Predictors of Medication Adherence of Patients With Coronary Heart Disease After Percutaneous Coronary Intervention: A Structural Equation Modeling Based on the Extended Theory of Planned Behavior.

BACKGROUND: The theory of planned behavior (TPB), combined with social support, forms the extended TPB, which has shown to predict adherence to health-related behavior effectively, but few studies have applied it to explain medication adherence in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). OBJECTIVES: The aim of this study was to explore the factors associated with medication adherence and the underlying mechanisms based on the extended TPB among patients with CHD after PCI. METHODS: A cross-sectional descriptive study was conducted among patients with CHD after PCI in 2 major hospitals in Guangzhou, China. Medication adherence was measured with the Medication Adherence Report Scale. Constructs of the TPB contributing to medication adherence were assessed by the Theory of Planned Behavior Questionnaire for Medication Adherence. Social support was measured by the Multidimensional Scale of Perceived Social Support. Structural equation modeling was used to examine the hypotheses based on the extended TPB. RESULTS: A total of 300 patients were surveyed and 26.0% of them were nonadherent. The structural equation modeling had good fit indices and estimated 62.6% of the variance in medication adherence. Regarding the relationships between the extended TPB constructs and medication adherence, "intention" was directly associated with medication adherence, and "perceived behavioral control" positively predicted medication adherence directly and indirectly. "Affective attitude" and "subjective norm" were indirectly associated with medication adherence through "intention." Social support exerted an indirect effect on medication adherence through "subjective norm." CONCLUSIONS: The extended TPB is an appropriate model to predict medication adherence and provides an effective framework for adherence-enhancing interventions.

Unmet Family Needs Concerning Healthcare Services in the Setting of Childhood Hospitalization for Cancer Treatment in Mainland China: A Qualitative Study.

PURPOSE: The focus of this paper is to identify the unmet family needs during children's hospitalization for cancer treatment. DESIGN AND METHODS: Qualitative interviews were carried out with five fathers and fourteen mothers purposively sampled from four pediatric oncology departments in Mainland China from September 2013 to March 2014. Audiotaped interviews were transcribed verbatim, and data in transcripts were coded and analyzed by qualitative content analysis. RESULTS: The identified unmet family needs pertaining to healthcare service during a child's hospitalization for cancer treatment were unmet need for warm and supportive attitudes; competent care; adequate information; a comfortable environment; and catering support. CONCLUSIONS: The results showed that families with children hospitalized for cancer treatment have a variety of unmet needs related to healthcare service. These identified unmet family needs have already shed light on areas for healthcare service improvement. PRACTICE IMPLICATIONS: This study have reminded nurses' to become more concerned about unmet family needs instead of only focusing on the hospitalized child in clinical settings. Healthcare professionals can assist in promoting family adaptation to children's hospitalization by satisfying their unmet family needs.

The Efficacy of a Comprehensive Reminder System to Improve Health Behaviors and Blood Pressure Control in Hypertensive Ischemic Stroke Patients: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVE: The health behaviors of hypertensive stroke patients in China are not satisfactory. In this study, we tested the effect of a Health Belief Model Comprehensive Reminder System on health behaviors and blood pressure control in hypertensive ischemic stroke patients after occurrence and hospital discharge. METHODS: A randomized, parallel-group, assessor-blinded experimental design yielded participation of 174 hospitalized hypertensive ischemic stroke patients. The intervention consisted of face-to-face and telephone health belief education, a patient calendar handbook, and weekly automated short-message services. Data were collected at baseline and 3 months after discharge. RESULTS: Three months after discharge, the intervention group showed statistically, significantly better health behaviors for physical activity, nutrition, low-salt diet, and medication adherence. The intervention group also had statistically, significantly decreased systolic blood pressure and increased blood pressure control rate. Smoking and alcohol use behaviors were not affected. CONCLUSION: At 3 months, use of the Comprehensive Reminder System based on the Health Belief Model, yielded improvement in most health behaviors and blood pressure control in hypertensive ischemic stroke patients. Continued implementation of this intervention protocol is warranted to determine the long-term effect. Smoking and alcohol use behaviors need to be targeted with a different intervention.

