Decision-making experiences related to mastectomy: A descriptive qualitative study.

AIM: To obtain an in-depth understanding of women's decision-making experiences related to mastectomy. DESIGN: A descriptive qualitative interview study. METHODS: Individual semi-structured interviews were conducted face-to-face with 27 Chinese women with breast cancer who underwent mastectomy at two tertiary hospitals in mainland China between September 2020 and December 2021 after obtaining the appropriate ethical approvals. Interviews were conducted in Mandarin. Data were analysed using inductive content analysis. RESULTS: Mean age of participants was 48 years (range 31-70). Most participants had low education, low monthly family income, had a partner and health insurance, had been diagnosed with early breast cancer, and had not undergone reconstructive surgery. Six categories related to decision-making experiences emerged: (1) Emotions affecting decision-making, (2) Information seeking for decision-making, (3) Beliefs about mastectomy and the breast, (4) Participation in decision-making, (5) People who influence decision-making, and (6) Post-decision reflection. Participants did not mention the role of nurses in their decision-making process for mastectomy. CONCLUSIONS: This study adds valuable insights into the limited evidence on women's experience with decision-making about mastectomy from a Chinese perspective, which is important given the continuing high prevalence of mastectomy in many regions. Future studies from other countries and ethnic groups are recommended to gain diverse knowledge. IMPACT: The findings of this study are useful for nurses and other healthcare professionals in the multidisciplinary team to better support women with breast cancer in their decision-making process regarding mastectomy. The findings could inform future interventions to support treatment decision-making and may be relevant to women living in similar socio-medical contexts to those in mainland China. REPORTING METHOD: The study was reported following the Standards for Reporting Qualitative Research checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Acupressure Intervention Program for Older Adults in Australian Residential Aged Care Facilities: A Qualitative Evaluation.

The current study explored participants' experiences and perceptions of receiving acupressure within an Australian aged care context. Participants were older adults living in three residential aged care facilities who had received an acupressure intervention. Data were collected using semi-structured interviews and analyzed using a thematic approach. Twelve participants (10 females and two males) were interviewed. Four major themes emerged: Having Better Sleep, Feeling Calm and Relaxed, Promoting Well-Being and Functional Status, and Acceptability of Acupressure. Participants' perception of the acupressure was positive, as participants found acupressure to be beneficial for the improvement of sleep, mood, and general well-being. Participants' overall perception supports the acceptability of acupressure and suggests acupressure may be beneficial for improving sleep, relaxation, and well-being in older adults. [Journal of Gerontological Nursing, 50(1), 30-36.].

"I use salt. However, I also use soy sauce, oyster sauce, sometimes chili sauce and .": interviews with Australians of Chinese ancestry regarding reducing salt consumption for hypertension prevention.

BACKGROUND: High dietary salt consumption is a significant health issue in Chinese populations. This study identified the facilitators for and barriers to salt reduction for prevention of hypertension among Chinese Australians. METHODS: An inductive qualitative study with semi-structured interviews (n = 8) was conducted with convenience samples recruited from social media. Adults who a) were over 18 years old, b) were of Chinese ancestry and c) had lived in Australia for at least 6 months were eligible for participation. Interview transcripts were transcribed and analysed using content analysis. RESULTS: Four facilitators for and eight barriers to reducing salt consumption were synthesised from the narrative materials. The facilitators were: 1) individual perceptions of health benefits, 2) salt alternatives, 3) digital information and 4) increased awareness of negative health impacts from a high-salt diet. The barriers identified were: 1) negative physical changes not apparent, 2) inadequate salt-related health education, 3) hidden salt in food products, 4) inadequate food literacy, 5) pricing, 6) busy lifestyle, 7) low perceived susceptibility and 8) individual food taste preference and cooking habits. Peer and family influence had positive and negative effects on participants' likelihood of reducing salt consumption. CONCLUSIONS: The facilitators for and barriers to maintaining a low-salt diet in Chinese Australians were multifaceted and interrelated. Future salt-reduction strategies should focus on the health benefits of reduced salt consumption and practical interventions such as salt alternatives and education on low-salt food choices and cooking methods and changing perceptions about salt reduction to become a social norm in the Chinese community.

