Diethylenetriaminepentaacetic Acid-based Conducting Solid Polymer Electrolytes Impede Lithium Dendrites and Impart Antioxidant Capacity in Lithium-Ion Batteries.

In the development of lithium-ion batteries (LIBs), cheaper and safer solid polymer electrolytes are expected to replace combustible organic liquid electrolytes to meet the larger market demand. However, low ionic conductivity and inadequate cycling stability impede their commercial viability. Herein, a novel flexible conducting solid polymer electrolytes (CSPEs) based on polyvinyl alcohol (PVA) and ion-polarized diethylenetriaminepentaacetic acid (P-DETP) is developed for the first time and applied in LIBs. PVA and P-DETP form a compact polymer network through hydrogen bonding, enhancing the thermomechanical stability of CSPE while restricting the migration of larger anions. Furthermore, density functional theory calculations confirm that P-DETP can facilitate the dissociation of Li+-TFSI- via electrostatic attraction, resulting in increased mobility of lithium ions. Additionally, P-DETP contributes to the formation of a stable electrode-electrolyte interface layer, effectively suppressing the growth of lithium dendrites and improving antioxidant capacity. These synergistic effects enable CSPE to exhibit remarkable properties including high ionic conductivity (2.8 × 10-4 S cm-1), elevated electrochemical potential (5.1 V), and excellent lithium transference number (0.869). Notably, the P-DETP/LiTFSI CSPE demonstrates stable performance not only in LiFePO4 batteries but also adapts to high-nickel ternary LiNi0.88Co0.06Mn0.06O2 cathode, highlighting its immense potential for application in high energy density LIBs.

Effect of simulation-based zoom learning on clinical decision-making among undergraduate nursing students and experiences of students and instructors: A mixed methods study.

Aim: To determine the effect of simulation-based Zoom learning (SBZL) on perceived capabilities and clinical decision-making skills among undergraduate nursing students and to explore experiences of the instructors and students participating in SBZL. Background: Nursing is a practice profession and students acquire clinical decision-making skills in clinical settings. However, the COVID-19 pandemic has disrupted conventional clinical learning activities. In this study, the outcomes of implementing SBZL in an undergraduate programme to support students' clinical learning were examined. Design: A mixed methods design was employed. Methods: This study recruited 195 final-year students to participate in the SBZL programme, which was developed based on the NLN Jeffries Simulation Theory to guide its design, implementation and evaluation. Case scenarios were developed and simulated through Zoom. Students' perceived capabilities, perceptions of the learning environment and clinical decision-making skills were assessed before and after SBZL. A historical control group of 226 previous final year students who had received a clinical practicum was included for comparison. Semi-structured interviews were conducted with 11 instructors and 19 students to explore their experiences of participating in SBZL. Results: A total of 102 students completed the post-SBZL questionnaire. An increase in perceived creative thinking (mean difference = 0.24, p < 0.001) was observed post-SBZL. After SBZL, the perceptions of the learning environment were significantly improved. However, the SBZL group demonstrated lower perceived problem-solving capability than the control group (mean difference = 0.14, p = 0.007). Clinical decision-making was significantly improved in the SBZL group than in the control group (p < 0.001). Both the instructors and students reported positive experiences with SBZL, and highlighted challenges and factors for improving its implementation. Conclusions: SBZL showed improvement in perceived creative thinking, perceptions of the learning environment and clinical decision-making. This innovative teaching and learning method can be valuable for nursing education in various regions to prepare students for real-life roles. Tweetable abstract: Simulation-based Zoom learning is better than traditional teaching in improving clinical decision-making skills among undergraduate nursing students.

Effects of Telephone Consultation on Safety, Service Use, Patient Satisfaction, and Workload: Systematic Review and Meta-Analysis of Randomized Trials.

