Clinical internship environment and caring behaviours among nursing students: A moderated mediation model.

BACKGROUND: Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students' caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy. RESEARCH OBJECTIVE: This study aimed to examine the mediating effect of moral sensitivity and the moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours. RESEARCH DESIGN: A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro. PARTICIPANTS AND RESEARCH CONTEXT: This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China. ETHICAL CONSIDERATIONS: This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students. RESULTS: The clinical internship environment (B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity (B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students' caring behaviours via moral sensitivity (B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours (B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity (B = 0.006, 95% CI = [0.003, 0.010]). CONCLUSION: Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students.

The experience of anxiety among Chinese undergraduate nursing students in the later period of their internships: findings from a qualitative study.

BACKGROUND: Clinical internships are a critical transition period for nursing students to develop into nursing professionals and are essential for the solidification of their professional attitudes. Undergraduate nursing students face multiple sources of severe anxiety that affect their nursing career development during this period. This study aimed to understand the anxiety experienced by undergraduate nursing students in the later period of their internship periods in a Chinese educational context. METHODS: A descriptive qualitative study was conducted. A purposive sample of 17 undergraduate nursing interns with experiences of anxiety was selected from three teaching hospitals in Hunan Province, China. Data were collected through semi-structured interviews and analyzed using the Colaizzi seven-step method for data analysis. RESULTS: Three themes emerged: the sources of perceived anxiety, the psychological journey of coping with anxiety, and suggestions for nursing management and education. The sub-themes for the first theme included career decision dilemmas, competitive pressures for employment, worries about progress of the graduation projects, challenges of the nursing licensure examination, and low self-confidence in clinical competence. The second theme consisted of two sub-themes: negative avoidance and retreat, and positive preparation and response. The third theme consisted of policy support to create more employment opportunities, comprehensive guidance from nursing schools and hospitals, and psychological assistance and counseling. CONCLUSIONS: This study revealed that undergraduate nursing students were prone to anxiety during the later period of their clinical internships. Specific sources of anxiety encompassed career decision-making, job pursuit, graduation, and licensure examination. Undergraduate nursing students adopted both positive and negative approaches in coping with anxiety during the later period of their clinical internships. Nursing educators and administrators should develop appropriate instructions and support systems to reduce anxiety among undergraduate nursing students.

Factors influencing the professional identity of nursing interns: a cross-sectional study.

BACKGROUND: Improving the professional identity of nursing intern is significant for enhancing the number of new registered nurses and easing the shortage of nursing personnel. The clinical internship is a key period for the formulation of professional identity. However, we know little about the factors influencing the nursing interns' professional identity during clinical internship. Therefore, this study explore the influencing factors of nursing interns' professional identity during clinical internship. This study will provide evidence and suggestions for generating effective strategies contributing to professional identity improvement of nursing interns. METHODS: This was a cross-sectional study. The convenience sampling was used to recruit 398 nursing interns from a teaching hospital in Hunan, China. The demographic characteristics information was collected by a self-developed questionnaire. The nursing interns' professional identity and potential influencing factors (e.g., work atmosphere, teacher capacity) were measured by questionnaires with good psychometric properties. The appropriate indicators were used for descriptive statistics, and t test, analysis of variance, Pearson's correlation analysis and multiple linear regression were used to analyse the influencing factors. RESULTS: In this study, the influencing factors of nursing interns' professional identity are education level, first choice of major, residential status, work atmosphere, and teacher capacity. The results showed that: (1) the nursing interns with a higher education level reported a lower level of professional identity; (2) the nursing interns whose first choice of major was not nursing discipline reported a lower level of professional identity; (3) the nursing interns live in rural areas (compared to urban areas) reported a higher level of professional identity; (4) the nursing interns in better work atmosphere reported a higher level of professional identity; (5) the nursing interns under the guidance of the teachers equipped with better teaching capacity reported a higher level of professional identity. CONCLUSION: The education level, first choice of major and residential status are influence factors of nursing interns' professional identity. The nursing educators need to pay attention to nursing interns whose first choice is not nursing, and in a bachelor program, who may have a lower level of professional identity. It is crucial to enhance the nursing interns' professional identity by improve the work atmosphere and clinical teachers' capacity, to promote nursing interns to choose nursing as a profession and reduce the shortage of nursing workforce.