Patients' experiences of using a mobile application-based rehabilitation programme after total hip or knee arthroplasty: a qualitative descriptive study.

BACKGROUND: An increasing number of patients are discharged from a total hip or knee arthroplasty with a short length of hospital stay. Technologies, such as mobile applications, are used to provide remote support to patients' postoperative rehabilitation. Patients' experiences of receiving mobile application-based rehabilitation after total hip or knee arthroplasty have not been investigated extensively. METHODS: This was a qualitative descriptive study. Twenty-five participants who had completed a mobile application-based rehabilitation programme for total hip or knee arthroplasty were recruited. Semi-structured interviews were conducted via telephone between July 2021 and January 2022 regarding the participants' experiences using the programme. All interviews were audio-recorded and verbatim transcribed. Data were analysed using inductive content analysis. The reporting of this study followed the Consolidated Criteria for Reporting Qualitative Research. RESULTS: Data analysis revealed five categories: (a) improved access to health care, (b) encouraged postoperative recovery, (c) established supportive relationships, (d) facilitated learning, and (e) future directions. CONCLUSION: The theory-underpinned mobile application-based rehabilitation programme demonstrated potential value in supporting patients' rehabilitation after arthroplasty. Nurses can consider using mobile technologies to expand their role in arthroplasty rehabilitation and improve the quality of rehabilitation care.

Development of a Prognostic App (iCanPredict) to Predict Survival for Chinese Women With Breast Cancer: Retrospective Study.

BACKGROUND: Accurate prediction of survival is crucial for both physicians and women with breast cancer to enable clinical decision making on appropriate treatments. The currently available survival prediction tools were developed based on demographic and clinical data obtained from specific populations and may underestimate or overestimate the survival of women with breast cancer in China. OBJECTIVE: This study aims to develop and validate a prognostic app to predict the overall survival of women with breast cancer in China. METHODS: Nine-year (January 2009-December 2017) clinical data of women with breast cancer who received surgery and adjuvant therapy from 2 hospitals in Xiamen were collected and matched against the death data from the Xiamen Center of Disease Control and Prevention. All samples were randomly divided (7:3 ratio) into a training set for model construction and a test set for model external validation. Multivariable Cox regression analysis was used to construct a survival prediction model. The model performance was evaluated by receiver operating characteristic (ROC) curve and Brier score. Finally, by running the survival prediction model in the app background thread, the prognostic app, called iCanPredict, was developed for women with breast cancer in China. RESULTS: A total of 1592 samples were included for data analysis. The training set comprised 1114 individuals and the test set comprised 478 individuals. Age at diagnosis, clinical stage, molecular classification, operative type, axillary lymph node dissection, chemotherapy, and endocrine therapy were incorporated into the model, where age at diagnosis (hazard ratio [HR] 1.031, 95% CI 1.011-1.051; P=.002), clinical stage (HR 3.044, 95% CI 2.347-3.928; P<.001), and endocrine therapy (HR 0.592, 95% CI 0.384-0.914; P=.02) significantly influenced the survival of women with breast cancer. The operative type (P=.81) and the other 4 variables (molecular classification [P=.91], breast reconstruction [P=.36], axillary lymph node dissection [P=.32], and chemotherapy [P=.84]) were not significant. The ROC curve of the training set showed that the model exhibited good discrimination for predicting 1- (area under the curve [AUC] 0.802, 95% CI 0.713-0.892), 5- (AUC 0.813, 95% CI 0.760-0.865), and 10-year (AUC 0.740, 95% CI 0.672-0.808) overall survival. The Brier scores at 1, 5, and 10 years after diagnosis were 0.005, 0.055, and 0.103 in the training set, respectively, and were less than 0.25, indicating good predictive ability. The test set externally validated model discrimination and calibration. In the iCanPredict app, when physicians or women input women's clinical information and their choice of surgery and adjuvant therapy, the corresponding 10-year survival prediction will be presented. CONCLUSIONS: This survival prediction model provided good model discrimination and calibration. iCanPredict is the first tool of its kind in China to provide survival predictions to women with breast cancer. iCanPredict will increase women's awareness of the similar survival rate of different surgeries and the importance of adherence to endocrine therapy, ultimately helping women to make informed decisions regarding treatment for breast cancer.

