Infertility psychological distress in women undergoing assisted reproductive treatment: A grounded theory study.

BACKGROUND: While there exists an ample body of research in international contexts focused on the characterization and quantification of infertility psychological distress, the level of scholarly scrutiny directed towards this phenomenon within the context of China remains scant. AIMS AND OBJECTIVES: To investigate the formation and developmental processes of psychological distress associated with infertility and infertility treatment among women within the Chinese cultural context and to construct a theoretical framework that elucidates this phenomenon. DESIGN: Qualitative approach with grounded theory methodology. METHODS: This study was conducted within the reproductive medicine department of a tertiary-level hospital located in central China from May to August 2023. Twenty-seven women who experienced infertility and underwent assisted reproductive treatment (ART) were interviewed. The interview sessions spanned durations ranging from 20 min to 1 h and 35 min. Data analysis included open coding, axial coding and selective coding. The study is reported using the COREQ checklist. RESULTS: The infertility psychological distress experienced by women undergoing ART is a socially constructed phenomenon influenced by a dynamic interplay of forces that construct and conciliate it. The formation and progression of infertility psychological distress are rooted in the process of self-construction. A Middle-Ranged Theory titled 'self-reconstruction under the dome of infertility and infertility treatment' (SUDIT theory) was developed to explain this phenomenon. Within this framework, infertility psychological distress manifests across three distinct phases under the gambling of the constructive force and conciliative force: (1) distress of disrupting the former self; (2) distress linked to the struggling present self; and (3) the renewed-self harmonized with distress. CONCLUSIONS: It is imperative for healthcare professionals and policymakers to acknowledge the socially constructed nature of infertility psychological distress, and proactively implement measures aimed at ameliorating it. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Interventions for Postextubation Dysphagia in Critically Ill Patients: A Systematic Review and Meta-analysis.

OBJECTIVE: This review evaluates the efficacy and safety of dysphagia interventions for patients with prolonged endotracheal intubation (⩾48 h) in critical care units. DATA SOURCES: We systematically searched PubMed, Cochrane Library, Medline, Embase, OVID, CINAHL, Wanfang (China), CNKI (China), and ProQuest Dissertations for studies published up to December 31, 2023. STUDY SELECTION: Inclusion criteria encompassed randomized controlled trials (RCTs), quasi-randomized trials, and cohort studies comparing dysphagia rehabilitation - such as swallowing stimulation, swallowing and respiratory muscle exercise, and neuromuscular electrical stimulation - with standard care or no treatment. The primary outcomes assessed were dysphagia severity, time to resume oral intake, and incidence of aspiration and aspiration pneumonia. DATA EXTRACTION: Detailed information on study design, setting, participant demographics, interventions, and outcomes was systematically extracted. DATA SYNTHESIS: Our analysis included ten studies with a total of 1031 participants. The findings demonstrate a significant reduction in dysphagia severity, time to oral intake and the risk of aspiration pneumonia, and an improvement in quality of life among patients receiving swallowing therapy. However, no substantial difference was found in nutritional status. Limited data availability necessitated a descriptive presentation of outcomes like the risk of aspiration, ICU/hospital stay duration, pharyngeal/oral residue severity, and intervention-related adverse events. CONCLUSION: The current evidence for the effectiveness of dysphagia interventions in critically ill patients with prolonged endotracheal intubation is limited. There is a pressing need for future research, particularly high-quality RCTs employing standardized outcome measures, to substantiate these findings.

The perception of childbearing sense of coherence among Chinese couples: a qualitative study.

BACKGROUND: Although childbearing health care is wellness-based and promotes normal physiology, it is in a medical model and focuses on risk aversion and disease prevention. The salutogenic theory might provide an alternative perspective to health care concerning childbearing, supporting health-promoting factors, not solely on avoiding adverse events. However, there is a dearth of qualitative research exploring couples' perceptions of childbearing from the salutogenic lens. This study aimed to explore perceptions and experiences concerning childbearing among couples in the perinatal period and identify salutogenic aspects of it. METHODS: The qualitative descriptive study adopted a directed content analysis to analyse data from a semi-structured and individual interview with 25 purposively selected Chinese couples between July 2022 and December 2022. The concepts of the sense of coherence (SOC) from the salutogenic theory were used as the theory framework for coding. RESULTS: Definitions and content for the salutogenic aspects of Chinese couples' perception of childbearing sense of coherence were developed. For comprehensibility of childbearing, four subthemes were extracted (the challenge to health and endurance; transition to and identification with the new role; conflict and reconciliation in relationships; resistance and compromise between social culture and personal development). For manageability of childbearing, two subthemes were extracted (helplessness and hope of childbearing; self-doubt and self-assurance of childbearing). For meaningfulness of childbearing, three subthemes were extracted (personal realisation; family bonding and harmony; the continuation of life). CONCLUSIONS: The findings of this study could give a greater understanding in maintaining couples' health in the perinatal period from the salutogenic lens and provide a guide to further research that the salutogenic theory could bring a health and wellness-focused agenda in practice and policy-making in the perinatal period.

