RESUMO
OBJECTIVE: To examine the dyadic effects of rumination and self-disclosure on posttraumatic growth among newly diagnosed gynecological cancer couples. METHODS: This cross-sectional study recruited 400 newly diagnosed gynecological cancer couples from a tertiary general hospital from July to December 2020. Questionnaires were administered to collect information on demographic and cancer-related characteristics, rumination, self-disclosure, and posttraumatic growth. The actor-partner interdependence model was used to explore the dyadic effects of rumination and self-disclosure on posttraumatic growth. RESULTS: Gynecological cancer survivors reported more posttraumatic growth than their spouses. The patients' deliberate rumination and self-disclosure and spouses' self-disclosure had actor and partner effects on their own and their spouses' posttraumatic growth. Besides, the patients' intrusive rumination and spouses' deliberate rumination had actor effects on their own posttraumatic growth. CONCLUSIONS: Spouses' posttraumatic growth was influenced by their own and their wives' deliberate rumination and self-disclosure, while survivors' posttraumatic growth was affected by their own deliberate rumination, intrusive rumination, self-disclosure, and their spouses' self-disclosure. Promoting deliberate rumination and self-disclosure could facilitate the couples' posttraumatic growth. Besides, reducing intrusive rumination may be useful for the survivors and indirectly contribute to spouses' posttraumatic growth. This study indicates that couple-centered interventions may be crucial and more effective in facilitating posttraumatic growth among newly diagnosed gynecological cancer couples.
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Sobreviventes de Câncer , Neoplasias , Crescimento Psicológico Pós-Traumático , Estudos Transversais , Revelação , Humanos , CônjugesAssuntos
Ansiedade , Depressão , Prostatectomia , Sexualidade , Incontinência Urinária , Humanos , Masculino , Prostatectomia/métodos , Prostatectomia/efeitos adversos , Depressão/etiologia , Ansiedade/etiologia , Incontinência Urinária/psicologia , Incontinência Urinária/etiologia , Sexualidade/psicologia , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/psicologiaRESUMO
BACKGROUND: The Wenchuan Earthquake that hit Sichuan, China in 2008 not only caused huge losses in terms of human life and economic damage. It also caused psychological trauma in survivors, especially those who had lost relatives and close friends (bereaved). In the aftermath of earthquakes, bereaved individuals require family and spiritual renewal in addition to material assistance. PURPOSE: This study investigated the status of and relationship between family function and depression in bereaved individuals living in areas devastated by the Wenchuan Earthquake. Results provide baseline information for post-disaster family reconstruction. METHODS: This cross-sectional study surveyed 264 qualified bereaved individuals who lived in an area hard hit by the Wenchuan Earthquake. Face-to-face interviews were administered based on the family APGAR(adaptation, partnership, growth, affection, resolve) index and Hamilton depression (HAMD) scale. RESULTS: The mean family function score for participants was 6.52 ± 2.65. Results for half (50.0%) of participants indicated "good" family function. Results indicated marital status, family structure and status of having another baby as factors that significantly influence family function (p < .05). Participants' mean depression score was 40.41 ± 9.35, with all (100%) of participants demonstrating symptoms of depression. The 5 most prevalent depressive symptoms were: depressed mood, decreased interest in work, mental anxiety, diminished capacity and agitation. Results showed marital status, leisure frequency, economic status, and having another baby as factors that significantly influenced family function (p < .05). A Pearson's correlation analysis indicated no significant relationship between level of depression and family function (p >.05). CONCLUSION: Family functions of the bereaved living in areas hard hit by the Wenchuan Earthquake were all undermined to varying degrees. Although participants all exhibited depressive symptoms, this study found no affect of such symptoms on family functions. Interventions delivered in the months and years after an earthquake should be tailored to address each individual's depression status. Interventions should also help these individuals learn to improve and enhance family functions to effectively reduce negative behaviors and reactions in order to better promote physical and mental health.