Cost-effectiveness of Web-Based and Home-Based Postnatal Psychoeducational Interventions for First-time Mothers: Economic Evaluation Alongside Randomized Controlled Trial.

BACKGROUND: The cost-effectiveness of interventions has attracted increasing interest among researchers. Although web-based and home-based psychoeducational interventions have been developed to improve first-time mothers' postnatal health outcomes, very limited studies have reported their cost-effectiveness. OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period. METHODS: A randomized controlled 3-group pretest and posttest design was adopted, and cost-effectiveness analysis from the health care's perspective was conducted. A total of 204 primiparas were recruited from a public tertiary hospital in Singapore from October 2016 to August 2017 who were randomly allocated to the web-based intervention (n=68), home-based intervention (n=68), or control (n=68) groups. Outcomes of maternal parental self-efficacy, social support, postnatal depression, anxiety, and health care resource utilization were measured using valid and reliable instruments at baseline and at 1 month, 3 months, and 6 months after childbirth. The generalized linear regression models on effectiveness and cost were used to assess the incremental cost-effectiveness ratios of the web-based and home-based intervention programs compared to routine care. Projections of cumulative cost over 5 years incurred by the 3 programs at various coverage levels (ie, 10%, 50%, and 100%) were also estimated. RESULTS: The web-based intervention program dominated the other 2 programs (home-based program and routine care) with the least cost (adjusted costs of SGD 376.50, SGD 457.60, and SGD 417.90 for web-based, home-based, and control group, respectively; SGD 1=USD 0.75) and the best improvements in self-efficacy, social support, and psychological well-being. When considering the implementation of study programs over the next 5 years by multiplying the average cost per first-time mother by the estimated average number of first-time mothers in Singapore during the 5-year projection period, the web-based program was the least costly program at all 3 coverage levels. Based on the 100% coverage, the reduced total cost reached nearly SGD 7.1 million and SGD 11.3 million when compared to control and home-based programs at the end of the fifth year, respectively. CONCLUSIONS: The web-based approach was promisingly cost-effective to deliver the postnatal psychoeducational intervention to first-time mothers and could be adopted by hospitals as postnatal care support. TRIAL REGISTRATION: ISRCTN registry ISRCTN45202278; https://www.isrctn.com/ISRCTN45202278.

Factors affecting reductions in dietary salt consumption in people of Chinese descent: An integrative review.

AIMS: To identify and synthesize the evidence on the perceptions of the health effects of dietary salt consumption and barriers to sustaining a salt-reduced diet for hypertension in Chinese people. DESIGN: A systematic integrated review integrating quantitative and qualitative studies using the PRISMA guidelines. DATA SOURCES: Three databases, MEDLINE, PubMed and CINAHL, were systematically searched for articles published between January 2001 and July 2020. REVIEW METHODS: The quality of the included studies was appraised using the Joanna Briggs Institute's critical appraisal tools for cross-sectional and qualitative studies. Descriptive analysis and constant comparison methods were used to analyse the extracted data. RESULTS: Fourteen studies met the inclusion criteria. The synthesized results identified that (i) adequate salt-related health education had a positive influence on dietary behaviour modifications, (ii) the level of educational exposure to the health benefits of salt reduction influenced Chinese people's perceptions of the health impact associated with high salt intake, (iii) the complexity of salt measurement was a barrier to salt reduction, (iv) salt reduction is a challenge to Chinese food culture, and (v) Chinese migrants may experience linguistic and cultural challenges when they seek appropriate dietary education and advice for hypertension management in their host countries. CONCLUSION: There is room for improvement in recognizing and translating the knowledge of salt-related health issues and the benefits of that knowledge about salt reduction into action. Future nursing interventions should incorporate individuals' cultural needs and the dietary culture of immediate family members. IMPACT: This integrative review reveals that unique Chinese customs and practices reduce the effectiveness of salt reduction campaigns. The effects of education vanish without family support, resulting in suboptimal adherence to dietary salt reduction strategies.

