To explore the impact of traumatic birth experiences on midwives' experience of empathy: A qualitative study.

OBJECTIVE: This study aimed to investigate the experiences of Chinese midwives during traumatic birth experiences and their impact. By doing so, we hope to develop effective empathetic educational strategies and provide valuable insights to improve the midwifery support system in China. METHODS: This study adopted Colaizzi's phenomenological approach, which aimed to understand and explore human experiences from the standpoint of the participants. A purposive sampling method was used to select 16 midwives for semi-structured interviews. The Colaizzi 7-step method was used to analyze the interview data. FINDINGS: Three themes and eight sub-themes were developed by analyzing and integrating the interview data. These included intertwined negative experiences (self-blame and guilt, regurgitated disturbances, intense and persistent physical and psychological discomfort, and low confidence in midwifery decision-making behaviours), the coexistence of positive effects (increased ability to tolerate life uncertainty, increased sense of control in coping with traumatic birth experiences), and needs and expectations (confiding in co-workers, an expectation of professional psychological support interventions). CONCLUSIONS: The experiences of midwives in showing empathy during traumatic birth experiences are complex and multifaceted. It is crucial to recognize and address negative empathic experiences, provide coping strategies, and enhance positive empathic experiences. Midwives' grief counselling competence education should be strengthened, as should their psychological well-being and the midwifery support system.

A study on the impact of life meaning on occupational identity of nursing students in China:a cross-sectional study.

BACKGROUND: With the alterations of the Chinese epidemic prevention policy, China experienced a nationwide wave of the Coronavirus disease 2019 (COVID-19) pandemic from December 2022 to January 2023.The impact of the COVID-19 pandemic extends beyond individual perceptions of the meaning of life and attitudes toward life and death; it also affects the professional identity of nursing students.This study explored nursing students' professional identity and life meaning of affected by the pandemic. METHODS: An online survey was conducted using the Chinese version of the Nursing Student Career Identity Scale and the Chinese version of the Meaning in Life Questionnaire to assess the current status of nursing students' professional identity and sense of life meaning. Data were also collected on participant gender, education, clinical practice experience, and COVID-19 infection. RESULTS: The scores for nursing students' sense of professional identity (61.58 ± 16.16) and sense of life meaning (45.29 ± 12.65) were both at an intermediate level. Compared to the scores before the COVID-19 pandemic, Chinese nursing students' professional identity scores increased, while their sense of life meaning scores decreased. Moreover, we found a positive correlation between professional identity and sense of life meaning (p < 0.001); nursing students exhibited a stronger professional identity when they had a relatively higher sense of life meaning than those with a relatively lower sense of life meaning. CONCLUSION: Enhancing nursing students' sense of meaning in life is crucial for maintaining their professional identity. Attention should be given to life education for nursing students and the development of relevant educational curricula.

Exploring the needs and barriers for death education in China: Getting answers from heart transplant recipients' inner experience of death.

Background: Promoting reflection about death may support better living, and how to carry out death education is an important issue to be addressed across the world. The purpose of the current study was to explore the attitude of heart transplant recipients toward death and their inner real experience to provide information for the development of death education strategies. Methods: A phenomenological qualitative study was conducted using a snowball method. A total of 11 patients who had undergone heart transplantation more than 1-year ago were recruited for the current study for semi-structured interviews. Results: A total of five themes were identified: "Not avoid talking about death," "Feeling fear about the pain in the process of death", "Wanting a good death at the end of life," "The richness of feelings during near-death is surprising," and "Being close to death makes people more receptive to death." Conclusion: Heart transplant recipients have a positive attitude toward death and wish for "good death" at the end of life. These patients' near-death experiences and positive attitudes toward death during the course of their illness provided evidence of the need for death education in China and supported the experiential approach to death education.

The development of a questionnaire to assess the willingness of Chinese community health workers to implement advance care planning.

BACKGROUND: To develop a questionnaire to evaluate the willingness of Chinese health care workers to implement an advance care planning (ACP) program for patients in a Chinese cultural context. METHODS: Guided by the framework of the theory of planned behavior (TPB), a literature analysis and semi-structured interviews were conducted to create a pool of questionnaire items, and then the initial assessment questionnaire was developed by two rounds of expert consultations. A random sampling method was used to pre-survey 204 health care workers in community health service centers (CHSCs) in three urban areas of Hangzhou, Zhejiang Province. The final questionnaire was derived from item analysis and exploratory factor analysis. RESULTS: Based on exploratory factor analysis, five common factors were identified from the questionnaire on community health care workers'(CHWs) willingness to implement ACP. In general, the content validity of the questionnaire was 0.91, and the content validity of each of the entries ranged from 0.80 to 1.00, indicating acceptable overall questionnaire content validity. The total Cronbach coefficient for the questionnaire was 0.966, the Cronbach coefficient for each dimension ranged from 0.865 to 0.954, and the retest reliability was 0.856. The questionnaire produced a final draft containing five dimensions (behavioral attitudes, subjective norms, direct control, indirect control, and behavioral intentions) and 30 items. CONCLUSION: The questionnaire on the willingness of CHWs to implement ACP was validated and found to be reliable.

