Gender similarities and differences in the perception of caring among nurses during the COVID-19 pandemic: a mixed-methods study.

BACKGROUND: Caring is the essence and core of nursing. Current studies on the effect of gender on nurses' perception of caring have been inconsistent. Most of these studies were quantitative and conducted before the COVID-19 pandemic. The study aimed to explore the gender similarities and differences in nurses' perception of caring during the COVID-19 pandemic. METHODS: In 2020, a cross-sectional mixed-method study was conducted in 11 cities in China using structured online questionnaire (n = 8030) and face-to-face individual interview (n = 42). Data collection tools included the Caring Dimensions Inventory and semi-structured interview. RESULTS: In stepwise multivariable linear regression analysis, female nurses scored 1.93 points higher on caring than male nurses, after completely controlling for the other factors. The interview results showed that both male and female nurses agreed that caring was to deal with three kinds of relationships, namely nurses and people, nurses and themselves, nurses and society. There were gender differences in the connotation of caring between nurses and themselves, but not in the connotations of caring between other relationships. The ranking of the importance of caring connotations among these relationships showed no gender difference except between nurses and themselves. CONCLUSION: The quantitative findings suggest that gender influences nurses' perception of caring. The qualitative findings demonstrate that nurses regard themselves as both recipients and implementers of caring. The qualitative results indicate nurses of different genders have similarities and differences in their perception of caring, and the biggest difference lies in the relationship between nurses and themselves.

Factors influencing caring behaviour among registered nurses during the COVID-19 pandemic in China: A qualitative study using the COM-B framework.

AIM: The aim of this work is to explore the influencing factors of nurses' caring behaviour during the COVID-19 pandemic based on the Capability, Opportunity, Motivation as determinants of Behaviour (COM-B) theoretical framework. BACKGROUND: Nurse caring behaviour is vital to reduce and speed up the healing process of COVID-19 patients. It is important to understand the factors that influence caring behaviour among nurses during the COVID-19 pandemic. Research suggests that when it comes to understanding behaviour, using a theoretical framework is likely to be most effective, and the COM-B framework is a recommended approach. METHODS: Semistructured interviews with 42 nurses working in 11 Chinese cities were conducted, and their verbatim statements were transcribed and analysed using thematic analysis. The results were mapped to COM-B framework. RESULTS: Ten key themes emerged: Capability (professional knowledge and skills, emotional intelligence, cross-cultural care competence); opportunity (resources, organizational culture, social culture); motivation (past experience, character, role, beliefs). CONCLUSIONS: Ten factors were found to influence nurses' caring behaviour. This study added two new influencing factors, social culture and past experiences, that further contributed to the understanding of nurses' care behaviours. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses' caring behaviour is influenced not only by themselves but also by institutions and society, so interventions aiming to improve their caring behaviour should consider these elements. The negative impact of the pandemic on capability factors that influence nurses' caring behaviour should be counteracted as soon as possible.

"I am called girl, but that doesn't matter" -perspectives of male nurses regarding gender-related advantages and disadvantages in professional development.

BACKGROUND: Exploration of professional development experiences of male nurses can help develop evidence-based strategies to attract males into nursing. The study aims to investigate the advantages and disadvantages of being a male in nursing profession that male nurses and male nursing students experience in their professional development. METHODS: A descriptive qualitative research was designed. Purposive sampling was applied and 24 males (12 nursing students and 12 clinical nurses) participated. Semi-structured individual interviews were used in data collection. Thematic analysis was used in data analysis. RESULTS: Professional development of male nurses was related to three interplayed identities: a man, a nurse, and a minority. Three themes emerged relating to the professional development of the males: "feeling role strains" "taking perceived advantage of masculine traits" and "taking an egalitarian viewpoint". There was no clear line between the gender-related advantages and disadvantages as factors influencing professional development can be turned by the males from barriers to facilitators. CONCLUSIONS: Male nurses perceive nursing as equally suitable for males and females and make use of masculine traits to thrive in their professional development.

Factors influencing recruitment and retention of male nurses in Macau and mainland China: a collaborative, qualitative study.