The effectiveness of a comprehensive reminder system in the secondary prevention of hypertensive ischaemic stroke: randomized controlled trial protocol.

AIM: The aim of this study was to determine whether the Comprehensive Reminder System based on the Health Belief Model improves health belief, health behaviours, medication adherence and blood pressure control as a means of decreasing the rate of stroke recurrence among hypertensive ischaemic stroke. BACKGROUND: Hypertensive patients having experienced recent ischaemic strokes are at high risk for stroke recurrence. Several trials attempted to improve secondary stroke prevention via patient education, however, patient outcomes remained poor. Long-term follow-up studies regarding secondary stroke prevention are limited. DESIGN: A multi-centre, 12-month, assessor-blinded, parallel-group, randomized controlled longitudinal trial. METHODS: Hypertensive patients having experienced an ischaemic stroke are the target population. The intervention consists of health belief education, a calendar handbook, a weekly automated short-message service and four telephone follow-up interviews. Outcomes will be assessed at baseline and at 3, 6 and 12 months following discharge. The primary outcome is blood pressure control. The secondary outcomes include health belief, health behaviours and medication adherence. The clinical endpoint is the rate of stroke recurrence. DISCUSSION: Although many efforts to improve secondary stroke prevention have been undertaken, research indicates that improvements remain possible and warranted. This research protocol based on the Health Belief Model will improve our understanding of stroke education and transitional care needed in China and with the world-wide target population.

Effectiveness of Goal-Setting Telephone Follow-Up on Health Behaviors of Patients with Ischemic Stroke: A Randomized Controlled Trial.

BACKGROUND: Adopting healthy behaviors is critical for secondary stroke prevention, but many patients fail to follow national guidelines regarding diet, exercise, and abstinence from risk factors. Compliance often decreases with time after hospital discharge, yet few studies have examined programs promoting long-term adherence to health behaviors. Goal setting and telephone follow-up have been proven to be effective in other areas of medicine, so this study evaluated the effectiveness of a guideline-based, goal-setting telephone follow-up program for patients with ischemic stroke. METHODS: This was a multicenter, assessor-blinded, parallel-group, randomized controlled trial. Ninety-one stroke patients were randomized to either a control group or an intervention group. Intervention consisted of predischarge education and 3 goal-setting follow-up sessions conducted by phone. Data were collected at baseline and during the third and sixth months after hospital discharge. RESULTS: Six months after discharge, patients in the intervention group exhibited significantly higher medication adherence than patients in the control group. There were no statistically significant differences in physical activity, nutrition, low-salt diet adherence, blood pressure monitoring, smoking abstinence, unhealthy use of alcohol, and modified Rankin Scale (mRS) scores between the 2 groups. CONCLUSIONS: Goal-setting telephone follow-up intervention for ischemic stroke patients is feasible and leads to improved medication adherence. However, the lack of group differences in other health behavior subcategories and in themRS score indicates a need for more effective intervention strategies to help patients reach guideline-recommended targets.

Validation of Hospitalization Impact Scale among families with children hospitalized for cancer treatment.

AIM: To make further modifications to and validate the psychometric properties of the Hospitalization Impact Scale. BACKGROUND: A child's repeated and prolonged hospitalization for cancer treatment can result in great changes for the entire family. A hospitalization-specific screening tool is needed to help clinical nurses identify families who are experiencing major impacts during their child's hospitalization. DESIGN: A cross-sectional study was employed to examine the psychometric properties of the Hospitalization Impact Scale. METHOD: The sample consisted of 253 families with children hospitalized for cancer treatment in four paediatric oncology departments in four hospitals in mainland China from September 2013 - March 2014. Parents completed the 36-item Hospitalization Impact Scale, demographic measures and the Family Impact Module of the Pediatric Quality of Life Inventory. Reliability, construct validity, known-group validity and concurrent validity were examined. RESULT: The revised Hospitalization Impact Scale included six factors containing 34 items. It demonstrated sound concurrent validity with the Family Impact Module of the Pediatric Quality of Life Inventory and excellent internal consistency. CONCLUSION: The revised Hospitalization Impact Scale met the standard psychometric criteria for reliability and validity. Thus, it could be applied in paediatric oncology departments to help nurses assess and identify families experiencing major impacts during a child's hospitalization for cancer treatment.