Clinical efficacy of drug-eluting coronary stents based on real-world data. / åŸºäºŽçœŸå®žä¸–ç•Œæ•°æ®çš„å† çŠ¶åŠ¨è„‰è¯ç‰©æ¶‚å±‚æ”¯æž¶çš„ä¸´åºŠåº”ç”¨æ•ˆæžœ.

OBJECTIVES: As the main implant material, coronary stent is one of the main factors that affect clinical treatment outcome and patient cost. The choice for coronary stent in clinic depends on multiply factors including patient preference, medical personnel expertise and current technology, and no recognized method has been established for the evaluation and choice of coronary stent. In this study, we aim to evaluate the safety, effectiveness, and economy of a few drug-eluting coronary stents in clinic. METHODS: A retrospective analysis was employed to study the cases treated by drug-eluting stent intervention in a third grade hospital from January 2018 to December 2019. Based on the specific products, these cases were assigned into a domestic stent A group, a domestic stent B group, a domestic stent C group, and an imported stent group. According to the severity of the disease, they were divided into an angina pectoris, an acute myocardial infarction, and an ischemic heart disease subgroups. Layer analysis was carried out for inter-subgroup comparisons in terms of safety (indicated by mortality rate, complication rate, and infection rate), efficacy (indicated by 31-day return rate, 365-day myocardial infarction rate, restenosis rate, secondary intervention rate, and thrombosis rate), and economy (indicated by averaged total cost and coronary stent cost). RESULTS: Among the 4 products, there was no difference in safety (P>0.05). Except for patients with acute myocardial infarction, there was no significant difference in the effectiveness of the 4 products for the other 2 diseases. The economical aspect of the domestic stent B and the domestic stent C was better than that of the domestic stent A and the imported stent (all P<0.05). CONCLUSIONS: With all the indicators of these 4 stents taken into consideration, we conclude that hospitals may appropriately increase the share of domestic coronary stent in product selection and in-hospital management. This measure helps increase product localization rate and ease the financial burden for patients by reducing coronary stent cost.

Cost-effectiveness of Morse Fall Scale assessment in fall prevention care in hospitalized patients. / Morseè·Œå€’é‡è¡¨è¯„ä¼°åœ¨ä½é™¢æ‚£è€ é˜²è·Œå€’æŠ¤ç†ä¸­çš„æˆæœ¬æ•ˆæžœ.

OBJECTIVES: To analyze the cost-effectiveness of the Morse Fall Scale by clinical big data for nurses in the prevention of falls in hospitalized patients. METHODS: A total of 59 358 hospitalized patients, who came from the Third Xiangya Hospital of Central South University in 1 year before nurses were trained by the Morse Fall Scale, served as a control, including 26 862 males and 32 496 females. While the 66 203 hospitalized patients served as an observation group in 1 year after nurses were trained by the Morse Fall Scale, including 29 881 males and 36 322 females. The time spent by clinical nurses in the fall-risk assessment and the fall number were recorded in the 2 groups, and the relationship was analyzed between the Morse Fall Scale assessment and the clinical ending along with the labor cost of nursing. The cost-effectiveness was analyzed. In addition, the incidence of fall in the observation group was compared between the falling high-risk patients and the non-high-risk patients. RESULTS: The Morse Fall Scale showed that the incidences of fall in the observation group and the control group were 3.39/100 000 and 3.82/100 000,respectively, there was no significant difference between the 2 groups (U=0.807, P>0.05); the injury rates of falls of Grade 2 and above in the observation group and the control group were 27.30% and 20.00%, respectively, with no significant difference (χ2=0.345, P>0.05); but the labor cost was increased by 130 641.82 Chinses Yuan, and the incremental cost-effectiveness ratio was 43 547.27. However, the incidence of fall was significant higher in the falling high-risk patients by the assessment of the Morse Fall Scale than that in the non-high-risk patients (U=2.941, P<0.05). CONCLUSIONS: The evaluation of the Morse Fall Scale has a certain effect, but it is limited in the prevention of falls in adult hospitalized patients, and the cost-effectiveness analysis is not good. It is recommended to implement the intervention measures for high-risk patients after the assessment, which may improve the management level and efficiency of fall prevention.

