Exploring the first-time transition to parenthood in mainland China: a qualitative study on the experiences of fathers and mothers using the transition shock model.

Background: The transition to parenthood, which is influenced a lot by local parenting culture, is a dramatic stress for both men and women. Chinese social and cultural contexts form specific parental culture, shaping the unique experience of transition to parenthood. However, the understanding of the transition to parenthood in mainland China is limited. Additionally, few qualitative studies explored the transition to parenthood from both dyadic perspectives. Aim: To explore the first-time transition to parenthood experience among mothers and fathers in mainland China during pregnancy, and compare the similarities and differences between their experiences in this transition period. Methods: A descriptive qualitative study was conducted with 36 parents, including 18 primiparous women and their husbands. Data were analyzed by directed content analysis guided by the Transition Shock Model. The interview texts were first analyzed at individual levels and subsequently at the couple level to identify dyadic themes. Results: Five themes and thirteen sub-themes emerged from the data analysis, including role integration, health risk, dilemma of preparation, protective isolation, and multi-dimensional expectation. Unexpectedly, the experiences and perspectives of mothers and fathers regarding the transition to parenthood were found to be similar, with the exception of the sub-theme extra-care requirement. Conclusion: The findings shed light on the complex emotional journey and expectations of parents, as well as the challenges they face in terms of physical well-being, limited coping resources, and restricted social connections. Notably, fathers in China often shared the stress of the whole process during the transition period alongside mothers but often lacked accessible avenues for seeking and receiving support. These findings underscore the importance of actively involving fathers as a key support population in perinatal care, as well as the need for comprehensive support systems and tailored interventions to enhance the well-being and adaptation of parents.

The Childbearing sense of coherence scale (CSOC-scale): development and validation.

BACKGROUND: the salutogenic theory is essential to explain an individual's ability to maintain health during the perinatal period. While previous studies mainly focused on the perspectives from a family-level orientation and a global orientation, the purpose of the present study was to develop and validate a scale, the childbearing sense of coherence scale (CSOC-scale) from the individual's perceptions of the stresses, resources, and meaningfulness of childbearing. METHODS: A total of 3 separate studies contributed to the development of the CSOC-scale between July 2022 and February 2023. In study 1, the initial item pool based on the conceptual framework of the childbearing sense of coherence and the salutogenic theory was developed. Delphi expert consultation was conducted to revise and improve items. Studies 2 and 3 were cross-sectional studies. In study 2, item analysis and explore factor analysis (EFA) (N = 351 for women, N = 256 for men) were used to screen items. In study 3, confirmatory factor analysis (CFA) and reliability analysis (N = 366 for women, N = 308 for men) were used to test the fit indices and reliability of the final scale. RESULTS: final analysis suggested the CSOC-scale includes three factors, consisting of 13 items. Confirmatory factor analysis demonstrated good model fit (χ2 = 157.448, df = 62, χ2/ df = 2.539, RMSEA = 0.065, CFI = 0.974, TLI = 0.968, SRMR = 0.029 for women; χ2 = 181.363, df = 62, χ2/ df = 2.925, RMSEA = 0.079, CFI = 0.968, TLI = 0.960, SRMR = 0.033 for men) and high factor loadings (from 0.751 to 0.929 for women; from 0.746 to 0.947 for men). Internal consistency (Cronbach's α ranging from 0.895 to 0.933 for women and 0.881 to 0.945 for men in three dimensions; Cronbach's α was 0.919 for women and 0.821 for men in the entire instrument) and split-half reliability (Spearman-Brown coefficients ranging from 0.876 to 0.921 for women and 0.841 to 0.937 for men in three dimensions; Spearman-Brown coefficient was 0.744 for women and 0.785 for men in the entire instrument) were excellent. CONCLUSIONS: the CSOC-scale has robust psychometric properties. It is reliable and valid in evaluating the childbearing sense of coherence in women and men during pregnancy. Utilisation of this scale can help healthcare professionals understand the health maintenance competencies of couples during the transition of parenthood and provide health promotion services from a salutogenic perspective.