BACKGROUND: Macau and the Mainland China have different political and socio-economic policies but are both influenced by Chinese culture. By comparing the professional development experiences of male nurses from Macau and the Mainland, this study aims to explore factors influencing the recruitment and retention of male nurses. METHODS: A collaborative, qualitative approach was adopted in which researchers from Macau and the Mainland were jointly involved in carrying out interviews and analyzing data. A total of 24 clinical male nurses were invited, with 12 each from Macau the Mainland. Recruitment was based on purposive sampling from various health institutions in the two regions. Semi-structured interviews were conducted in 2017-2018 with similar interview guidelines for both Macau and the Mainland sites. Thematic analysis was used for data analysis, and Nvivo11 Plus software was used to facilitate the analysis. RESULTS: Key facilitators/barriers to recruitment and retention of male nurses were clustered under the two research questions: 1) What are the factors influencing the recruitment of male nurses? 2) What are the factors influencing the retention of male nurses? Males in Macau and the Mainland experienced pressure while entering nursing because of the stereotype that nursing is a feminine occupation. However, males in Macau chose nursing as a college major under their own volition while males in the Mainland were mostly forced into nursing. The males in Macau hardly thought of leaving nursing while their Mainland counterparts constantly felt uncertain about their professional future. The males on both sides hoped to thrive in career development. While the Macanese tended to pursue advanced programs in specialty nursing for better health care in the frontline, the Mainlanders wanted to get promoted to leave the frontline. CONCLUSION: Male nurses in Macau and Mainland share some common experiences in professional development but have different views and values regarding nursing.

Mental Health-Care Delivery for Older People in China: An Update of Challenges and Recent Clinical Research.

China is facing rapid population aging and the country has the world's largest aging population. The rapid demographic shift in aging population is associated with many social and health problems, in particular mental health issues. The aim of this article is to summarize the challenges and recent progress in mental health-care delivery and clinical research for older people in China.

"This is part of the body" - Student nurses' de-sexualisation of intimate care for patients.

BACKGROUND: Effective intimate care can significantly impact the clinical outcomes of patients. However, conducting intimate care, which involves exposing and touching sexually sensitive areas of the body, presents challenges and anxieties for student nurses, particularly when providing care for patients of the opposite sex. OBJECTIVES: This study aims to identify the challenges and struggles encountered by student nurses when providing intimate care for patients of the opposite sex, as well as to explore the coping strategies employed by the students. DESIGN: A constructivist grounded theory research approach. SETTINGS: The study was conducted in Macau, a Special Administrative Region of China. PARTICIPANTS: Twenty-six student nurses across various stages of their education, and three clinical mentors. METHODS: Purposive and theoretical sampling techniques were utilized to recruit participants. Semi-structured interviews were conducted. The data analysis was in line with the principles of constructivist grounded theory research. RESULTS: A two-stage adaptation model was established, demonstrating a dynamic pathway of student nurses toward intimate care. The first stage 'gendered confinement in intimate care' was characterized by student nurses' negative feelings and lack of nurse-patient interactions; the second stage 'emancipation to gendered confinement' was characterized by the development of constructive therapeutic nurse-patient relationships. The successful transfer was achieved through students' reconstructing the meaning of intimate care and nursing profession in three interplayed types: objectification of patients' body, moral authority of nursing care, and legitimisation of nursing profession. While the transfer process involved the students' intentional efforts to de-sexualize intimate care, clinical mentors facilitated the process. CONCLUSION: Student nurses' adaption to intimate care is a dynamic process which enhances the construction of the nursing professional identity. Support from nursing educators can facilitate student nurses' coping with intimate care-related challenges.

Social anxiety mediates between victimization experiences and internet addiction among adolescents: results from propensity score matching.

