Global migration and factors influencing retention of Asian internationally educated nurses: a systematic review.

BACKGROUND: Given nurses' increasing international mobility, Asian internationally educated nurses (IENs) represent a critical human resource highly sought after within the global healthcare workforce. Developed countries have grown excessively reliant on them, leading to heightened competition among these countries. Hence, this review aims to uncover factors underlying the retention of Asian IENs in host countries to facilitate the development of more effective staff retention strategies. METHODS: A mixed-methods systematic review was conducted using the Joanna Briggs Institute methodology for mixed-method systematic review. A search was undertaken across the following electronic databases for studies published in English during 2013-2022: CINAHL, Embase, PubMed, Scopus, Web of Science and PsycINFO. Two of the researchers critically appraised included articles independently using the Joanna Briggs Critical Appraisal Tools and Mixed Methods Appraisal Tool (version 2018). A data-based convergent integrated approach was adopted for data synthesis. RESULTS: Of the 27 included articles (19 qualitative and eight quantitative), five each were conducted in Asia (Japan, Taiwan, Singapore and Malaysia), Australia and Europe (Italy, Norway and the United Kingdom); four each in the United States and the Middle East (Saudi Arabia and Kuwait); two in Canada; and one each in New Zealand and South Africa. Five themes emerged from the data synthesis: (1) desire for better career prospects, (2) occupational downward mobility, (3) inequality in career advancement, (4) acculturation and (5) support system. CONCLUSION: This systematic review investigated the factors influencing AMN retention and identified several promising retention strategies: granting them permanent residency, ensuring transparency in credentialing assessment, providing equal opportunities for career advancement, instituting induction programmes for newly employed Asian IENs, enabling families to be with them and building workplace social support. Retention strategies that embrace the Asian IENs' perspectives and experiences are envisioned to ensure a sustainable nursing workforce.

Virtual reality-based reminiscence therapy for older adults to improve psychological well-being and cognition: A systematic review.

BACKGROUND: Virtual reality-reminiscence therapy (VR-RT) has increasingly been applied to older adults to improve psychological well-being and cognition. OBJECTIVE: This review aims to identify (1) the design characteristics of conducting a VR-RT and (2) the effects of VR-RT on the user experience, cognitive outcomes and psychological well-being. DESIGN: Systematic review. METHODS: Eligible studies were sourced across nine electronic databases, trial registries, grey literature and hand-searching of the reference list. A narrative synthesis was conducted. Twenty-two studies were included, and most were appraised as high quality. Most of the VR-RTs were highly immersive and personalised, with participants having the autonomy of control. VR-RT has the potential to improve anxiety and depression, and cognitive outcomes for older adults. Overall, VR-RT was reported to be an enjoyable experience for older adults. CONCLUSIONS: VR-RT is a promising innovation that can improve older adults' psychological well-being and cognition without significant side effects, including cybersickness and with the potential for scalability across various settings. More randomised controlled studies are needed to evaluate the effectiveness of VR-RT and its features and treatment dosage. These studies could also examine the effectiveness of VR-RT as an intervention to promote independence in activities of daily living and physical rehabilitation. RELEVANCE TO CLINICAL PRACTICE: VR-RT is a promising intervention for older adults in community settings to enhance psychological well-being and cognition. VR's versatility enables personalised experiences within dynamic virtual environments, possibly enhancing engagement and therapeutic outcomes. NO PATIENT OR PUBLIC CONTRIBUTION: This systematic review did not directly involve patient or public contribution to the manuscript.

Social media use and its impact on adult's mental health and well-being: A scoping review.