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Depressão/epidemiologia , Terremotos , Família , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Estudos Transversais , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Previous studies have shown that reflective learning and mind mapping have many advantages in nursing education, but the relevant researches on the joint application of the two strategies are very limited. OBJECTIVES: To confirm the efficacy of reflective learning based on visual mind mapping for educational purposes to support the critical thinking, academic self-efficacy, and professional self-concept of nursing students. DESIGN: A quasi-experimental design with pretest and posttest model. SETTINGS: A nursing college in Chengdu, Sichuan Province, China. PARTICIPANTS: Eighty 2nd year baccalaureate nursing students in two parallel classes were assigned to an intervention group (n = 40) and a control group (n = 40) with one class for each group. METHODS: This study was carried out from September 15 to November 30, 2021. The Chinese version of Critical Thinking Disposition Inventory (CTDI-CV), the Chinese version of Academic Self-Efficacy Scale (ASE-CV), and the Chinese version of Professional Self-Concept of Nurses Instrument (PSCNI-CV) were used to evaluate the effects of the study intervention on nursing students. Firstly, the pretest data were collected from students in the two groups. Then, the intervention group students made regular reflective entries based on mind mapping and the control group students conducted traditional reflective journal, while attending routine educational and clinical activities, about their experiences of the Fundamentals of Nursing course learning process. After the intervention, both groups completed the three scale tests again, and an open-ended question was set for intervention group to explore the difficulties or challenges encountered by students. Descriptive statistics, Chi-square, Mann-Whitney U test, and content analysis were performed. RESULTS: There were no significant baseline demographic variables differences between the two groups. The intervention group showed significant improvement in critical thinking (P = 0.000), including truth-seeking, open-mindedness, analyticity, systematization, and inquisitiveness sub-dimensions (P = 0.000-0.014), and professional self-concept (P = 0.015), including flexibility and satisfaction sub-dimensions (P = 0.015-0.039), as compared to the baseline. There was no significant difference in students' academic self-efficacy level between pretest and posttest of the two groups. Compared to the total level of critical thinking between the intervention and the control group, the difference median values (posttest score-pretest score) were 14.0 and 1.5 respectively; and for professional self-concept, were 4.5 and 0.5 respectively, which were statistically significant at P < 0.05 level (P = 0.001-0.020). According to open-ended question survey, difficulties or challenges faced by the intervention group students were mainly problem of charting mind mapping, unfamiliar with tools, problem of mentors' guidance, and time-consuming. CONCLUSIONS: This study found that it is appropriate for students to adopt reflective learning based on visual mind mapping. Although there were no significant differences in the improvement level of students' academic self-efficacy, students' critical thinking and professional self-concept were greatly improved by the intervention. This approach may be used as a complementary learning method for baccalaureate nursing education.
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Bacharelado em Enfermagem , Educação em Enfermagem , Estudantes de Enfermagem , Humanos , Bacharelado em Enfermagem/métodos , Aprendizagem , PensamentoRESUMO
Self-management is essential for patients who require regular hemodialysis treatment. This study aimed to explore the relationships between social support, sense of coherence (SOC), and self-management in hemodialysis patients and to examine whether SOC plays a mediating role. In a cross-sectional study, 402 hemodialysis patients from four tertiary hospitals were recruited. Data were analyzed using structural equation modeling. Social support, SOC, and self-management were significantly correlated with each other. The proposed model provided a good fit to the data. Social support had a direct effect on self-management and SOC, partially mediated the effect of social support on self-management (ß = 0.248, p = 0.001). Social support and SOC explained 69% of the variance in self-management. Our findings indicate that health care providers can enhance social support with an emphasis on strengthening SOC strategies to better improve self-management in hemodialysis patients.