Infertility psychological distress in women undergoing assisted reproductive treatment: A grounded theory study.

BACKGROUND: While there exists an ample body of research in international contexts focused on the characterization and quantification of infertility psychological distress, the level of scholarly scrutiny directed towards this phenomenon within the context of China remains scant. AIMS AND OBJECTIVES: To investigate the formation and developmental processes of psychological distress associated with infertility and infertility treatment among women within the Chinese cultural context and to construct a theoretical framework that elucidates this phenomenon. DESIGN: Qualitative approach with grounded theory methodology. METHODS: This study was conducted within the reproductive medicine department of a tertiary-level hospital located in central China from May to August 2023. Twenty-seven women who experienced infertility and underwent assisted reproductive treatment (ART) were interviewed. The interview sessions spanned durations ranging from 20 min to 1 h and 35 min. Data analysis included open coding, axial coding and selective coding. The study is reported using the COREQ checklist. RESULTS: The infertility psychological distress experienced by women undergoing ART is a socially constructed phenomenon influenced by a dynamic interplay of forces that construct and conciliate it. The formation and progression of infertility psychological distress are rooted in the process of self-construction. A Middle-Ranged Theory titled 'self-reconstruction under the dome of infertility and infertility treatment' (SUDIT theory) was developed to explain this phenomenon. Within this framework, infertility psychological distress manifests across three distinct phases under the gambling of the constructive force and conciliative force: (1) distress of disrupting the former self; (2) distress linked to the struggling present self; and (3) the renewed-self harmonized with distress. CONCLUSIONS: It is imperative for healthcare professionals and policymakers to acknowledge the socially constructed nature of infertility psychological distress, and proactively implement measures aimed at ameliorating it. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Functional teeth and cognitive function among the Chinese elderly: The chain mediating effect of depressive symptoms and social participation.

The objective of this study was to investigate the chain mediating effects of depressive symptoms and social participation between functional teeth and cognitive function based on the biopsychosocial model. Data from the 2018 China Health and Retirement Longitudinal Study were analyzed. The findings revealed a favorable connection between the lack of edentulism and cognitive function, persisting even when accounting for the mediating factors of denture usage, depressive symptoms, and social participation. Furthermore, the study identified six indirect pathways in this relationship. The present study has substantiated the correlation between edentulism and cognitive function, thereby proposing that interventions aimed at denture usage, depressive symptoms, and social participation could potentially serve as preventive measures against cognitive decline in elderly individuals afflicted with edentulism. This underscores the significance of addressing these factors to alleviate cognitive decline.

The association between school educational atmosphere, learning engagement, and professional commitment of nursing students, and learning engagement as the mediator.

BACKGROUND: The current shortage and loss of nurses has become a significant problem in healthcare systems around the world. Professional commitment is essential to prevent the loss of nursing staff and stabilize the nursing workforce. OBJECTIVES: This study aimed to explore the unique relationship between school educational atmosphere, learning engagement, and professional commitment, and whether learning engagement would mediate the relationship between educational atmosphere and professional commitment. DESIGN: A cross-sectional study design was used. SETTINGS: The participants came from six schools in four cities in Hubei Province, China. PARTICIPANTS: A total of 1009 nursing students above the first year of undergraduate studies were included by convenient sampling method. METHODS: Data were collected using the Educational Climate Inventory, the Utrecht Work Engagement Scale-student, and the Professional Commitment Scale. Pearson correlation was used to examine the relationship between educational atmosphere, learning engagement, and professional commitment. Mediation analysis was used to test whether learning engagement mediated the relationship between educational atmosphere and professional commitment. RESULTS: A positive educational atmosphere was associated with a high level of learning engagement, which was associated with a higher level of professional commitment. Learning engagement mediated the relationship between educational atmosphere and professional commitment. CONCLUSIONS: The findings provide empirical evidence for promoting professional commitment in nursing students. Learning engagement is an important mediating variable connecting educational atmosphere and professional commitment. In order to stabilize the career choices of nursing students, it is necessary to take measures to improve their learning engagement during school.

"I am not a good enough parent": The experience of self-stigma in parents of children with mental illness in China.

