Occupational burnout and stress of nurses in Taiwan regarding COVID-19: An intervention with gong medication.

AIMS: This study aimed to explore the effectiveness of gong meditation on nurses' perceived stress and occupational burnout during the COVID-19 pandemic. BACKGROUND: Nurses play an important role in hospitals, and they currently encounter additional stress due to the COVID-19 pandemic. DESIGN AND METHODS: In this experimental study, participants were provided intervention with seven sections of gong meditation, and each session lasted for approximately 50-60 min. Data were collected from July 2020 to February 2021. Eighty nurses were randomly assigned to the experimental or control group, and 79 completed all the processes of our protocol. Generalized estimating equations (GEE) were used in data analysis. RESULTS: Compared with the control group, the experimental group experienced significant improvements in stress and occupational burnout. CONCLUSIONS: Gong meditation can effectively alleviate stress and occupational burnout among nurses during the COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Gong meditation can be provided by hospital managers to all nurses to reduce their stress, occupational burnout and subsequent mental health problems. Additionally, we suggest that gong meditation can be used as an effective intervention for individuals in other occupational fields, as it is accessible and inexpensive intervention.

The Influence of Preoperative Anxiety, Optimism, and Pain Catastrophizing on Acute Postoperative Pain in Patients Undergoing Cardiac Surgery: A Cross-sectional Study.

BACKGROUND: Acute postoperative pain (APOP) may cause complications and delay healing. Analgesics alone cannot completely relieve APOP. Preoperative anxiety, optimism, and pain catastrophizing are predictors of APOP. No study author has examined the mediating effect of pain catastrophizing on APOP in patients undergoing cardiac surgery. OBJECTIVE: The aims of this study were to investigate the relationship between preoperative anxiety, optimism, pain catastrophizing, confounding factors (age, sex, type of surgery, and preoperative pain), and APOP and to examine the mediating effect of pain catastrophizing. METHODS: The authors of this cross-sectional study used a convenience sampling method and included 100 adults undergoing cardiac surgery in a southern Taiwanese medical center. The patients were asked to complete the State-Trait Anxiety Inventory-State subscale, Pain Catastrophizing Scale, and Life Orientation Test-Revised questionnaires before surgery. Postoperatively, the patients were asked to report their pain intensity on a numerical rating scale. Results were analyzed using SPSS version 22. RESULTS: Patients had a mild level of anxiety, a moderate level of optimism, and pain catastrophizing before surgery, as well as a moderate level of APOP. Men reported lower levels of APOP than women (z = -2.0, P < .05). APOP was significantly associated with preoperative anxiety (r = 0.48, P < .01), optimism (r = -0.45, P < .01), and pain catastrophizing (r = 0.65, P < .01). Only pain catastrophizing was a significant predictor of APOP (ß = 0.60, P < .001) and fully mediated the relationship between anxiety and APOP (z = 4.92, P < .001). The final model explained 42% of the variance in APOP. CONCLUSIONS: Pain catastrophizing should be assessed before surgery. Reducing pain catastrophizing would decrease APOP and improve the quality of pain management.

Factors influencing the mobile instant messaging application usage behaviours among home healthcare providers.

AIMS AND OBJECTIVES: To explore the practice related to mobile instant messaging applications usage among home healthcare providers in Taiwan; and based on the unified theory of acceptance and usage of technology and perceived risk theory to examine the influencing factors. BACKGROUND: Previous work has indicated the potential for using mobile instant messaging applications in chronic disease, disasters and public health emergencies. However, few studies have conducted to understand how healthcare professionals use them. DESIGN: A cross-sectional design was used in the study. METHODS: A wide-ranging empirical investigation was conducted in Taiwan. A total of 102 home agencies participated in this study, and 331 valid data were collected. The ODS guideline was followed. RESULTS: 69% of the participants had used mobile instant messaging applications, with high functionality and interesting value can integrate various messages and contribute to adoption. Performance expectancy, effort expectancy, and social influence were significantly positively correlated with behavioral intention. The perceived risk had a significant negative correlation with performance expectancy and use behavior. Among the relevant influencing factors, different types of organization, job position, and institutional policy were related to significant differences in use behaviors. CONCLUSIONS: Our research reported on mobile instant messaging applications usage and behavioral intention among home healthcare providers. This study also highlighted the need to establish regulations within the applications and improve safety and security guidelines. Further research may extend the understanding of the organizations' influencing factors. RELEVANCE TO CLINICAL PRACTICE: This study may help programmers, managers and policymakers improve their strategies for expanding usage of mobile instant messaging applications.