Effect of borneol on the transdermal permeation of drugs with differing lipophilicity and molecular organization of stratum corneum lipids.

The aim of the present paper was to investigate the promoting activity of borneol on the transdermal permeation of drugs with differing lipophilicity, and probe its alterations in molecular organization of stratum corneum (SC) lipids. The toxicity of borneol was evaluated in epidermal keratinocyte HaCaT and dermal fibroblast CCC-HSF-1 cell cultures and compared to known enhancers, and its irritant profile was also assessed by transepidermal water loss (TEWL) evaluation. The promoting effect of borneol on the transdermal permeation of five model drugs, namely 5-fluorouracil, antipyrine, aspirin, salicylic acid and ibuprofen, which were selected based on their lipophilicity denoted by logp value, were performed using in vitro skin permeation studies. Attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FTIR) was employed to monitor the borneol-induced alteration in molecular organization of SC lipids. The enhancer borneol displayed lower cytotoxicity or irritation in comparison to the well-established and standard enhancer Azone. Borneol could effectively promote the transdermal permeation of five model drugs, and its enhancement ratios were found to be parabolic curve with the logp values of drugs, which exhibited the optimum permeation activity for relatively hydrophilic drugs (an estimated logp value of -0.5 ∼0.5). The molecular mechanism studies suggested that borneol could perturb the structure of SC lipid alkyl chains, and extract part of SC lipids, resulting in the alteration in the skin permeability barrier.

[Effect of the integration pattern of hospital-community on the grade-based management for hypertension in elders].

OBJECTIVE: To investigate the effect of the integration pattern of hospital-community on the grade-based management for hypertension in elders.
 METHODS: We randomly chosen 218 (male, n=121; female, n=97) primary senile hypertension patients from a Community Health Service Center of District in Changsha City, from June, 2013 to December, 2013. Based on the risky factors, the subjects were divided into three groups and every group received grade-based management on blood pressure with a integration pattern of hospital-community for six months. According to the HILL-BONE high blood pressure compliance scale and the self- designed blood pressure monitoring form, we assessed the effect of compliance and blood pressure control on senile hypertension patient. 
 RESULTS: Hypertension treatment rate for the elders ranged from 22.9% to 88.1% (P<0.01). The levels of blood pressure of the subjects were significantly decreased compared with baseline. The level of diastolic blood pressure in the low, average, high and very high-risk group was decreased by 17, 20 and 23 mmHg, respectively (P<0.01). The level of systolic blood in the low, average, high and very high-risk group was decreased by 6, 5 and 7 mmHg, respectively (P<0.01). The compliance rate of HILL-BONE hypertension rose from 54.5% to 87.4% (P<0.01).
 CONCLUSION: The integration pattern of hospital-community with the grade-based management for hypertension significantly improved the senile hypertension control rate and compliance of drug treatment. The rational for drug usage rate rose obviously. The integration pattern of hospital-community with the grade-based management for elders deserves to spread.

[Depression in patients with facial acne vulgaris and the influential factors].

OBJECTIVE: To understand the influential factors for depression in patients with facial acne vulgaris and to provide scientific evidence for a comprehensive and systematic treatment for acne vulgaris.
 METHODS: A total of 287 outpatients with facial acne vulgaris, who visited the dermatology of the Third Xiangya Hospital, were surveyed by Beck Depression Inventory (BDI). The data was collected by Epidata software (version 3.1) and processed by SPSS software package (version 18.0). The influential factors for the depression of outpatients with facial acne vulgaris were analyzed by multinomial logistic regression.
 RESULTS: A total of 181 patients with facial acne vulgaris showed various degrees of depression (BDI score≥5) and the rate was 63.1%. The symptoms for depression included sad and pessimistic attitude as well as the decreased attention to others (social withdrawal). The influential factors for mild, moderate or severe depression were gender, the degree and the course of acne. Female patients were more likely to suffer mild, moderate or severe depression (OR=3.62, 2.63, respectively); the risk of depression in acne patients was increased with the increase in degree of the severity (OR=2.31, 4.51, respectively); the patients with the acne course more than a year were more likely to show mild depression than those with a course less than a year (OR=4.30, 7.44, respectively). The patients with acne course more than 3 years were more likely to show moderate or severe depression compared to those with a course less than a year (OR=3.60).
 CONCLUSION: Most of facial acne patients show a different degree of depression. The acne course is longer in female patients. The more severe the acne vulgaris is, the more suffering of the depression is. Psychological care should be considered to improve the treatment and quality of life.

