Predictors of caring ability and its dimensions among nurses in China: A cross-sectional study.

BACKGROUND: Caring is an essential component of professional nursing practice, which directly affects the quality of patient care. Nurses' caring ability may not meet patients' demands for high-quality care. There are challenges in designing and implementing interventions to improve nurses' caring ability, especially in China. Understanding Chinese nurses' caring ability and related influential factors serves as the basis for effective interventions to improve their ability to care for patients. AIM: To describe the caring ability of nurses and its potential predictors in China. METHODS: From January to February 2018, a cross-sectional survey was conducted among 2304 Registered Nurses working at different levels of hospitals across 29 provinces in China. The structured online survey included socio-demographic information, Caring Ability Inventory, Caring Efficacy Scale and Professional Quality of Life. Descriptive statistics, univariate analyses and multivariate analyses were conducted. RESULTS: Overall caring ability and its three dimensions of the participants were all significantly lower than the Nkongho' norm, an international scoring standard of nurse's caring ability. Age, employment type, workplace, caring efficacy, compassion satisfaction, burnout and secondary traumatic stress were predictors of knowing, explaining 41.8% of the variance. Predictors of courage were educational level, bereavement experience, caring efficacy, compassion satisfaction and burnout (31.7% of the variance). Educational level, workplace, exposure to critically ill patients, caring efficacy, compassion satisfaction, burnout and secondary traumatic stress were influencing factors of patience, accounting for 19.5% of the variance. CONCLUSIONS: Chinese nurses' caring ability, with patience, knowing, and courage in descending order. Particular attention needs to be paid to the courage dimension of the nurses' caring ability. Further, the predictors of overall caring ability and each dimension were diverse. These results indicate that nurse educators and administrators need to identify training priorities and design targeted interventions based on the influencing factors.

Stigma in HBV-infected pregnant women in disclosed situations: Current status, influencing factors, and impacts on the quality of life.

OBJECTIVE: Few studies have reported the status of stigma and the impact of stigma on the quality of life of HBV-infected pregnant women in disclosed situations. This study aims (a) to investigate the current status of the stigma of HBV-infected pregnant women in the situation of disease exposure, (b) to explore the influencing factors of the stigma, and (c) to identify the impacts quality of life. METHOD: Using cross-sectional descriptive design and convenience sampling, 270 HBV-infected pregnant women from two infectious hospitals were investigated using the Chronic Hepatitis B Virus Infectors' Discrimination Measurement Scale, the Medical Outcomes Study Short-Form-36v2, and a demographic questionnaire. The collected data were analyzed by SPSS20.0. RESULTS: The total stigma score is (74.05 ± 11.26). The variables of education, the payment method of medical expenses, living with family members, and spouse with hepatitis B virus infection accounted for 35.7% of the variance in the stigma altogether. Stigma is significantly negatively correlated with the quality of life and accounted for 18.1%-20.0% of the variance in scores for quality of life of HBV-infected pregnant women in disclosed situations. CONCLUSION: The level of stigma and quality of life is serious in China. the stigma can significantly reduce the quality of life of affected individuals. Health care policy-maker and professionals should pay more attention to this issue and through improving health education, increasing the reimbursement rate of antiviral drugs and the number of professional medical staff to reduce stigma and promote their quality of life.

An innovative course to prepare advanced practice registered nurses to spearhead quality and safety initiatives for older adults.

ABSTRACT: Current trends dictate that advanced practice registered nurses (APRNs) must be competent to address quality/safety issues specific to older adults. A gap analysis and review of key competencies in an adult-gerontology APRN-Doctorate of Nursing Practice (DNP) curriculum prompted the design and evaluation of an innovative online course, Quality and Safety for the Aging Adult. Course objectives align with key competencies, including graduate-level Quality and Safety Education for Nurses (QSEN) and the DNP Essentials. The course purpose was to prepare adult-gerontology APRN-DNP students as leaders to promote quality/safety outcomes for aging adults. The six-step Knowledge-to-Action Framework guided course development and evaluation. Select graduate-level QSEN competencies were used to construct a 20-item Quality and Safety Survey (4-point Likert scale) (Cronbach's alpha, 0.916). This survey was used during week 1 (pre) and week 15 (post) of the semester to evaluate students' preparation and confidence to perform key QSEN competencies. Significant improvements (p < .000) between pre/post scores on the Quality and Safety Survey were found across five classes. Students felt more prepared and confident to apply selected QSEN competencies on course completion. Moreover, nearly 60% (primary care) and nearly 35% (acute care) adult-gerontology APRN students selected the older adult population for their DNP projects. The Quality and Safety for the Aging Adult course positively influenced five classes of adult-gerontology APRN-DNP students. Integrating QSEN competencies with gerontology and quality/safety content is an effective strategy to prepare APRNs to lead quality/safety initiatives in aging adults. This innovative online course offers a successful model for innovative DNP education of adult-gerontology APRNs.