BACKGROUND: Social media use has grown in importance and prevalence, with its estimated number of users at 4.9 billion worldwide. Social media use research has revealed positive and negative impacts on users' mental health and well-being. However, such impacts among adults have not been examined in any reviews. METHODS: A scoping review was conducted based on the framework by Arksey and O'Malley and reported based on the PRISMA-ScR guidelines. Eight databases were searched from 2005 to December 2021. Articles were included after being reviewed by three independent teams, with discrepancies resolved through consensus with the senior author. Publication-related information (i.e., authors, year of publication, aims, study population, methodology, interventions, comparisons, outcome measures and key findings) were extracted from each study. Thematic analysis was conducted to answer the research questions. RESULTS: Among the 114 eligible articles, young adults (69.6%) represented the main age group. Most studies (78.6%) focused on the negative impacts of social media use on mental health and well-being, with nearly a third (32.1%) assessing such impacts on depression. Notably, this scoping review found that more than three-quarters (78.6%) of the included studies revealed that excessive and passive social media use would increase depression, anxiety, mood, and loneliness. Nevertheless, a third (33.0%) also reported positive impacts, where positive and purposeful use of social media would contribute to improvements in mental health and well-being, such as increased perceived social support and enjoyment. LINKING EVIDENCE TO ACTION: This review has provided an overview of the existing knowledge on how social media use would affect adults and identified areas of research that merit investigations in future studies. More attention should be given to maximizing the positive impacts of social media use on mental health and well-being among adults.

Characteristics, methodological, and reporting quality of scoping reviews published in nursing journals: A systematic review.

INTRODUCTION: Given the diversity of the scope for inquiry and methodologies used in nursing research, the synthesis of primary research may not be as straightforward as conducting a meta-analysis or systematic review on clinical trials. Scoping reviews offer an option to nursing academics for inquiries involving a range of applications and interpretations. Given the continual advances in evidence-based research, it is, therefore, crucial for nursing to constantly substantiate its research capabilities and uphold standards in its research inquiry. Accordingly, an updated overview would be timely to characterize scoping reviews in the nursing literature. Hence this review aimed to examine the characteristics of scoping reviews published in nursing journals and evaluate the methodological and reporting quality of the scoping reviews. DESIGN: A systematic review. METHODS: A comprehensive search of three electronic databases (PubMed, CINAHL, and Embase) were conducted. Scoping reviews published in English on or before December 31, 2020 were included, with the criterion that their publication had been in nursing journals indexed in the Journal Citation Reports (2020 Science Edition) of the Web of Science. Two reviewers independently screened the titles and abstracts for eligibility. A standardized data extraction form was used for data collection, and a 29-item checklist was developed to assess the methodological and reporting quality of the scoping reviews. The methodological and reporting quality was assessed independently by four reviewers and subsequently counter-checked by another two reviewers. Descriptive statistics were used to characterize the included papers, and narrative synthesis was undertaken to explain the results. RESULTS: This review included 422 papers from 88 nursing journals. They were published between 2008 and 2021 (median year 2019). Only 15 (3.5%) reviews reported accessible protocols, and 63 (15.0%) presented data on their critical appraisal of the included sources of evidence. Poor reporting of the selection of sources of evidence and data extraction was also identified. Overall, the 422 included reviews had complied with 20 (median [range: 9-27]) of the 29 items on the checklist. CONCLUSIONS: Scoping reviews have garnered wider acceptance in nursing research, of which the scopes and methodologies exhibit much diversity. Our systematic review has provided insights into existing scoping reviews published in nursing journals through our characterization of them and appraisal of their methodological and reporting quality. However, our findings underline several areas needing improvement: the lack of transparency, the absence of critical appraisal, non-compliance to established checklists, and inconsistencies in the data processing. CLINICAL RELEVANCE: Appraising included sources of evidence and maintaining transparency in the conduct and reporting of scoping reviews increases the practical utility of scoping reviews.

Effectiveness of game-based exercise interventions on modifiable cardiovascular risk factors of individuals with type two diabetes mellitus: A systematic review and meta-analysis.