A social epidemiological study on HIV/AIDS in a village of Henan Province, China.

The HIV/AIDS epidemic caused by commercial blood donation in rural Henan Province of China in the early- to mid-1990s is the largest known cohort in the world related to blood donation but is not fully described. The objectives of this study were to describe the epidemic, epidemiology, and social epidemiology of commercial blood donation and HIV/AIDS. Both qualitative and quantitative mixed methods were used. A village was randomly selected from the 38 key HIV/AIDS pandemic villages in Henan Province. "Demographic Data Form" was applied to collect demographic information of each resident. Focus groups were held for the managers, some residents, members of "HIV/AIDS Work-Team" (organized by the Henan Provincial Government) in the village. Every village physician, people living with HIV/AIDS (PLWHA), school header, and other stakeholders were interviewed individually. The social epidemiology of HIV/AIDS was analyzed under three perspectives of the framework: individual, social, and structural perspectives. In this village, there were 2335 residents, 484 (20.3%) were former donors, 107 (4.6%) were PLWHA, and 96.3% of PLWHA were infected through commercial blood donation. Individually, low education and plasma donation were the risky factors of HIV/AIDS infection. Socially, the epidemic was geography-, kinship-, and conformity-related. Structurally, the related macrostructure factor was policy endorsement of national blood products. The microstructure factors were poverty and value belief on male child in passing down generations. It is concluded that commercial blood donation and HIV/AIDS epidemic in the village are symbiotically related. The epidemic is temporary and socially determined.

Pathways from the clinical learning environment and ego identity to professional identity: A cross-sectional study.

BACKGROUND: The clinical learning environment and ego identity are positively related to professional identity. However, the pathways from these factors to professional identity are unknown. Aim This study explores the pathways from the clinical learning environment and ego identity to professional identity. METHODS: The study used a convenience sampling method in a comprehensive hospital in Hunan Province, China to enrol 222 nursing interns between April and May 2021. General information questionnaires and scales with good psychometric properties (e.g., Environment Evaluation Scale for Clinical Nursing Internship, Ego Identity Scale, and Professional Identification Scale) were used to collect data. A structural equation model was used to explore the relationships between the clinical learning environment, ego identity, and professional identity among nursing interns. RESULTS: The professional identity of nursing interns was positively correlated with the clinical learning environment and ego identity. The clinical learning environment had a direct effect (Effect = -0.052, P < 0.05) and an indirect effect through ego identity (Effect = -0.042, P < 0.05) on nursing interns' professional identity. CONCLUSION: The clinical learning environment and ego identity are important influencing factors of professional identity among nursing interns. Therefore, clinical teaching hospitals and teachers should pay attention to the improvement in the clinical learning environment and the cultivation of nursing interns' ego identity.

[Analysis of the relationship between the MecA gene and resistance of ß-lactam antibiotics].

OBJECTIVE: To investigate the mechanisms by which MecA gene expression leads to ß-lactam resistance in methicillin-resistant Staphylococcus aureus (MRSA), and to study the resistance mechanism of MRSA at the molecular level. METHODS: A variety of molecular biological techniques were employed, including screening MRSA using cefoxitin paper disk method, extraction of MRSA mRNA, reverse transcription into cDNA, real-time fluorescence PCR for quantitation of MecA gene expression, and agar dilution method for assessment of minimum inhibitory concentrations in MRSA treated with cefoxitin, oxacillin, vancomycin, or linezolid. RESULTS: According to the level of resistance of MRSA to cefoxitin, 40 MRSA strains were divided into a low resistance group (n=12), a middle resistance group (n=15), and a high resistance group (n=13). The expression level of the MecA gene in the low resistance group, the middle resistance group, and the high resistance group was 58.87±30.30, 363.37±200.05, and 1257.72±446.63, respectively. MRSA resistance to cefoxitin and oxacillin was 100%; MRSA resistance to vancomycin or linezolid could not be detected. For all 40 MRSA strains the MIC90 for vancomycin was 2.0 µg/mL. CONCLUSION: MecA gene expression levels may correlate with the MRSA level of resistance to cefoxitin within a certain range of concentration.