Background: Previous research has indicated that Victimization Experiences (VE) may be linked to a heightened likelihood of developing psychological symptoms and Internet Addiction (IA) among adolescents. However, the precise mechanism through which VE contributes to IA in adolescents remains uncertain. This study aimed to investigate whether Social Anxiety (SA) serves as a mediation between VE and IA, utilizing the framework of General Strain Theory. Methods: A cross-sectional survey among 11 middle schools or high schools in Macao was conducted from October to December 2022. Respondents in the victimized group and non-victimized group were 1:1 paired using Propensity Score Matching (PSM) to control the potential confounding factors. Results: A total of 1,089 questionnaires were valid for analysis and 311 pairs were generated through PSM. Respondents in the victimized group reported significantly higher IA than those in non-victimized group (23.5% vs. 12.5%, p < 0.001) after PSM treatment. Multivariate logistic regression analysis showed that VE (p = 0.015, OR = 1.750, 95% CI = 1.115 to 2.746, E-value = 2.90) and SA (p < 0.001, OR = 1.052, 95% CI = 1.030 to 1.074, E-value = 1.29) were the predictors of IA. The model successfully classified 81.7% of cases overall (R 2 N = 0.133). Further analysis indicated that SA mediates between VE and IA (Z = 3.644, p < 0.001). Conclusion: This study revealed the potential mediation effect of SA on the link between VE and IA. By acknowledging the mediating influence of SA, researchers and practitioners can develop more accurate and effective strategies to mitigate Internet Addiction among adolescents.

Nursing students' experiences of sexual harassment - A qualitative study from feminist identity perspective.

AIM: To explore experiences of sexual harassment among nursing students in an East Asian region and to gain knowledge of the underlying factors influencing nursing students' conceptualization of and response to sexual harassment. BACKGROUND: Nursing students are susceptible to sexual harassment due to gender and power inequality in healthcare systems. Sexual harassment has an adverse impact on the students' physical and mental health. Studies on sexual harassment among nursing students are limited and reported significantly varied occurrence prevalence in different cultures. Feminist identity theory can provide a framework to examine social-culturally constructed perceptions of sexual harassment. DESIGN: A qualitative descriptive study. METHODS: The study was conducted in Macau, a Special Administrative Region of China. Purposive sampling was applied. Twenty-six nursing students and five nursing educators participated in the study. Semi-structured interviews were conducted. Thematic analysis was used to analyze the interview data. A series of measures were applied to enhance the trustworthiness of the study. RESULTS: While most of the students had not experienced or heard of sexual harassment, a limited number claimed sexual harassment as a frequently encountered instance. The students expressed uncertainty about what constituted sexual harassment, mainly due to a lack of exposure to information on sexual harassment. They were caught in a dilemma between exerting nursing professional virtues and exposing the misconduct of the suspected perpetrators, leading to taking passive approaches of ignoring and avoiding as the primary coping strategies. In contrast, nursing educators advocated proactive approaches as coping strategies to address sexual harassment. CONCLUSIONS: A conflict between nursing professional identity and feminist identity is observed among nursing students. Healthcare institutions and nursing schools should develop interventions to enhance nursing students' assertiveness to sexual harassment.

Comparisons of Dementia Knowledge and Attitudes among the Youth and Older Adults: Insights from the Construal Level Theory Perspective.

Based on Construal Level Theory (CLT), the youth and older adults have different psychological distances towards dementia that may lead to different dementia knowledge and attitudes. A cross-sectional survey among 239 youth and 62 older adults using a two-step sampling approach in Macao aimed to examine the hypothesis. Results showed older adults had a higher score of dementia knowledge (F(1,299) = 45.692, p <0.001) but a lower score of dementia attitudes (F(1,299) = 161.887, p <0.001) compared to the youth. Age group explained the majority of the variances in the hierarchical multiple regressions for dementia knowledge (R2 = 0.178, F = 9.059, p < 0.001) and for dementia attitudes (R2 = 0.399, F = 24.233, p < 0.001), which are ß = 0.47 and -0.56, respectively. Thus, the hypothesis was supported and revealed an interesting pattern of dementia knowledge and attitudes among the youth and older adults. From the CLT perspective, the study implies that reducing and bridging the psychological distance of dementia would probably be an effective strategy to increase dementia awareness among young people, and intergenerational programs may be a good option to increase community acceptance and support for people with dementia.

The impact of caring for COVID-19 patients on nurse professional identity: A cross-sectional study using propensity score analysis.