Objective: Telephone consultation (TC) is widely used for its easy access and convenience. This review aimed to assess the effects of TC including triage on safety, service use, patient satisfaction, and health professionals' workload to inform directions for future health service practice. Methods: CENTRAL, MEDLINE, Embase, CINAHL, ProQuest Dissertation & Theses (Health & Medicine), ClinincalTrials.gov, and International Clinical Trial Registry Platform were searched on April 7, 2022. The included were randomized controlled trials that compared TC with standard (face-to-face [F2F]) management or that by another group of call advisers. Cochrane methods were used to select eligible studies, assess the risk of bias, estimate summary effect measure, and grade evidence certainty. Meta-analysis was performed on important outcomes with moderate- or high-quality evidence. Results: Eight studies were included involving 40,002 participants. TC could increase call resolution-proportion of callers' concerns being addressed by telephone advice alone (two studies; high certainty) and reduce F2F contacts with doctors for the first consultation (two studies, moderate certainty) compared with standard management or TC by doctors. None of included studies reported increases in adverse events, including all-cause mortality, acute and emergency department visit, and hospitalization. There was inadequate evidence regarding the effects of TC on patient satisfaction and length of consultation. Conclusion: The findings support the benefits of TC on improving call resolution and reducing F2F contacts with doctors on the day of first management for regular day service; and TC by nurses can provide better effects than that by doctors for out-of-hours service.

Perceptions and experiences of exercise among pregnant women.

INTRODUCTION: Though exercise during pregnancy can yield important maternal benefits, most pregnant women in China do less aerobic exercise than is currently recommended. This qualitative study aimed to explore the perceptions and experiences of physical exercise among pregnant women and to identify perceived barriers to and facilitators of exercise participation. METHODS: Purposive sampling was used to recruit 40 pregnant women attending prenatal visits at an obstetrics outpatient department of a tertiary general hospital in Southern China. Individual semi-structured telephone interviews were conducted with the verbatim transcripts analyzed through content analysis. RESULTS: Three main themes emerged from the data: perceptions and patterns of exercise; concerns and hesitations about participating in exercise; and determinants of adoption and maintenance of exercise participation. Though pregnant women recognised their need for physical exercise instruction, their demands remained unmet due to a combination of factors such as lack of knowledge, confidence, and support, and concerns about safety. DISCUSSION: The findings of this study suggest that the provision of tailored exercise programs for pregnant women, which include education, reassurance, motivational strategies, and lay and professional support, may help improve knowledge, allay concerns, boost confidence, and bolster support when doing physical exercise.

The effects of decision aids for genetic counselling among people considering genetic testing: A systematic review.

AIM: To assess the effectiveness of decision aids for genetic counsellees to improve their conflicts in decision-making and psychological well-being when considering genetic tests for inherited genetic diseases, and their knowledge about these tests and their genetic risks. DESIGN: Systematic review. DATA SOURCES: Six electronic databases (PubMed, MEDLINE, OVID Nursing, APA PsycINFO, EMBASE and CINAHL) were searched from inception to May 2022. REVIEW METHODS: Only randomised controlled trials that examined the effect of decision aids for information provision centring genetic testing on outcomes including decisional conflicts, informed choice making, knowledge on genetic risks or genetic tests, and psychological outcomes among participants who had undergone genetic counselling were included. Their risk of bias was assessed using the Version 2 of the Cochrane risk of bias tool for randomised trials. Results were presented narratively. The review was conducted according to the PRISMA checklist. RESULTS: Eight included studies examined the effect of booklet-based, computer-based, film-based or web-based decision aids on individuals considering genetic testing for their increased cancer risks. Despite contrasting findings across studies, they showed that decision aids enable genetic counsellees to feel more informed in decision-making on genetic tests, although most showed no effect on decisional conflict. Knowledge of genetic counsellees on genetic risks and genetic tests were increased after the use of decision aids. Most studies showed no significant effect on any psychological outcomes assessed. CONCLUSIONS: Review findings corroborate the use of decision aids to enhance the effective delivery of genetic counselling, enabling genetic counsellees to gain more knowledge of genetic tests and feel more informed in making decisions to have these tests. RELEVANCE TO CLINICAL PRACTICE: Decision aids can be used to support nurse-led genetic counselling for better knowledge acquisition and decision-making among counsellees. NO PATIENT OR PUBLIC CONTRIBUTION: Patient or public contribution is not applicable as this is a systematic review.