BACKGROUND: Sedentary lifestyles have been identified as a major risk factor for cardiovascular complications for individuals with type 2 diabetes mellitus (T2DM). Using video-gaming components, game-based exercise interventions can encourage these individuals to engage in regular physical activity (PA), given their favorable interactive interfaces, feedback, and on-demand flow experiences. AIM: To evaluate the effectiveness of game-based exercise interventions, on modifiable cardiovascular risk factors, quality of life, and PA levels among individuals with T2DM. METHODS: Published and unpublished studies were retrieved from eight electronic databases and reference lists of the included studies. Articles included in this study were from the inception of the databases to January 2022. Two reviewers performed screening, quality appraisal, and data extraction independently. Meta-analyses were conducted for the primary and secondary outcomes through RevMan. The protocol was registered on PROSPERO (CRD42022298894). RESULTS: Of the 11 selected studies involving 1045 individuals of both genders with T2DM, 9 were included in the meta-analyses for glycosylated hemoglobin, blood pressure (BP), low-density lipoprotein cholesterol, quality of life, and physical activity levels. The meta-analyses reported very small to large effect sizes favoring game-based exercise interventions. Large effect sizes were reported for systolic BP, diastolic BP, and quality of life measured through SF-12 Mental Component Summary scores. LINKING EVIDENCE TO ACTION: Game-based exercise interventions may improve modifiable cardiovascular risk factors, quality of life, and PA levels among individuals with T2DM. Supervision, PA levels, or motivation can affect the effectiveness of game-based exercise interventions.

Nursing Students' Perceptions Toward Recovery in Mental Health: A Descriptive Qualitative Study.

BACKGROUND: Recovery in mental health remains inconclusive where the two most prevailing definitions "clinical" and "personal" remain. In nursing schools, students are predominantly taught straightforward concepts of clinical recovery, which result in only a perfunctory and rudimentary understanding of recovery among the undergraduates. AIMS: To explore the perceptions of nursing undergraduates on recovery for people experiencing mental health conditions. METHOD: A descriptive qualitative study was conducted on 14 nursing undergraduates from Years 1 to 4 of the study. Participants were recruited through convenience sampling, and the required sample size was determined by data saturation. Semistructured questions were used during the individual face-to-face interviews from October and December 2019. Recordings were transcribed verbatim; the transcripts were then subjected to thematic analysis. RESULTS: Three themes were identified to support the research questions: (1) semantics of major terms used in mental health care-where participants provided the description of terminologies used; (2) the meaning of recovery-where participants explained their views on "recovery"; and (3) sources of conceptualization-where participants explained their conceptual understanding on mental health conditions and recovery. CONCLUSION: The findings suggest that the need for a more holistic approach encompassing personal recovery should be included in the nursing curriculum. This is necessary to promote enabling support in the recovery of people experiencing mental health conditions beyond medical interventions.

Health care professionals and care staff challenges and experiences of managing sexual expression among older adults ≥60 years in long-term care facilities: a qualitative review and meta-synthesis.

Long-term care (LTC) facilities, in which older adults are institutionalised, have the responsibility to address their residents' rights, privacy and comfort in expressing themselves sexually in an acceptable manner. However, many older adults have reported barriers in their sexual expression, which is often a result of the care staff's attitudes in the facilities. This review synthesis evidence from qualitative studies on the challenges faced by care staff when supporting sexual expression of older residents in LTC facilities. The systematic review and meta-synthesis is reported according to the Enhanced Transparency in Reporting the Synthesis of Qualitative Research Statement. A systematic literature search for peer-reviewed studies was conducted on PubMed, Cochrane Library, EMBASE, Scopus, Web of Science, PsycINFO, CINAHL and ProQuest Theses and Dissertations from inception until December 2020. Sandelowski and Barroso's two-step approach was used to synthesise the evidence. Seventeen qualitative studies published between 2004 and 2020 were included. This review encapsulated the experiences and challenges of 4,387 care staff whose age ranged from 18 to 69 years. Through the meta-synthesis, four themes were identified: varying manifestations of sexual expression and situations encountered, a spectrum of care staff's attitudes, setting boundaries in dementia care and workplace support. Managing sexual expression can be challenging for the care staff, given the complex interplay between personal beliefs, social contexts, moral dilemmas, practical barriers and the lack of clear policies. This review highlighted the need to equip them with knowledge, skills and confidence in managing sexuality in LTC facilities.