Effects of decisional conflict, decision regret and self-stigma on quality of life for breast cancer survivors: A cross-sectional, multisite study in China.

AIMS: To examine the differences in decisional conflict, decision regret, self-stigma and quality of life among breast cancer survivors who chose different surgeries, as well as the effects of decisional conflict, decision regret and self-stigma on quality of life. DESIGN: Observational study. METHODS: Paper and online surveys were used to collect data from March to September 2020. The Chinese version of the Decisional Conflict Scale, Decision Regret Scale, Self-Stigma Form and Functional Assessment of Cancer Treatment-B were used to measure the corresponding health outcomes for breast cancer survivors who chose different surgeries from three university-affiliated hospitals. One-way analysis of variance, Pearson's correlation coefficient and hierarchical multiple regression analysis were used for data analysis. RESULTS: Among the 448 participants, only 21% chose breast conservative surgery, while 79% chose mastectomy with or without reconstruction. Women who chose mastectomy with reconstruction reported higher decisional conflict (p = .028) and more decision regret (p = .013) than women who chose breast conservative surgery; women who chose mastectomy without reconstruction indicated higher decisional conflict (p = .015), more decision regret (p < .001), and higher self-stigma (p = .034) than women who chose breast conservative surgery. Decisional conflict (r = -.430), decision regret (r = -.495), and self-stigma (r = -.561) were negatively correlated with quality of life. After controlling for sociodemographic and clinical variables, decisional conflict and decision regret explained 19.7% and self-stigma explained 12.9% of the variance in quality of life. CONCLUSION: Decisional conflict, decision regret and self-stigma vary according to different breast surgeries and are greatly associated with the quality of life of breast cancer survivors. IMPACT: Future studies are warranted to investigate the decision-making process and the underlying reasons for surgical choices. Decision support strategies pre-surgery are needed to inform women about the risks and benefits of surgery options. Moreover, psychosocial support post-surgery is warranted to relieve women's self-stigma, thus improving their quality of life.

Patients' needs regarding rehabilitation services delivered via mobile applications after arthroplasty: A qualitative study.

AIMS AND OBJECTIVES: To obtain an in-depth understanding of the specific needs of patients for rehabilitation services delivered via mobile applications after total hip or knee arthroplasty. BACKGROUND: Due to increased demand for arthroplasty, the provision of face-to-face rehabilitation services for patients is becoming challenging. New approaches using digital technologies are being developed, such as mobile applications to deliver rehabilitation services. However, the perspectives of patients on the delivery of these services via mobile applications after total hip or knee arthroplasty have not been explored extensively. DESIGN: A qualitative descriptive study. METHODS: Twenty patients who had been discharged from the hospital after a total hip or knee arthroplasty were interviewed via telephone about their needs regarding the future use of mobile applications to conduct arthroplasty rehabilitation. Interview records were transcribed verbatim and analysed using inductive content analysis. Reporting of the findings complies with the COREQ checklist for qualitative studies. RESULTS: Four categories emerged from the data collected from the participants: (1) assisting rehabilitation self-management, (2) facilitating peer support, (3) facilitating contact with healthcare professionals and (4) supporting emotional well-being. CONCLUSIONS: The study provided an in-depth understanding of the specific needs of patients for rehabilitation services delivered via mobile applications after total hip or knee arthroplasty. The findings of the study could be used in the development or revision of mobile application rehabilitation programmes to better support the rehabilitation of patients. Future studies are needed to evaluate the effectiveness of such programmes, especially including the self-efficacy of patients as an outcome measure. RELEVANCE TO CLINICAL PRACTICE: From the perspective of patients who have undergone arthroplasty, a mobile application rehabilitation programme should encourage patients in rehabilitation self-management, assist them to contact healthcare professionals and other patients and support their postoperative emotional well-being. The study findings will assist nurses with the preparation and delivery of telerehabilitation programmes after arthroplasty.

Psychometric properties of Brief Coping Orientation to Problems Experienced in patients with multiple chronic conditions: A preliminary study.

