Developing and validating the nurse-patient relationship scale (NPRS) in China.

BACKGROUND: Poor nurse-patient relationship poses an obstacle to care delivery, jeopardizing patient experience and patient care outcomes. Measuring nurse-patient relationship is challenging given its multi-dimensional nature and a lack of well-established scales. PURPOSE: This study aimed to develop a multi-dimensional scale measuring nurse-patient relationship in China. METHODS: A preliminary scale was constructed based on the existing literature and Delphi consultations with 12 nursing experts. The face validity of the scale was tested through a survey of 45 clinical nurses. This was followed by a validation study on 620 clinical nurses. Cronbach's α, content validity and known-group validity of the scale were assessed. The study sample was further divided into two for Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), respectively, to assess the construct validity of the scale. RESULTS: The Nurse-Patient Relationship Scale (NPRS) containing 23 items was developed and validated, measuring five dimensions: nursing behavior, nurse understanding and respect for patient, patient misunderstanding and mistrust in nurse, communication with patient, and interaction with patient. The Cronbach's α of the NPRS ranged from 0.725 to 0.932, indicating high internal consistency. The CFA showed excellent fitness of data into the five-factor structure: χ2/df = 2.431, GFI = 0.933, TLI = 0.923, CFI = 0.939, IFI = 0.923, RMSEA = 0.070. Good content and construct validity are demonstrated through expert consensus and psychometric tests. CONCLUSION: The NPRS is a valid tool measuring nurse-patient relationship in China.

Emotional labour and turnover intention among nurses in China: Mediating effects of nurse-patient relationship and self-rated health.

AIM: This study tested the mediating role of the nurse-patient relationship and self-rated health in the effect of emotional labour on turnover intention among nurses in China. BACKGROUND: The underlying mechanism behind the effect of emotional labour on turnover intention remains inadequately understood. INTRODUCTION: Nurses with a high level of emotional labour are predisposed to experiencing poor health and tension in their relationships with patients, which may increase turnover intention. METHODS: A cross-sectional survey of 527 nurses in a public tertiary hospital in Qiqihar, located in China's Heilongjiang province, was conducted. Emotional labour and turnover intention were assessed using existing validated scales containing multiple items, while the nurse-patient relationship and self-rated health were assessed using single items, respectively. Baron and Kenny's causal steps and the Karlson/Holm/Breen method were adopted to test the mediating effects of the nurse-patient relationship and self-rated health in the association between emotional labour and turnover intention after adjusting for variations in sociodemographic and job characteristics. RESULTS: Emotional labour was positively associated with turnover intention. Self-rated poor health and a disharmonious nurse-patient relationship partially mediated the positive effect of emotional labour on turnover intention. CONCLUSIONS: Emotional labour significantly affects the turnover intention of nurses working in public tertiary hospitals in China, and this effect is partially mediated by self-rated health and the nurse-patient relationship. IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY: Giving more attention to nurses' negative emotions and work attitudes is crucial. Developing comprehensive strategies for enhancing nurses' emotional management ability, promoting their physical and psychological well-being, and improving nurse-patient relationship to reduce nurses' turnover.

Attitudes of medical professionals towards patient-centredness: a cross-sectional study in H City, China.

OBJECTIVES: Patient-centred communication improves patient experiences and patient care outcomes. This study aimed to assess the preference of medical professionals in China towards patient-centred communication under the context of the deteriorating doctor-patient relationship. METHODS: A cross-sectional survey of medical professionals was conducted in January and February 2018 in H City of Heilongjiang province, the northeast of China. The Chinese-Revised Patient-Practitioner Orientation Scale (CR-PPOS) was adopted to measure the individual preference of respondents towards patient-centredness in clinical communication. Multivariate logistic regression models were established to identify the sociodemographic (gender, age, marital status and educational attainment) and work experience (years of working, seniority, satisfaction with income, daily workload and perceived doctor-patient relationship) predictors of the preference towards patient-centredness. PATIENT AND PUBLIC INVOLVEMENT: Not applicable. RESULTS: A total of 618 valid questionnaires were returned. The CR-PPOS demonstrated acceptable reliability and validity. Overall, a low level of preference towards patient-centredness in clinical communication was found. Relatively higher scores on 'caring for patients' (20.42±4.42) was found compared with those on 'information/responsibility sharing' (15.26±4.21). Younger age, higher educational attainment, lower daily workload and a perception of harmonious doctor-patient relationship were associated with a higher preference towards patient-centredness in clinical communication. CONCLUSIONS: A low level of preference towards patient-centredness in clinical communication was found in medical professionals in the northeast of China, which may further jeopardise the efforts to improve doctor-patient relationship.