Machine Learning in Health Promotion and Behavioral Change: Scoping Review.

BACKGROUND: Despite health behavioral change interventions targeting modifiable lifestyle factors underlying chronic diseases, dropouts and nonadherence of individuals have remained high. The rapid development of machine learning (ML) in recent years, alongside its ability to provide readily available personalized experience for users, holds much potential for success in health promotion and behavioral change interventions. OBJECTIVE: The aim of this paper is to provide an overview of the existing research on ML applications and harness their potential in health promotion and behavioral change interventions. METHODS: A scoping review was conducted based on the 5-stage framework by Arksey and O'Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guidelines. A total of 9 databases (the Cochrane Library, CINAHL, Embase, Ovid, ProQuest, PsycInfo, PubMed, Scopus, and Web of Science) were searched from inception to February 2021, without limits on the dates and types of publications. Studies were included in the review if they had incorporated ML in any health promotion or behavioral change interventions, had studied at least one group of participants, and had been published in English. Publication-related information (author, year, aim, and findings), area of health promotion, user data analyzed, type of ML used, challenges encountered, and future research were extracted from each study. RESULTS: A total of 29 articles were included in this review. Three themes were generated, which are as follows: (1) enablers, which is the adoption of information technology for optimizing systemic operation; (2) challenges, which comprises the various hurdles and limitations presented in the articles; and (3) future directions, which explores prospective strategies in health promotion through ML. CONCLUSIONS: The challenges pertained to not only the time- and resource-consuming nature of ML-based applications, but also the burden on users for data input and the degree of personalization. Future works may consider designs that correspondingly mitigate these challenges in areas that receive limited attention, such as smoking and mental health.

Exploring undergraduate nursing students' experiences towards home-based learning as pedagogy during the COVID-19 pandemic: a descriptive qualitative exploration.

BACKGROUND: The global COVID-19 pandemic has led to the need for educators to explore online platforms in delivering lessons to students. Home-based learning is one of the most commonly-used teaching methods that allow learning to take place despite a physical separation between the students and the educators. METHODS: A descriptive qualitative approach was used to explore the experiences of nursing undergraduates when using home-based learning as a pedagogy during the COVID-19 pandemic. Data were collected from twenty-three nursing students (n = 14 in year one; n = 9 in year two) of their full-time pre-registration nursing program in a public-funded university in Singapore. Semi-structured interviews using an interview guide was conducted through Zoom-based video-conferencing from November 2020 to January 2021. The interview lasted between 45 and 65 min (median = 45 min). Data collection took place concurrently with thematic analysis through Braun and Clarke's six-step approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research. RESULTS: Three main themes identified during the data analysis were: (1) challenges of home-based learning, where students detailed their experiences and difficulties encountered during the process; (2) the effectiveness of home-based learning, which explored the pedagogy's impact on the students' learning experience; and (3) students' motivation to learn, where the effects on student morale and motivation in partaking in learning tasks were discussed. CONCLUSIONS: Results from this study suggested that universities should incorporate more home-based learning opportunities as home-based learning to continue playing a crucial role in the foreseeable future. Universities should continue to incorporate more home-based learning opportunities into the existing nursing curriculaa in order to test their capacities and address technical challenges in online learning. Future studies should also consider incorporating other pedagogical strategies when conducting lessons online.

Understanding the gender gap in advanced practice nursing: A qualitative study.