Objective: To examine the impact of caring for COVID-19 patients on the professional identity of nurses. Methods: An online survey was conducted between 19 May and 7 August 2020 in 11 Chinese cities, including Dongguan, Foshan, Guangzhou, Hong Kong, Huizhou, Jiangmen, Macao, Shenzhen, Zhaoqing, Zhongshan, and Zhuhai. Propensity score matching was used to adjust for confounding variables between nurses with and without experience caring for COVID-19 patients. To analyze the impact of caring for COVID-19 patients on nurses' professional identity, a nominal logistic regression model was used rather than an ordinal regression model because the parallel regression assumption was violated. Results: After propensity score matching, the final sample contained 1,268 participants, including 634 nurses who cared for COVID-19 patients. During the COVID-19 outbreak, 88.6% of nurses had high levels of professional identity. Nurses who cared for COVID-19 patients had the lowest percentage of high score level on the professional identity subscale for "sense of organizational influence," as did nurses who did not care for COVID-19 patients. The findings indicated that nurses who cared for COVID-19 patients were 17.95 times more likely to have a high professional identity than a low professional identity (95% CI 2.38-135.39, p = 0.005), after completely controlling for the other factors. There were significant differences between nurses who cared for COVID-19 patients and those who did not in scores on the subscales of professional identity, except for the subscales "sense of self-decision-making" (χ2 = 4.85, p = 0.089) and "sense of organizational influence" (χ2 = 4.71, p = 0.095). Conclusion: Nurses' professional identity is positively impacted by their experience caring for COVID-19 patients. Caring for COVID-19 patients should be highlighted as an opportunity to enhance nurses' professional identity. To further enhance the professional identity of nurses, we call for visible nursing leadership during the COVID-19 pandemic and improve their working environment.

The Willingness to Help People With Dementia Symptoms Among Four Occupation Practitioners in Macao.

BACKGROUND: Dementia-friendly community has been promoted in Macao since 2016. There is no study investigating the understanding of nor attitudes towards dementia among public contact staff in Macao. This study aimed to (i) understand the level of knowledge of dementia, (ii) examine the attitudes towards people living with dementia, and (iii) explore the associated factors of the willingness to help people with dementia symptoms among police officers, bank officers, bus drivers, and building superintendents. METHODS: A cross-sectional survey was conducted between January and May 2019 using a structured questionnaire. RESULTS: A total of 351 valid questionnaires were received. Building superintendents had more knowledge while police officers and bank officers had more positive attitudes. All practitioners were more willing to help people with dementia symptoms when they were on official duty. Participants who had more knowledge about dementia were associated with a higher willingness to help people with dementia symptoms.

"You Need to Get Over the Difficulties and Stand Up Again"-A Qualitative Inquiry into Young Nurses' Coping with Lateral Violence from the Feminist Perspective.

Previous studies have reported lateral violence (LV) styles among nurses and the adverse impacts of LV on nurses and nursing. Young nurses, including nursing students and novice nurses, are often victims of LV. A large qualitative research study that contained three sub-studies exploring professional identity development in different professional stages was conducted by a research team in Macau, Special Administrative Region of China. Semi-structured interviews with nursing students and clinical nurses were carried out; among the 58 participants in the three sub-studies, 20 described some forms of LV and their ways of dealing with them. Framed by the feminist perspective, the researchers explored young nurses' coping strategies in dealing with LV perpetrated by senior colleagues. Two themes were developed reflecting the coping strategies for LV: "making extra efforts" and "soothing emotional distress". Three sub-themes were under the theme of "making extra efforts": "catching up knowledge", "making the most use of learning resources", "adjusting communication manner"; another batch of sub-themes was under the theme of "soothing emotional distress": "seeking support from schoolmates", "living with family but crying alone", and "adjusting lifestyle". The study implied that young nurses exerted their agency in coping with LV in clinical practices. Nursing managers and educators should support young nurses' efforts in overcoming power-based LV and incivility.

Health Literacy Regarding Infectious Disease Predicts COVID-19 Preventive Behaviors: A Pathway Analysis.

Health literacy has been identified as one vital determinant of public health and healthy behaviors, but very few studies regarding infectious disease prevention have been found. This descriptive cross-sectional study aimed to validate the pathway of infectious disease-specific health literacy (IDSHL), COVID-19 (coronavirus disease 2019) preventive behaviors, and their determinants. A sample of 1459 casino workers in Macao was eligible for analysis. The concept model was verified with a comparative fit index of 0.937 and goodness-of-fit index of 0.971. Government responses was a significant determinant of situational factors (helpfulness of health information, resource accessibility, and organizational training adequacy), while situational factors showed a direct effect on COVID-19 preventive behaviors. Education and organization training adequacy was the strongest influencing factor of IDSHL, which should be a key target of intervention programs for COVID-19.