The career success scale in nursing: psychometric evidence to support the Chinese version.

AIM: The purpose of this study was to examine the psychometric properties of the 11-item Chinese version of the Career Success Scale. BACKGROUND: Nurses play an important role in the healthcare system. Opportunities to achieve success and satisfaction from one's career affect the retention and stability of the nursing workforce. The Career Success Scale was originally developed in English and has been translated into Chinese. Psychometric testing of the Chinese Career Success Scale for measuring career success in nurses has not been performed. DESIGN: A cross-sectional survey was conducted. METHOD: A convenience sample of 1148 clinical nurses were recruited from 10 level-3 hospitals in Guangdong Province, mainland China, from December 2010-December 2011. RESULTS: Results indicated that the Chinese Career Success Scale demonstrated good internal consistency and test-retest reliability. Principal component analysis supported the three-factor structure of the original instrument: Career Satisfaction, Perceived within Organization Competitiveness and Perceived External Organization Competitiveness. There were significant correlations among the three factors, which demonstrated the good construct validity of the Chinese version of this scale. CONCLUSION: The Chinese Career Success Scale appears to be a reliable and valid instrument. It has the potential to be used to measure nurses' career success in mainland China. The findings will be useful for nurse leaders and policymakers in the evaluation of nurses' self-perceived career success and to develop strategies to promote nurse retention and career development.

The association of Chinese hospital work environment with nurse burnout, job satisfaction, and intention to leave.

The purpose of this study was to describe nurse burnout, job satisfaction, and intention to leave and to explore the relationship of work environment to nursing outcomes in a sample of 9,698 nurses from 181 hospitals in China. Nurses reported moderate levels of emotional exhaustion and depersonalization and high levels of reduced personal accomplishment. Nearly one-fifth of the nurses reported high levels of burnout on all three dimensions. Forty-five percent of the nurses were dissatisfied with their current job; these nurses were most dissatisfied with their salary. Five percent of nurses reported an intention to leave. Nurses reporting mixed and good work environments were less likely to report high burnout, job dissatisfaction, and intention to leave compared with those in poor work environments. The results suggest that high burnout and low job satisfaction are prominent problems for Chinese nurses, and improving work environment might be an effective strategy for better nursing outcomes in Chinese hospitals.

Psychometric properties of a mainland Chinese version of the Iowa Infant Feeding Attitude Scale among postpartum women in China.

BACKGROUND: The Iowa Infant Feeding Attitude Scale (IIFAS) is used to evaluate maternal infant feeding attitude. The breastfeeding rate has declined but no validated instruments to assess infant feeding attitudes or related studies have been available in mainland China. AIMS: The purpose of this study was to assess the reliability and validity of a mainland Chinese version of the IIFAS among postpartum women. METHODS: Postpartum women (N = 660) were recruited from three university hospitals in Guangzhou in mainland China. The participants completed an IIFAS questionnaire before being discharged and accepted telephone follow-up sessions at 6 weeks and 3 months postpartum. The reliability of the scale was evaluated using intra-class correlations (ICC) for test-retest reliability, correlated item-total correlations and Cronbach's a. The validity of the scale was evaluated using the content validity index (CVI), construct validity using exploratory factor analysis and predictive validity using independent t-tests. RESULTS: The ICC was 0.861. The correlated item-total correlations ranged from 0.262-0.691. Cronbach's a was 0.623. The CVI was 0.996. Four factors were extracted using exploratory factor analysis and they contributed to 48.69% of the total variance. CONCLUSIONS: The mainland Chinese version of the IIFAS scale can be considered a reliable, valid and predictive scale for assessing infant feeding attitudes among women in mainland China. In-hospital scores on the scale were significant predictors of the infant feeding method and breastfeeding duration at 3 days, 6 weeks and 3 months postpartum. Construct validity was confirmed and showed four factors. However, future studies are required to improve the lower level internal consistency of the IIFAS.

Nurse staffing levels make a difference on patient outcomes: a multisite study in Chinese hospitals.