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Autogestão , Senso de Coerência , Estudos Transversais , Humanos , Diálise Renal , Apoio Social , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Essential hypertension is a major preventable risk factor for early cardiovascular disease, premature death and disability. It has been reported that telemedicine interventions can provide an innovative solution to essential hypertension to overcome the barriers that exist in traditional treatment or control. Nevertheless, this subject has not been thoroughly investigated. The goal of this study is to systematically evaluate and describe the impact of telemedicine interventions on essential hypertension. METHODS AND ANALYSIS: To find relevant research, we will conduct a systematic literature search of three databases (PubMed, Embase and Cochrane Library), with no language limitations, in addition to researching grey literature. Two reviewers will extract the data individually, and any disagreements will be resolved by discussion or by a third reviewer. The randomised controlled trials will be chosen based on predetermined inclusion criteria. Primary outcomes will include systolic blood pressure and diastolic blood pressure after the telemedicine intervention. Secondary outcomes will include medication adherence (eg, the Morisky Medication Adherence Questionnaire), quality of life (eg, the MOS item scale of the Health Survey Short Form 36 questionnaire), blood pressure control rate and adverse events (eg, stroke, chronic renal failure, aortic dissection, myocardial infarction and heart failure). The quality of the included studies will be assessed using the Cochrane risk-of-bias method. The data will be analysed using RevMan V.5.3.5 software and STATA V.16.0 software. If heterogeneity testing reveals little or no statistical heterogeneity, a fixed effect model will be used for data synthesis; otherwise, a random effect model would be employed. We will synthesise the available evidence to perform a high-quality meta-analysis. ETHICS AND DISSEMINATION: This project does not require ethical approval because it will be conducted using publicly available documents. The review's findings will be published in peer-reviewed journals and publications. PROSPERO REGISTRATION NUMBER: CRD42021293539.
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Infarto do Miocárdio , Telemedicina , Hipertensão Essencial/terapia , Humanos , Metanálise como Assunto , Extratos Vegetais , Qualidade de Vida , Revisões Sistemáticas como AssuntoRESUMO
OBJECTIVE: To evaluate the effectiveness of preoperative shaving and postoperative shampooing on the infection rate in neurosurgery. DESIGN: Meta-analysis. DATA SOURCE: We conducted a search of the Embase, CINAHL, Scopus and PubMed databases up until February 1, 2022. Comparative studies were included. No language restrictions were applied. REVIEW METHODS: Original articles that compared the infection rate of patients who had their hair shaved before neurosurgery to the infection rate of unshaven patients were included. Original articles comparing the infection rates of patients whose hair was early postoperative shampooing versus patients whose hair was not shampooed after neurosurgery were also included. The risk of bias was also evaluated using the Newcastle-Ottawa quality assessment scale by two authors independently. The meta-analyses were performed using Review Manager software (RevMan 5.3; Cochrane Collaboration). The odds ratios (ORs) and 95% confidence intervals (CIs) were assessed for dichotomous data (infection rate). The heterogeneity of the included studies was assessed using the I2 statistic (ranging from 0 to 100%). RESULTS: A total of 3451 studies were identified by searching the PubMed, Scopus, CINAHL and Embase databases. Fourteen studies met the inclusion criteria, however two studies did not provide data suitable for meta-analysis. Twelve studies were included in the review. Two historical control studies, four prospective studies, one clinical trial and five retrospective studies were identified. There were 4583 patients whose hair was not shaved and 4295 patients whose hair was shaved. Among them, there were 3874 patients whose hair was unshaved and was early postoperative shampooing. No significant difference in the infection rate was found between the unshaved group and shaved group (OR: 0.86, 95% CI [0.62, 1.19], P = 0.85, I2 = 0%). A significant difference in the infection rates in shunt surgery patients was found between the unshaved group and shaved group (OR: 0.43, 95% CI [0.19, 0.99], P = 0.89, I2 = 0%). No significant difference was found between the unshaved with early shampooing group and the shaved group (OR: 0.82, 95% CI [0.48, 1.41], P = 0.80, I2 = 0%). CONCLUSION: Hair preservation before neurosurgery and early shampooing after neurosurgery did not increase the infection rate.
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Remoção de Cabelo , Neurocirurgia , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
PURPOSE: Despite increasing research on posttraumatic growth (PTG) of spouses of cancer patients, and the positive effects of spouses' PTG on both spouses and patients, there is little information on PTG and its correlates among husbands of gynecological cancer survivors, especially those of newly diagnosed survivors. We aimed to assess PTG among spouses of newly diagnosed gynecological cancer survivors and to examine its correlates. METHODS: In a cross-sectional study, a total of 400 spouses of newly diagnosed gynecological cancer survivors were recruited and completed questionnaires with information on general characteristics, rumination, self-disclosure, locus of control, and PTG. Univariate analysis and multiple linear regression analysis were performed. RESULTS: The mean score of PTG among the spouses was 57.77 (SD = 12.03). There were significant differences in PTG among spouses with different education levels, marriage duration, number of children, per capita monthly income, other traumatic events within 6 months, and time since diagnosis groups. Pearson's correlation analysis revealed that deliberate rumination, self-disclosure, and locus of control were significantly associated with PTG. The multiple regression model revealed that 53.6% of the variance in PTG was explained by marriage duration, time since diagnosis, self-disclosure, deliberate rumination, and internality locus of control. CONCLUSIONS: This study was one of the early attempts in evaluating PTG among spouses of newly diagnosed gynecological cancer survivors and identified several significant, potentially modifiable factors (self-disclosure, deliberate rumination, and internality locus of control) associated with PTG, providing an important guide for the development of effective psychosocial interventions for this population.