Food frequency questionnaire for dietary assessment among adults at a risk of coronary heart disease: A mixed-methods study.

AIMS AND OBJECTIVES: To develop and psychometrically test a food frequency questionnaire for adults at risk of coronary heart disease (Cardio-FFQ). BACKGROUND: Comprehensive dietary assessment is critical for the prevention of cardiovascular disease, but appropriate instruments to perform this work are lacking. DESIGN: A sequential mixed-methods study followed the COREQ and STROBE guidelines. METHODS: This study was conducted between April 2016 and November 2017. It started with dietary history interviews (Phase 1) to identify candidate food items of the Cardio-FFQ, which validity and reliability were assessed (Phase 2) through expert consultation and four seasonal measurements, including test and retest with a 2-week gap every season. Physical activity and blood glucose and lipids were assessed seasonally, while another FFQ was administered during the fourth measurement. Content analysis was used to analyse verbatim interview transcripts, while descriptive and inferential analyses were used to simplify the Cardio-FFQ and examine its psychometric properties. RESULTS: Phase I involved 34 participants during their first onset of acute coronary syndrome and generated 176 candidate food items (consumed by at least three participants) under 12 food categories. These food items were simplified to form the 133-item Cardio-FFQ after discarding items with trivial contributions to food commonalities or between-person variance. Further analysis showed that the simplified questionnaire had satisfactory content validity, concurrent validity, convergent validity, predictive validity, known-group validity and test-retest reliability. CONCLUSION: The 133-item Cardio-FFQ is a valid and reliable tool for a comprehensive dietary assessment appropriate for adults at risk of coronary heart disease. RELEVANCE TO CLINICAL PRACTICE: Nurses may use the Cardio-FFQ to conduct a dietary assessment to better support people to commit to healthy diets, aiming to reduce the risk of coronary heart disease.

Effects of a hospital-based leisure activities programme on nurses' stress, self-perceived anxiety and depression: A mixed methods study.

AIMS: To determine the effects of a hospital-based leisure activities programme on nurses' stress, self-perceived anxiety and depression. BACKGROUND: Nursing work in clinical settings is highly stressful and may result in an increase in nurses' turnover rate, which threatens the quality of nursing care and patient safety. METHODS: We used a mixed methods design and a three-month intervention (January to April, 2019) involving a convenience sample of 176 nurses working at a Chinese tertiary hospital. We conducted 12 semi-structured interviews and performed a content analysis. The pre- and post-intervention comparisons of nurses' stress, self-perceived anxiety and depression were performed using a paired t test. RESULTS: The 3-month leisure activities programme significantly decreased nurses' job stress (t = 3.80, p < .01), perceived personal stress (t = 3.30, p < .01), self-perceived anxiety (t = 3.76, p < .01) and depression (t = 2.73, p < .01). The qualitative findings revealed five mechanisms linking leisure activities to subjective well-being: detachment recovery, autonomy, mastery, meaning and affiliation. CONCLUSIONS: A hospital-based leisure activities programme had a positive effect on job stress, self-perceived anxiety and depression, thus improving nurses' well-being. IMPLICATIONS FOR NURSING MANAGEMENT: A hospital-based leisure activities programme provides a beneficial strategy for ameliorating nurses' psychosocial issues. Interventions aimed at facilitating or increasing nurses' participation in leisure activities are greatly needed.

Chinese stroke survivors' perceptions of participation in exercise or sitting Tai Chi.