Effectiveness of Multidisciplinary Care for Chronic Kidney Disease: A Systematic Review.

BACKGROUND: Chronic kidney disease (CKD) is a common chronic disease. As this disease is extremely complex, multidisciplinary care (MDC) is needed to provide complete and continuous care. AIM: A systematic literature review was performed to examine the constituents of MDC, the content of MDC interventions, and the health outcomes in CKD patients receiving MDC. METHODS: Searches of five Chinese and English databases for studies of CKD patients who had received MDC from 2007 to 2019 revealed 11 studies, which comprised 16,066 CKD patients. The Physiotherapy Evidence Database scale (Physiotherapy Evidence Database, 2017) was used to appraise study quality for randomized controlled trials, and the Joanna Briggs Institute Critical Appraisal tools (Joanna Briggs Institute, 2017) were for cohort studies. RESULTS: The MDC teams that provided comprehensive medical care for these patients included nephrologists, nurses, surgeons, general practitioners, pharmacists, psychotherapists, social workers, nutritionists, and other specialists. The literature review revealed that MDC for CKD slows the decline in estimated glomerular filtration rate and decreases patient mortality, the risk of renal replacement therapy, the need for emergent dialysis, and annual medical costs. Analyses of biochemical markers in the CKD patients showed that MDC improves control of serum levels of calcium and phosphate, improves control of parathyroid hormone, and reduces proteinuria and fasting blood glucose values. However, further studies are needed to determine the effects of MDC on all-cause mortality, blood pressure control, hospitalization rate, hospitalization for cardiovascular or infection events, medications use, and other biochemical markers in CKD patients. LINKING EVIDENCE TO ACTION: Cross-disciplinary collaboration of healthcare professionals is needed to ensure that patients undergo regular follow-up and periodic assessment of clinical status, in addition to ensuring that relevant resources and assistance are provided in a timely manner. A follow-up period of at least 2 years is also needed to ensure sufficient time to observe MDC results.

Primary diagnoses and outcomes of emergency department visits in older people with dementia: a hospital-based retrospective study in Taiwan.

OBJECTIVES: The objectives of this study were to investigate the primary diagnoses and outcomes of emergency department visits in older people with dementia and to compare these parameters with those in older adults without dementia. DESIGN AND SETTING: This hospital-based retrospective study retrieved patient records from a hospital research database, which included the outpatient and inpatient claims of two hospitals. PARTICIPANTS: The patient records were retrieved from the two hospitals in an urban setting. The inclusion criteria were all patients aged 65 and older who had attended the two hospitals as an outpatient or inpatient between January 1, 2009, and December 31, 2016. Patients with dementia were identified to have at least three reports of diagnostic codes, either during outpatient visits, during emergency department visits, or in hospitalized database records. The other patients were categorized as patients without dementia. MEASUREMENTS: The primary diagnosis during the emergency department visit, cost of emergency department treatment, cost of hospital admission, length of hospital stay, and diagnosis of death were collected. RESULTS: A total of 149,203 outpatients and inpatients aged 65 and older who were admitted to the two hospitals were retrieved. The rate of emergency department visits in patients with dementia (23.2%) was lower than that in those without dementia (48.6%). The most frequent primary reason for emergency department visits and the main cause of patient death was pneumonia. Patients with dementia in the emergency department had higher hospital admission rates and longer hospital stays; however, the cost of treatment did not show a significant difference between the two groups. CONCLUSIONS: Future large and prospective studies should explore the severity of disease in older people with dementia and compare results with older adults without dementia in the emergency department.