PROBLEM: Self-stigma in parents of children with mental illness is an area easily overlooked by mental health providers. Many studies have shown that self-stigma in parents may result in social interaction avoidance, lower self-esteem, increased psychological pressure, and so on. However, a comprehensive picture of how parents of children with mental illness in China experience self-stigma is lacking. METHODS: Individual semistructured face-to-face interviews were conducted with 20 parents from China during their child's psychiatric hospitalization. We followed the consolidated criteria for reporting qualitative research (COREQ) checklist. FINDINGS: Four main themes were identified that captured the experience of self-stigma in parents of children with mental illness: (1) losing face and fear, (2) internalizing affiliate stigma, (3) feeling of self-blame and self-doubt, and (4) keeping oneself away from society. CONCLUSIONS: These findings explain how Chinese parents of children with mental illness experience self-stigma. To better effect the treatment and rehabilitation of children with mental illness, it is necessary to recognize this self-stigma in parents and take action to improve their mental health.

The perception of childbearing sense of coherence among Chinese couples: a qualitative study.

BACKGROUND: Although childbearing health care is wellness-based and promotes normal physiology, it is in a medical model and focuses on risk aversion and disease prevention. The salutogenic theory might provide an alternative perspective to health care concerning childbearing, supporting health-promoting factors, not solely on avoiding adverse events. However, there is a dearth of qualitative research exploring couples' perceptions of childbearing from the salutogenic lens. This study aimed to explore perceptions and experiences concerning childbearing among couples in the perinatal period and identify salutogenic aspects of it. METHODS: The qualitative descriptive study adopted a directed content analysis to analyse data from a semi-structured and individual interview with 25 purposively selected Chinese couples between July 2022 and December 2022. The concepts of the sense of coherence (SOC) from the salutogenic theory were used as the theory framework for coding. RESULTS: Definitions and content for the salutogenic aspects of Chinese couples' perception of childbearing sense of coherence were developed. For comprehensibility of childbearing, four subthemes were extracted (the challenge to health and endurance; transition to and identification with the new role; conflict and reconciliation in relationships; resistance and compromise between social culture and personal development). For manageability of childbearing, two subthemes were extracted (helplessness and hope of childbearing; self-doubt and self-assurance of childbearing). For meaningfulness of childbearing, three subthemes were extracted (personal realisation; family bonding and harmony; the continuation of life). CONCLUSIONS: The findings of this study could give a greater understanding in maintaining couples' health in the perinatal period from the salutogenic lens and provide a guide to further research that the salutogenic theory could bring a health and wellness-focused agenda in practice and policy-making in the perinatal period.

Validation of publication pressure questionnaire-revised into Chinese nurses from a university hospital.

AIMS: To translate and validate the Publication Pressure Questionnaire-revised (PPQ-r) among the Chinese nurses. DESIGN: A cross-sectional descriptive study. METHODS: The classical forward/backward translation of the PPQ-r was conducted first, and then the psychometric values were tested using the data collected in September, 2021 among 924 Chinese nurses from a university hospital in China by calculating its content validity index, construct validity, both convergent and discriminant validity, and internal consistency reliability following the COSMIN guidelines. RESULTS: The proposed three-factor structure of original PPQ-r cannot be confirmed in present study. With exploratory factor analysis, a new two-factor structure with 9 items was extracted, accounting for 62.718% of the variance. Confirmatory factor analysis indicated satisfactory goodness of all fit index values: χ2 = 75.53; df = 23; χ2 /df = 3.28; CFI = 0.973; TLI = 0.958; RMSEA = 0.07 and SRMR = 0.047. Both sub-scales yielded good internal consistency with Cronbach's alpha being 0.845 and 0.876, respectively. The Chinese version of PPQ-r could be accepted as a reliable and valid tool to measure the Chinese nurses' publication pressure. PATIENT OR PUBLIC CONTRIBUTION: Participation of nurses in this study was limited to the data provided through participant survey.

Decision-making process of breastfeeding behavior in mothers with gestational diabetes mellitus based on health belief model.