PURPOSE: The purpose of this study is to examine the relationship between nurse staffing and patient outcomes in hospitals in mainland China. METHODS: The study was conducted in 181 hospitals across all of the eight economic zones in mainland China using a four-stage sampling design. Two instruments, the China Nurse Survey and the patient satisfaction measurement from the Hospital Consumer Assessment of Healthcare Providers and Systems, were employed in data collection. In this article, 7,802 nurse surveys and 5,430 patient surveys from 600 medical and surgical units were analyzed. RESULTS: The adjusted joint effects of nurse staffing on patient outcomes from logistic regression analyses showed that more nursing staff per patient had statistically significant positive effects on all necessary nursing care, nurses' reports of quality of care, their confidence on patients' self-care ability on discharge from the hospital, patient adverse events, as well as patients' report of satisfaction. When the nurse-to-patient ratio (total number of nurses on all shifts on the unit divided by total number of patients who stay on the unit) increased to the 0.5-<0.6 category, most patient outcomes were significantly improved, considering hospital and patient factors and nurse skill mix in the logistic regression models. CONCLUSIONS: The findings provide evidence on how inadequate nurse staffing might result in missed but needed nursing care and negative patient outcomes, while better staffing levels could be an effective strategy for improving patient outcomes. CLINICAL RELEVANCE: We recommend that the nurse-to-patient ratio on medical and surgical units in Chinese hospitals be increased to at least 0.5-0.6 so as to secure patient safety and the quality of health services.

The relationship between hospital work environment and nurse outcomes in Guangdong, China: a nurse questionnaire survey.

AIMS AND OBJECTIVES: This study examines the relationship between hospital work environments and job satisfaction, job-related burnout and intention to leave among nurses in Guangdong province, China. BACKGROUND: The nursing shortage is an urgent global problem and also of concern in China. Studies in Western countries have shown that better work environments are associated with higher nurse satisfaction and lower burnout, thereby improving retention and lowering turnover rates. However, there is little research on the relationship between nurse work environments and nurse outcomes in China. DESIGN: This is a cross-sectional study. Survey data were collected from 1104 bedside nurses in 89 medical, surgical and intensive care units in 21 hospitals across the Guangdong province in China. METHODS: Stratified convenience sampling was used to select hospitals, and systematic sampling was used to select units. All staff nurses working on participating units were surveyed. The China Hospital Nurse Survey, including the Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory, was employed to collect data from nurses. Statistical significance level was set at 0·05. RESULTS: Thirty-seven per cent of the nurses experienced high burnout, and 54% were dissatisfied with their jobs. Improving nurses' work environments from poor to better was associated with a 50% decrease in job dissatisfaction and a 33% decrease in job-related burnout among nurses. CONCLUSION: Burnout and job dissatisfaction are high among hospital nurses in Guangdong province, China. Better work environments for nurses were associated with decreased job dissatisfaction and job-related burnout, which may successfully address the nursing shortage in China. RELEVANCE TO CLINICAL PRACTICE: The findings of this study indicate that improving work environments is essential to deal with the nursing shortage; the findings provide motivation for nurse managers and policy makers to improve work environments of hospital nurses in China.

A pilot study of a systematic method for translating patient satisfaction questionnaires.

AIMS: This paper is a report of a descriptive comparative pilot study of use of a method that simultaneously tests the content validity and quality of translation of English-to-Chinese translations of two patient satisfaction questionnaires: the La Monica-Oberst Patient Satisfaction Scale and Hospital Consumer Assessment of Healthcare Providers and Systems. BACKGROUND: Patient satisfaction is an important indicator of the quality of healthcare services. In China, however, few good translations of patient satisfaction instruments sensitive to nursing services exist. METHODS: The descriptive pilot study took place in 2009 and used content validity indexing techniques to evaluate the content, context and criterion relevance of a survey question. The expert raters were 10 nursing faculty and 10 patients who evaluated the two patient satisfaction questionnaires. The experts evaluated the relevance of each item on a scale of 1-4 and the research team compared their responses to choose the most appropriate. Only the nurse faculty experts, who were bilingual, evaluated the quality of the translation using a binary rating. RESULTS: The 'Nurse Rater' relevance scores of the LaMonica-Oberst Patient Satisfaction Scale and the Hospital Consumer Assessment of Healthcare Providers and Systems were 0·96 and 0·95 respectively, whereas the patient's overall relevance scores were 0·89 and 0·95. A Mann-Whitney U-test demonstrated that results between the two groups were statistically significantly different (P = 0·0135). CONCLUSIONS: Using content validity indexing simultaneously with translation processes was valuable for selecting and evaluating survey instruments in different contexts.