Self-perceived burden and associated factors in Chinese adult epilepsy patients: A cross-sectional study.

Objectives: Epilepsy requires long-term or lifelong treatment, and patients are prone to financial, emotional and psychological burdens that can cause psychological changes during the treatment process. This study aimed to describe the prevalence and associated factors of Self-Perceived Burden (SPB) in Chinese adult epilepsy patients, informing the treatment and nursing of epilepsy. Methods: A total of 143 adult epilepsy patients were included in this study, and the clinical questionnaire survey was conducted at the Third Xiangya Hospital of Central South University in Hunan, China, from March 2022 to June 2022. The sociodemographic and clinical characteristics of adult epilepsy patients were collected using a self-developed questionnaire, and the data on SPB, stigma and quality of life were collected through the Self-Perceived Burden Scale (SPBS), Kilifi Stigma Scale for Epilepsy (KSSE) and Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Multiple linear regression analysis was used to determine the associated factors influencing SPB in adult epilepsy patients. Results: The average score of SPBS for the 143 adult epilepsy patients was 30.77 (SD = 9.06), and 89.5% of them had obvious SPB. The results of the univariate analysis showed that residence, monthly household income, duration of epilepsy, type of medication and electroencephalogram finding were associated with SPB (P < 0.05). In Spearman correlation analysis indicated that SPBS score were positively correlated with KSSE score (r = 0.510, P < 0.05) while negatively correlated with QOLIE-31 score (r = -0.506, P < 0.05). Multiple linear regression analysis revealed that factors such as KSSE, type of medication, residence and electroencephalogram finding accounted for 32.8% of the factors influencing SPB in adult epilepsy patients. Conclusion: 89.5% of adult epilepsy patients have varying degrees of SPB, which is associated with high stigma and poor quality of life. Therefore, during the treatment and nursing of adult epilepsy patients, clinical staff should pay attention to the psychological status of patients, help them reduce their psychological burden, and guide them to develop a healthy lifestyle.

Nursing students' perceptions and experiences of e-internships during the COVID-19 pandemic: A phenomenological study.

BACKGROUND: Clinical internship is an indispensable stage for nursing students to graduate successfully and become qualified nurses. However, COVID-19, a novel coronavirus disease with strong human-to-human transmission, hit China in late 2019 and forced the Chinese government to suspend classes and clinical internships. To cope with this situation, e-internship, which facilitate varied interactions without the need for direct contact, is used as an alternative strategy to help nursing students continue their internships. OBJECTIVES: To describe the perceptions and experiences of undergraduate nursing students in e-internships during the COVID-19 pandemic. METHODS: A descriptive phenomenological design was adopted. Seventeen undergraduate nursing students in a major teaching hospital in Changsha, China, were recruited into the study. Data were collected through semi-structured, in-depth, face-to-face interviews. The interviews were transcribed verbatim and analyzed using Colaizzi's approach. RESULTS: Four themes were captured from the data analysis: perceived images of clinical nurses in e-internships, psychological experience, perceived benefits of e-internships, and perceived limitations of e-internships. CONCLUSIONS: Our findings suggest that e-internship is a suitable method for training and cultivating undergraduate nursing students during a crisis. To enhance the efficiency of e-internships, guidelines and standards should be formulated, and effective measures should be taken to build better e-internship platforms. In the future, we suggest combine on-site internships with e-internships, thereby fully using their advantages, and improve the efficiency of internships as much as possible.

Prediction Model of Immunosuppressive Medication Non-adherence for Renal Transplant Patients Based on Machine Learning Technology.