AIMS: We aim to explore the perceptions of registered nurses undergoing the advanced practice nurse preparatory programme and of advanced practice nurses towards the recruitment of men into the advanced practice nursing workforce. BACKGROUND: Given the need to expand and diversify the advanced practice nursing workforce, it is important to recognize the potential implications of gender disparity. It is critical to understand why few males are recruited into the advanced practice nursing preparatory programme and to determine whether gender-related bias is present in the professional development of nurses. METHOD: We use a descriptive qualitative design. Semi-structured interviews were conducted via Zoom (April to August 2021). RESULTS: Three themes were generated: 'The odds are eventually in the favour of men', 'The APN career-track is unpopular among men', and 'Balancing the gender gap in the APN workforce'. All themes are supported by three subthemes. CONCLUSIONS: Although males in nursing enjoy opportunistic advantages in entering the advanced practice nursing workforce, they are not interested in the role and not staying long enough in the nursing profession to become advanced practice nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should be more cognizant of the different social stereotypes faced by males and females in nursing. With such awareness, they can be more supportive and less biased in career counselling and job appraisals.

Online HOPE intervention on mental health literacy among youths in Singapore: An RCT protocol.

AIMS: The study aims to examine the effectiveness of the online HOPE intervention to increase mental health literacy (MHL), psychological well-being (PWB); and in reducing stress among youths aged 18-24 living in Singapore. DESIGN: The study will be conducted in two phases. The first phase will adopt a single-group pre-post repeated quasi-experimental research design. The second phase adopts a two-group, parallel randomized control trial, with a pre-test, posttest and follow-up. METHODS: The study will be conducted in a University in Singapore, in 2019-2021. Participants will be recruited and randomly assigned into one of the two groups. Approval from the institutional review board has been obtained in August 2019. Research funding from National Youth Fund has been obtained in November 2019. Outcome measures will be measured using Depression Literacy Questionnaire, Anxiety literacy Questionnaire, validated depression vignette, Ryff's PWB Scale and Perceived Stress Scale, at baseline, postintervention and 2 months' follow-up. Participants' perceptions of the intervention will be measured qualitatively. DISCUSSION: The online HOPE intervention had been developed based on the principles of the Self-Efficacy Theory. IMPACT: There is no research about MHL intervention in Singapore. Low MHL prevents early help-seeking and delays treatment. Hence, this study highlights the importance of mental health public education as primary care. Increased MHL will enhance early help-seeking behaviours, promoting early recovery and enhancing the health of the young people worldwide.

Experiences of nurses working in a triage area: An integrative review.

OBJECTIVES: The aim of the study is to review the literature on the experiences of nurses working in triage within emergency departments in hospitals. REVIEW METHOD: This is an integrative review based on Cooper's five-stage framework. DATA SOURCES: Primary research articles published from January 2008 to January 2018 were identified from seven databases: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane, ProQuest, and Scopus. A manual search of the end references from the published studies was also conducted to ensure a comprehensive search. REVIEW METHOD: The included studies were evaluated independently by two authors based on the Joanna Briggs Institute appraisal checklist for Interpretive and Critical Research and Descriptive/Case Series to ensure methodological rigour and validity of the review. RESULTS: The literature review included 35 articles; of which, 18 were qualitative studies, 13 were quantitative studies, and four were mixed-method studies. The findings from this review were categorised into three themes: (1) making judgement, (2) service delivery, and (3) effective communication. CONCLUSIONS: The results from the review suggest that triage is a complex process involving decision-making and interprofessional communication. Nurses need to make judgement, consider factors affecting service delivery, and engage in effective communication, which is central to triaging. Decision-making is contextual and requires judicious judgement. Effective communication with fellow healthcare personnel and with patients and their caregivers is paramount to optimise care delivery. Finally, more support is needed to empower the nurses to cope with the work involved in triaging.