Perceived Family Impact During Children's Hospitalization for Treatment of Acute Lymphoblastic Leukemia: A Cross-sectional Study.

BACKGROUND: Improved survival rates of acute lymphoblastic leukemia (ALL) in children are often associated with repeated and prolonged hospitalization, creating an immensely stressful situation for the family. OBJECTIVE: The aims of this study were to assess perceived family impact and coping during the child's hospitalization for ALL treatment and identify potential predictors of perceived family impact. INTERVENTIONS/METHODS: A total of 212 families with children hospitalized participated. The hospitalization impact and coping scales were used to assess perceived family impact and coping, respectively. RESULTS: The mean (SD) total score for perceived family impact was 88.11 (22.39); social impact received the highest average score. The mean (SD) total score for family coping was 39.02 (9.84). A significant decrease in family coping was associated with more readmissions. Predictors of perceived family impact were severity of the child's illness, total days of all admissions, and coping, accounting for 37% of the observed variance. CONCLUSIONS: Families were moderately affected by children's hospitalizations; social functioning was most affected. Families' perceived coping effectiveness decreased as the readmissions increased. The higher risk category a child's diagnosis is, the longer a child's hospitalization is, and the less perceived coping effectiveness, the higher family perceived impact. IMPLICATIONS FOR PRACTICE: The findings provide a direction for the development of family-centered supportive intervention programs. Nurses should be aware that the total days of admission and severity of a child's illness are significant factors associated with perceived family impact and likely justify special attention. Family coping enhancement interventions could alleviate perceived family impact.

Evaluation of the simplified therapeutic intervention scoring system: Chinese version.

OBJECTIVE: To prepare the Simplified Therapeutic Intervention Scoring System (TISS-28) to measure nursing workload in Intensive Care Units in Guangdong Province of China. METHODS: A non-experimental descriptive study was conducted in the intensive care units in the Province. TISS-28, TISS-76, Acute Physiology and Chronic Health Evaluation (APACHE II) were all measured. RESULTS: There were significant positive correlations between TISS-28 and APACHE II (n=91, r=0.432, p<0.001), TISS-76 scores (n=83, r=0.764, p<0.001). A significant difference was found between the mean TISS-28 score in the first day of the intensive care stay and the last day (30.76±6.86 vs 24.67±5.48, p<0.001). A significant intra-class correlation was found between TISS-28 scores collected by the researcher and research associates (ICC=0.959, p<0.001). CONCLUSION: The reliability and validity of TISS-28 were shown in Chinese intensive care units. It is a practical tool for estimating the nursing workload and providing opportunities to compare the data between intensive care units in different facilities. The TISS-28 Chinese version is recommended to guide the allocation of nursing manpower in Chinese intensive care units.

Psychometric Validation of an Instrument to Measure Family Coping During a Child's Hospitalization for Cancer.

BACKGROUND: Families with children hospitalized for cancer treatment experience multiple, serious challenges. Family coping is a crucial moderator between family stress and family adaptation. A newly developed instrument, the Hospitalization Coping Scale (HCS), measures the effectiveness of family coping during a child's hospitalization. OBJECTIVE: The aims of this study were to revise and validate the psychometric properties of the HCS for families with children hospitalized for cancer treatment in pediatric oncology departments in Mainland China. METHODS: Psychometric properties of the HCS were examined among 253 families with children hospitalized in pediatric oncology departments in 4 hospitals. Reliability, construct validity, known-group validity, and concurrent validity of the revised HCS were examined. RESULTS: The revised 15-item HCS contains 3 renamed factors: maintaining mental stability, mutual support for child care, and seeking support from external systems. Cronbach's α coefficients for the total and 3 factors were .87, .78, .83, and .79, respectively. The revised scale demonstrated sound known-group validity and concurrent validity. CONCLUSIONS: The revised 15-item HCS is a reliable and valid instrument to measure coping effectiveness of families with children hospitalized for cancer treatment. IMPLICATIONS FOR PRACTICE: The HCS can be used by pediatric oncology nurses to assess the effectiveness of family coping during a hospitalization of their child with cancer and may help pediatric oncology nurses to develop and implement realistic support strategies based on assessments of family coping effectiveness.