BACKGROUND: Gestational diabetes mellitus (GDM) threatens GDM mothers and their offspring's health and breastfeeding is one of the most effective ways to decrease the risk. However, the prevalence of breastfeeding among GDM mothers is far from optimal and how GDM mothers develop their feeding behavior is still unclear. Thus, this study aimed to explore the formation of GDM mothers' breastfeeding behaviors based on the health belief model (HBM). METHODS: A questionnaire survey was conducted on 324 GDM mothers who have given birth within 6 months from January 1 to February 6, 2022. According to HBM, GDM mothers' knowledge, the perceived threat from GDM, the perceived value of breastfeeding, self-efficacy, social support and GDM mothers' breastfeeding behavior were measured. Exclusive breastfeeding (EBF) was defined as an infant who received only breast milk in the past 24 h before the survey. Structural equation modeling (SEM) was applied to explore how GDM mothers form their breastfeeding behaviors based on HBM. RESULTS: The prevalence of EBF among GDM mothers was 33.95%. GDM mothers had limited knowledge of GDM (average 63.14% correct answer to 7 questions), especially poor on the long-term effect of GDM (39.81%) and protective effect of breastfeeding (34.57%-45.99%). Although GDM mothers showed high perceived benefits (Mean: 3.35, SD: 0.46), high self-efficacy (Mean: 3.43, SD: 0.97) and high level of social support for breastfeeding (Mean: 3.74, SD: 0.74), the various barriers (Mean: 2.20, SD: 0.47) hindered their success in EBF. The SEM results showed that a higher level of social support and more self-efficacy of breastfeeding resulted in a higher likelihood of EBF, while the higher level of knowledge of GDM, perceived higher barriers and benefits of breastfeeding and higher susceptibility to GDM consequences led to less EBF. CONCLUSION: To promote EBF, physicians' education, emphasizing the protective effect of breastfeeding and how to correct breastfeeding, is highly recommended. In addition, social support for GDM mothers is also important to reduce their barriers to breastfeeding and help enhance self-efficacy in breastfeeding.

Puerperium experience and lifestyle in women with gestational diabetes mellitus and overweight/obesity in China: A qualitative study.

Introduction: Women with overweight or obesity and gestational diabetes mellitus (GDM) are at a high risk of developing type 2 diabetes mellitus (T2DM) and other metabolic diseases. Healthy postpartum lifestyles in women with GDM are important for effectively preventing early T2DM occurrence; however, few studies and guidelines focus in China on this issue. Aims: This qualitative study aimed to understand the puerperium experience and lifestyle of women with overweight/obesity and GDM. Methods: A face-to-face, in-depth, and semi-structured interview was conducted using a hermeneutical phenomenology method to collect data that were analyzed through thematic analysis. Results: Out of 61 recruited women with overweight/obesity and history of GDM, 14 women underwent an interview and provided detailed descriptions of their lifestyle experiences during puerperium. The interview data were used to generate four themes-puerperium dietary behavior, weight perception and "confinement" behavior, family support, disease knowledge, and perceived risk-and nine sub-themes. Conclusion: Unhealthy lifestyles, misconceptions about food, the conflict between physical activity and confinement behavior, a lack of social and family support, and low awareness of disease risk are all common among overweight/obese women with a history of GDM. Thus, we emphasized that healthcare providers should provide continuous preventive care from pregnancy to postpartum and promote long-term health in high-risk populations with a history of GDM associated with overweight/obesity.

The association between childbirth-related fear, childbirth readiness, and fertility intentions, and childbirth readiness as the mediator.