Development of interventions for an intelligent and individualized mobile health care system to promote healthy diet and physical activity: using an intervention mapping framework.

BACKGROUND: The mortality of coronary heart disease can be largely reduced by modifying unhealthy lifestyles. However, the long-term effectiveness of interventions for modifying unhealthy diet and physical inactivity of patients with coronary heart disease remain unsatisfactory worldwide. This study aims to systematically design a set of theory-based and evidence-based, individualized, and intelligent interventions for promoting the adoption and maintenance of a healthy diet and physical activity level in patients with coronary heart disease. METHODS: The interventions will be delivered by a mobile health care system called Individualized, Intelligent and Integrated Cardiovascular Application for Risk Elimination. Three steps of the intervention mapping framework were used to systematically develop the interventions. Step 1: needs assessment, which was carried out by a literature review, in-depth interviews and focus group discussions. Step 2: development of objective matrix for diet and physical activity changes, based on the intersection of objectives and determinants from the Contemplation-Action-Maintenance behavior change model. Step 3: formulation of evidence-based methods and strategies, and practical applications, through a systematic review of existing literature, research team discussions, and consultation with multidisciplinary expert panels. RESULTS: Three needs relevant to content of the intervention, one need relevant to presentation modes of the intervention, and four needs relevant to functional features of the application were identified. The objective matrix includes three performance objectives, and 24 proximal performance objectives. The evidence-based and theory-based interventions include 31 strategies, 61 evidence-based methods, and 393 practical applications. CONCLUSIONS: This article describes the development of theory-based and evidence-based interventions of the mobile health care system for promoting the adoption and maintenance of a healthy diet and physical activity level in a structured format. The results will provide a theoretical and methodological basis to explore the application of intervention mapping in developing effective behavioral mobile health interventions for patients with coronary heart disease. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-INR-16010242. Registered 24 December 2016. http://www.chictr.org.cn/index.aspx.

Smartphone-Based Self-Empowerment App on Secondary Prevention of Patients with Cardiovascular Disease.

We developed a HeartGuardian app and explored its effects supporting people with CVD on lipid control and medication adherence. Fifty-seven patients were enrolled, 29 in the intervention group and 28 in the control group. The 12-week intervention resulted in a moderate improvement in lipid level and greater improvement in medication adherence (82.14% vs 37.93%, P = 0.001). These outcomes translate into significant differences in occurrence of major adverse cardiac events (28.75% vs 72.43%, P = 0.001).

High nursing workload is a main associated factor of poor hand hygiene adherence in Beijing, China: An observational study.

AIM: The aim of the study was to explore the impact of nurse workloads on adherence to hand hygiene. BACKGROUND: Adherence to hand hygiene and nursing workloads have been linked to quality of patient care. Therefore, it was important to understand the relationship to safe patient care. DESIGN: This cross-sectional study was performed from January 2016 to June 2016. METHODS: Workloads and adherence to hand hygiene for nurses on 3-day shifts in a tertiary hospital were investigated in 2016. Actual hours worked per shift were timed using a stopwatch to assess nursing workloads. Descriptive and inferential statistics and multiple variable regression analysis were used to analyse the data. RESULTS: Sixty-four nurses from four wards were observed. The average adherence rate of hand hygiene was 26.6% and the average nursing workload per shift was 6.7 hours. Multiple regression revealed that nursing workload was negatively related to adherence rate of hand hygiene. CONCLUSION: Nurses in this study that had a low rate of adherence with hand hygiene frequently had high workloads. Adherence to hand hygiene was independently associated with actual hours worked per shift.

Identification of Family Factors That Affect Self-Management Behaviors Among Patients With Type 2 Diabetes: A Qualitative Descriptive Study in Chinese Communities.