Nurse-Led Tele-Coaching on Modifiable Cardiovascular Risk Factors in People with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

BACKGROUND: Tele-coaching has been used by nurses as one of the accessible and sustainable interventions for individuals with type 2 diabetes mellitus. However, evidence has been lacking to demonstrate its effectiveness in mitigating the related cardiovascular risk factors. AIMS: To systematically evaluate the effectiveness of nurse-led tele-coaching on the modifiable cardiovascular risk factors (glycated hemoglobin, blood pressure, & lipid levels) among individuals with type 2 diabetes mellitus. METHODS: A systematic search of eight databases (Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, PsycINFO, Web of Science, & ProQuest Dissertations and Theses) was conducted for randomized controlled trials of nurse-led tele-coaching for individuals with type 2 diabetes mellitus published in English up to October 30, 2018. A meta-analysis was conducted for the primary outcomes of the studies. RESULTS: Twelve randomized controlled trials were selected that included 3,030 participants. Results from the meta-analysis revealed statistically significant reductions for not only glycated hemoglobin (pooled mean difference = -1.23, 95% CI: -1.63 to -0.8, I2  = 0%, p < .00) but also systolic blood pressure (SBP; pooled mean difference = -2.22, 95% CI: -3.95 to -0.49, I2  = 0%, p < .01); such findings are supportive of the use of nurse-led tele-coaching on the primary outcome. LINKING EVIDENCE TO ACTION: Results from the meta-analyses have shown that nurse-led tele-coaching is an effective and accessible intervention that could improve the glycemic control and SBP among individuals with type 2 diabetes mellitus.

Acculturation, quality of life and work environment of international nurses in a multi-cultural society: A cross-sectional, correlational study.

AIM: The aim is to examine the acculturation level of international nurses working in a multi-cultural society. The relationship between acculturation, working environment and quality of life of international nurses was also explored. METHODS: A cross-sectional, correlational study using self-report questionnaire was conducted on 814 international nurses using stratified random sampling based on the nationality distribution of international nurses registered with the Singapore Nursing Board. Outcome measures included World Health Organisation Quality of Life-BREF (WHOQOL_BREF) and Practice Environment Scale of the Nursing Work Index-Revised (PES-NWI-R). Data were collected from June to December 2012. RESULTS: There were variations in the acculturation level among different nationality groups of international nurses. Acculturation levels were the lowest among Mainland Chinese international nurses (M=27.47, SD 5.23). A positive correlation was found between acculturation and quality of life whereas a lower perception of work environment was associated with lower acculturation level. CONCLUSION: Data obtained from this study can be utilized to develop interventions targeted at the unique needs of the international nurses as they migrate.

Job satisfaction, work environment and intention to leave among migrant nurses working in a publicly funded tertiary hospital.

AIM(S): This study sought to explore the job satisfaction level of migrant nurses working in a multicultural society and, more specifically, the relationship between their job satisfaction levels, work environment, their intentions to leave and the predictors of their intentions to leave. BACKGROUND: Nursing shortages have led to the increasing trend of employing migrant nurses, which necessitated studies examining nurses' migration. EVALUATION: A cross-sectional, correlational design using a stratified random sample was conducted on 495 migrant nurses working in a tertiary public-funded hospital in Singapore. RESULTS: The results showed that migrant nurses were satisfied with their jobs; with job satisfaction negatively correlated with work environment. Interestingly, pre-existing groups of Chinese migrant nurses did not help newly arrived Chinese migrant nurses to assimilate better. Predictors of migrant nurses' intentions to leave included having supportive nurse managers and nursing practice environment. CONCLUSIONS: The presence of a supportive work environment is essential to retain migrant nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Health administrators need to empower nursing managers with skills to implement career development plans as part of hospitals' retention strategies for migrant nurses. Information should also be provided during recruitment campaigns to enable migrant nurses to make informed choices.

Profiling nurses' job satisfaction, acculturation, work environment, stress, cultural values and coping abilities: A cluster analysis.