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Sobreviventes de Câncer , Neoplasias , Crescimento Psicológico Pós-Traumático , Transtornos de Estresse Pós-Traumáticos , Adaptação Psicológica , Criança , Estudos Transversais , Humanos , Cônjuges , Inquéritos e Questionários , SobreviventesRESUMO
Coronavirus disease 2019 is an emerging public health problem threatening not only the life but also the normal psychology of people. University students' mental health is the focus in the field of higher education. The coronavirus disease 2019 pandemic has brought into attention the mental health problems of this vulnerable group. The aim of this study was to assess the impact of coronavirus disease 2019 on the mental health of university students in Sichuan Province, China. We conducted a cross-sectional study from April 2020 to May 2020. The participants responded to an online questionnaire that included informed consent, basic information, 20-item Self Reporting Questionnaire (SRQ-20), and Self-Rating Anxiety Scale (SAS). We received 521 effective responses. The results included the following: 19.0% of respondents reported distress, and 31.5%, 8.1%, and 5.8% of them reported mild, moderate, and severe anxiety, respectively; respondents aged ≤ 22 years, medical students, and those who were in general health reported more distress than others; and medical students and those who paid more attention to pandemic information reported more anxiety than others. Findings suggest that the mental health of university students should be monitored during pandemic, especially for younger students, medical students, students in general health status, and those who paid too much attention to the news of the pandemic. Due to the limited sample representativeness, we must be cautious when generalizing these findings to other regions of China or other countries.
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COVID-19 , Saúde Mental , Idoso , Ansiedade/epidemiologia , China/epidemiologia , Estudos Transversais , Depressão , Humanos , SARS-CoV-2 , Autorrelato , Estudantes , Inquéritos e Questionários , UniversidadesRESUMO
This cross-sectional study assessed the overall symptom burden, including the prevalence, frequency, severity, and distress of symptoms among hemodialysis patients, and explored the relationship between demographic characteristics, clinical variables, self-management, sense of coherence, social support, and symptom burden in these patients. Herein, a regression analysis was performed to determine associations with symptom burden. The mean score of symptom burden among the participants (n = 382) was 74.12, with an average number of 12 symptoms. The analysis revealed that self-management, sense of coherence, and social support were negatively associated with the overall symptom burden. The multiple regression model showed that 48.6% of the variance in symptom burden was explained by meaningfulness, emotional management, daily urine output, subjective support, gender, and manageability. These findings contribute to the knowledge of symptom burden among hemodialysis patients and some new predictors (self-management, sense of coherence, and social support) of their symptom burden.
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Diálise Renal , Autogestão , Estudos Transversais , Humanos , Prevalência , Apoio Social , Inquéritos e QuestionáriosRESUMO
CONTEXT: Hemodialysis (HD) patients experience a heavy symptom burden that leads to a decreased quality of life. Pharmacological treatment is effective but costly and has adverse effects. Exercise is a promising approach for symptom management, but the effect of exercise on restless legs syndrome (RLS), depression, sleep quality, and fatigue in HD patients is still uncertain. OBJECTIVES: This meta-analysis was conducted to identify whether exercise training is beneficial in the treatment of the symptoms of RLS, depression, poor sleep quality, and fatigue in patients receiving HD. METHODS: A systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials, and Web of Science was conducted to identify randomized controlled trials (RCTs) comparing exercise training with routine care on RLS, depression, sleep quality, and fatigue among HD patients. Quality assessment was conducted using the Cochrane risk of bias tool, and RevMan 5.3 was used to analyze the data. RESULTS: Fifteen RCTs that met our inclusion criteria were included. The pooled effect size showed that exercise training was effective on RLS (P < 0.001), depression (P < 0.001), and fatigue (P < 0.001). However, effect size combinations for sleep quality were not performed owing to the sensitivity analysis results. CONCLUSION: Exercise training may help HD patients to reduce the severity of RLS, depression, and fatigue. More high-quality RCTs with larger samples and comparative RCTs focused on different exercise regimens are needed.