AIMS: Exercise promotes functional recovery among stroke survivors and is recommended to be commenced as soon as is feasible. However, little is known about stroke survivors' perception of participation in exercise or sitting Tai Chi, a more culturally appropriate and popular movement in China. To explore Chinese stroke survivors' perceptions of participation in exercise or sitting Tai Chi. METHODS AND RESULTS: Face-to-face semi-structured interviews and content analysis of transcripts were conducted with a purposive sample of 30 stroke survivors. The qualitative study explored perceptions of post-stroke participation in exercise or sitting Tai Chi. The consolidated criteria for reporting qualitative research checklist was used to report findings. Perceived facilitators of exercise participation were healthcare professionals' encouragement and recommendations, family and peer support and survivors' motivation, intention, and self-perceived benefits. Perceived barriers were fear of falling, physical discomfort, and challenges in standing. Despite some reservations, most participants were willing to try sitting Tai Chi. CONCLUSIONS: Encouragement and support, motivation, and perceived benefits were important for exercise participation after stroke. With the premise that all medical and nursing students in China are trained in Tai Chi, for stroke survivors with no access to formal exercise programmes, sitting Tai Chi may offer an appropriate alternative.

Chinese adolescents' sexual and reproductive health education: A quasi-experimental study.

OBJECTIVE: This study investigated the effectiveness of an interactive sexual and reproductive health education program in aspects of knowledge, attitudes, and self-efficacy among adolescents. DESIGN: Quasi-experimental study underpinned by social cognitive theory. SAMPLE: A stratified cluster sample of 469 students from the two-branch middle school in a city in eastern China who were assigned to the experimental (n = 233) and control (n = 236) groups. MEASUREMENTS: Students' sexual knowledge, attitudes, and refusal self-efficacy were assessed before (T0), immediately after (T1), and 1 month after the intervention (T2), respectively. INTERVENTION: Students in the experimental group received two 40-min sessions of the educational program while the control group received the usual mode of sexual and reproductive health education. RESULTS: Compared with the control group, students in the experimental group acquired more sexual knowledge (p < .01), and developed more positive sexual attitudes (p < .05) and stronger sexual self-efficacy (p < .05) across the study period. CONCLUSIONS: The proposed sexual and reproductive health education program incorporating various interactive activities was effective and could be used for school-based implementation led by nurses and other health care workers.

The protective effect of self-esteem on suicidal ideation among nursing home residents with limited social support in China: A cross-sectional study.

AIM: This cross-sectional study aimed to assess the impact of limited social support and loneliness on suicidal ideation, under the influence of self-esteem, an important inner resource for quality living. DESIGN: An observational cross-sectional study conducted from September 2018-April 2019. METHODS: The participants comprised 538 nursing home residents selected by a stratified sampling method from all seven administrative districts in a capital city of eastern China. All the participants completed the survey that constituted the measurement of suicidal ideation, self-esteem, social support and loneliness. Path analysis was performed using the structural equation modelling method. RESULTS: A moderating effect, with satisfactory model fit indices and significant path coefficients, was detected between self-esteem and suicidal ideation through limited social support and loneliness, revealing the multiple protective mechanisms of this psychological characteristic on the change of suicidal ideation.

Dispatched nurses' experience of wearing full gear personal protective equipment to care for COVID-19 patients in China-A descriptive qualitative study.

AIMS AND OBJECTIVES: We explored dispatched nurses' experiences of wearing full gear personal protective equipment to care for patients with coronavirus disease-2019 (COVID-19) in Wuhan, China. BACKGROUND: Full gear personal protective equipment is the primary and foremost measure to prevent the contact and transmission of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2); however, working in full gear personal protective equipment may hinder nursing care activities and thus negatively affect patients' and nurses' health. DESIGN: This descriptive qualitative inquiry followed the COREQ guidelines. METHODS: Individual semi-structured telephone interviews were conducted in a purposive sample of 15 frontline nurses who were dispatched to the outbreak epicentre from March to April 2020. Verbatim transcripts were content analysed. RESULTS: Four themes emerged from the data: inadequate preparedness for working with full gear personal protective equipment, full gear personal protective equipment stimulated stress responses, coping strategies and professional growth. Participants learned a great deal from problem-focussed and emotion-focussed strategies to tackle challenges related to the prolonged wearing of full gear personal protective equipment for quality nursing care and reduced risk of exposure. They became more vigilant to the adherence to evolving protocols and appropriate training concerning full gear personal protective equipment use. CONCLUSIONS: Frontline nurses confronted various but diminishing challenges related to the use of full gear personal protective equipment when caring for patients with COVID-19 across the approximate 40-day period. Consistent use of coverall personal protective equipment to protect from SARS-CoV-2 in high exposure settings would be feasible if nurses were better prepared; therefore, scenario-based skill training concerning the prolonged use of full gear personal protective equipment should be offered regularly and intensively. RELEVANCE TO CLINICAL PRACTICE: This study informs future decisions concerning improved full gear personal protective equipment-related psychomotor training and promoting ways for nurses to cope with the stress that comes from working in highly contiguous environments.