Medical and non-medical students' knowledge, attitude and willingness towards the COVID-19 vaccine in China: a cross-sectional online survey.

In the context of the novel Coronavirus outbreak and China's official policy of free vaccination against COVID-19 for all, medical students' attitudes and knowledge toward vaccines can influence public acceptance to some extent, however, the large base of non-medical students cannot be ignored. We aimed to investigate the knowledge, attitude, and willingness toward the COVID-19 vaccine among medical and non-medical students. Online surveys were completed by 652 medical students and 590 non-medical students to compare differences in knowledge and attitude of COVID-19 vaccine and vaccination willingness from three universities in the Zhejiang Province. The awareness rate of the vaccine among medical students (65.3%) was higher than that of non-medical students (53.6%). The approval rate of medical students for the safety and efficacy of the COVID-19 vaccine was higher than that of non-medical students. 81.8% of university students were willing to be vaccinated against COVID-19; Multiple stepwise regression analyses showed that lower class grades, rural students' origin, COVID-19 vaccine attitude and higher cognition level of health self-management influenced the acceptance of COVID-19 vaccination among medical students. However, urban origin, COVID-19 vaccine attitude were the factors hindering non-medical students' vaccination against COVID-19. The knowledge, attitude and willingness toward the COVID-19 vaccine on medical and non-medical students had different characteristics. Moreover, health self-management was associated with COVID-19 vaccination willingness. Staff involved in the university should pay more attention to the self-managementability of students, send out accurate and transparent information to enhance their cognitive level, further improving the students' willingness to receive the COVID-19 vaccine.

Qualitative assessment of the intention of Chinese community health workers to implement advance care planning using theory of planned behavior.

BACKGROUND: The aging population coupled with progressive medical technology has increased the demand for improved quality of end-of-life in China. However, implementation of an advance care planning (ACP) program in mainland China is still in its infancy owing to the significant influence of filial piety in Chinese culture. Research on implementation of ACP program among community health workers (CHWs) is limited. The current study sought to explore the willingness of CHWs to implement ACP based on the theory of planned behavior (TPB) and provide a reference for promotion of ACP in Chinese communities. METHODS: Phenomenological qualitative study using semi-structured face-to-face interviews. Interviews were audio-recorded. Colaizzi's method was used for data analysis. The study received ethical approval and all participants provided written consent. RESULTS: Thirteen CHWs from 3 community health service centers (CHSCs) in Hangzhou, Zhejiang Province, China were interviewed. Through the analysis of the interview content, we determined that most CHWs have a supportive attitude towards the implementation of ACP, the reasons for which are as follows: relieve suffering of patients and respect their medical autonomy; relieve economic and psychological burden on family members; promote development of community palliative care. However, some CHWs believe that the implementation of ACP will lead to doctor-patient disputes and medical risks. CHWs reported that the support of patients and their families, community lawyers, psychosocial professionals, and CHSCs senior managers helped them to implement ACP. In addition, they indicated that the improvement of doctor-patient communication ability, the improvement of community medical environment, the support of government policy, and the training of CHWs were the promoting factors influencing their implementation of ACP. The hindrance factors include insufficient allocation of community health human resources, imperfect ACP legislation in China, and deep-rooted traditional culture. CONCLUSION: Findings demonstrated that Chinese CHWs tend to support the implementation of ACP, but their willingness to implement is affected by different factors. CHSCs should actively organize standardized ACP training and comprehensively consider community medical environment, organizational norms, and human resources in implementation of ACP.

The relationship between death attitude and professional identity in nursing students from mainland China.

BACKGROUND: Professional identity reduces the risk of job burnout in nurses, and attitudes towards death might be a factor affecting nurses' professional identity. Little research has been conducted to directly investigate the relationship between professional identity and death attitudes in nursing students. In addition, there are cultural differences in the formation of death attitudes. It is necessary to explore attitudes towards death in Chinese nursing students and investigate the relationship between death attitudes and professional identity. OBJECTIVES: To investigate the relationship between professional identity and death attitudes in nursing students in mainland China. DESIGN: A cross-sectional study. PARTICIPANTS: A total of 2119 nursing students from mainland China were included in this survey. METHODS: The survey was conducted online. The questionnaire included the Chinese version of the Professional Identification Scale and the Chinese version of the Death Attitude Profile - Revised to measure the nursing students' professional identity and attitudes towards death. The survey also collected the participants' age, gender, institution type, place of residence and self-assessed health state. RESULTS: The professional identity of the nursing students (average scores: 33.68 ± 5.12) from mainland China was above an intermediate level, and their attitudes towards death were positive overall (escape acceptance: 3.37 ± 0.96, approach acceptance: 3.36 ± 0.79, fear of death: 2.88 ± 0.77, death avoidance: 2.74 ± 0.84, neutral acceptance: 2.29 ± 0.77). Among the nursing students, professional identity was correlated with attitudes towards death. Specifically, professional identity was positively correlated with approach acceptance (p < 0.001), escape acceptance (p < 0.001) and neutral acceptance (p < 0.001) but negatively correlated with fear of death (p < 0.001) and death avoidance (p < 0.001). The nursing students with relatively low professional identity showed stronger death anxiety than those with relatively high professional identity (p < 0.001). CONCLUSION: The outcome of this study suggests that education on life and death and internship experience in palliative care contribute to the development of a high level of professional identity in nursing work.

