Prevalence, patterns of multimorbidity and associations with health care utilization among middle-aged and older people in China.

BACKGROUND: Multimorbidity has become one of the main challenges in health care system. The association between prevalence, patterns of multimorbidity and health care utilization is less often discussed in China. The purpose of this study is to examine this association among Chinese middle-aged and older adults and take into account different sociodemographic, behavioral and health characteristics. Based on this, implications of current evidence and effective intervention on multimorbidity and health care utilization can be identified and put into practice. METHODS: The wave 4 in 2018 of the China Health and Retirement Longitudinal Study (CHARLS) was used in the study. Multimorbidity was defined as the co-occurrence of two or more chronic medical condition of a list of fourteen chronic diseases in one person. The presence of chronic diseases was assessed through self-report. Health care utilization include whether the respondents received outpatient service last month and inpatient service in the past year. Latent Class Analysis was conducted to identify the clustering pattern of chronic diseases. Logistic regressions were employed to explore the association between prevalence, patterns of multimorbidity and health care utilization. Analyses were weighted using individual sample weights, adjusted for non-response of individual and household. RESULTS: Among 19,559 participants aged 45 and older, 23.10% were aged above 70 years and 52.42% were female. The prevalence of multimorbidity was 56.73%. Four patterns were identified: relatively healthy class, respiratory class, stomach-arthritis class and vascular class. Multimorbid individuals used more outpatient services (OR = 1.89, 95%CI = 1.65-2.17) and more inpatient services (OR = 2.52, 95%CI = 2.22-2.86) compared to their no-multimorbid counterparts. Compared to relatively healthy class, the respondents classified into respiratory class, stomach-arthritis class and vascular class used more outpatient services (OR = 1.90, 95%CI = 1.57-2.30; OR = 2.39, 95%CI = 2.06-2.78; OR = 1.53, 95%CI = 1.32-1.79 respectively) and more inpatient services (OR = 2.19, 95%CI = 1.83-2.62; OR = 2.93, 95%CI = 2.53-3.40; OR = 1.90, 95%CI = 1.65-2.19 respectively). CONCLUSION: Our study provided evidence that multimorbidity is high among Chinese older adults and is associated substantially higher health care utilization in China. Four multimorbidity patters were identified. Policy should prioritize improving the management of individuals with multimorbidity to increase healthcare efficiency. Further research is necessary with special emphasis on the trajectory of multimorbidity and the role of health system in satisfying needs of multimorbid individuals.

Nursing Students' Intention to Work as Community Health Nurse in China and Its Predictors.

PURPOSE: To identify nursing students' intention and the predictors of intention to work as a community health nurse in China. DESIGN: A cross-sectional investigation was conducted. METHODS: A questionnaire based on the Theory of Planned Behavior was delivered by Wechat to a convenience sample of 810 students. FINDINGS: In the study, 345 students (42.6%) expressed the intention to be a community health nurse, and the program type, students' attitude, subjective norm and  perceived behavioral control were significant predictors of this intention. CONCLUSION: The results highlight the necessity of community health nursing education reform in curriculum, teaching methods and nursing educators training, so as to improve students' ability and acceptance of community health nursing. CLINICAL EVIDENCE: Working as community health nurse is not favored by students, and the current situation of community health nursing and nursing education system in China has not helped students recognize the attractive complexity in community care.

Cultural competence among nurses and its influencing factors: A cross-sectional study.

The purpose of this study was to investigate the level of cultural competence and its influencing factors among Chinese nurses by using a cross-sectional design. Participants were recruited from four tertiary hospitals in Jiangsu, China, and 325 nurses completed the Cultural Competence Inventory for Nurses in China. Data were analyzed using stepwise multiple regression to identify factors influencing cultural competence. The results showed that Chinese nurses self-rated cultural competence at a moderate level (mean value of 101.7 out of 145), which indicates that cultural training is necessary to improve their cultural competence. Nurses who were younger and had fewer years of working experience, had lower educational backgrounds, seldom learned about different cultures via mass media, and rarely resided in or visited places with different cultures tended to have lower cultural competence levels, and should be provided more opportunities for cultural training. By considering demographic characteristics that influence cultural competence among Chinese nurses, educators can specifically design cultural training content at an appropriate level, targeting trainees' needs and thereby enhance training effectiveness.

Identifying the essential components of cultural competence in a Chinese nursing context: A qualitative study.

This qualitative study using semi-structured interviews was conducted to identify the essential components of cultural competence from the perspective of Chinese nurses. A purposive sample of 20 nurse experts, including senior clinical nurses, nurse administrators, and educators in transcultural nursing, was recruited. Using thematic analysis, four themes: awareness, attitudes, knowledge, and skills, with two subthemes for each, were identified. Notably, culture in China was understood in a broad way. The participants' responses focused upon demographic attributes, individuality, and efforts to facilitate quality care rather than on the cultural differences of ethnicity and race and developing the capacity to change discrimination or health disparities. A greater understanding of cultural competence in the Chinese nursing context, in which a dominant cultural group exists, is essential to facilitate the provision of culturally competent care to diverse populations.

Factors Influencing Wearing Face Mask in Public During COVID-19 Outbreak: A Qualitative Study.

