Moderating effect of family structure on the relationship between early clinical exposure and emotional labor of nursing students: a cross-sectional study.

BACKGROUND: Emotional labor is an essential component of nursing practice and is important for Generation Z nursing students born from the mid-1990s to early 2010s. They will become the backbone of the nursing workforce but present more emotional regulation problems. Studies on emotional labor are limited to clinical nurses and influencing factors at the individual level. The impacts of external systems on emotional labor of nursing students have not been explored. This study aimed to quantify the relationship between early clinical exposure and emotional labor and test the moderating effect of family structure on the relationship. METHODS: The cross-sectional study recruited 467 nursing students using convenience sampling from seven colleges and universities in mainland China. An e-survey created on WJX.CN was used to collect data in January 2023. Emotional labor (surface acting and deep acting) was measured with the Emotional Labor scale. Early clinical exposure (exposure or not and times of exposure) and family structure (nuclear family, extended family, and single-parent family) were assessed with self-reported questions. Descriptive statistics and the linear mixed-effects modeling were used to do the analyses. RESULTS: The mean scores of surface acting and deep acting were 26.66 ± 5.66 and 13.90 ± 2.40, respectively. A significant difference in scores of surface acting was not observed for exposure or not, whereas such a significant difference was found for times of exposure. Nursing students from extended families demonstrated significantly lower scores on surface acting while exposed to clinical practice compared with those from nuclear families. Family structure moderated the relationship between times of exposure and surface acting of nursing students when exposed to clinical practice for one time, but the significance disappeared when the times of exposure increased. No significant findings of early clinical exposure on deep acting were observed. CONCLUSIONS: Early clinical exposure influenced emotional labor, and students from extended families were more likely to get benefits from early clinical exposure. Studies are needed to help students from nuclear families get comparable benefits on emotional labor as those from extended families, and improve deep acting by early clinical exposure.

A study to untangle the puzzle of urinary incontinence and frailty co-occurrence among older adults: The roles of depression and activity engagement.

AIMS: To explore the co-occurrence of urinary incontinence and frailty by testing the roles of depression and activity engagement guided by the mechanisms of common cause and interaction pathways. DESIGN: A secondary analysis of a 1-year three-wave panel data collected from older nursing home residents in China. METHODS: Changes in depression and activity engagement were regressed on urinary incontinence and frailty incidence underpinned by the common cause mechanism of chronic conditions co-occurrence, and these changes were also taken as mediators linking from frailty to urinary incontinence incidence supported by the interaction pathways' mechanism. RESULTS: A total of 348 older adults were included in this study, and 55.7% were women. The co-occurrence of urinary incontinence and frailty was found in 16.7% of the participants at baseline. Older adults with sole frailty at baseline had almost twice the rate of incident urinary incontinence (32.7%) compared with those without (16.7%) over a 1-year period. The subsample analyses showed that changes in depression and activity engagement failed to significantly predict the incidence of urinary incontinence and frailty. The mediating roles of these changes linking frailty to urinary incontinence incidence were also not statistically significant. CONCLUSION: The co-occurrence of urinary incontinence and frailty is prevalent in older nursing home residents. Older adults with frailty at baseline are more likely to develop urinary incontinence a year later. The common cause and interaction pathways mechanisms for the co-occurrence of urinary incontinence and frailty were not verified with changes in depression and activity engagement. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The phenomenon of urinary incontinence and frailty co-occurrence should be given extreme emphasis. Although statistically significant findings on the roles of depression and activity engagement were not inferred, this study provides multiple possibilities for future studies to test and depict a clear picture of this co-occurrence. IMPACT: What problem did the study address? This study was designed to test the roles of depression and activity engagement in predicting the incidence of urinary incontinence and frailty, and the mediating roles in linking frailty to urinary incontinence incidence. What were the main findings? Despite the methodological pitfalls in literature have been addressed, neither depression nor activity engagement would significantly predict the incidence of urinary incontinence and frailty in older adults. Their mediating roles in linking frailty to urinary incontinence incidence were also not significant. Where and on whom will the research have an impact? Our findings add important pieces of evidence to promote researchers' understanding and provide an important basis for untangling the puzzle of urinary incontinence and frailty co-occurrence. REPORTING METHOD: The report of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Barriers and Facilitators of Self-Management for Older Adults Living With Type 2 Diabetes Mellitus: A Qualitative Study in China.