The association between childbirth-related fear, childbirth readiness, and fertility intentions, and childbirth readiness as the mediator.

BACKGROUND: Fertility intentions have been proved to be a reliable predictor of actual fertility behaviour. Also, childbirth-related fear (CBRF) has been proven to be negatively associated with childbirth readiness and fertility intentions among women, while childbirth readiness was positively related to fertility intentions. However, the associations and potential mechanisms between CBRF, childbirth readiness, and fertility intentions remain unknown. This study aimed to investigate the unique association between CBRF, childbirth readiness, and fertility intentions and whether childbirth readiness would mediate the relationship between CBRF and fertility intentions. METHOD: A cross-sectional study of women (N = 1119, aged 16-53 years) who gave birth within 72 h was conducted. Using a convenience sampling, women were recruited from obstetric wards-10 comprehensive hospitals and 3 specialized hospitals in 7 provinces in mainland China. Pearson correlation was used to examine the relationship between CBRF, childbirth readiness, fertility intentions, and social support. Multivariate linear regression was further used to analyze the association between demographic and personal characteristics, CBRF, childbirth readiness, and fertility intentions. Mediation analysis was used to examine whether childbirth readiness mediates the relationship between CBRF and fertility intentions. RESULTS: Women with high childbirth readiness (ß = 0.09, P = 0.002) had higher fertility intentions. However, women with high CBRF (ß = - 0.17, P < 0.001) were more likely to have lower fertility intentions. CBRF had both direct and indirect effects on the level of fertility intentions. As predicted, childbirth readiness mediated the relationship between CBRF and the level of fertility intentions (estimate = - 0.012, 95% bootstrap CI: - 0.021 to - 0.005). Higher CBRF was associated with lower scores of childbirth readiness, which was associated with lower levels of fertility intentions. CONCLUSIONS: This study established the evidence that CBRF had both direct and indirect effects on the level of fertility intentions and childbirth readiness mediated the relationship between CBRF and the level of fertility intentions. Specifically, higher CBRF was associated with lower scores of childbirth readiness, which was associated with lower levels of fertility intentions. This finding suggested that it is important for health policymakers and health providers to pay more attention to improving women's childbirth readiness, which might reduce the negative influence of CBRF on fertility intentions, thus strengthening their fertility intentions.

Over the past two decades, fertility rates have been dropping steadily in most countries. Fertility intentions have been proven to be a reliable predictor of actual fertility behaviour. The worldwide sluggish fertility trend has brought about a series of issues, such as accelerated population ageing, shrinking workforce, and economic decline. China has the largest national population in the world, accounting for nearly one-fifth of the world's population, thus having a huge impact on global population trends. Therefore, in the context of significant fertility decline and population policy changes, timely research on fertility intention is of great significance for China and other low-fertility countries. CBRF has been proven to be negatively associated with childbirth readiness and fertility intentions among women, while childbirth readiness was positively related to fertility intentions. This study aimed to investigate the unique association between fertility intentions, CBRF, and childbirth readiness, and whether childbirth readiness would mediate the relationship between CBRF and fertility intentions. In this cross-sectional study, we found that women with high childbirth readiness had higher fertility intentions. However, women with high CBRF were more likely to have lower fertility intentions. Furthermore, CBRF had both direct and indirect effects on the level of fertility intentions. Childbirth readiness mediated the relationship between CBRF and the level of fertility intentions. Higher CBRF was associated with lower scores of childbirth readiness, which was associated with lower levels of fertility intentions. This finding suggested that it is important for health policymakers and health providers to pay more attention to improving women's childbirth readiness, which might reduce the negative influence of CBRF on fertility intentions, thus strengthening their fertility intentions.