OBJECTIVES: Predicting adherence to immunosuppressive medication (IM) is important to improve and design future prospective, personalized interventions in Chinese renal transplant patients (RTPs). METHODS: A retrospective, multicenter, cross-sectional study was performed in 1,191 RTPs from October 2020 to February 2021 in China. The BAASIS was used as the standard to determine the adherence of the patients. Variables of the combined theory, including the general data, the HBM, the TPB, the BMQ, the PSSS and the GSES, were used to build the models. The machine learning (ML) models included LR, RF, MLP, SVM, and XG Boost. The SHAP method was used to evaluate the contribution of predictors to predicting the risk of IM non-adherence in RTPs. RESULTS: The IM non-adherence rate in the derivation cohort was 38.5%. Ten predictors were screened to build the model based on the database. The SVM model performed better among the five models, with sensitivity of 0.59, specificity of 0.73, and average AUC of 0.75. The SHAP analysis showed that age, marital status, HBM-perceived barriers, use pill box after transplantation, and PSSS-family support were the most important predictors in the prediction model. All of the models had good performance validated by external data. CONCLUSIONS: The IM non-adherence rate of RTPs was high, and it is important to improve IM adherence. The model developed by ML technology could identify high-risk patients and provide a basis for the development of relevant improvement measures.

Corrigendum: Prediction model of immunosuppressive medication non-adherence for renal transplant patients based on machine learning technology.

[This corrects the article DOI: 10.3389/fmed.2022.796424.].

Examining impulsivity and risky decision making among school youth in balloon analogue risk task.

BACKGROUND: Impulsivity trait as a risk factor which typically displayed in risk decision among school youth. This study aims to examine behavioral and cognitive problems of risky decision among Chinese young people aged 15-25 years. The balloon analogue risk task (BART) and event-related potential (ERP) were combine used to explore the neural mechanism of risky decision process whether infected by impulsivity trait. METHODS: A total of 31 subjects were included, including 16 experimental subjects with risk behavior (RS), and 15 health control subjects with non-risk behavior (HC). BART were used to measure risk-taking propensity and ERP were to record in real time. RS vs. HC were compared to explain the relationship between impulsivity and risky decision. RESULTS: Behavioral data in BART task shown that the RS subjects tended to make risky decisions. ERP results illustrate that P300 in RS subjects is more significant positive-going than HC that means dysfunction of cognitive control, and FRN in RS subjects is more negative-going than HC in negative feedback condition, which means individual with high impulsive would be more sensitive to unexpected outcome. CONCLUSIONS: Impulsiveness is a risk factor for school adolescent, because RS subjects performed more risky decision than control group, the evidence indicate that individual with high impulsiveness would lead to be less sensitive to harmful consequences and more inclination to immediate rewards. Therefore, the inclination of risk taking can be powerfully informed by different levels of impulsiveness.

Self-Efficacy Intervention Programs in Patients with Chronic Obstructive Pulmonary Disease: Narrative Review.

Chronic obstructive pulmonary disease (COPD) is a common chronic disease whose development is irreversible, which leads to more than six million deaths each year. There is no treatment confirmed effective for the improvement of impaired lung function, but the combination of drug therapy with non-drug therapy such as pulmonary rehabilitation training has demonstrated a great potential in reducing the occurrence of complications and delaying the progression of COPD. Self-efficacy is the core of cognitive theory, which is crucial for chronic disease management. It has been proposed as an important component of disease management to help people develop skills to manage diseases more effectively. This study reviewed the development of self-efficacy and its application in patients with COPD, with the purpose of providing a better clinical reference for the treatments of COPD.

Undergraduate nursing students' participation in pre-hospital first aid practice with ambulances in China: A qualitative study.