Predictors of depressive symptoms among psychiatric nurses who suffered from workplace violence.

AIMS: We examined the possible factors that contributed to or prevented developing depressive symptoms among psychiatric nurses who suffered from workplace violence under Hill's ABC-X Model. BACKGROUND: Workplace violence-related depressive symptoms are some of the major causes leading to impaired quality of life of victims and a heavy burden on society. DESIGN: This is a cross-sectional and correlational study. METHOD: All participants were recruited from psychiatric wards of six hospitals in Taiwan. The data were collected through structured questionnaires from October 2013-March 2014 and a total of 278 psychiatric wards nurses participated in this study and completed all questionnaires. Logistic regression was used to examine the relationships among types and severity of violence, social support and depressive symptoms. RESULTS: Of assaulted psychiatric ward nurses, 75.9% had depressive symptoms and those with higher family support had significantly lower depressive symptoms. CONCLUSIONS: Family support plays the most important role among assaulted psychiatric ward nurses as a protective factor against developing depressive symptoms in this study.

The relationships among personality, social support, and resilience of abused nurses at emergency rooms and psychiatric wards in Taiwan.

The aim of the authors in this study was to identify factors associated with resilience that helped abused nurses face and cope with violent events. The data for this cross-sectional study were collected from June 2013 to December 2013; 272 participants were recruited from emergency rooms and psychiatric wards in four hospitals in central Taiwan. Among these participants, 230 (84.6%) met the inclusion criterion and completed all questionnaires; 69 (30%) of them reported having experienced only verbal violence; 46 (20%) reported having experienced only physical violence, and 115 (50%) reported having experienced a combination of verbal and physical violence. The following were positively associated with resilience score: having a college education or greater (exp(ß) = 1.045, p = .018), extraversion (exp(ß) = 1.012 per unit increase in the score, p < .001), family support (exp(ß) = 1.004 per unit increase in the score, p = .031), peer support (exp(ß) = 1.008 per unit increase in the score, p = .006), and lower level of neuroticism (exp(ß) = 0.983 per unit increase in the score, p < .001); 43.6% of the variance in resilience was explained by the variables assessed. Adequate support and advanced education are important for abused nurses to enhance their resilience.

Factors of Resilience in Emergency Department Nurses Who Have Experienced Workplace Violence in Taiwan.

PURPOSE: This study investigated the relationship among personality traits, social network integration (SNI), and resilience in emergency department (ED) nurses who had suffered from physical or verbal violence by patients or their families. DESIGN AND METHODS: A cross-sectional study with convenience sampling was conducted for exploring the related factors of resilience on abused nurses. A total of 187 participants met our inclusion criteria and completed all questionnaires. FINDINGS: Higher degrees of extraversion and peer support were associated with greater resilience among all abused nurses, whereas neuroticism was inversely associated with their resilience. CONCLUSIONS: Among all forms of SNI, only peer support was shown to enhance an individual's resilience. In addition, personality traits were associated with resilience, and religions did not play an important role in enhancing resilience among our participants. CLINICAL RELEVANCE: Through a clearer understanding of the role of peer support in resilience among ED nurses, healthcare managers should provide and enhance their peer support to intensify their resilience for prevention of consequences of workplace violence.

Association among components of resilience and workplace violence-related depression among emergency department nurses in Taiwan: a cross-sectional study.