Development and psychometric testing of a scale for assessing the psychological birth trauma.

Background: Psychological birth trauma is widespread in postpartum women, and its harms are serious to mothers' health. Existing tools rely on posttraumatic stress disorder to evaluate, which cannot effectively evaluate its connotation. The aim of this study was to develop a new instrument for use to comprehensively assess the psychological birth trauma level of women after birth and test the scale's psychometric properties. Methods: The scale was developed and evaluated through item generation, expert consultation, pre-survey, and psychometric evaluation. A literature review, focus group, and individual deep semi-structured interviews were utilized to identify the scale items. The expert consultation evaluated the content validity. Psychometric testing was conducted in a convenience sample of 712 mothers within the first 72 h postpartum who were recruited from three hospitals in China. Results: The total Cronbach alpha coefficient of the scale was 0.874. Exploratory factor analysis supported that the final scale consisted of four dimensions and fifteen items. The explanatory variance of the four factors was 66.724%. The four dimensions are named "being neglected," "out of control," "physiological emotional response," and "cognitive behavioral response." The results of the confirmatory factor analysis showed that the fit indices were all at acceptable and good levels. Conclusion: The 15-item Birth Trauma Scale is a valid and reliable tool to evaluate the psychological trauma of mothers who experienced spontaneous childbirth. The scale is a maternal self-assessment scale that can help women understand their mental health. Healthcare providers can identify key populations and intervene with them.

Why do pregnant women with fear of birth prefer vaginal birth? A qualitative study in China.

Background: Fear of birth (FOB) is becoming increasingly recognized as a mental health issue that may endanger maternal and infant health and affects women's subsequent fertility desires. It has also been shown to be related to the choice of delivery mode. Given the differences in healthcare systems and policies between countries, and the gaps in the exploration of women's experience of fear of birth and its association with the delivery mode in the Chinese cultural context, this study thus attempt to understand Chinese women's experience with fear of birth and their preferences for delivery mode through a qualitative study. Methods: A descriptive qualitative research was performed among twenty pregnant women from the obstetric outpatient of a tertiary hospital in China. Colaizzi's method was used to analyze the participants' data. Results: We proposed three themes and nine subthemes on the participants' experience with fear of birth: (1) an invisible dilemma: trapped in lingering fear (fear of all sides, the untold loneliness, and ambivalence with mixed feelings); (2) an unexpected decision: choose to give birth naturally (initiative selection and passive acceptance); and (3) A strength to confront challenges head-on: move forward with fear (awaken of maternal spirit, hope in bloom, Chinese tolerance culture, and obstetric analgesia). Conclusion: Fear of birth is a complex emotion, accompanied by feelings of loneliness and ambivalence in addition to fear. We found that women with fear of birth in this study prefer vaginal birth, and it was revealed to be the result of a combined action of intrinsic and extrinsic factors.

Relationship between perceived organizational support and professional values of nurses: mediating effect of emotional labor.

OBJECTIVES: Perceived organizational support was a benefit for the work performance of nurses, which may affect emotional labor and the development of professional values. This study aimed to explore the relationship between nurses' perceived organizational support and professional values, and investigate the mediating role of emotional labor. METHODS: This was a cross-sectional study. The study was conducted in 3 tertiary hospitals in Wuhan from October 2020 to January 2021. The data were collected by a questionnaire consisting of demographic characteristics, the Emotional Labor Scale for Nurses, the nurses' Perceived Organizational Support Scale, and the Nursing Professional Values Scale (NPVS-R). A convenience sample of 1017 nurses responded to the questionnaire survey. Pearson's correlation analysis was used to test the relationship between variables. Predictor effects were tested using hierarchical multiple regressions. The structural equation model (SEM) was used to test the mediation effect of emotional labor on the pathway from perceived organizational support to professional values. RESULTS: A positive moderate correlation was observed between the perceived organizational support and emotional labor (r = 0.524, P < 0.01), and a positive strong correlation was observed between perceived organizational support and professional values (r = 0.609, P < 0.01). Emotional labor and perceived organizational support were positive predictors of professional values (B = 0.531, 95%CI = 0.414 ~ 0.649; B = 0.808, 95%CI = 0.715 ~ 0.901, respectively). The association between perceived organizational support and professional values was mediated by emotional labor. CONCLUSIONS: Results showed that perceived organizational support was positively related to nurses' emotional labor, which was in turn associated with high professional values. For nurses, improving organizational support and training nurses to engage in emotional labor through providing multiple support systems, establishing appropriate incentive mechanisms, and training nurses to regulate emotions can be effective ways to promote nurses' professional values.