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Terapia por Exercício , Fadiga/terapia , Diálise Renal , Síndrome das Pernas Inquietas/terapia , Sono , Exercício Físico , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: To explore the efficacy and complication of bilateral multi-target radiofrequency lesion operation in patients with affective disorder. METHODS: One hundred and eighty-two cases with affective disorder were treated with unstaged bilateral multi-target radiofrequency thermocoagulation. The efficacy was evaluated with the method established in 1990 by the National Psychosurgery Cooperative Group. RESULTS: After 2 weeks of operation, 86 cases with remarkable improvements, 81 cases with improvements, 15 case with no improvements, no case with progression, total efficient ratio was 91.76%. With 6-54 months of follow-up to all of 166 cases, 38 cases with recovery, 59 cases with remarkable improvements, 52 cases with improvements, 17 cases with no improvements, no case with progression, total efficient ratio was 89.76%. Except for early temporal complication of stereotaxic operation, the long-term complication ratio was less than 1%. CONCLUSION: CT-guided bilateral multi-target operation is prominent in treatment of affective disorder with high efficacy and safety.
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Transtornos do Humor/cirurgia , Técnicas Estereotáxicas , Adolescente , Adulto , Ablação por Cateter/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Espiral , Resultado do TratamentoRESUMO
AIM: To evaluate the effects of a hospital-community partnership transitional program among patients with coronary heart disease. METHODS: This was a randomized controlled trial with 236 patients who were randomized into two groups. The patients in the control group received the usual care. In contrast, the patients in the study group received the transitional care program. The data were collected at the baseline, 30 days, and 90 days after discharge. The primary outcomes were the 30 and 90 day readmission rates after discharge. The secondary outcomes included the quality-of-care transitions, medicine adherence, and chronic disease self-efficacy. RESULTS: The findings indicated that: (i) the patients in the study group reported significantly lower 30 and 90 day readmission rates after their discharge than those in the control group; (ii) statistically significant differences were found in the quality-of-care transitions at 30 days postdischarge between the two groups as the patients in the study group reported significantly higher quality-of-care transitions, compared to those in the control group; and (iii) the patients in the study group reported significantly higher scores in medication adherence and chronic disease self-efficacy at 30 and 90 days after discharge than those in the control group. CONCLUSION: This study is an original effort to establish and evaluate a hospital-community partnership transitional care program in patients with coronary heart disease in China and the findings have demonstrated its effects.
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Relações Comunidade-Instituição , Doença das Coronárias/terapia , Cuidado Transicional , Idoso , China , Doença das Coronárias/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde , AutoeficáciaRESUMO
OBJECTIVE: The aim of this review was to systematically search and critique relevant literature on the potential psychological impact of earthquakes on peripartum women to synthesize existing knowledge for further action. METHODS: A search through 5 databases was conducted for relevant publications in English, and the results were screened through a set of inclusion and exclusion processes. RESULTS: Eight articles were included. Depression and posttraumatic stress disorder were the most often reported mental disorders. Some factors (eg, family relationships and social support) were associated with mental disorders suffered by peripartum women after earthquakes. An assessment of the quality of the studies showed that most did not have high levels of evidence because of their cross-sectional design and limitations. CONCLUSIONS: Among the factors that influenced the mental health of pregnant and postpartum women after earthquakes, family function appears to be one of the most important and deserves further exploration. Other mental health conditions such as minor psychiatric disorders should also be studied for their relationship with disasters and pregnancy. Well-designed studies are needed to enable a better understanding of the relationship between earthquakes and the mental disorders of peripartum women so that the most appropriate interventions can be proposed.