BACKGROUND: Fertility intentions have been proved to be a reliable predictor of actual fertility behaviour. Also, childbirth-related fear (CBRF) has been proven to be negatively associated with childbirth readiness and fertility intentions among women, while childbirth readiness was positively related to fertility intentions. However, the associations and potential mechanisms between CBRF, childbirth readiness, and fertility intentions remain unknown. This study aimed to investigate the unique association between CBRF, childbirth readiness, and fertility intentions and whether childbirth readiness would mediate the relationship between CBRF and fertility intentions. METHOD: A cross-sectional study of women (N = 1119, aged 16-53 years) who gave birth within 72 h was conducted. Using a convenience sampling, women were recruited from obstetric wards-10 comprehensive hospitals and 3 specialized hospitals in 7 provinces in mainland China. Pearson correlation was used to examine the relationship between CBRF, childbirth readiness, fertility intentions, and social support. Multivariate linear regression was further used to analyze the association between demographic and personal characteristics, CBRF, childbirth readiness, and fertility intentions. Mediation analysis was used to examine whether childbirth readiness mediates the relationship between CBRF and fertility intentions. RESULTS: Women with high childbirth readiness (ß = 0.09, P = 0.002) had higher fertility intentions. However, women with high CBRF (ß = - 0.17, P < 0.001) were more likely to have lower fertility intentions. CBRF had both direct and indirect effects on the level of fertility intentions. As predicted, childbirth readiness mediated the relationship between CBRF and the level of fertility intentions (estimate = - 0.012, 95% bootstrap CI: - 0.021 to - 0.005). Higher CBRF was associated with lower scores of childbirth readiness, which was associated with lower levels of fertility intentions. CONCLUSIONS: This study established the evidence that CBRF had both direct and indirect effects on the level of fertility intentions and childbirth readiness mediated the relationship between CBRF and the level of fertility intentions. Specifically, higher CBRF was associated with lower scores of childbirth readiness, which was associated with lower levels of fertility intentions. This finding suggested that it is important for health policymakers and health providers to pay more attention to improving women's childbirth readiness, which might reduce the negative influence of CBRF on fertility intentions, thus strengthening their fertility intentions.

Over the past two decades, fertility rates have been dropping steadily in most countries. Fertility intentions have been proven to be a reliable predictor of actual fertility behaviour. The worldwide sluggish fertility trend has brought about a series of issues, such as accelerated population ageing, shrinking workforce, and economic decline. China has the largest national population in the world, accounting for nearly one-fifth of the world's population, thus having a huge impact on global population trends. Therefore, in the context of significant fertility decline and population policy changes, timely research on fertility intention is of great significance for China and other low-fertility countries. CBRF has been proven to be negatively associated with childbirth readiness and fertility intentions among women, while childbirth readiness was positively related to fertility intentions. This study aimed to investigate the unique association between fertility intentions, CBRF, and childbirth readiness, and whether childbirth readiness would mediate the relationship between CBRF and fertility intentions. In this cross-sectional study, we found that women with high childbirth readiness had higher fertility intentions. However, women with high CBRF were more likely to have lower fertility intentions. Furthermore, CBRF had both direct and indirect effects on the level of fertility intentions. Childbirth readiness mediated the relationship between CBRF and the level of fertility intentions. Higher CBRF was associated with lower scores of childbirth readiness, which was associated with lower levels of fertility intentions. This finding suggested that it is important for health policymakers and health providers to pay more attention to improving women's childbirth readiness, which might reduce the negative influence of CBRF on fertility intentions, thus strengthening their fertility intentions.

Development and psychometric testing of a scale for assessing the psychological birth trauma.

Background: Psychological birth trauma is widespread in postpartum women, and its harms are serious to mothers' health. Existing tools rely on posttraumatic stress disorder to evaluate, which cannot effectively evaluate its connotation. The aim of this study was to develop a new instrument for use to comprehensively assess the psychological birth trauma level of women after birth and test the scale's psychometric properties. Methods: The scale was developed and evaluated through item generation, expert consultation, pre-survey, and psychometric evaluation. A literature review, focus group, and individual deep semi-structured interviews were utilized to identify the scale items. The expert consultation evaluated the content validity. Psychometric testing was conducted in a convenience sample of 712 mothers within the first 72 h postpartum who were recruited from three hospitals in China. Results: The total Cronbach alpha coefficient of the scale was 0.874. Exploratory factor analysis supported that the final scale consisted of four dimensions and fifteen items. The explanatory variance of the four factors was 66.724%. The four dimensions are named "being neglected," "out of control," "physiological emotional response," and "cognitive behavioral response." The results of the confirmatory factor analysis showed that the fit indices were all at acceptable and good levels. Conclusion: The 15-item Birth Trauma Scale is a valid and reliable tool to evaluate the psychological trauma of mothers who experienced spontaneous childbirth. The scale is a maternal self-assessment scale that can help women understand their mental health. Healthcare providers can identify key populations and intervene with them.