The illness experience for people with amyotrophic lateral sclerosis: A qualitative study.

AIMS AND OBJECTIVES: This study aims to gain a comprehensive understanding of the illness experience of amyotrophic lateral sclerosis (ALS) patients in China and the meaning they attach to those experiences. BACKGROUND: ALS is a progressive and fatal neurodegenerative disorder that significantly impacts individuals and families. There is a large number of patients with ALS in China. However, little is known about how they live with ALS. DESIGN: Phenomenological qualitative research was performed among twenty people with ALS from the neurology department of a tertiary hospital in China. Colaizzi's method was used to analyse the participants' data. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used as a guideline to secure accurate and complete reporting of the study. RESULTS: We proposed three themes and eight subthemes on the illness experience of participants: (1) life countdown: 'my body was frozen' (body out of control and inward suffering); (2) family self-help: 'we kept an eye on each other' (family warmth and hardship, and supporting the supporter); and (3) reconstruction of life: 'what was the meaning of my life' (learning to accept, rebuilding self-worth, resetting the priority list and living in the moment). CONCLUSIONS: In the family self-help model, patients are prompted to turn from negative mentalities to search for meaning in life actively. Healthcare providers need to attach importance to the family self-help model to alleviate the pressure on medical resources. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers should encourage patients to play a supportive role in the family and provide more care support and professional care knowledge guidance to caregivers, to promote the formation of the family self-help model which might help to improve the experience of patients and families.

Women's experience of psychological birth trauma in China: a qualitative study.

BACKGROUND: The psychological birth trauma is a universal phenomenon in childbearing women. The influences could extend in a wide range, which includes the mothers' health, mother-infant relationship, partner relationship. The medical staff could even choose to quit playing their part in the birthing process. The phenomenon has gradually garnered attention around the world. However, it has rarely been discussed under Chinese special conditions. The study was to explore Chinese women's lived experiences of psychological birth trauma during labor and birth. METHODS: A descriptive phenomenological approach was adopted in this study. Twenty-four women were recruited, who reported having experienced psychological birth trauma. In-depth interviews were conducted within 1 week after birth. Colaizzi's method was used to analyze the data. RESULTS: Twenty-four women participated in the study. Four themes emerged to describe the women's experience of psychological birth trauma: "How am I supposed to relieve the endless pain?" " Can't I be weak?" "Am I not important?" "What uncertainties are waiting for me?" CONCLUSIONS: The findings provide deep insight into Chinese women's unique experience of psychological birth trauma. The social and health system could prevent psychological harm during birth and promote maternal health by measures of pain management, thoughtful attention, adequate caring, and prenatal preparation.

Effect of pain on depression among nursing home residents: Serial mediation of perceived social support and self-rated health. A cross-sectional study.

AIM: The aim of this study was to investigate how perceived social support and self-rated health together could mediate the relationship between pain and depression among Chinese nursing home residents with pain. METHODS: The study was conducted in 38 nursing homes in 13 cities in China. A convenience sample of 2154 older adults responded to the questionnaire survey. A mediation analysis was performed on the data of 990 participants with pain. The data were collected by a questionnaire consisting of socio-economic and demographic characteristics, the Geriatric Depression Scale-15, the Multidimensional Scale of Perceived Social Support, Self-rated Health Scale and the Numerical Rating Scale of pain. The sample was subdivided by sex. Descriptive analysis, t-tests, chi-squared tests, Mann-Whitney U-tests, Spearman correlation analyses and the bootstrap method were used to analyze data. RESULTS: The prevalence rate of pain and depression among nursing home residents were 46.0% and 20.7% respectively. Pain, perceived social support and self-rated health were all significantly correlated with depression (r = 0.217, P < 0.01; r = -0.216, P < 0.01; r = 0.385, P < 0.01, respectively). Perceived social support and self-rated health independently and in series partly explained the relationship between pain and depression. CONCLUSIONS: The results of the study showed that pain was associated with low perceived social support first, and then poor self-rated health, which was in turn related to the development of depression among nursing home residents with pain. For nursing home residents, perceived social support and self-rated health as an internal resource can affect the ability to overcome the suffering of pain and reduce the level of depression. Geriatr Gerontol Int 2020; 20: 1234-1240.