BACKGROUND: Multiple chronic conditions (MCCs) are highly prevalent in primary care. Coping is an important psychological factor that influences patients' ability to adapt physically and mentally to MCCs. Testing a reliable and valid psychometric inventory is necessary to identify coping strategies before developing coping-oriented interventions. PURPOSE: The purpose of this study is to examine the psychometric properties of the Chinese version of the Brief Coping Orientation to Problems Experienced (Brief COPE-CN) inventory in patients with MCCs. METHOD: This study adopted a cross-sectional design. A convenience sample of 290 Chinese patients with MCCs was recruited from a tertiary hospital in East China. The Brief COPE-CN, sociodemographic characteristics and clinical data were collected using a self-reported questionnaire from November 2017 to May 2018. Factor analysis and reliability analysis were performed. RESULTS: The mean age of the participants was 58.5 years (range from 23 to 95 years), and approximately half of the participants were female (49.3%). Most participants had two chronic conditions (82.1%) and reported having had MCCs for more than 2 years. The explanatory factor analysis (EFA) identified five factors in the Brief COPE-CN that explained 58.4% of the total variance. The Cronbach's α coefficients ranged from .65 to .85 for the five subscales. CONCLUSIONS: The psychometric properties of the Brief COPE-CN were acceptable for use with Chinese patients with MCCs. With further evaluation, this instrument may help health-care professionals understand patients' coping and develop coping-based interventions to promote coping in this population.

Psychometric testing of the Determinants of Salt-Restriction Behaviour Questionnaire in people of Chinese ancestry: a methodological study.

PURPOSE: Nurses play a key role in educating people about a salt-reduced diet to prevent or manage hypertension or cardiac failure. Assessment tools such as the Chinese Determinants of Salt-Restriction Behaviour Questionnaire (DSRBQ) can provide essential evidence to inform education strategies. This study aimed to translate the DSRBQ into English and evaluate the psychometric properties of the Chinese and English versions for people of Chinese ethnicity in Australia. METHODS: A two-phase cross-sectional descriptive study was conducted. Phase 1: The questionnaire was translated into English using the back-translation method. The translation equivalence and content relevance were evaluated by an expert panel. Three items were revised and eight items were removed. Phase 2: Internal consistency and stability of the questionnaires were evaluated by a group of Chinese Australians. RESULTS: Both the English and Chinese versions had satisfactory psychometric properties. In phase 2, 146 participants completed the questionnaire (test), and 49 participants completed the retest. The Cronbach's alpha scores were 0.638 and 0.584 respectively, and the overall intra-class correlation coefficients were 0.820 and 0.688 respectively for the English and Chinese versions. The Item-Content Validity Index (CVI) ranged from 0.50 to 1.00. The Scale-CVI was 0.94. CONCLUSION: The DSRBQ has been translated into English. Both English and Chinese versions have acceptable validity and reliability. The tools can be used in people from a Chinese cultural background living in Australia. Further validation testing may allow the tools to be adapted for use with other Chinese diaspora groups. The validated DSRBQ will support the development of evidence-based salt reduction nursing assessment tool and interventions for Chinese diasporas who reside in a country where Chinese cultural practices are employed by a minority.

The Effect of Acupressure on Sleep Quality of Older People in Australian Residential Aged Care Facilities: A Pilot Randomized Controlled Trial.

This study investigated the effects of acupressure on sleep quality, anxiety, depression, and quality of life among older people in Australia. Acupressure improved overall subjective sleep quality and anxiety but no differences in depression and quality of life. Future studies with larger sample sizes are required to generate good evidence.

A cross-sectional examination of the relationship between nurses' experiences of skin lesions and anxiety and depression during the COVID-19 pandemic: Exploring the mediating role of fear and resilience.