AIM AND OBJECTIVES: This correlation study examined the relationship among recently workplace violence, depressive tendency, social support, and resilience of victimised nurses, and we also tried to identify protective factors and potential targets for preventive interventions for these nurses. BACKGROUND: Workplace violence in hospitals negatively affects occupational health and safety of medical professionals, especially for emergency department nurses. DESIGN: A cross-sectional, correlation research design was applied. METHODS: Hierarchical regression was used to examine data which were collected from June 2013 to December 2013 from emergency departments in Taiwan. One hundred and eighty nurses were recruited from two hospitals. Structured interviews and questionnaires were applied to collect data, including the Social Support Scale, the Resilience Scale and the Center for Epidemiologic Studies Depression. RESULTS: A total of 159 (88·33%) nurses had suffered from physical or verbal violence by patients or their family. Resilience and peer support were significantly higher in the group without depressive tendency. Components of resilience of personal strength, social competence, structure style and religious beliefs were significant factors which accounted for 46·0% of variance in depressive tendency. Three of the five components of resilience: personal strength, social competence and structured style were found to have profounder effects against depressive tendency than peer support. CONCLUSIONS: Hospital managers should establish a safer working environment for emergency department nurses and reinforce their resilience against depression when they encounter workplace violence. RELEVANCE TO CLINICAL PRACTICE: This study showed that three of the five components of resilience: personal strength, social competence and structured style are protective factors against depressive tendency in victimised nurses. Improving these three components with coping and problem-solving skills by healthcare manager would be effective measures for enhancing their resilience in situations of workplace violence.

Clinical competencies of emergency nurses toward violence against women: a delphi study.

BACKGROUND: An increasing number of survivors of intimate partner violence (IPV) have begun to seek help from hospital emergency departments. This study was conducted to develop a list of requisite clinical competencies for emergency nurses to provide adequate care for women experiencing IPV. METHOD: An e-mail survey using the Delphi technique was administered, involving three rounds of questionnaires from 30 participants. Participants were asked to score the importance of each item on a 4-point Likert scale. RESULTS: The study identified three dimensions, comprising 38 items of competencies related to care for individuals experiencing IPV, including Knowledge (10 items), Attitudes (11 items), and Practice (17 items). CONCLUSION: The emergency department is where direct medical treatment and care is provided for those who have experienced IPV. The study findings can provide a reference for the development of in-service educational programs in hospitals and can guide future policy making.

Social welfare utilization and needs of older adults in Taiwan: survey research.

BACKGROUND: The demand for long-term care for older adults has escalated sharply. A good policy dedicated to the welfare of older adults has improved their quality of life. The purpose of this study was to explore the social welfare utilization and needs of older adults and compare their differences among age groups, genders, and functional dependency levels. METHODS: Three hundred eighty-four stratified, random-sampled Taiwanese community-dwelling older adults were recruited for this survey research. Participants rated their utilization of and needs for the 30 social welfare services provided by the government on a Likert-type scale. RESULTS: The most widely used and needed social welfare services by the older adults were senior monetary stipend and a subsidy for the national health insurance premium. Young-old, male, and functionally independent older adults had more knowledge of the social welfare services than their counterparts. CONCLUSIONS: While designing a comprehensive social welfare system, differing needs of different age groups, genders, and functional dependency levels should be taken into consideration.

[The development of forensic nursing from the perspective of domestic violence and sexual assault preventive policies].

Forensic nursing is a new nursing specialty that provides forensic nursing service to domestic violence victims and offenders. Development of the role of forensic nurses has become urgent and necessary. The high rates of domestic violence and sexual assault in Taiwan suggest that forensic nurses have an important role to play in domestic healthcare. This article highlights the significance of forensic nursing in Taiwan in the future in terms of its origin, definitions, models, roles and functions, training and education, and previous studies. Through cooperation among academia, government, industry, and law enforcement agencies, it is expected that forensic nursing will be a positive and important area of expansion for professional nursing.

Understanding the Workplace-Violence-Related Perceptions and Coping Strategies of Nurses in Emergency Rooms.