OBJECTIVES: The aim of this study is to understand the feelings and experiences of nursing undergraduates who participate in pre-hospital first aid and to explore the training programme of pre-hospital first aid for nursing undergraduates. The main objective is to provide a reference for the reform of pre-hospital first aid teaching in undergraduate colleges. METHODS: Semi-structured interviews were conducted with 16 nursing undergraduates who had participated in pre-hospital first aid in an ambulance from a teaching hospital in Hunan, China. The interview data were transcribed, and Colaizzi's seven-step method was used for subject analysis. RESULTS: The experiences of undergraduate nursing interns can be summarized into five themes: helplessness and fear of death, uncertainty of unknown events, satisfaction with self-improvement, need for professional competence, and the perception of a gap in pre-hospital emergency resources. CONCLUSIONS: Nursing colleges and teaching hospitals should pay attention to death education and pre-hospital first aid training. Teachers should be able to apply situational teaching methods to pre-hospital first-aid teaching and should focus on cultivating the comprehensive abilities of nursing students. At the same time, schools and teaching hospitals should also strengthen the cultivation of professional identity during pre-hospital first aid practice to reduce the rate of nursing personnel turnover. It's very important to supplement and retain professional nurses for the pre-hospital first aid.

A modified 6-form Tai Chi for patients with COPD.

BACKGROUND AND OBJECTIVE: 24-form Tai Chi is a traditional exercise popular among old people in China, but it has some complex movements beyond of capabilities of patients with COPD. This study was to modify and simplify 24-form Tai Chi and evaluate effects of the modified Tai Chi on lung function, exercise capacity, dyspnea symptom and health status in patients with COPD. METHODS: A two-step procedure was applied: an initial qualitative research module consisting of focus group discussion, expert consultation and patient interviews was conducted to simplified and modified 24-form Tai Chi for patients with COPD. Then, a randomized controlled trial consisting of 60 patients with II to IV COPD was conducted to evaluate effects of the modified Tai Chi on lung function (FEV1%), exercise capacity (Six minutes walking distance,6MWD), dyspnea symptom (Modified Medical Research Council Scale, mMRC) and health status (COPD Assessment Test, CAT). All measures were obtained at baseline, 3-month follow-up and 9-month follow-up. RESULTS: A new simpler 6-form Tai Chi that combining characteristics of COPD, the experts' wisdom and patients' needs was developed. Patients with COPD can grasp it in about 3 h and participants showed 86.0% adherence to the Tai Chi training and no negative accidents occurred. Generalized estimating equations (GEE) showed that there were significant differences in FEV1%, 6MWD and CAT scores between modified Tai Chi (MTC) group and the control group over time (model group × time interaction χ2 = 13.68, P < 0.001; χ2 = 192.39, P < 0.001;χ2 = 6.05, P = 0.014, respectively), however, no statistical significance in mMRC scores was found between the 2 groups over time (model group × time interaction χ2 = 3.54, P = 0.06). The baseline of FEV1%,6MWD, mMRC scores and CAT scores are significant covariates for lung function, exercise capacity, dyspnea symptom and health status, respectively (χ2 = 149.43, P < 0.001; χ2 = 5.78, P = 0.016; χ2 = 66.71, P < 0.001; χ2 = 81.83, P < 0.001, respectively). CONCLUSIONS: This modified 6-form Tai Chi routine is easy to grasp, easy to adhere to, safe to practice and effective to improve lung function, exercise capacity, health status and to prevent dyspnea symptom from getting worse for patients with COPD and it can be recommended as a suitable exercise therapy for them.

A safety culture training program enhanced the perceptions of patient safety culture of nurse managers.

Positive perceptions of patient safety culture are associated with lower rates of adverse events, but they have not been widely established in many health care organizations. The purpose of this study is to examine the impacts of a safety culture training program (SCTP) on enhancing the perceptions of patient safety in nurse managers. This was a quasi-experimental design. 83 nurse managers were recruited from five randomly selected 2nd level hospitals. Sixty-seven nurse managers received training under the educational SCTP. The Hospital Survey on Patient Safety Culture (HSPSC) and Chinese Safety Attitudes Questionnaire (C-SAQ) were administered just before and six months after the educational program. The data of hospital-acquired pressure ulcers, patient falls, and unplanned extubations were collected. The total positive scores of HSPSC were significantly improved and four dimensions of C-SAQ significantly increased six months after SCTP. The rate of patient falls and rate of hospital-acquired pressure ulcers decreased significantly six months post SCTP. In conclusion, nurse manager participation in a SCTP can enhance the perceptions of patient safety and reduce the rates of adverse events. More rigorous trials with larger numbers of participants and a control group are needed to strengthen the conclusions.