AIM: To explore the mediating role of fear and resilience on the relationship between clinical nurses' reporting of skin lesions and their anxiety and depression during the coronavirus disease 2019 (COVID-19) pandemic. BACKGROUND: Prolonged personal protective equipment wearing may cause severe skin lesions among clinical nurses. The possible relationship between clinical nurses' reporting of skin lesions and their anxiety and depression remains unknown. Moreover, little is known about what factors could mediate such a relationship. METHODS: This is a cross-sectional online survey. CHERRIES was used to report results. RESULTS: Of 2014 participants, 94.8% (n = 1910) reported skin lesions. Skin lesions were positively related to anxiety (p < .001, ß = .228, SE = .099) and depression (p < .001, ß = .187, SE = .093). Fear activated while resilience buffered the relationship between clinical nurses' reporting of skin lesions and anxiety and between skin lesions and depression. CONCLUSION: Reduced fear and enhanced resilience level were related to decreased levels of anxiety and depression among clinical nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should evaluate the occurrence and severity of clinical nurses' skin lesions, arrange reasonable working duration to relieve skin lesions, provide appropriate psychological support to reduce clinical nurses' fear and implement various strategies to enhance their resilience, thereby decreasing their anxiety and depression. CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR2000030290.

Frontline nurses' willingness to work during the COVID-19 pandemic: A mixed-methods study.

AIM: Frontline nurses' willingness to work has significant implications for maintaining workforce stability and quality of care during the COVID-19 pandemic; however, few studies have investigated their willingness and the corresponding reasons. This study aims to examine frontline nurses' willingness to work, identify its predictors and explore its corresponding reasons. DESIGN: A mixed-methods design was conducted. METHODS: Based on a multilevel behavioural-diagnostic model, a questionnaire survey was used to collect quantitative and qualitative data concurrently from 13 February to 24 February 2020 to explore frontline nurses' willingness to work and the corresponding reasons in two hospitals in Wuhan, China. One was a designated hospital which only received COVID-19 patients, and the other was built up temporarily for COVID-19 patients. RESULTS: Of the 2014 participants, most (n = 1950, 96.8%) indicated their willingness to work, and a few (n = 64, 3.2%) expressed their unwillingness. Binary logistic regression analysis identified five predictors of participants' willingness to work, including monthly family income, average working hours per shift, belief in their colleagues' preparedness, belief in their hospitals' preparedness and levels of depression. These indicators explained 27% of the variance (p < .05). Frontline nurses' willingness to work mainly arose from professional commitment, patriotism and faith, while unwillingness to do so primarily stemmed from safety concerns and family responsibility. CONCLUSION: Most frontline nurses were willing to work and showed great professional commitment. IMPACT: Professional commitment and patriotism were two important individual-level factors affecting frontline nurses' willingness to work during a pandemic. Strategies should be implemented, such as appreciating and acknowledging their contribution, rewarding their valuable work, arranging reasonable working hours, enhancing colleagues' and hospitals' preparedness, and providing emotional support. Moreover, adequate personal protective equipment, self-protection training and social support should be ensured to address frontline nurses' safety concerns and family responsibility.

A multi-centre randomized controlled trial of mobile gynaecological cancer support program for patients with gynaecological cancer undergoing chemotherapy: Study protocol.

AIM: Patients with gynaecological cancer often experience high levels of uncertainty in illness during chemotherapy and report unmet supportive care needs. Mobile applications (apps) are increasing being used as an easily accessible alternative to support these patients, but a lack of rigorous trials have been conducted to explore their effectiveness. Based on Mishel's uncertainty in illness theory, the Mobile Gynaecological Cancer Support (MGCS) program is an app-based program that includes four modules: 1) weekly topics, 2) emotional care, 3) discussion centre and 4) health consultation. The aim of this study is to assess the effectiveness of MGCS for Chinese patients with gynaecological cancer receiving chemotherapy in respect of reducing uncertainty in illness and symptom distress and improving quality of life and social support. DESIGN: A multi-centre randomized controlled trial will be used. METHODS: One hundred and sixty-eight patients with gynaecological cancer commencing chemotherapy will be recruited from three university affiliated hospitals and assigned to the control or intervention group with block randomization. The control group will only receive routine care. The intervention group will access the MGCS program for 24 weeks and receive routine care. Health outcomes will be evaluated at baseline, 12 weeks, and 24 weeks. Repeated measures multivariate analysis of covariance (intention-to-treat) will be used to assess the effectiveness of MGCS. DISCUSSION: This is the first trial to explore the effectiveness of an app-based program for patients with gynaecological cancer using a robust and rigorous study design in China. If effective, this trial will provide evidence for an app-based program to support these patients. IMPACT: The knowledge gained can be applied to develop other culturally appropriate app-based programs for cancer groups worldwide, and provide evidence for health policymakers to allocate more resources and train staff for e-health. TRIAL REGISTRATION: ChiCTR2000033678 (Chinese Clinical Trial Registry Registered 08 June, 2020).