Analysis of the correlation between clinical nurses' professional quality of life and family care and organizational support.

Background and aim: Nurses' professional quality of life (ProQOL) is closely related to nursing life, and it is essential to clarify the professional quality of life of nurses and enhance it effectively. We aimed to explore the influence of family care and organizational support on the professional quality of life of clinical nurses and to improve the theoretical basis for improving the professional quality of life of clinical nurses in China. Methods: A single center, descriptive, cross-sectional design was used in this study. From February to April 2,022, 2,200 nurses from Tongji Hospital were selected as the study population, using the General Information Form, Family Care Scale, Professional Quality of Life Scale, Nurses' Sense of Organizational Support Questionnaire, and Work-Family Conflict Scale, and analyzing the relationship between professional quality of life and family care and organizational support among clinical nurses for correlation analysis as well as multiple linear regression to determine the factors affecting participants' Factors affecting ProQOL. P < 0.05 values were considered statistically significant. Results: The Cronbach coefficients of the scales were generally above 0.8, with good validity. All nurses had empathic satisfaction, burnout, and secondary trauma scores of 28.74 ± 3.83, 30.82 ± 3.45 and 29.40 ± 3.69, respectively, and correlation analysis, as well as multiple linear regression results, showed that the three dimensions of nurses' professional quality of life were associated with family care and organizational support (P < 0.05). Conclusions: The professional quality of life of nurses deserves to draw focused attention. The degree of family care and organizational support are predictive of professional quality of life, and nursing managers should pay attention to rationalizing tasks, pay attention to the physical and mental health of nursing staff, and improve the quality of life of nurses.

Why do pregnant women with fear of birth prefer vaginal birth? A qualitative study in China.

Background: Fear of birth (FOB) is becoming increasingly recognized as a mental health issue that may endanger maternal and infant health and affects women's subsequent fertility desires. It has also been shown to be related to the choice of delivery mode. Given the differences in healthcare systems and policies between countries, and the gaps in the exploration of women's experience of fear of birth and its association with the delivery mode in the Chinese cultural context, this study thus attempt to understand Chinese women's experience with fear of birth and their preferences for delivery mode through a qualitative study. Methods: A descriptive qualitative research was performed among twenty pregnant women from the obstetric outpatient of a tertiary hospital in China. Colaizzi's method was used to analyze the participants' data. Results: We proposed three themes and nine subthemes on the participants' experience with fear of birth: (1) an invisible dilemma: trapped in lingering fear (fear of all sides, the untold loneliness, and ambivalence with mixed feelings); (2) an unexpected decision: choose to give birth naturally (initiative selection and passive acceptance); and (3) A strength to confront challenges head-on: move forward with fear (awaken of maternal spirit, hope in bloom, Chinese tolerance culture, and obstetric analgesia). Conclusion: Fear of birth is a complex emotion, accompanied by feelings of loneliness and ambivalence in addition to fear. We found that women with fear of birth in this study prefer vaginal birth, and it was revealed to be the result of a combined action of intrinsic and extrinsic factors.

The influence of sense of coherence on psychological birth trauma: a parallel mediation model based on health Salutogenesis theory.