OBJECTIVE: Wearing face masks is believed to mitigate coronavirus disease 2019 (COVID-19) virus transmission by filtering respiratory droplets. This study was to explore the factors influencing wearing face masks in public in China during COVID-19 outbreak. METHODS: This study was a qualitative semi-structured interview research design and was guided by the Protection Motivation Theory. Participants from Jiangxi Province China were interviewed by means of WeChat video call. Thematic analysis was used to analyze the data. RESULTS: Recruitment efforts were suspended when 21 participants (aged 23 to 72 y) were successfully enrolled and the data reached thematic saturation. Four themes were identified when participants described factors influencing them to wear face masks: knowledge of disease (subthemes were severity of disease, and individual vulnerability to disease), environmental facilitators and constraints (subthemes were government recommendations, public opinion, and affordability and availability of face masks), understanding of protection effectiveness (subthemes were protection effectiveness of wearing face masks, and selection of protective measures), and past experiences. CONCLUSIONS: Individuals' decision to wear face masks was influenced by the combination of factors identified. Identification of these factors provides guidance for explaining wearing face masks in public and helps policy-makers develop feasible recommendations for wearing face masks during COVID-19 outbreak.

Bibliometric analysis of pressure ulcer research: 1990-2009.

PURPOSE: Bibliometric evaluation provides a method for evaluating trends in publications related to a specific topic. This search focused on pressure ulcer (PU) care; journals and authors with the greatest contribution and impact were emphasized. DESIGN: Bibliometric evaluation. METHODS: Data encompassing the period from 1990 to 2009 were extracted from the Science Citation Index online version. We analyzed selected documents with "pressure ulcer" as a part of the title, abstract, or key words and reported the following parameters: trends of publication output, document types, subject category, journal pattern, authorship, and research in nursing disciplines. RESULTS: The annual number of articles on PUs grew at a rapid rate, from approximately 39 in 1991 to 259 in 2009. The main subject categories in which research on PUs was conducted were surgery and nursing, each of which accounted for more than 10% of total articles. The United States was the dominant country in terms of volume of articles. The relationship between nurse staffing and PU-related outcomes is currently the major focus of PU nursing research, followed by risk assessment scale evaluations. CONCLUSION: We found that the number of PU-related publications has grown at a rapid rate over the past 20 years, reflecting an increasing awareness of the importance of PU prevention and management.

Community health nursing courses in baccalaureate nursing programs in China: A descriptive study based on website information.

OBJECTIVE: To survey current community health nursing (CHN) courses offered in baccalaureate nursing programs in the mainland of China from the perspective on information available on websites of colleges and universities. METHODS: A descriptive research design was used. Data were collected from the official websites of colleges and universities providing baccalaureate nursing programs in the mainland of China. A checklist was applied to identify academic year, type of course, credit, and class hours for both theory and practice teaching of CHN courses including Community Nursing, Geriatric Nursing, Rehabilitation Nursing, and Health Education. The prescribed textbooks were consulted for teaching content. RESULTS: Colleges (n = 16) and universities (n = 26) offering baccalaureate nursing programs with accessible online information for curriculum setting were recruited. The results showed that most of the accessible educational institutions (92.86%) have offered three to four investigated CHN courses. Community Nursing, Geriatric Nursing and Rehabilitation Nursing are generally offered to juniors, while Health Education is offered in half of these institutions in different academic years. Community Nursing is mainly offered as a required course with 2 credits, while Geriatric Nursing, Rehabilitation Nursing and Health Education are provided as elective courses with fewer credits. Around half of the institutions have practice hours for Community Nursing, Geriatric Nursing and Rehabilitation Nursing courses. However, the proportion of practice hours in the courses is generally less than 50%. The teaching content focuses on clinical care competencies instead of complementary competencies. CONCLUSION: It was revealed that CHN education in China is still in its infancy from website information of colleges and universities. CHN courses should be included in curriculum design, and teaching reforms and innovations should be taken to prepare nursing students to practice in primary health care and community settings.

Relationship between the pH of enema solutions and intestinal damage in rabbits.

Mechanical enemas can lead to intestinal mucosal injuries and bowel barrier damage, presenting as electrolyte disturbances and functional intestinal disorders. Most researchers believe that the mechanism of injury is related to osmolality, volume and temperature of the solution, infusion pressure, and the composition of the enema tube. We hypothesized that the pH of the enema solution may also contribute to intestinal damage. We administered enema solutions--normal saline, soapsuds, or vinegar (neutral, alkaline, or acidic solutions, respectively)--to three groups of rabbits (n = 20 per group). The solutions were standardized for volume and temperature and the soapsuds and vinegar solutions were adjusted to be isotonic with normal saline or deionized water. We also included a control group (n = 20) in which the enema tubes were inserted but no solution was administered. We biopsied 3 sites (rectum and distal and proximal colon). Damage to intestinal mucosa was observed by light microscopy and transmission electron microscopy. In order to explore the detection of damage using noninvasive methods, cyclooxygenase (COX)-2 gene expression was measured in the exfoliated cells gathered from postenema defecation. Epithelial loss, inflammatory reaction, and cellular microstructure damage was increased in the vinegar and soapsuds groups. Also, exfoliated cells in these groups had higher COX-2 expression than the normal saline group. The acidic and alkaline enema solutions thus caused more severe damage to the intestinal mucosa compared to the neutral liquid, supporting our hypothesis. Further, the detection of COX-2 expression shows promise as a noninvasive method for estimating enema-induced damage.