Corrigendum to "Nursing research on intimate partner violence in China: A scoping review" [The Lancet Regional Health - Western Pacific 2 (2020) 100017].

[This corrects the article DOI: 10.1016/j.lanwpc.2020.100017.].

Nurses Who Are More Willing to Participate in the Fight against COVID-19: Evidence from China.

When facing an infectious disease disaster, nurses' willingness to work is critical. Nurses' lack of willingness to work during a pandemic may worsen the shortage of health care personnel. The purpose of this study is to assess the willingness of nurses to participate in the fight against COVID-19 in China and to identify factors associated therewith. This cross-sectional study examines nurses working in 11 Chinese cities including Macau, Hong Kong, Shenzhen, Dongguan, Huizhou, Guangzhou, Zhaoqing, Foshan, Jiangmen, Zhongshan, and Zhuhai. Questionnaires were collected from 19 May to 7 August 2020. A total of 8065 questionnaires were received, of which 8030 valid questionnaires were included for analysis. A total of 53.4% of participants reported that they had signed up to support the COVID-19 pandemic response. Multivariate logistic regression analysis revealed that being single (OR = 0.72, 95% CI: 0.60-0.87), having no children (OR = 0.81, 95% CI: 0.68-0.97), possessing higher professional qualifications (OR = 1.25, 95% CI: 1.14-1.37), having a more prestigious professional title (OR = 1.68, 95%CI: 1.50-1.90), being an administrative supervisor (OR = 0.53, 95% CI: 0.45-0.63), having a higher caring dimensions inventory score (OR = 1.01, 95% CI: 1.01-1.01), working in a hospital (OR = 0.53, 95% CI: 0.39-0.72), and receiving employer-provided care training (OR = 0.77, 95% CI: 0.68-0.87) were predictive of nurses' willingness to participate in the fight against COVID-19. We suggest that unmarried nurses should be given priority when recruiting to fight an epidemic and, for married nurses with children who are recruited to fight an epidemic, supporting measures should be provided for childcare. We suggest strengthening workplace training of caring for nurses in order to better retain and recruit qualified support for an epidemic outbreak of infectious diseases.

A Chinese Version of the Caring Dimensions Inventory: Reliability and Validity Assessment.

Caring is central to nursing practice. Chinese nurses take care for the health of about 20% of the world's population and their perception of caring is critical. However, until recently, instrument specifically designed to measure the caring of nurses in China was not found. Caring dimensions inventory (CDI) is one of the most frequently used instrument when measuring caring and is applicable to nurses from different cultures. The aim of this study is to test the validity and reliability of the Chinese version of the 25-item CDI. The English version of CDI was translated into Chinese according to the guidelines of the World Health Organization. Content validity was conducted among seven senior nurses from different institutions in different cities in China. A convenience sample of nurses from 11 cities in China was employed. Exploratory factor analysis and confirmatory factor analysis of the CDI was carried out using a sample of 880 nurses. The overall content validity index was 0.98. Three factors (Nurturance, Collaboration, Skill) were identified in exploratory factor analysis and were confirmed by confirmatory factor analysis. The three-factor solution explains 70.15% of the total variance. The Cronbach alpha for overall the CDI was 0.97. This study demonstrated that the Chinese version of the CDI showed satisfactory reliability and validity, indicating that it could be a useful measurement to assess nurses' perception of caring in China.

Comparison of Postoperative Pain Management Outcomes in the United States and China.

To compare pain management outcomes in postoperative patients from an American hospital and a Chinese hospital. A convenience sample of 244 patients in the United States and 268 patients in China with similar surgical sites completed the American Pain Society Patient Outcome Questionnaire-Revised (APS-POQ-R) and the Pain Management Index (PMI) was calculated on their first postoperative day. Patients in the United States reported a higher score on the "perception of pain management" subscale of the APS-POQ-R and a higher proportion of adequate treatment as measured by the PMI (85.2% vs. 39.0%, p < .001). Patient education and degrees of pain relief predicted patient satisfaction with pain management (item in APS-POQ-R) in patients from both countries. A higher level of compliance with pain management guidelines has contributed to a higher level of perception in patients in the United States. Establishing procedure-specific protocols and clinical pathways may improve pain management outcomes for Chinese patients.