Background: Psychological birth trauma has been associated with a variety of negative consequences for mothers, partners, newborns, and midwives. While prior research has identified demographic and clinical factors that may contribute to the development of psychological birth trauma, interventions targeting these factors can prove challenging. Therefore, the aim of this study was to explore how psychological birth trauma is influenced by psychosocial factors including Sense of Coherence, Childbirth-related Fear, Social Support and Childbirth Readiness. Methods: A cross-sectional study was conducted in 13 tertiary or secondary hospitals in mainland China from November 2021 to June 2022. One thousand three hundred and sixty-six women were recruited totally. Data regarding basic characteristics, Sense of Coherence (SOC, Sense of Coherence Scale-3), Childbirth-related Fear (CBRF, Fear of Childbirth Scale), Social Support (SS, Medical Outcomes Study Social Support Survey), Childbirth Readiness (CR, Childbirth Readiness Scale) and Psychological Birth Trauma (PBT, Psychological Birth Trauma Scale) were collected. Parallel mediation analysis was adopted to identify the underlying mechanisms between study variables. Results: It was found that: (1) SOC has been found to have both direct and indirect effects on PBT. Women with higher level of SOC tend to report lower level of PBT; (2) the indirect effect of SOC on PBT was significantly exerted through CBRF, SS and CR; (3) CBRF was found to weaken the protective effect of SOC, whereas SS and CR were found to enhance it. No significant difference was found in contracts of the three specific indirect effects. Conclusion: SOC, CBRF, SS, and CR should be paid enough attention when designing intervention programs for women who might experience PBT. Interventions targeting SOC and CR are more likely to yield positive outcomes.

The unmet needs of older adults living in nursing homes in Mainland China: a nation-wide observational study.

BACKGROUND: The unmet needs of older adults in nursing homes could result in their poor health status physically and psychologically. The aim of this study was to understand the characteristics of unmet needs of older adults residing in nursing homes in China, and to probe into the contributing factors. METHODS: In this cross-sectional design, the demographic and health status questionnaire, Modified Barthel Index, the Numerical Rating Scale for pain assessment, Geriatric Depression Scale, Camberwell Assessment of Need for the elderly were employed to survey older adults living in 38 nursing homes in 13 cities in China from July 2017 to June 2018 through a multi-stage, stratified sampling scheme. The Short Portable Mental Status Questionnaire was adopted to exclude participants with severe cognitive impairment. Aside from descriptive analysis, a raft of hierarchical logistic regression models were run by sequentially controlling for the independent variables at 5 levels (demographic characteristics, health status, pain, ADL, and depression), aiming to identify the influencing factors of the unmet needs of the residents. RESULTS: The effective sample size involved 2063 older adults (63.4% female versus 36.6% male), with a response rate of 98.5%. The median and inter-quartile range of the total needs and unmet needs of the sample was 3(1, 4) and 0(0, 1) respectively, with 122 older participants having more than 3 unmet needs (high unmet need category) versus 1922 older ones having ≤ 3 unmet needs (low unmet need category). The unmet needs of older adults in nursing homes mainly fell into social domains. Gender, religion, educational background, marital status, living condition before admission, room type, incomes, staffing, number of diseases, pain, Barthel Index, and depression were contributive to unmet needs of older adults in long-term care facilities in the final model that was adjusted for all levels of variables (all p < 0.05). CONCLUSION: Understanding the influencing factors of the unmet needs of older adults in long term care provides clues for healthcare professionals to offer better care for this population. System-level support to nursing homes and training of staff are highlighted. Plus, taking measures to beef up social connections for the older adults to meet their social needs was suggested.

How breastfeeding behavior develops in women with gestational diabetes mellitus: A qualitative study based on health belief model in China.