Psychometric properties of the Chinese version of the Trunk Impairment Scale in people with a stroke.

BACKGROUND: The Trunk Impairment Scale (TIS) has been translated into Chinese, but the psychometric properties of the Chinese version of the TIS (TIS-C) have not yet been established. We aimed to examine the reliability and validity of the TIS-C for assessing sitting balance among Chinese people with a stroke. METHODS: A descriptive, cross-sectional design was used. We recruited a convenience sample of 170 subacute stroke patients aged 18 years or over from the neurology departments of four traditional Chinese medicine hospitals in China. Patients completed the TIS-C, the Berg Balance Scale and the Modified Barthel Index. The psychometric properties of the TIS-C were examined to establish test-retest reliability, internal consistency, equivalence, and content, criterion, and construct validity. RESULTS: Intraclass correlation coefficients for inter-rater and intra-rater reliability ranged from 0.75 to 0.89 and from 0.90 to 0.97, respectively. The TIS-C Cronbach α was 0.86. The strong correlation between the total score of the TIS-C and the Berg Balance Scale (rs = 0.81, p < 0.001) or Modified Barthel Index (rs = 0.84, p < 0.001) suggested good concurrent and convergent validity, respectively. Known-group validity was supported by the significant difference (p < 0.001) in TIS-C scores between participants with mild and moderate stroke. CONCLUSIONS: The TIS-C is a valid and reliable tool for assessing static and dynamic sitting balance as well as coordination of trunk movement among stroke survivors with mild and moderate stroke.

The Influence of Confucianism on the Perceptions and Process of Caring Among Family Caregivers of Persons With Dementia: A Qualitative Study.

Introduction: Scant evidence reveals the influences of Confucianism on family caregiving in dementia. The purpose of this study was to explore the influence of Confucianism on the perceptions and process of caring among the Chinese family caregivers. Method: A qualitative study was conducted using semistructured interviews with 15 Chinese family caregivers of persons with dementia in three elderly care centers in Hong Kong. The interviews were audiotaped and transcribed, while a thematic analysis was performed to analyze the transcript at the latent level. Results: Three themes emerged from the interviews: (a) setting family as a top priority, (b) growth and development in families, and (c) enhancing family relationships. Discussion: Our findings provided insights into how Confucianism influences the experience of family caregivers in caring persons with dementia in Chinese communities. These findings help develop culturally adapted interventions to improve the support for family caregivers of persons with dementia.

Emergency preparedness for heat illness in China: A cross-sectional observational study.

BACKGROUND: The morbidity and mortality rates from heat illness have increased due to a higher number of heatwaves. Effective urgent care of heat illness is crucial for optimizing patient outcomes. However, few studies have examined the emergency preparedness measures required for treating such patients. METHODS: From December 23, 2019, to January 23, 2020, a content-validated instrument containing the Perceived Emergency Preparedness Scale for heat illness (heatPEPS) was administered to emergency nurses in China through WeChat. Some of these nurses were retested two weeks later. SPSS 26, IRTPRO 4.2, and NVivo 12 Plus were used for data analysis. RESULTS: In total, 46.4% (200/431) of the participants returned valid responses. With dichotomous scoring, a high score for heatPEPS (mean 7.29; SD 1.667) was elicited. The reduced 9-item heatPEPS had a perfect fit with the 2PL model (M2 = 27.24, p > 0.05; RMSEA = 0.01) and acceptable internal (α = 0.68) and test-rest reliability (intraclass correlation = 0.56). Many participants (74%) were dissatisfied with their heat illness-related knowledge and skills, suggesting an area that could be improved for better emergency preparedness. CONCLUSION: Emergency departments appear to be well-prepared; however, this is subject to social desirability bias. The 9-item heatPEPS is a reliable and valid tool to measure emergency preparedness for heat illness.