"But I'm not going to be a mental health nurse": nursing students' perceptions of the influence of experts by experience on their attitudes to mental health nursing.

BACKGROUND: Mental health nursing skills and knowledge are vital for the provision of high-quality healthcare across all settings. Negative attitudes of nurses, towards both mental illness and mental health nursing as a profession, limit recognition of the value of these skills and knowledge. Experts by Experience have a significant role in enhancing mental health nursing education. The impact of this involvement on attitudes to mental health nursing has not been well researched. AIM: To explore the impact of Expert by Experience-led teaching on students' perceptions of mental health nursing. METHODS: Qualitative exploratory study involving focus groups with nursing students from five European countries and Australia. RESULTS: Following Expert by Experience-led teaching, participants described more positive views towards mental health nursing skills and knowledge in three main ways: learning that mental health is everywhere, becoming better practitioners, and better appreciation of mental health nursing. CONCLUSIONS: Experts by experience contribute to promoting positive attitudinal change in nursing students towards mental health nursing skills and knowledge. Attitudinal change is essential for the provision of high-quality mental health care in specialist mental health services and throughout the healthcare sector.

The effectiveness of online interventions for patients with gynecological cancer: An integrative review.

OBJECTIVE: With advantages of easy accessibility and various multimedia interactivity formats, online interventions have been developed to improve health outcomes for patients with a variety of gynecological cancers, but evidence regarding their effectiveness for such patients is not well-understood. This review aimed to synthesize study findings that were published in English or Chinese regarding the effectiveness of online interventions on the quality of life, symptom distress, social support, psychological distress, sexual well-being, and body image in patients with gynecological cancer. METHODS: This integrative review adhered to five steps, including problem identification, literature search, quality appraisal, data analysis, and presentation. Ten electronic databases (MEDLINE, ScienceDirect, SpringerLink, PubMed, Wiley Online Journals, Web of Science, OVID, CINAHL Plus with Full Text, China National Knowledge Infrastructure, and Cochrane Library) were searched from the inception of each database to April 2019 in accordance with the rigid and explicit inclusion and exclusion criteria. Version 2018 of the Mixed Methods Appraisal Tool was used for the quality appraisal of the articles. RESULTS: Out of 276 articles, 24 potentially eligible articles were initially identified. A manual search retrieved an additional eligible three articles. After nine articles were excluded, ten quantitative, six qualitative, and two mixed-methods articles were finally included. Online interventions improved quality of life and body images in patients with gynecological cancer, but there were inconclusive effects on symptom distress, social support, psychological distress, and sexual well-being. CONCLUSIONS: Online interventions have been increasingly used as clinically promising interventions to promote health outcomes among patients with gynecological cancer. Studies with more rigorous designs and sufficient sample sizes are needed to elucidate the effectiveness of such online interventions. Healthcare workers can incorporate existing or new online interventions into their routine care to improve health outcomes for patients with gynecological cancer.

Illness Perceptions, Coping Strategies, and Quality of Life in People With Multiple Chronic Conditions.

