews have yet been published and its epidemiological status among Chinese nurses remains unclear. Objective: To systematically evaluate the status and distribution characteristics of work alienation among nurses in China. Methods: CINAHL, Embase, Web of Science, PubMed, CENTRAL, Wanfang, SinoMed, CNKI, and VIP were searched for cross-sectional studies before 10 January 2022 on the current status of work alienation among nurses. Two investigators independently screened the articles, extracted the data, and evaluated the risk of literature bias. Stata16.0 software was used for analysis. Results: A total of 12 studies were included, with 7,265 nurses involved. Meta-analysis results showed that the score of work alienation was 35.43 [95%CI (31.82, 39.04)]. Subgroup analysis showed that the scores of male and female nurses were 37.62 and 35.79 respectively; the scores of junior, undergraduate, and graduate nurses were 34.90, 37.15, and 40.02 respectively; the scores of primary, intermediate, and senior nurses were 36.95, 35.38, and 33.11 respectively; the scores of unmarried and married nurses were 38.59 and 36.70 respectively; the scores of nurses who had worked for 1~ <6 years, 6~10 years, and more than 10 years were 37.46, 36.69, and 32.89 respectively; the scores of nurses with salary <5,000 yuan, 5,000~10,000 yuan, and more than 10,000 yuan were 40.25, 37.19 and 34.52 respectively; and the scores of nurses in emergency department and intensive care units, internal medicine, surgery, and pediatrics were 37.25, 38.73, 36.28, and 31.98 respectively. Conclusion: Chinese nurses had a moderate level of work alienation. The scores of nurses in the following categories were quite high: male, higher education levels, low-professional titles, unmarried, shorter clinical working time, lower income, working in internal medicine, and working in the emergency department and intensive care units. Managers should take effective measures as soon as possible to reduce the occurrence of nurses' sense of work alienation. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022298746.

Health-related quality of life in breast cancer patients in Asia: A meta-analysis and systematic review.

Objectives: The primary purposes of this meta-analysis and systematic review were to evaluate the health-related quality of life (HRQoL) of Asian breast cancer (BC) patients to understand their holistic HRQoL level and provide medical and nursing recommendations to improve and preserve their quality of life. Methods: A comprehensive literature search was conducted to find cross-sectional studies published in Chinese and English concerning HRQoL in BC patients from the inceptions of databases to 14 March 2022. The databases consulted were PubMed, Web of Science, Embase, Cochrane, PsyclNFO, CINAHL, and CNKI. Literature screening, data extraction, risk bias assessment, and data synthesis were independently carried out by two researchers. The Endnote X9 and Stata 15.0 software programs were used during the meta-analysis process. Results: Out of the 8,563 studies identified, 23 cross-sectional studies involving 3,839 Asian BC patients were included in this meta-analysis. Two tools, namely, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and Quality of Life Questionnaire Breast Cancer module 23 (EORTC QLQ-BR23)-were used to evaluate the HRQoL of BC patients in Asia. The pooled mean of the global health status of Asian BC patients was 58.34 (95% confidence interval [CI]: 53.66-63.02). According to functional subscales of EORTC QLQ-C30 and EORTC QLQ-BR23, Asian BC patients suffered from the worst emotional functioning (pooled mean=66.38; 95% CI: 59.66-73.11) and sexual enjoyment (pooled mean=49.31; 95% CI: 31.97-63.36). In addition, fatigue (pooled mean=42.17; 95% CI: 34.46-49.88) and being upset by hair loss (pooled mean=48.38; 95% CI: 36.64-60.12) were the most obvious symptoms that Asian BC patients experienced according to the meta-analysis results of the EORTC QLQ-C30 and EORTC QLQ-BR23 symptom subscales. Conclusion: Asian BC patients experience a relatively low HRQoL due to the prominent decline in their body functions, as well as the unpleasant experiences caused by their symptoms. It is suggested that timely, appropriate, and targeted intervention should be provided in relation to the physical, psychological, and social aspects of Asian BC patients' lives to enhance their ability to function, relieve them of adverse symptoms, and improve their overall HRQoL. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022321165.

A meta-analysis of nursing students' knowledge and attitudes about end-of-life care.

OBJECTIVES: To synthesize nursing students' knowledge and attitudes about end-of-life care and to identify strategic directions for optimizing end-of-life care education. DESIGN: A meta-analysis of observational studies. DATA SOURCES: PubMed, Web of Science, EMBASE, CINAHL, PsycINFO, MEDLINE, CNKI, and WANFANG 8 electronic databases in English and Chinese were systematically searched from inception until 10 April 2022. REVIEW METHODS: Two reviewers independently screened literature and extracted data using structured tables. The Agency for Healthcare Research and Quality (AHRQ) was used to appraise the methodological quality of included studies. The study outcomes were synthesized using a meta-analysis. RESULTS: 26 cross-sectional studies of medium or high quality from 13 countries met the eligibility criteria, involving 9749 nursing students. In our review, nursing students demonstrated insufficient knowledge about end-of-life care, with a pooled mean score of 7.50 (95 % CI: 6.55-8.45); of these, knowledge about philosophy and principles, psychosocial and spiritual care, and pain and symptom management were all deficient, with pooled mean scores of 1.49 (95 % CI: 0.78-2.21), 1.00 (95 % CI: 0.35-1.65), and 3.44 (95 % CI: 2.25-4.63), respectively. Conversely, nursing students showed positive attitudes toward end-of-life care, with a pooled mean score of 102.97 (95 % CI: 99.43-106.51). The subgroup analysis revealed that male nursing students had lower pooled mean scores for end-of-life care knowledge and attitudes. CONCLUSION: There is a mismatch between nursing students' knowledge and attitudes about end-of-life care, they have a positive attitude but lack the necessary knowledge. Male nursing students seem to have a greater deficit of knowledge and a relatively conservative attitude toward end-of-life care. These findings may provide a significant reference for nursing educators to adjust educational strategies promptly.