This study aimed to determine whether definable profiles existed in a cohort of nursing staff with regard to demographic characteristics, job satisfaction, acculturation, work environment, stress, cultural values and coping abilities. A survey was conducted in one hospital in Singapore from June to July 2012, and 814 full-time staff nurses completed a self-report questionnaire (89% response rate). Demographic characteristics, job satisfaction, acculturation, work environment, perceived stress, cultural values, ways of coping and intention to leave current workplace were assessed as outcomes. The two-step cluster analysis revealed three clusters. Nurses in cluster 1 (n = 222) had lower acculturation scores than nurses in cluster 3. Cluster 2 (n = 362) was a group of younger nurses who reported higher intention to leave (22.4%), stress level and job dissatisfaction than the other two clusters. Nurses in cluster 3 (n = 230) were mostly Singaporean and reported the lowest intention to leave (13.0%). Resources should be allocated to specifically address the needs of younger nurses and hopefully retain them in the profession. Management should focus their retention strategies on junior nurses and provide a work environment that helps to strengthen their intention to remain in nursing by increasing their job satisfaction.

Perceptions of community mental health services among culturally diverse adult Singaporeans with major depressive disorder: A descriptive qualitative study.

Persons with major depressive disorder (PMDDs) often experience pernicious ramifications on the biopsychosocial aspects of their health. While community mental health services (CMHSs) in Singapore are increasingly leveraged to meet the escalating demand for mental healthcare, shortcomings such as a substantial treatment gap and the lack of holistic, culturally sensitive care have been highlighted. Of note, the perspectives of the service users, which have hardly been studied in the literature, are crucial to our understanding of their needs to continuously improve CMHSs. Accordingly, this qualitative descriptive study explored the perceptions and experiences of community-dwelling adults with major depressive disorder in their use of CMHSs in Singapore. Seventeen adults with major depressive disorder purposefully sampled from a CMHS provider were interviewed through a semi-structured guide between October and November 2021. Data analysis via Braun and Clarke's six-step thematic framework yielded five themes corresponding to three different phases: pre-CMHS encounter ((i) procrastination to seek help and (ii) factors influencing CMHS utilization); intra-CMHS encounter ((iii) incongruous perceptions of the impacts on biopsychosocial health and (iv) differing perceptions and experiences of culturally sensitive care); and post-CMHS encounter ((v) enhancing CMHSs for PMDDs based on end-users' experiences). Our findings underscore the need to improve the delivery of personalized mental healthcare services, use of settings- and culturally-specific anti-stigma strategies, and nationwide mental health literacy in symptom recognition and awareness of help-seeking resources.

Nursing students' empathy in response to biological and psychosocial attributions of depression: A vignette-based cross-cultural study.

BACKGROUND: Empathy is vital for quality nursing care in acute mental health settings. Although different explanations of mental illnesses shape mental health clinicians' empathy towards people with mental illnesses, it is unclear how such findings translate to the culturally diverse nursing context. AIM: The study investigated nursing students' empathy towards people with depression and their perceived clinical utility of biological and psychosocial explanations of depression in Australia and Singapore, focusing on two factors of cultural difference: relational mobility and cultural tightness. DESIGN: We used a cross-sectional research design with a repeated-measures component. PARTICIPANTS: The sample included 211 nursing students from Australia and Singapore. Participants were predominantly female (81 %), with ages ranging from 18 to 57 years (M = 26.51, SD = 7.61). METHODS: Participants completed a vignette-based online questionnaire containing measures of empathy, perceived clinical utility, relational mobility, and cultural tightness. RESULTS: Nursing students' empathy in response to the biological and psychosocial explanations of depression differed in Australia (biological: M = 2.96, SD = 0.89, 95 % CI [2.80, 3.13]; psychosocial: M = 3.56, SD = 0.91, [3.39, 3.73]) but not in Singapore (biological: M = 3.05, SD = 0.91, [2.87, 3.23]; psychosocial: M = 3.25, SD = 0.93, [3.06, 3.43]). Relational mobility mediated cross-cultural variances in empathy, b = -0.16, SE = 0.06, 95 % CI [-0.29, -0.05], and perceptions of clinical utility, b = -0.08, SE = 0.05, [-0.20, -0.00], when depression was explained psychosocially. CONCLUSIONS: Nursing students' empathy and perceived clinical utility of explanations of depression are shaped differently across cultures in part due to relational mobility and cultural tightness. As such, embedding cultural awareness education in nursing curricula to address any culturally rooted biases towards people with mental illnesses may present a promising avenue to optimise nursing students' empathy towards people with mental illnesses.