Microscale Silicon-Based Anodes: Fundamental Understanding and Industrial Prospects for Practical High-Energy Lithium-Ion Batteries.

To accelerate the commercial implementation of high-energy batteries, recent research thrusts have turned to the practicality of Si-based electrodes. Although numerous nanostructured Si-based materials with exceptional performance have been reported in the past 20 years, the practical development of high-energy Si-based batteries has been beset by the bias between industrial application with gravimetrical energy shortages and scientific research with volumetric limits. In this context, the microscale design of Si-based anodes with densified microstructure has been deemed as an impactful solution to tackle these critical issues. However, their large-scale application is plagued by inadequate cycling stability. In this review, we present the challenges in Si-based materials design and draw a realistic picture regarding practical electrode engineering. Critical appraisals of recent advances in microscale design of stable Si-based materials are presented, including interfacial tailoring of Si microscale electrode, surface modification of SiOx microscale electrode, and structural engineering of hierarchical microscale electrode. Thereafter, other practical metrics beyond active material are also explored, such as robust binder design, electrolyte exploration, prelithiation technology, and thick-electrode engineering. Finally, we provide a roadmap starting with material design and ending with the remaining challenges and integrated improvement strategies toward Si-based full cells.

Factors Associated With Individual Emergency Preparedness Behaviors: A Cross-Sectional Survey Among the Public in Three Chinese Provinces.

Introduction: This study aimed to identify factors associated with individual emergency preparedness behaviors which play an important role in effective emergency response. Methods: Data were drawn from a cross-sectional survey conducted in China's Heilongjiang, Guangdong and Sichuan provinces in 2017. Questionnaires were administered through face-to-face interviews, and 2,506 were valid for data analyses. A structural equation model was established to test the direct and indirect effects of the relevant factors on individual emergency preparedness behaviors. Results: Low levels of emergency preparedness were found: 28% of respondents reported being fully/partly prepared. The attitudes of the respondents toward emergency preparedness had the strongest association with emergency preparedness behaviors, with a total effect of 0.483. This was followed by self-efficacy (0.305) and training/exercise (0.295). Risk perception had the weakest effect (0.045) on emergency preparedness behaviors. Discussion: Improving attitudes of the public as well as their ability to prepare for emergency events is important for effective emergency management.

A meta-analysis of active smoking and risk of meningioma.

INTRODUCTION: Cigarette smoking has been hypothesized to be a risk factor for meningioma. However, the results of studies exploring the relationship between smoking exposure and the occurrence of meningioma are inconsistent. METHODS: A search of PubMed, Medline, Embase, and Science Direct (up to June 2020) databases was performed. Two authors independently extracted the data. The Newcastle-Ottawa Scale was employed for judging the quality of articles. A random-effects model was utilized for meta-analysis. Association analysis between smoking and meningioma was based on the adjusted RR and the 95% CI, as reported by eligible studies. Subgroup and sensitivity analyses were performed and publication bias was assessed. Subgroup analysis was conducted by geographical region, study design, sex, study quality, and adjustments of RR score. Begg's and Egger's tests were employed for detecting publication bias. RESULTS: Twelve articles, including 2 cohort studies and 10 case-control studies, and a total of 1210167 participants were identified. The pooled relative risk (RR) with 95% confidence interval (95% CI) implied that smoking was not associated with increased risk of meningioma in men and women combined (RR=1.09; 95% CI: 0.90-1.33). From the sex-stratified subgroup analysis, the risk of meningioma was significant in men (RR=1.42; 95% CI: 1.16-1.74). Risk of meningioma in women did not remain significant (RR=0.92; 95% CI: 0.73-1.16). There was a high heterogeneity in the results (I2=58.4%, p=0.002). Sensitivity analyses showed stable results and there was no evidence of publication bias. CONCLUSIONS: Cigarette smoking is not associated with a significantly increased risk of meningioma in the whole population, but there is a positive association in men but not in women.

Household preparedness for emergency events: a cross-sectional survey on residents in four regions of China.