INTRODUCTION: In the past 30 years, the prevalence of diabetes in China has increased from 0.67% to 11.6%. Self-management behaviors (SMBs) are significant to improve health outcomes for diabetics. However, little is known about self-management experiences of Chinese diabetic patients. The purpose of this study was to explore family factors affecting SMBs. METHODOLOGY: A qualitative descriptive study was used. Purposive samples were recruited from Chinese communities. Semistructured interviews were conducted, and audio-recordings transcripts were analyzed using content analysis methods. RESULTS: Twenty participants were interviewed, including 8 with well-controlled HbA1c while 12 were poorly controlled. Facilitators that promote patients' SMBs were responsibility toward children and commitment to spouse; barriers that hinder patients' SMBs were family experiences about starvation, seeking harmony-eating in a big family, living in an "empty nest," and family financial burden. DISCUSSION: This study provides insight into SMBs of Chinese diabetic patients. Professionals can develop tailored interventions in a Chinese cultural context according to patients' perceptions of family responsibility, early experience, activities, and resources.

Determining the motivations of family members to undertake cardiopulmonary resuscitation training through grounded theory.

AIMS: To explore the motivation of family members of patients at high risk for sudden cardiac death for undertaking cardiopulmonary resuscitation (CPR) training. BACKGROUND: Home cardiac arrests are associated with poor outcomes because few family members learn CPR. Little is known about factors that motivate family members to participate in CPR training. DESIGN: We used grounded theory to establish a theoretical framework to explore the motivational factors for learning CPR among family members. METHODS: Twelve participant observations and 42 semi-structured interviews with family members of different behaviours towards CPR training were conducted from December 2013 - November 2016. Data were analysed using constant-comparisons, situational analysis, and encoding. FINDINGS: A motivation-behaviour theoretical framework for learning CPR was constructed. We identified meeting inner needs as the core category to demonstrate motivation. Security motivation and responsibility motivation emerged as main categories, which demonstrate that seeking a sense of security and shouldering family responsibility were important considerations for family members to learn CPR. These two motivations produced high-engagement behaviours of family members to learn CPR. CONCLUSIONS: The motivations we identified-deriving from a sense of security and family responsibility-are the main reasons family members would learn CPR and, therefore, should be understood by medical professionals. Understanding these motivations may help in the formulation of customized CPR training that further meets the needs of family members. For example, motivational interventions that are integrated with a family-based CPR course can be designed to improve the participation of family members and the sustainability of the course.

Knowledge and practice in cardiovascular disease prevention among hospital registered nurses: a cross-sectional study.

AIMS AND OBJECTIVES: To investigate the knowledge and clinical practices of cardiovascular disease prevention among registered nurses who worked on three major clinical units in Beijing hospitals. BACKGROUND: Health education on cardiovascular disease prevention is an important component of nursing practice; however, Chinese registered nurses' knowledge and practice patterns have been poorly explored in previous studies. DESIGN: A cross-sectional study. METHODS: A stratified random sample of three hundred registered nurses was recruited from two tertiary hospitals in Beijing, China. A validated questionnaire was used to examine nurses' knowledge of cardiovascular disease risk factors, their practices and perceived barriers to cardiovascular disease prevention-related patient education. The differences in knowledge of cardiovascular disease risk factors and the practice pattern associated with cardiovascular disease prevention were compared among nurses who worked on three major clinical units. RESULTS: Questionnaires were completed by 273 registered nurses with a response rate of 91%. More than 75% of the registered nurses knew the cardiovascular disease risk factors; however, less than half knew the right target goals for cardiovascular disease risk factors. Notably, fewer than 70% of registered nurses routinely provided health education for cardiovascular disease prevention during their practice. There was inconsistency between registered nurses' knowledge of target goals for cardiovascular disease risk reduction and their education practices on cardiovascular disease prevention. The three major barriers to providing cardiovascular disease risk factor preventive education were lack of time, patients' reluctance to change lifestyle and lack of physicians' support. CONCLUSIONS: Not all of the registered nurses were motivated to educate and encourage patients to engage healthy lifestyle changes, even though most of them were knowledgeable about cardiovascular disease risk factors. A gap between the knowledge and practice for the prevention of cardiovascular disease was identified. RELEVANCE TO CLINICAL PRACTICE: The findings highlight the need to advocate for knowledge application and address knowledge deficits in the area of cardiovascular disease prevention among registered nurses.

What Features of Smartphone Medication Applications Are Patients with Chronic Diseases and Caregivers Looking for?