Psychometric Properties of the Kessler 10 Scale in Chinese Parents of Children With Cancer.

BACKGROUND: The Kessler Psychological Distress Scale (K10) has been widely used in rating psychological distress in general and clinical populations. However, whether it can be used in parents of children with cancer is unknown. Still lacking is the evidence on its reliability and validity in culturally diverse groups. OBJECTIVE: The aim of this study was to translate the K10 into Mandarin Chinese and test its psychometric properties (especially the factor structure) of the Chinese version (C-K10) in parents of children with cancer. METHODS: By convenience sampling, 2 samples of parents of children with cancer (sample I, n = 206, and sample II, n = 103) were surveyed in Guangzhou, China. Sample I completed the C-K10, and the internal consistency reliability and exploratory factor analysis of the C-K10 were estimated. Sample II completed the C-K10, the State Subscale of State-Trait Anxiety Inventory, and the Zung Self-rating Depression Scale; confirmatory factor analysis and concurrent validity estimates were completed. RESULTS: The C-K10 demonstrated strong internal consistency reliability (Cronbach's α = .93). Both exploratory and confirmatory factor analyses supported a 2-factor structure (ie, anxiety and depression). The concurrent validity was moderate with Pearson correlations greater than 0.50 (P < .001). CONCLUSION: The C-K10 demonstrated very acceptable reliability and validity in screening psychological distress in Chinese parents of children with cancer. IMPLICATIONS FOR PRACTICE: This study provides evidence that the C-K10 is a valid tool that can be used in clinical settings to screen for psychological distress in Chinese parents of children with cancer.

Uncertainty and Personal Growth Through Positive Coping Strategies Among Chinese Parents of Children With Acute Leukemia.

BACKGROUND: Having a child in the family with acute leukemia (AL) is a challenge for the parents and can trigger parental uncertainty. Through positive coping with uncertainty, parents can demonstrate positive psychological changes, including higher adaptability. OBJECTIVES: The purposes of this study were to measure uncertainty, coping strategies, and growth through uncertainty (GTU) and explore the relationships among them in parents of children with AL in China. Related factors of parental uncertainty were also explored. METHODS: A descriptive and correlative design was used. Ninety-five parents of children with AL participated. Parental uncertainty, coping, and GTU were measured by the translated Chinese versions of scales originally developed by Mishel, McCubbin, and Mishel. RESULTS: Parental uncertainty was found to be prevalent in parents of children with AL in China. It did not have a direct impact on GTU, but rather was mediated through coping. Coping was negatively associated with unpredictability (r = -0.225, P < .05), while positively associated with GTU (r = 0.391, P < .01). CONCLUSIONS: Through reordering of priorities of life events, parents acquired GTU during the process of their child's illness and treatment. Use of positive coping strategies by parents could help them to manage the stress associated with the unpredictability of child's illness and to promote a healthy maintenance of GTU. IMPLICATIONS FOR PRACTICE: Nurses could assume a more active role in identifying sources and level of parental uncertainty, encouraging parents to stay optimistic, and promoting change in perceptions of uncertainty from danger to opportunity.

The development and issues of nursing education in China: a national data analysis.