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Desastres , Terremotos , Relações Familiares , Transtornos Mentais/psicologia , Período Pós-Parto/psicologia , Gestantes/psicologia , Apoio Social , Bases de Dados Bibliográficas , Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/prevenção & controle , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Transtornos Mentais/etiologia , Transtornos Mentais/prevenção & controle , Gravidez , Fatores de Proteção , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Transtornos de Estresse Pós-Traumáticos/psicologia , Fatores de TempoRESUMO
AIMS: This survey aims to describe the perception of barriers to and facilitators of research utilization by registered nurses in Sichuan province, China, and to explore the factors influencing the perceptions of the barriers to and facilitators of research utilization. METHODS: A cross sectional survey design and a double cluster sampling method were adopted. A total of 590 registered nurses from 3 tertiary level hospitals in Sichuan province, China, were recruited in a period from September 2006 to January 2007. A modified BARRUERS Scale and a Facilitators Scale were used. Data were analyzed with descriptive statistics, rank transformation test, and multiple linear regression. RESULTS: Barriers related to the setting subscale were more influential than barriers related to other subscales. The lack of authority was ranked as the top greatest barrier (15.7%), followed by the lack of time (13.4%) and language barrier (15.0%). Additional barriers identified were the reluctance of patients to research utilization, the lack of funding, and the lack of legal protection. The top three greatest facilitators were enhancing managerial support (36.9%), advancing education to increase knowledge base (21.1%), and increasing time for reviewing and implementing (17.5%), while cooperation of patients to research utilization, establishing a panel to evaluate researches, and funding were listed as additional facilitators. Hospital, educational background, research experience, and knowledge on evidence-based nursing were the factors influencing perceptions of the barriers and facilitators. CONCLUSIONS: Nurses in China are facing a number of significant barriers in research utilization. Enhancing managerial support might be the most promising facilitator, given Chinese traditional culture and existing health care system. Hospital, educational background, research experience and knowledge on evidence-based nursing should be taken into account to promote research utilization. The BARRIERS Scale should consider funding and involvement of patients in research utilization.
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Atitude do Pessoal de Saúde , Estudos Transversais , Pesquisa em Enfermagem , Recursos Humanos de Enfermagem Hospitalar , Adulto , China , Análise por Conglomerados , Coleta de Dados , Feminino , Humanos , Masculino , Recursos Humanos de Enfermagem Hospitalar/psicologiaRESUMO
BACKGROUND: This study provides a comprehensive evaluation of nurse resources in Chinese hospitals and the link between nurse resources and nurse and patient outcomes. METHODS: Survey data were used from 9688 nurses and 5786 patients in 181 Chinese hospitals to estimate associations between nurse workforce characteristics and nurse and patient outcomes in China. Nurse and patient assessments in China were compared with a similar study in Europe. RESULTS: Thirty-eight percent of nurses in China had high burnout and 45% were dissatisfied with their jobs. Substantial percentages of nurses described their work environment and the quality of care on their unit as poor or fair (61% and 29%, respectively) and graded their hospital low on patient safety (36%). These outcomes tend to be somewhat poorer in China than in Europe, though fewer nurses in China gave their hospitals poor safety grades. Nurses in Chinese hospitals with better work environments and higher nurse-assessed safety grades had lower odds of high burnout and job dissatisfaction (ORs ranged from 0.56 to 0.75) and of reporting poor or fair quality patient care (ORs ranged from 0.54 to 0.74), and patients in such hospitals were more likely to rate their hospital highly, to be satisfied with nursing communications, and to recommend their hospitals (significant ORs ranged from 1.24 to 1.40). Higher patient-to-nurse ratios were associated with poorer nurse outcomes (each additional patient per nurse increases both burnout and dissatisfaction by a factor of 1.04) and higher likelihoods of nurses reporting poor or fair quality of care (OR=1.05), but were unrelated to patient outcomes. Higher percentages of baccalaureate nurses were strongly related to better patient outcomes, with each 10% increase in the percent of baccalaureate nurses increasing patient satisfaction, high ratings, and willingness to recommend their hospital by factors ranging from 1.11 to 1.13. INTERPRETATION: Nursing is important in quality and safety of hospital care and in patients' perceptions of their care. Improving quality of hospital work environments and expanding the number of baccalaureate-prepared nurses hold promise for improving hospital outcomes in China.