We explored the desired features of medication applications for patients with chronic disease and their caregivers with a questionnaire survey, 50 from patients and 50 from their caregivers. Although the majority of people (75%) are willing to use medication apps, the actual usage rate is quite low (11%). Worrying about privacy of personal information seems to be the main reason of not using applications. The overall score desired for use was 3.29 ± 1.02 (out of 5). Searching medications and diseases and assistance with making doctors' appointments are the most wanted categories. Online shopping for drugs and delivery were the least desired items. The main concerns for people who do not want certain features include: they are not useful, worrying about buying counterfeit drugs and reliability of content. Compared with patients, caregivers seems to be more concerned on nutrition tips for chronic illness, fall detection, and privacy protection (P < 0.05 for all).

Quality of Chinese CVD Medication Apps.

The quality of Chinese cardiovascular disease medication apps was evaluated and compared to those in the Google Play Store. Only 21% of 257 CVD medication apps covered medication issues, but the quality is in question. The quality of top 10 CVD medication apps from China was inferior to international apps. An app quality assurance mechanism is needed to ensure patient safety.

Impact of APN Home Visits in Reducing Healthcare Costs and Improving Function in Homebound Heart Failure.

By providing quality primary care in the home setting, nurse practitioners can treat homebound patients effectively and decrease the number of hospitalizations, 30-day readmissions, and emergency department visits. Forty patients with a diagnosis of Class III or IV heart failure who were homebound were chosen for this project. The project manager, an Adult-Gerontological nurse practitioner, made home visits to these patients on a monthly and as-needed basis throughout the 3-month project. The rate of hospital admissions, emergency department visits, and 30-day readmissions was reduced by 64%, 85%, and 95%, respectively. Patients were assessed using the Kansas City Cardiomyopathy Questionnaire (Green et al., 2000) at the initial visit and at 3 months. The scoring for physical functionality, symptom frequency, and quality of life were improved by 44%, 40%, and 54%, respectively.

Creating a culture of safety for safe patient handling.

Healthcare workers who handle patients have little guidance to help them identify when to use the existing equipment for moving patients. Manual lifting of patients and healthcare worker injuries continue despite equipment installation and training. The purpose of this project was to decrease the number and severity of healthcare worker injuries by implementing a culture of safety for safe patient handling. A multicomponent safe patient handling program was deployed on one inpatient unit at a Midwest academic acute care hospital. There was a 36% decrease in the number of patient handling injuries, a 71% reduction in the number of lost work days, and a 60% reduction in costs in 1 year related to patient handling injuries. The RN Satisfaction Survey question regarding having enough help to lift/move on last shift improved from 41% presurvey to 69% postsurvey.

A national initiative to train long-term care staff for disaster response and recovery.

A 3-year national initiative entitled "PREPARE: Disaster and Emergency Preparedness Training for the Long-Term Care Workforce" had the purpose of training long-term care (LTC) healthcare providers with the core competencies necessary to respond to and recover from large-scale disasters and public health emergencies. Older adults in LTC settings comprise a vulnerable population requiring special attention in preparedness efforts. The PREPARE program delivers geriatric-specific training to LTC providers through 2-day train-the-trainer sessions, conference seminars, and distance learning opportunities. Outcomes are measured through content posttests, course evaluations, exercise evaluation tools, and pre and post surveys measuring the impact of the PREPARE training on organizational disaster plans. Lessons learned resulted in the revisions to the PREPARE program that increased participation and program completion rates. Participating organizations demonstrated improvement within the three areas of preparedness measured: disaster planning, community linkages and collaborations, and emergency response exercises.

Transforming your professional self: encouraging lifelong personal and professional growth.

Transforming from student nurse to registered nurse is often discussed in a capstone class or a hospital orientation program. Changes in professional plans later in the career continuum often occur, but are not always planned. This article discusses the challenges of change, the need for career planning, stages of role acquisition, role socialization, and role transformation. In addition, it outlines the importance of creating a career plan to meet future career goals.

Elders at risk during disasters.

Recent natural and manmade disasters such as the September 11, 2001 terrorist attacks, the hurricanes of 2005, and Chicago heat waves demonstrate the vulnerability of older adults to such events. In this article, the specific physical, psychosocial, and cultural characteristics of older adults that place them at greater risk during disasters and emergencies are discussed. Unique concerns of older adults and their families in disasters and emergencies are addressed. In addition, the impact that these characteristics have on the ability of older adults to respond to such events and recover from them is discussed. Finally, strategies that home health providers can use in working with vulnerable older adults are explored.