Nurses' Perceptions of Factors Influencing Elder Self-neglect: A Qualitative Study.

PURPOSE: Elder self-neglect is a global public health issue and should be taken seriously at large. Nurses, usually working directly with elderly patients, have a better understanding of what factors may cause elder self-neglect. In this qualitative study, we explored the influencing factors of elder self-neglect from the perception of nurses in the context of Chinese culture. METHODS: Face-to-face, in-depth interviews were conducted from November 2018 to December 2018. Purposive sampling was used. Twenty one participants recruited from eight geriatric wards of a general hospital located in Wuhan were interviewed. A content analysis of qualitative nature was performed to analyze the data. RESULTS: Our conceptual model illustrated the findings based on the three themes of the conflict between personal recognition and social judgment, the choice between current needs and individual beliefs, as well as the compromise between insufficient abilities and limited resources. CONCLUSION: Nurses together with family members and social workers can help older adults improve their awareness of self-neglect to bridge the gap with social judgment, learn to focus on their own needs, as well as seek as much support as possible. Nurses should also respect the autonomy and self-determination of elder self-neglecters because self-neglect is related to older adults' values. Furthermore, larger studies are needed to quantitatively test and refine the model.

Plasma 25-hydroxyvitamin D level and the risk of frailty among Chinese community-based oldest-old: evidence from the CLHLS study.

BACKGROUND: Vitamin D deficiency has been linked to the risk of frailty. However, there are limited methods for evaluations of the potential association of vitamin D with frailty in a longevous (80+) population. The aim of this study was to examine the association between plasma 25-hydroxyvitamin D [25(OH)D] levels and the risk of frailty among the Chinese community based oldest-old. METHODS: Secondary analysis of data compiled in the 2011 wave of the Chinese Longitudinal Healthy Longevity Survey (n = 1324) was performed. Frailty was assessed by the Study of Osteoporotic Fractures (SOF) index. Multivariate logistic regression and spline smoothing with threshold effect analysis were performed to investigate the association between 25(OH) D level and the risk of frailty after adjusting for socio-demographic variables, health characteristics and confounding biomarkers. RESULTS: The mean age was 92.89 ± 7.92 years, and 844 (63.7%) participants were women. In all, data from 426 (33.2, 95% confidence interval, CI: 29.66-34.69) frail participants were recorded. After adjustment for confounding covariates, the level of 25(OH) D was significantly related to frailty. By spline smoothing with threshold effect analysis, a monotonically negative association between 25(OH) D and frailty was identified. Subgroup analyses revealed that the association did not differ by sex or age. CONCLUSIONS: The 25(OH) D level was inversely associated with the risk of frailty among the Chinese community-based oldest-old.

Exploring Contributing Factors to Psychological Traumatic Childbirth from the Perspective of Midwives: A Qualitative Study.

PURPOSE: As midwives witness and attend the whole process of childbirth, they have a better understanding of which factors may cause traumatic childbirth. However, because most of the studies paid their attention on mothers, little is known about psychological birth trauma from the perspective of midwives. This study aims to gain a full understanding of which factors may contribute to psychological traumatic childbirth from the perspective of midwives. METHODS: A qualitative research was conducted using in-depth interviews, which involved fourteen midwives from the maternal ward of a tertiary hospital. The interviews were recorded and transcribed, and then, Colaizzi's method was used to analyze the contents of the interviews. RESULTS: We proposed four themes and eight subthemes on the influencing factors of psychological traumatic childbirth from the perspective of midwives: low perceived social support (lack of support from family and lack of support from medical staff), hard times (protracted labor in the first stage and futile efforts during the second stage), poor birth outcomes (poor birth outcomes of the mother and poor birth outcomes of the baby), and excruciating pain (unbearable pain of uterine contraction and labor pain was incongruent with the mother's expectations). CONCLUSION: Medical staff should pay attention to psychological traumatic childbirth and its effects, and emphasis on the screening and assessment of birthing women with negative feelings so that their psychological traumatic childbirth can be prevented and decreased.