BACKGROUND: The development of and the issues arising in the nursing educational sector as the provider for nursing workforce have drawn increasing attention. OBJECTIVES: To describe the development of nursing education in mainland China and to analyze related issues. DESIGN: A retrospective, descriptive study with secondary data analysis. METHODS: The scale and composition of nursing education programs from 2006 to 2012 in mainland China were analyzed, and changes in the scale of the nursing workforce from 2002 to 2013 were compared to facilitate an interpretation of nursing education. RESULTS: The scale of initial nursing education was large and expanded rapidly. In 2012, the total recruitment was 515,710, including 39,747 (7.71%) students training for a baccalaureate degree, 143,726 (27.87%) students training for an advanced diploma, and 332,237 (64.42%) students training in secondary diploma programs. The nursing workforce in China grew dramatically, with an increase of 120,000 to 286,000 nurses each year since 2006, but the nurse shortage remained existed (there were only 2.05 nurses per 1000 population, and the nurse to doctor ratio was 1:1 in 2013). The recruitment of nursing students per 1000 population was greater in the west (0.51) and middle (0.40) regions than in the east region (0.28), while the number of nurses per 1000 population had the opposite pattern (1.71, 1.75, and 2.02 nurses per 1000 population in the west, middle, and east regions, respectively) in 2012. CONCLUSIONS: Nursing education in China has developed rapidly, and some issues require attention. We suggest that initial nursing education be improved by increasing the recruitment to advanced diploma and baccalaureate programs and decreasing the recruitment to secondary diploma programs and by ensuring the quality of education. Multiple strategies should be taken to effectively raise the social status and prestige of the nursing profession and to ease the nurse shortage.

The relationship between patient safety culture and adverse events: a questionnaire survey.

BACKGROUND: Patient safety culture is an important factor in the effort to reduce adverse events in the hospital and improve patient safety. A few studies have shown the relationship between patient safety culture and adverse events, yet no such research has been reported in China. OBJECTIVES: This study aimed to describe nurses' perception of patient safety culture and frequencies of adverse events, and examine the relationship between them. DESIGN: This study was a descriptive, correlated study. SETTING AND PARTICIPANTS: We selected 28 inpatient units and emergency departments in 7 level-3 general hospitals from 5 districts in Guangzhou, China, and we surveyed 463 nurses. METHODS: The Hospital Survey on Patient Safety Culture was used to measure nurses' perception of patient safety culture, and the frequencies of adverse events which happened frequently in hospital were estimated by nurses. We used multiple logistic regression models to examine the relationship between patient safety culture scores and estimated frequencies of each type of adverse event. RESULTS: The Positive Response Rates of 12 dimensions of the Hospital Survey on Patient Safety Culture varied from 23.6% to 89.7%. There were 47.8-75.6% nurses who estimated that these adverse events had happened in the past year. After controlling for all nurse related factors, a higher mean score of "Organizational Learning-Continuous Improvement" was significantly related to lower the occurrence of pressure ulcers (OR=0.249), prolonged physical restraint (OR=0.406), and complaints (OR=0.369); a higher mean score of "Frequency of Event Reporting" was significantly related to lower the occurrence of medicine errors (OR=0.699) and pressure ulcers (OR=0.639). CONCLUSIONS: The results confirmed the hypothesis that an improvement in patient safety culture was related to a decrease in the occurrence of adverse events.

Translation and validation of a Chinese version of the 8-item Morisky medication adherence scale in myocardial infarction patients.

RATIONALE, AIMS AND OBJECTIVES: Poor medication adherence is a major global public health challenge. A valid, reliable, cost-effective tool for measuring medication adherence would lead to a better understanding of non-adherence and lay the groundwork for interventions aimed at facilitating adherence to therapies. The aim of this study was to translate and evaluate the psychometric properties of the Chinese version of the 8-item Morisky medication adherence scale (C-MMAS-8) in Chinese myocardial infarction (MI) patients. METHODS: Psychometric testing of the C-MMAS-8 was conducted using a convenience sample of 176 MI patients recruited from four major hospitals in Guangzhou in southern China. Socio-demographic data, C-MMAS-8 and three subscales of the revised illness perception questionnaire (treatment control, personal control and illness coherence subscales) were administered to the MI patients. Thirty MI patients participated in a 4-week retest. RESULTS: The C-MMAS-8 demonstrated good internal consistency (Cronbach's α = 0.77) and test-retest reliability (r = 0.88, P < 0.001). Significant correlations with treatment control subscale (r = 0.32, P < 0.01), personal control subscale (r = 0.47, P < 0.01), and illness coherence subscale (r = 0.44, P < 0.01) of the revised illness perception questionnaire demonstrated good construct validity. CONCLUSIONS: The psychometric properties of the C-MMAS-8 are satisfactory.