Emotional states and coping methods in nursing and non-nursing students responding to COVID-19: a cross-sectional study in China.

OBJECTIVES: To evaluate the emotion, coping strategy, dealing methods and their correlation in the COVID-19 outbreak among nursing and non-nursing students. DESIGN AND SETTING: A cross-sectional online survey. PARTICIPANTS: Full-time nursing and non-nursing undergraduate students. MAIN OUTCOME MEASURE: The Generalized Anxiety Disorder 7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to determine the emotional status in the COVID-19 pandemic among nursing and non-nursing students. Emotion Regulation Questionnaire (ERQ) was used to measure the emotion regulation strategies and the Simplified Coping Style Questionnaire (SCSQ) was used to evaluate the coping methods among nursing and non-nursing students. RESULTS: In total, 746 students including 366 nursing students and 380 non-nursing students participated in the survey. Compared with the non-nursing students, a significant decrease was noticed in GAD-7 score (p<0.01) and PHQ-9 (p<0.01) in the nursing students. The cognition re-evaluation score in the nursing students was significantly lower than that of the non-nursing students (p<0.05). In the nursing students, the score of anxiety was positively correlated with ERQ expression inhibition (p<0.01) and SCSQ negative coping (p<0.01), while the score of depression was also positively correlated with ERQ expression inhibition (p<0.01) and SCSQ negative coping (p<0.01). There was a negative correlation between SCSQ and the scores of anxiety (p<0.05) and depression (p<0.05). In the non-nursing students, the anxiety score was positively correlated with the SCSQ negative coping (p<0.01), while the depression score was positively correlated with the ERQ expression inhibition (p<0.01) and SCSQ negative coping (p<0.01). CONCLUSIONS: COVID-19 affected the emotional status of nursing and non-nursing students. The emotional status was correlated with the emotional regulation and coping methods. Staff involved in the nursing professionals should pay attention to the psychological status of the nursing and non-nursing students, and give moderate psychological interference in the presence of COVID-19.

Exploring the Relationship Between Professional Identity and Psychological Resilience of Organ Donation Coordinators in Zhejiang Province (China).

Background: An organ donation coordinator plays an important role in the process of organ donation and transplant. Therefore, investigating and analyzing the current situation in organ donation and examining the correlation between professional identity and psychological resilience of human organ donation coordinator, provides a reference for promoting stable development of organ donation. Methods: A total of 48 coordinators of organ donation in Zhejiang Province were recruited for the study by using the method of convenience sampling. The psychological resilience scale and professional identity questionnaire were used to collect data. Results: The results revealed that the total average score of the professional identity of organ donation coordinators was 34.92 ± 8.57. Compared with the median professional identity score of 34.50, the professional identity of the coordinator in this survey was at a moderate level. The total average score of psychological resilience was 64.44 ± 11.91. There was a significant positive correlation between the professional identity of the coordinator and the total score of psychological resilience (r = 0.641, P < 0.01). Conclusion: The professional identity and psychological resilience of the coordinators in Zhejiang Province were found to be in the middle level and the higher the psychological resilience score, the stronger the professional identity of the coordinators. It is important to improve the level of psychological resilience among organ donation coordinators to enhance their professional identity.

The immediate psychological effects of Coronavirus Disease 2019 on medical and non-medical students in China.

OBJECTIVES: To investigate the immediate psychological effects of Coronavirus Disease 2019 (COVID-19) on medical and non-medical students. METHODS: An online survey of 805 medical students and 1900 non-medical students was conducted from Feb 4, 2020 to Feb 7, 2020, in China. The questionnaire measured the subjective estimated severity of COVID-19, the impact of the outbreak, and the levels of anxiety and depression of both medical and non-medical students. RESULTS: Medical students estimated COVID-19 to be more serious and disastrous than non-medical students, while they scored lower than non-medical students on the Impact of Event Scale-Revised (IES-R), and less severe anxiety and depression than non-medical students. The students experienced greater impact from the outbreak and a higher rate of anxiety and depression with increased time focusing on the outbreak. The difference in psychological effects between medical and non-medical students was further enlarged when focusing time was prolonged. CONCLUSIONS: The immediate psychological effects of COVID-19 on medical and non-medical students exhibit different characteristics. The outcome of this study provides implication that providing accurate and transparent information about the epidemic and appropriate COVID-19-based knowledge in accessible ways will contribute to the public's mental health during the outbreak.