Caregivers' experiences in helping individuals with severe and enduring mental health challenges integrate into the community: A qualitative descriptive study in Singapore.

WHAT IS KNOWN ABOUT THE SUBJECT: Individuals with severe and enduring mental health challenges continued to consume mental health services for an average of 13 years as they needed multiple acute psychiatric admissions due to the challenges they experienced in their everyday activities. As caregivers of individuals with severe and enduring mental health challenges, they often bear the brunt of caregiving through their assistance with activities of daily living (ADL), providing emotional support and ensuring medication compliance for their loved ones. When caring for their loved ones, caregivers often reported psychological stress, social isolation and emotional exhaustion due to stressors such as uncertainty of the future, the lack of support from professional services and the isolation from their own social network and support mechanism. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Insights from this study revealed that caregivers for individuals with severe and enduring mental health challenges went through a lonely and exhausting journey fraught with psychological, physical, social and financial challenges, echoing the caregiving needs and the prevalence of the caregiver burden. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Insights shared by the caregivers demonstrated the need for a centralised point of contact to navigate Singapore's fragmented mental healthcare sector. Peer-support groups should be further promoted because they offer the benefits of information exchange, mutual support and a sense of empowerment and hopefulness, which may help ease the caregiver burden. Life skills training, such as teaching how to communicate empathetically with family members, resolve conflicts using open communication, maintain a structured daily routine and solve pragmatic problems in daily life, is more critical for individuals with severe and enduring mental health challenges. This will help them learn how to manage their well-being, live independently, and stabilise their conditions. Lastly, public awareness campaigns should honour caregivers by highlighting their strength, resilience, and dedication. The state can provide financial assistance in the form of tax relief for their income per annum or caregiver allowance to alleviate the financial stress that caregivers are facing. ABSTRACT: Introduction The progressive deinstitutionalisation of mental healthcare has increasingly shifted care responsibilities from healthcare professionals to family caregivers for individuals with severe mental illness. Caregivers must balance many obligations, which often compromise their overall health and well-being, while helping their loved ones integrate into the community. Aim To identify and understand caregivers' needs and challenges as they help individuals with severe and enduring mental health challenges integrate into the community. Methods This study used a descriptive qualitative approach to explore the experiences and challenges of caregivers for individuals with severe and enduring mental health challenges when integrating back into the community. A semi-structured guide was used during the video-conferencing interviews conducted between December 2021 and November 2022. This study was reported according to the 32-item Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Findings Fourteen caregivers were individually interviewed by the primary author. Most caregivers were female, with an average of 15 years of experience caring for their loved ones. Using Braun and Clark's six-phase thematic framework, we inductively generate the themes and subthemes from the data. The two themes were (i) challenges (whose subthemes included personal challenges in caregiving, the lack of awareness, and stigma and employment) and (ii) support (whose subthemes included the importance of socialisation for individuals with mental health conditions, existing avenues of support and potential areas for support). Discussion Our findings informed the contemporary needs of caregivers caring for individuals with severe and enduring mental health challenges integrating into the community. Like the global challenges for people with mental health issues, psychosocial support and other supplementary support are still common themes in mental health settings. The findings further specifically highlighted the importance of accessible points of contact as resources and employment-enabling and sustaining initiatives to help manage caregivers' emotional and system challenges, which addresses the gaps identified in the findings. Caregivers' peer-support groups, life skills training and public mental health awareness are also necessitated by the caregivers' voices. Implications for Practice Priority areas include having a centralised point of contact within the community for caregivers. Government or not-for-profit organisations can take the lead by initiating employment-enabling initiatives for individuals with severe and enduring mental health challenges and their caregivers.

Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study.

Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.