Socioeconomic instability and the availability of health resources: their effects on infant mortality rates in Macau from 1957-2006.

AIM: To investigate the effects of socioeconomic instability and the availability of health resources on infant mortality rate. BACKGROUND: In 1960, the infant mortality rate was 46.3 infants per 1000 live births in Macau but by 2006 it had declined to 2.7 infants per 1000 live births. DESIGN: A retrospective design collecting yearly data for the Macau covering the period from 1957-2006. The infant mortality rate was the dependent variable and demographics, socioeconomic status and health resources are three main explanatory variables to determine the mortality rate. METHODS: Regression modelling. RESULTS: Results show that higher birth (Beta = 0.029, p = 0.004) and unemployment rates (Beta = -0.120, p = 0.036) and more public expenditure on health (Beta = -0.282, p < 0.001) were significantly more likely to reduce the infant mortality rate. CONCLUSIONS: These results indicate that the socioeconomically disadvantaged are at a significantly higher risk for infant mortality. In contrast, more public expenditure on health resources significantly reduces the risk for infant mortality. This study provides further international evidence that suggests that improving aspects of the healthcare system may be one way to compensate for the negative effects of social inequalities on health outcomes. RELEVANCE TO CLINICAL PRACTICE: The implication of these results is that more effort, particularly during economic downturns, should be put into removing the barriers that impede access to healthcare services and increasing preventive care for the population that currently has less access to health care in communities where there is a scarcity of medical resources. In addition, efforts should be made to expand and improve the coverage of prenatal and infant healthcare programmes to alleviate regional differences in the use of health care and improve the overall health status of infants in Macau.

Exploring the profiles of nurses' job satisfaction in Macau: results of a cluster analysis.

AIMS: To determine whether definable subtypes exist within a cohort of nurses with regard to factors associated with nurses' job satisfaction patterns and to compare whether these factors vary between nurses in groups with different profiles. BACKGROUND: Globally, the health care system is experiencing major changes and influence nurses' job satisfaction and may ultimately affect the quality of nursing care for patients. DESIGN: A descriptive survey. METHODS: Data were collected using a self-reported structured questionnaire. Nurses were recruited in two hospitals in Macao. Two main outcome variables were collected: Predisposing characteristics and five components on job satisfaction outcomes. RESULTS: A cluster analysis yielded two clusters (n = 649). Cluster 1 consisted of 60.6% (n = 393) and Cluster 2 of 39.4% (n = 256) of the nurses. Cluster 1 nurses were younger, more educated and had less work experience and more intention to change their career than nurses in Cluster 2. Cluster 2 nurses had more work experiences, were of more senior grade and were more satisfied with their current job in terms of peer supports, autonomy and professional opportunities, scheduling and relationships with team members than nurses in Cluster 1. CONCLUSIONS: Findings might help by providing important information for health care managers to identify strategies/methods to target a specific group of nurses in hopes of increasing their job satisfaction levels. RELEVANCE TO CLINICAL PRACTICE: As a long-term investment, hospital management has to promote work environments that support job satisfaction to attract nurses and thereby improve the quality of nursing care. The results of this study might provide hospital managers with a model to design specified interventions to improve nurses' job satisfaction.

"My Friends are at the Bottom of My Schedule": A Qualitative Study on Social Health among Nursing Students during Clinical Placement.

Clinical placement is an essential component for nursing students, allowing them to transfer professional knowledge into practice. The quality of life among nursing students and nurses was reviewed to examine its impact on the quality of provided care. However, it is unclear how social health among nursing students is affected during clinical placement. Final-year students who had finished clinical placement were invited to participate in this qualitative study. Twenty-one in-depth interviews were conducted and transcribed verbatim for thematic analysis. Two main themes, i.e., contributors to lack of social health, and manifestations of lack of social health, emerged from seven sub-themes. Students experienced different challenges during the clinical placement, but some of these did contribute to effects on their social health. Lack of social health might further influence career development after graduation. Supportive strategies from colleagues, nursing colleges and hospitals might potentially improve students' social health during the clinical placement.