BACKGROUND: Workplace violence (WPV) is a well-known and serious issue in most countries, and WPV against healthcare providers is of particular concern, especially among nurses working in emergency rooms (ERs). PURPOSE: We aimed to develop a deeper understanding of nurses' perceptions and coping strategies related to WPV that took place over a 1-year period from the perspective of nursing victims still working in ERs in southern Taiwan. METHODS: This is a qualitative study with in-depth and semistructured interviews. Nineteen ER nurse victims were recruited from six hospitals in southern Taiwan from June 2015 to April 2016. All of the interview recordings were analyzed using content analysis. RESULTS: The content analysis identified two themes of perceptions and two themes of coping strategies toward WPV. The two themes of perceptions were "adversity" and "dilemma," with the former covering the three subthemes of "misunderstanding of health policy," "unsafe environment," and "nursing shortage" and the latter covering the two subthemes of "burnout" and "keeping or quitting the job." The two themes of coping strategies were "adjustment" and "resilience," with the former covering the three subthemes of "acceptance of the reality of WPV," "self-regulation," and "culture and belief" and the latter covering the two subthemes of "living with WPV" and "problem solving." CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings revealed that ER nurse victims of WPV experienced a complicated journey after encountering WPV. Their coping strategies may be referenced by other ER nurses to better prevent and manage violent events in ERs. To prevent and manage violence in ERs, hospital managers should create a safe working environment through, for example, assigning sufficient security personnel and staff; provide relevant training to ER nurses in communications and other skills; and implement support systems to strengthen nurse resilience.

Nursing Assistant Staffing Model: Implementation and Outcome Evaluation in Taiwan Hospitals.

BACKGROUND: A key policy of the Taiwan healthcare system is promoting the hiring of nursing assistants (NAs) to reduce the workload of nurses. However, few studies in the literature have compared the relative effectiveness of different nurse staffing policies, and no studies have addressed the impact of the NA staffing (NAS) model. PURPOSE: This study explored the current status of the NAS model as implemented in Taiwan hospitals and to investigate the methods used to evaluate the outcomes of NAS model implementation. METHODS: A cross-sectional online survey was performed in hospitals nationwide from June 1 to December 31, 2018. There were 153 government-accredited hospitals being invited to participate in the survey. RESULTS: Of the 139 hospitals that completed the online survey, 26% (36 hospitals) had implemented the NAS model. Many of the hospitals had hired full-time, certified NAs. Most of the tasks assigned to NAs were in the nonprofessional/general and technical work categories. In addition, medical wards were the most frequently assigned workplace, especially on day shifts. Few of the surveyed hospitals had evaluated the effectiveness of the NAS model. Improvement after implementation of the NAS model (based on the 35 outcome indicators) was found to vary significantly. The most commonly used outcome indicator was patient satisfaction. All the stakeholders, including patients, family caregivers, nurses, and nurse supervisors, supported implementation of the NAS model. However, some of the participants expressed concerns regarding the difficulties involved with model implementation. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Although the NAS model may be beneficial, further empirical research is necessary to confirm the contributions of NAs. Additional evidence regarding the benefits of the NAS model for hospital performance and patient outcomes may be expected to motivate more hospital administrators to adopt this model.

Supportive Care Needs Trajectories in Patients With Advanced Non-Small-Cell Lung Cancer Receiving Chemotherapy: A Longitudinal Study.