Background: Gestational diabetes mellitus (GDM) is a condition in which women develop hyperglycemia during pregnancy, and is associated with long-term health burden on both mother and their offspring, such as future type 2 diabetes mellitus (T2DM). Although breastfeeding was expected to mitigate metabolic sequelae for both mothers and their newborns, the prevalence of breastfeeding in GDM mothers are sub-optimal worldwide. Objective: To explore the experience of disease among mothers with GDM and how they develop feeding behaviors. Methods: This study was conducted in three branches of an integrated tertiary hospital in the central area of China. Mothers who were diagnosed with GDM, had no other complications, and gave birth before no more than 6 months were approached based on a purposive sampling. GDM mothers' experience of the disease and breastfeeding were collected via in-depth interviews. A theory-driven thematic analysis based on Health Belief Model (HBM) was applied for data analysis. Inductive reasoning was used to identify emerging themes which were not included in HBM. Results: 16 GDM mothers were included in the current study, with nine using breastfeeding, six mixed feeding and one artificial feeding, respectively. Nine themes were identified, including: 1) GDM diagnosis and severity; 2) information searching and GDM knowledge;3) GDM management; 4) perceived susceptibility of future diabetes;5) perceived severity of future diabetes;6) perceived benefits of breastfeeding;7) perceived barriers of breastfeeding;8) decision making process of feeding and social support. Generally, mothers with GDM lack reliable sources of information, considered the disease as a minor and transient illness during pregnancy, and failed to realize the long-term risk of GDM and the protective effect of breastfeeding to themselves and their babies. They rarely considered GDM in their feeding decision. Instead, the formation of feeding behaviors depends on the balance between the benefits and barriers of breastfeeding as well as the level of social support. Conclusion: To promote breastfeeding, a multi-facet intervention targeted on healthcare providers (HCPs), GDM mothers and their networks was important to help GDM mothers better and correctly understand the disease and breastfeeding, and increase their capacity of breastfeeding.

Reflexive Hospice Care: A Concept Analysis.

Background: Currently, the definition and naming of reflexive hospice care (RHC) vary, hindering its correct application in hospice care. Aims and Objectives: The study aims to understand the meaning of RHC by clarifying its uses, attributes, antecedents, and consequences. Design: The study focused on concept analysis. Methods: Walker and Avant's model was adopted for concept analysis, with a review based on PRISMA principles. Results: RHC included three attributes: supporting a person verbally, actionally, spiritually, materially, and/or through actions; providing reverse care (from patient to his/her relatives, friends, and/or care team); and a two-way flow of love. Its antecedents were terminal patients' knowledge, affection, and intention for RHC, strong emotional connection between patients and their family members, and medical staff's knowledge and skills of RHC. Its consequences benefit the patients and their family members, medical staff, and society. Conclusions: RHC could improve patients' quality of life, alleviate the anxiety and depression of their family members, and deepen society's cognition of life and death. There is an urgent need to develop strategies, assessment tools, and courses for RHC to promote its application. Relevance to Clinical Practice: Terminally ill patients who provide RHC will have better quality-of-life outcomes and face death more peacefully. Identifying the concept of RHC can help nurses and other health care professionals who wish to serve patients and their families better in hospice care.

Relationship between perceived organizational support and professional values of nurses: mediating effect of emotional labor.

OBJECTIVES: Perceived organizational support was a benefit for the work performance of nurses, which may affect emotional labor and the development of professional values. This study aimed to explore the relationship between nurses' perceived organizational support and professional values, and investigate the mediating role of emotional labor. METHODS: This was a cross-sectional study. The study was conducted in 3 tertiary hospitals in Wuhan from October 2020 to January 2021. The data were collected by a questionnaire consisting of demographic characteristics, the Emotional Labor Scale for Nurses, the nurses' Perceived Organizational Support Scale, and the Nursing Professional Values Scale (NPVS-R). A convenience sample of 1017 nurses responded to the questionnaire survey. Pearson's correlation analysis was used to test the relationship between variables. Predictor effects were tested using hierarchical multiple regressions. The structural equation model (SEM) was used to test the mediation effect of emotional labor on the pathway from perceived organizational support to professional values. RESULTS: A positive moderate correlation was observed between the perceived organizational support and emotional labor (r = 0.524, P < 0.01), and a positive strong correlation was observed between perceived organizational support and professional values (r = 0.609, P < 0.01). Emotional labor and perceived organizational support were positive predictors of professional values (B = 0.531, 95%CI = 0.414 ~ 0.649; B = 0.808, 95%CI = 0.715 ~ 0.901, respectively). The association between perceived organizational support and professional values was mediated by emotional labor. CONCLUSIONS: Results showed that perceived organizational support was positively related to nurses' emotional labor, which was in turn associated with high professional values. For nurses, improving organizational support and training nurses to engage in emotional labor through providing multiple support systems, establishing appropriate incentive mechanisms, and training nurses to regulate emotions can be effective ways to promote nurses' professional values.