OBJECTIVE: This study aimed to assess household preparedness for emergency events and its determinants in China. DESIGN: A cross-sectional questionnaire survey was conducted on 3541 households in China in 2015. PARTICIPANTS: Households were selected using a stratified cluster sampling strategy, representing central, eastern, western and southern regions of China. The designed questionnaires were administered through face-to-face interviews. OUTCOME MEASURES: Household emergency preparedness was measured with 14 indicators, tapping into the supply of nine emergency necessities (food and water, extra batteries, battery-powered radio, battery-operated torch, first-aid kit, gas mask, fire extinguisher, escape ropes, whistle), coverage of accident insurance, knowledge of local emergency response systems (emergency numbers, exit routes and shelters) and availability of a household evacuation plan. If an individual acted on 9 of the 14 indicators, they were deemed well prepared. Logistic regression models were established to identify predictors of well preparedness based on 3541 returned questionnaires containing no missing values. RESULTS: Only 9.9% of households were well prepared for emergencies: 53.6% did not know what to do and 31.6% did not want to think about it. A higher level of preparedness was found in the respondents who have attained higher education (adjusted OR=0.826 compared with the higher level), participated in emergency training activities (adjusted OR=2.299), had better emergency knowledge (adjusted OR=2.043), reported less fate-submissiveness (adjusted OR=1.385) and more self-reliance (adjusted OR=1.349), prior exposure to emergency events (adjusted OR=1.280) and held more positive attitudes towards preparedness (adjusted OR=1.286). CONCLUSION: Household preparedness for emergency events is poor in China. Lack of motivation, negative attitude to preparedness and knowledge shortfall are major but remediable barriers for household preparedness.

Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care.

OBJECTIVE: Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. METHODS: We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. FINDINGS: About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust-the most significant predictor of patient satisfaction-is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. CONCLUSION: At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders.

Community preparedness for emergency: a cross-sectional survey of residents in Heilongjiang of China.

OBJECTIVE: This article aims to identify factors that shape the knowledge, attitudes and behaviours of community residents in China's Heilongjiang province towards emergency preparedness. Findings of such a study may provide evidence to support the development of effective public risk communication strategies and education campaigns. DESIGN: A cross-sectional household questionnaire survey was conducted in Heilongjiang province in 2014. A stratified cluster sampling strategy was employed to select study participants. The questionnaires were administered using face-to-face interviews. 2800 questionnaires were completed, among which 2686 (95.9%) were considered valid for data analyses. A multivariate logistic regression model was adopted to identify the extent to which the independent variables were associated with emergency preparedness. RESULTS: Fewer than 5% respondents were well prepared for emergency. Over half (52%) of poorly prepared respondents did not know what to do in emergency; women (OR=1.691), higher household income (OR ranging from 1.666 to 2.117), previous experience with emergency (OR=1.552), higher levels of knowledge about emergency (OR=2.192), risk awareness (OR=1.531), self-efficacy (OR=1.796), as well as positive attitudes towards emergency preparedness (OR=2.265) were significant predictors for emergency preparedness. Neither educational attainment nor exposure to awareness-raising entered into the logic regression model as a significant predictor for emergency preparedness. CONCLUSIONS: The level of emergency preparedness in Heilongjiang residents is very low, which is linked with poor knowledge and attitudes of the residents towards emergency preparedness. Future emergency awareness campaigns should be more focused and tailored to the needs of intended audience, taking into consideration of their usual source of information and knowledge in relation to emergency.

Nursing informatics in clinical practice in China.

Nursing informatics has become a useful tool for worldwide patient care and management; however, its implementation greatly varies according to specialty, healthcare setting, and nation. The purpose of this study was to determine nursing informatics implementation in Qiqihar, China. Questionnaires evaluating the advantages and disadvantages of nursing informatics implementation and hospital information system knowledge were distributed among three hospitals in Qiqihar. A convenient sample of 50 nurses from each hospital (total N = 150) was selected to participate in this study. Responses indicated that despite a relatively brief training period, nursing informatics was adequately implemented, and nurses were knowledgeable about hospital information systems. Respondents identified several key advantages of nursing informatics implementation, particularly its usefulness in aiding patient care for data management. Finally, respondents identified hospital information system instability as a major obstacle to nursing informatics implementation. Our study results may help clinical nursing practitioners improve their technology skills and help nursing administrators improve information programs. These findings provide an important reference for both nursing informatics practice and further studies.