The effects of sitting Tai Chi on physical and psychosocial health outcomes among individuals with impaired physical mobility.

BACKGROUND: Impaired physical mobility, most often seen in people with neurological disorders (i.e., stroke and spinal cord injury survivors), musculoskeletal diseases or frailty, is a limitation in independent and purposeful physical movement of the body or one or more extremities. The physical restrictions result in negative consequences on an individual's physical and psychosocial functions. This proposal describes a systematic review protocol to determine the effectiveness and approaches of sitting Tai Chi intervention for individuals with impaired physical mobility. Our review would inform stakeholders' decisions in integrating this complementary therapy into current rehabilitation services. METHODS: Randomized controlled trials or quasi-experimental studies that compared an intervention group receiving sitting Tai Chi with a control group among adult participants with impaired physical mobility resulting from any health condition(s) will be included. Outcomes of interest will include physical and psychosocial health outcomes. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, Scopus, Web of Science, AMED, PsycINFO, SPORDiscus, PEDro, WanFang Data and China National Knowledge Infrastructure will be searched from their inception to January 2020. Additional searches will be performed to identify studies that are being refereed, to be published, unpublished or ongoing. Two reviewers will select the trials and extract data independently. The risk of bias of the included studies will be assessed using the Cochrane risk-of-bias tools. The Grading of Recommendations, Assessment, Development and Evaluation will be used to assess evidence quality for each review outcome. Data synthesis will be performed using Review Manager 5.3. When a meta-analysis is possible, we will assess the heterogeneity across the studies by computing the I statistics. RESULTS: A high-quality synthesis of current evidence of sitting Tai Chi for impaired physical mobility will be stated from several aspect using subjective reports and objective measures of performance. CONCLUSION: This protocol will present the evidence of whether sitting Tai Chi is an effective intervention for impaired physical mobility. PROSPERO REGISTRATION NUMBER: CRD 42019142681.

A cross-sectional observational study of missed nursing care in hospitals in China.

AIM: To identify the risk of missed nursing care (MNC), and contributing factors, in Chinese hospitals. BACKGROUND: National reporting of adverse incidents diminishes errors of commission. To further improve service quality and patient safety, MNC should be reduced. METHODS: An online survey comprising the MISSCARE Survey and the McCloskey/Mueller Satisfaction Scale was conducted with a convenience sample of nurses (n = 6,158) in 34 Chinese hospitals. RESULTS: Participants' mean age was 30.6 (SD = 7.014), and 2.5% were male. The most frequently missed nursing care items were basic care (12.7%-51.8%). The most frequently reported reasons were human resource issues (63.1%-88.2%). Being female, no child, better educated, a manager, permanently employed, no night shift, inadequate friend support and job dissatisfaction influenced the perception of MNC (odds ratio 1.00-4.848). CONCLUSIONS: MNC often occurred in basic care involving informal caregivers or in surge status due to a sudden increase in workload. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should prioritize effective measures that target delegation competency and mobilization of nurses for flexible repositioning during need.

Barriers and facilitators in the use of formal dementia care for dementia sufferers: A qualitative study with Chinese family caregivers in Hong Kong.

Understanding the barriers and facilitators in the use of formal dementia care for dementia sufferers is crucial. However, such studies have largely been conducted in Western countries, and current evidence is not fully applicable to Asian societies. This qualitative enquiry aims to identify the barriers and facilitators for family caregivers of persons with dementia (PwDs) to use relevant services at communities in Hong Kong. Semi-structured face-to-face interviews with 15 PwDs were conducted in three elderly care centres. The content analysis of transcribed audiotaped interviews revealed various barriers related to financial support, service availability and accessibility, life burden, and referral, and facilitators about family responsibility, perceived benefits, and caring relations. The culture rooted in Confucianism with a British melioration may play an important role in shaping PwDs' experiences in the use of dementia services in Hong Kong. Cultural sensitive services could be attempted to attract more PwDs to utilise them.