PURPOSE: The purpose of the study was to explore the barriers to and facilitators of self-management among older adults with type 2 diabetes mellitus (T2DM). METHODS: This study followed a qualitative descriptive methodology. Older adults with T2DM living in Jinan, Shandong Province, China were recruited using purposive sampling. Information saturation was used to gauge the sample size. Semistructured interviews were conducted with 23 participants. The data analysis was guided using a thematic approach. Themes were inducted from the interview data undergirded by the cumulative complexity model. RESULTS: The key findings of this study are presented in terms of 2 themes: facilitators of T2DM self-management and barriers to T2DM self-management. Each theme has subthemes, including that having family members with diabetes, having family members who are health care professionals, and visual cues were factors for good self-management practices by older adults with T2DM. Conversely, poor health status (ie, multimorbidity and lower-limb dysfunction and pain) and intergenerational care responsibilities were identified as barriers to effective self-management. Moreover, the use of media resources, especially traditional media, was found to both assist and hinder participants in their self-management practices. CONCLUSION: The findings from this study can inform new research to build on existing self-management promotion programs and restructure existing services to improve the self-management of older adults with T2DM. With the increase in the number and types of media outlets, our finding implies that researchers or clinical practitioners may develop strategies to leverage media resources to enhance the self-management of diabetes among older adults with T2DM.

Short-Form Video Exposure and Its Two-Sided Effect on the Physical Activity of Older Community Women in China: Secondary Data Analysis.

Background: There is a tendency for older adults to become more physically inactive, especially older women. Physical inactivity has been exacerbated since the COVID-19 pandemic. Lockdowns and information-based preventive measures for COVID-19 increased the number of short-form video app users and short-form video exposure, including content exposure and the duration of exposure, which has demonstrated important effects on youths' health and health-related behaviors. Despite more older adults viewing short-form videos, less is known about the status of their short-form video exposure or the impacts of the exposure on their physical activity. Objective: This study aims to describe physical activity-related content exposure among older adults and to quantify its impacts along with the duration of short-form video exposure on step counts, low-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Methods: We analyzed a subsample (N=476) of older women who used smartphones and installed short-form video apps, using the baseline data collected from an ongoing cohort study named the Physical Activity and Health in Older Women Study (PAHIOWS) launched from March to June 2021 in Yantai, Shandong Province, China. The information on short-form video exposure was collected by unstructured questions; physical activity-related content exposure was finalized by professionals using the Q-methodology, and the duration of exposure was transformed into hours per day. Step counts, LPA, and MVPA were assessed with ActiGraph wGT3X-BT accelerometers. Multiple subjective and objective covariates were assessed. Linear regression models were used to test the effects of short-form video exposure on step counts, LPA, and MVPA. MVPA was dichotomized into less than 150 minutes per week and 150 minutes or more per week, and the binary logistic regression model was run to test the effects of short-form video exposure on the achievement of spending 150 minutes or more on MVPA. Results: Of 476 older women (mean age 64.63, SD 2.90 years), 23.7% (113/476) were exposed to physical activity-related short-form videos, and their daily exposure to short-form videos was 1.5 hours. Physical activity-related content exposure increased the minutes spent on MVPA by older women (B=4.14, 95% CI 0.13-8.15); the longer duration of short-form video exposure was associated with a reduced step count (B=-322.58, 95% CI -500.24 to -144.92) and minutes engaged in LPA (B=-6.95, 95% CI -12.19 to -1.71) and MVPA (B=-1.56, 95% CI -2.82 to -0.29). Neither content exposure nor the duration of exposure significantly increased or decreased the odds of older women engaging in MVPA for 150 minutes or more per week. Conclusions: Short-form video exposure has both positive and negative impacts on the physical activity of older adults. Efforts are needed to develop strategies to leverage the benefits while avoiding the harms of short-form videos.