BACKGROUND: The supportive care needs trajectories in patients with advanced non-small-cell lung cancer (NSCLC) during chemotherapy and the related factors have yet to be explored or addressed in the literature. PURPOSE: This study was designed to investigate supportive care needs trajectories in patients with advanced NSCLC receiving chemotherapy and the association between the sociodemographic and disease characteristics of these patients over the four cycles of chemotherapy. METHODS: For this longitudinal study, 95 patients with advanced NSCLC were recruited using convenience sampling at a medical center in Taiwan. The supportive care needs of the participants were assessed in each of the four chemotherapy cycles using the Needs Evaluation Questionnaire-Chinese version (NEQ-C) with 23 dichotomous items on the day before and the seventh day after the end of each cycle. Group-based trajectory modeling was applied to identify the classes of supportive care needs trajectories, whereas chi-square tests were used to examine the factors related to these classes. RESULTS: Seventy-one participants completed all eight questionnaire sessions across the four cycles. The mean NEQ-C scores for these participants ranged between 14.4 and 14.6. Three classes of supportive care needs trajectories (low, moderate, and high) were identified for the entire NEQ-C and for each domain. Marital status was found to be associated with the classes of trajectories related to supportive care and assistance/care needs, spouse as the primary caregiver was found to be associated with the classes of trajectories related to information needs, and educational level was found to be associated with the classes of trajectories related to psychoemotional support needs. CONCLUSIONS: The results of this study indicate that marital status and spouse as primary caregiver relate significantly to supportive care needs trajectories in patients with advanced NSCLC during chemotherapy. Healthcare professionals should provide continuous, tailored supportive care interventions that address the needs of patients and their spouses/partners.

Efficacy of a Smartphone App in Enhancing Medication Adherence and Accuracy in Individuals With Schizophrenia During the COVID-19 Pandemic: Randomized Controlled Trial.

BACKGROUND: Poor medication adherence or inaccuracy in taking prescribed medications plays an important role in the recurrence or worsening of psychiatric symptoms in patients with schizophrenia, and the COVID-19 pandemic impacted their medication adherence with exacerbated symptoms or relapse. The use of mobile health services increased during the COVID-19 pandemic, and their role in improving mental health is becoming clearer. OBJECTIVE: This study aimed to explore the effectiveness of a smartphone app (MedAdhere) on medication adherence and accuracy among patients with schizophrenia and to measure their psychiatric symptoms and cognitive functions. METHODS: In this 12-week experimental study, participants were provided interventions with the MedAdhere app, and data were collected between June 2021 and September 2022. A total of 105 participants were randomly assigned to either the experimental or control groups. We used the Positive and Negative Syndrome Scale and Mini-Mental State Examination to measure the participants' psychiatric symptoms and cognitive functions. Generalized estimating equations were used for data analysis. RESULTS: A total of 94 participants met the inclusion criteria and completed the protocol, and the medication adherence rate of the experimental group was 94.72% (2785/2940) during the intervention. Psychotic symptoms (positive, negative, and general psychopathology symptoms) and cognitive functions (memory, language, and executive function) were significantly improved in the experimental group compared to the control group after the intervention. CONCLUSIONS: The MedAdhere app effectively and significantly improved medication adherence and, thereby, the psychiatric symptoms of patients with schizophrenia. This artificial intelligence assisted app could be extended to all patients who need to be reminded to take medication on schedule. TRIAL REGISTRATION: ClinicalTrials.gov NCT05892120; https://clinicaltrials.gov/study/NCT05892120.

Mediator Roles of Social Support and Hope in the Relationship Between Body Image Distress and Resilience in Breast Cancer Patients Undergoing Treatment: A Modeling Analysis.

Breast cancer and its treatment are particularly distressing for patients because of their potential impacts on body image. The most difficult phase of cancer treatment is usually the first year after a diagnosis. Cancer patients with strong resilience have the positive attitude, internal strength and external resources needed to cope with the disease and its treatment. This cross-sectional study investigated the mediator roles of hope and social support in the association between body image distress and resilience. A structured questionnaire was used to collect data for a convenience sample of 141 breast cancer patients undergoing treatment in southern Taiwan. Structural equation modeling was used for data analysis. The results showed that the final model had a good fit to the data and accounted for 51% of the total variance in resilience. The model of multiple parallel mediators of resilience revealed that hope and social support had mediator roles in the effect of body image distress on resilience. Hope had an important partial mediating role in the association between body image distress and resilience. Social support also had a partial mediating role in the relationship between body image distress and resilience. Social support did not directly affect resilience and indirectly affected resilience through hope. Psychosocial interventions aimed at reducing the impact of body image distress and increasing resilience in breast cancer patients should focus on cultivating hope and increasing social support, particularly support from family members and health professionals.