PURPOSE: To determine whether illness perceptions, coping strategies, and sociodemographic and clinical variables are related to the quality of life (QoL) in adults with multiple chronic conditions (MCCs) living in China. DESIGN: By employing a cross-sectional design based on the transactional stress and coping theory, a convenience sample of adults with MCCs were recruited from a university-affiliated hospital between November 2017 and May 2018 in Northern Anhui, China. METHODS: A self-reported questionnaire, including the Brief Illness Perceptions Questionnaire, the Brief Coping Orientation to Problems Experienced inventory, and the Short Form Survey version 2, was administered. Sociodemographic and clinical data regarding MCCs were also collected. Descriptive statistics including frequencies, means, standard deviations, and correlation coefficients were calculated to examine the relationship between illness perceptions, coping, and QoL. Hierarchical multiple regression models were used to identify variables associated with physical and mental QoL. FINDINGS: A total of 351 participants (50% male) were recruited, with a mean age of 58.9 years (SD = 14.6). Of the participants, 83% had two chronic conditions. Participants reported impaired physical and mental QoL when compared with the general population in China. Poorer QoL was correlated with stronger illness perceptions of consequences and timeline and increased use of denial and disengagement and self-blame. Increasing age and more chronic conditions were associated with worse QoL. A higher education level was significantly associated with better physical and mental QoL. CONCLUSIONS: This study found that adults with MCCs living in China experienced impaired QoL. The strong relationship found between the participants' perceptions of MCCs, coping strategies, and QoL suggested that healthcare professionals should recognize the physical and psychological impacts of MCCs and address the significance of adaptations to MCCs in future treatment programs. The findings will help healthcare professionals design more specific interventions to modify illness perceptions and enhance certain coping strategies to improve the QoL of people with MCCs. Healthcare professionals can mobilize available resources from healthcare and social systems to enhance people's coping and adaptation to MCCs. CLINICAL RELEVANCE: With an understanding of the illness perceptions of people with MCCs, healthcare professionals could offer information related to consequences, timeline, and personal control to enable better alignment between people's expectations and their actual situations. By knowing people's coping strategies, healthcare professionals can offer additional support to people who prefer strategies of denial and disengagement and self-blame.

Prevalence of burnout in mental health nurses in China: A meta-analysis of observational studies.

OBJECTIVE: Burnout is common in mental health nurses because of work-related stress. Burnout has a negative impact on nurses' health and work performance. The prevalence of high burnout in mental health nurses has been inconclusive across studies. This meta-analysis aimed to estimate the pooled prevalence of high burnout in mental health nurses in China. METHODS: Electronic databases (PubMed, EMBASE, PsycINFO, Web of Science, CNKI, WanFang and SinoMed) were independently and systematically searched from their commencement date up to 14 May 2018. Studies that reported the prevalence of any of the 3 burnout dimensions (high Emotional Exhaustion (EE), Depersonalization (DP), and low Personal Accomplishment (PA)) as measured by the Maslach Burnout Inventory (MBI) were included and analyzed using the random-effects model. RESULTS: A total of 19 studies were included in this meta-analysis. The pooled prevalence of high EE was 28.1% (95% CI: 20.4-35.8%), DP was 25.4% (18.1-32.6%) and low PA was 39.7% (28.3-51.1%). Subgroup analyses found that short working experience, use of MBI-Human Services Survey (HSS), and younger age had moderating effects on prevalence of high burnout. CONCLUSIONS: Burnout is common in mental health nurses in China. Considering its negative impact on health and work performance, regular screening, preventive measures and effective interventions should be implemented.

Coping with multiple chronic conditions: An integrative review.

There is a paucity of summarized evidence concerning coping with multiple chronic conditions. An integrative review approach was used to synthesize current evidence on: (i) coping in forms of perceptions and strategies, (ii) relationship between coping and health-related outcomes, and (iii) factors related to coping. Five electronic databases were searched without time limitation. Thirty-two studies met inclusion criteria and were included for full-text review: 24 qualitative, seven quantitative, and one mixed-methods study. Studies were assessed for quality using an appraisal system of rigor and relevance. A constant comparison method was used to synthesize findings from eligible studies. This review synthesized perceptions of multiple chronic conditions involving negative moods and physical limitations, and strategies of coping with multiple chronic conditions including problem- and emotion-focused strategies. Findings suggested that coping is a promising path to manage multiple chronic conditions and emphasized that appropriate coping might have positive impacts on health-related outcomes. Five impact factors including age, gender, clusters of multiple chronic conditions, social support, and ethnicity and culture were associated with people's coping. Future healthcare plans should address the physical and psychological needs of people with multiple chronic conditions and highlight the importance of modifying their illness perceptions and enhancing appropriate coping strategies.