Limitation on activities of daily living, depressive symptoms and suicidal ideation among nursing home residents: The moderating role of resilience.

Nursing home residents are at a higher risk of suicidal ideation, and depressive symptoms and limitations on activities of daily living (ADL) are presumed to be contributory factors, whereas resilience may buffer the negative effects of risk factors. This study aimed to investigate the prevalence of suicidal ideation and the moderating effect of resilience on suicidal ideation to dilute the adverse contribution of ADL limitation and depressive symptoms. A stratified random sampling was used to recruit 538 residents from 37 nursing homes in China. Participants' suicidal ideation, resilience, depressive symptoms, and ADL limitation were measured and tested by structural equation modeling. Statistics show that 14.9% of participants had suicidal ideation and the model where resilience moderated the effects of ADL limitation and depressive symptoms on suicidal ideation had the best model fit index. This suggests that positive psychological interventions for resilience building might be effective in reducing suicidal ideation.

Physical Illnesses and Medically Serious Suicide Attempts in Rural China.

Background: Physical illness is a strong correlate of suicidal behavior. However, its impact on attempted suicide in rural China is under-studied. Aims: This study was designed to assess the influence of physical illness on risk of suicide attempts and to identify distinguishing characteristics among medically serious suicide attempters with physical illnesses from those without. Method: Participants were medically serious suicide attempters identified through hospital emergency rooms (n = 659) as well as age- and gender-matched community controls (n = 659) from Shandong Province, China. Face-to-face interviews with the respondents were conducted with a semistructured protocol that included sociodemographic and psychological measures. Results: Physical illness was a significant risk factor for medically serious suicide attempts (OR = 1.739, 95% CI = 1.182-2.560). Older age was a significant risk factor, while female gender, no religion, and non-peasant occupations were significant protective factors for suicide attempts with physical illness. Limitations: Samples from only one province may not completely represent all serious suicide attempters in China. Furthermore, we did not assess the severity and the degree to which their physical illness limited the functioning of the individual. Conclusion: Physical illness is an important risk factor for suicide attempts in rural China. More efforts are needed to specifically target older people, males, those with religious beliefs, and peasant workers with physical illness.

An integrative review: Developing and measuring creativity in nursing.

OBJECTIVE: To analyze and synthesise the existing evidence on creativity in nursing. DESIGN: An integrative review. DATA SOURCES: A systematic search was conducted using seven English databases (PubMed, Science Direct, Web of Science, Cochrane, EBSCO, Wiley, and Medline) and the top three best Chinese databases (CNKI, Wanfang Data, and VIP). REVIEW METHODS: The combined keywords, creativity and nursing/nurse, were used to search for relevant journal articles that were written in English or Chinese from January 1995 to December 2016. The components of articles, i.e. title, abstract, full-text and the cited reference, were screened, filtered, evaluated and recorded according to the PRISMA statements and Joanna Briggs Institute Checklists. Thematic analysis was performed to synthesise evidence from the full-texts of studies. RESULTS: Fifteen quantitative and seven qualitative studies were included in this review. A joyful affective perspective enriched the conceptualization of creativity in nursing. Many intrinsic factors (e.g. learning styles, thinking styles, intrinsic passion, interest in nursing and achievement motivation) or extrinsic factors (mostly workplace problems and nurses' shortage) could influence nurses' and nursing students' creativity. Artistic expressions (e.g. painting, music, and pottery), self-directed learning and group/team work were reported to have a positive effect on creativity enhancement. None of existing instruments can adequately measure nurses' or nursing students' creativity. CONCLUSIONS: The concept of creativity requires an explicit definition, which is essential to the development and evaluation of creativity in nursing education and practice. Many factors influencing nurses' and nursing students' creativity can be implemented to achieve positive outcomes through efforts at artistic expressions, self-directed learning and teamwork. An instrument with satisfactory psychometric properties should be available for monitoring creativity development among nurses and nursing students.