Exploring the Mediating Effects of Cognitive Function, Social Support, Activities of Daily Living and Depression in the Relationship between Age and Frailty among Community-Dwelling Elderly.

With 16.15% of its total population aged 65 or above, Taiwan is already an aging society. Frailty is a natural consequence of aging, which may decrease physical strength and deteriorate physiological functioning. We examined the mediating effects of cognitive function, social support, activities of daily living (ADL), and depression in the relationship between age and frailty in older people living in the community. This cross-sectional study used a structured questionnaire to collect data from a convenience sample of 200 pre-frail to mildly frail older adults in southern Taiwan. Structural equation modeling was used for data analysis, with data collected from July to November 2020. ADL mediated the relationship between age and frailty, while cognitive function also mediated the relationship between age and frailty, indicating that ADL and cognitive function were significant determinants of frailty. The path from age to frailty was significant, indicating that age was a significant determinant of frailty. The standardized total effect of age affected frailty through the mediating roles of ADL and cognitive function. Age, depression, ADL, and cognitive function explained 59% of the variance in frailty among older adults. ADL and cognitive function are significant mediators of frailty among older adults.

Exploring Quality of Life, Stress, and Risk Factors Associated with Irritable Bowel Syndrome for Female University Students in Taiwan.

Irritable bowel syndrome (IBS) is a common recurrent functional gastrointestinal disorder that impacts on patients physically and mentally. Studies on IBS have focused on adults, yet few studies have examined IBS among female university students. The aim of this study was to investigate the prevalence of IBS for female university students and its related factors. Using a cross-sectional study design, a total of 2520 female university students were recruited in southern Taiwan. The structured questionnaires, including the Rome III IBS diagnostic questionnaire, IBS symptom severity scale, Perceived Stress Scale, and World Health Organization Quality of Life BREF questionnaire (WHOQOL-BREF) were used for data collection. A total of 1894 female students complete the questionnaires. The response rate was 75.15%. The results indicated 193 female students with IBS and the prevalence of IBS was 10.1%. IBS female students had higher levels of stress and lower QOL than non-IBS female students. The risk factors for female university students developing IBS were dysmenorrhea, food avoidance, class absenteeism, and the lower physical domain of QOL. It is advised to consider these factors when providing students with counselling and relevant services in the expectation of alleviating their IBS symptoms, reducing the incidence rate of IBS, and further improving their QOL.

Relations between Stress and Depressive Symptoms in Psychiatric Nurses: The Mediating Effects of Sleep Quality and Occupational Burnout.

This study examines the parallel multiple mediators of quality of sleep and occupational burnout between perceived stress and depressive symptoms in psychiatric nurses. Nurses are more likely to experience depression, anxiety, decreased job satisfaction, and reduced organizational loyalty as a result of the stressful work environment and heavy workload. A total of 248 psychiatric ward (PW) nurses participated in this cross-sectional survey study. Structural equation modelling was used for data analysis. In the model of parallel multiple mediators for depressive symptoms, quality of sleep and occupational burnout played mediating roles, and these two mediators strengthened the effect of stress on depressive symptoms, with the final model showing a good fit. Stress, occupational burnout, and quality of sleep explained 46.0% of the variance in psychiatric nurses' depressive symptoms. Stress had no significantly direct effect on psychiatric nurses' depressive symptoms, but it had a completed mediation effect on their depressive symptoms through occupational burnout and quality of sleep. This study showed that reduction of occupational burnout and improvement of quality of sleep play important roles against depressive symptoms among PW nurses. Healthcare managers should provide PW nurses with a better environment for improving quality of sleep and reducing occupational burnout.