Chenxi Zhou

Background: Nursing process competency is essential for clinical reasoning and the delivery of systematic and individualised nursing care. However, evidence remains limited regarding the level of this competency among nursing interns and the psychological, cognitive, and environmental and social factors associated with it. Aim(s): Guided by the Clinical Learning Environment Model, this study aimed to describe the level of nursing process competency among nursing interns and identify the psychological, cognitive, environmental and social factors associated with this competency. Methods: A single‐centre, hospital‐based cross‐sectional study was conducted in a tertiary teaching hospital in China. A self‐selected non‐probability sample of 348 final‐year nursing interns completed a structured online survey. The survey included the Competency of Nursing Process Questionnaire, the Belongingness Scale–Clinical Placement Experience, the Academic Support in the Practicum Scale, and investigator‐developed indicators of cognitive and skill‐related and environmental and social factors. Data were analysed using descriptive statistics, bivariate analyses, and multiple linear regression, with all prespecified variables entered simultaneously into the regression model. Results: The mean nursing process competency score was 81.35 (SD = 12.22; observed range: 26–105), with diagnosis and planning having the lowest item‐level mean scores. The fully adjusted regression model was statistically significant, F (27, 320) = 30.51, p < 0.001, and explained 72.0% of the variance in nursing process competency (adjusted R ² = 0.697). Clinical belongingness showed the strongest positive mutually adjusted association with competency ( β = 0.732, p < 0.001; semi‐partial R ² = 0.2742), followed by self‐rated theoretical nursing knowledge ( β = 0.137, p = 0.009; semi‐partial R ² = 0.0061). Perceived support from physicians showed a smaller positive association in the primary model ( β = 0.115, p = 0.048; semi‐partial R ² = 0.0034), but this association was not statistically significant in the sensitivity analysis ( p = 0.058) and was therefore interpreted as exploratory. Conclusion: Clinical belongingness was the factor most strongly associated with nursing process competency, highlighting the potential relevance of interns' sense of acceptance and connection within the clinical learning environment. Self‐rated theoretical nursing knowledge was also associated with competency after mutual adjustment. The smaller association involving perceived support from physicians was not robust to sensitivity analysis and requires further investigation. Given the cross‐sectional design, these findings should not be interpreted as evidence of causal relationships. Implications for Nursing Practise: The findings suggest that nurse educators, preceptors, and clinical managers should consider structured orientation, inclusive team communication, continuity of preceptorship, and regular feedback to foster interns' clinical belongingness, alongside supervised opportunities to apply theoretical knowledge during assessment, diagnosis, and care planning. These strategies should be prospectively evaluated before their effectiveness is assumed. Reporting Method: This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and its checklist for cross‐sectional studies. No Patient or Public Contribution: Nursing interns participated only as survey respondents and were not involved in the study design, conduct, data analysis, interpretation, reporting, or dissemination.

Aims: Accelerated population aging has driven substantial growth in demand for palliative care services. Such services can effectively enhance the living quality for end‐of‐life patients through multidimensional interventions. Currently, China lacks a localised experience‐oriented quality assessment scale for palliative care, resulting in gaps in service quality supervision. To develop a self‐reported measurement for palliative care services, with the foundation in the Senses Framework. Design: This study developed a scale by extracting core contributors of palliative care experiences through 14 patients and 16 families' narratives. To refine and improve the scale, a total of 19 experts were invited to participate in a two‐round Delphi expert consultation. Additionally, an empirical research was conducted, with 380 valid samples from two independent cohorts collected to complete the full psychometric testing of the scale. Results: The final Palliative Care Experience Scale (PCES) comprises two dimensions: sense of security and belonging, and sense of purpose and significance, with a total of 13 items. The total variance includes 79.26% that is explained by these two factors. Confirmatory factor analysis confirmed a stable factor structure for the PCES. The scale exhibited good reliability, with a total Cronbach' α of 0.937, McDonald' ω of 0.952, and Spearman‐Brown corrected split‐half reliability of 0.897. Cronbach's α for both dimensions exceeded 0.88. The scale's SEM was 1.50 and MDC95 was 4.16, offering a validated threshold to identify real changes in patients' palliative care experience. Conclusion: This study developed an assessment scale of palliative care quality based on the Senses Framework, uniquely centred on patient experiences. Validated through robust methodologies, this scale fills a gap in the evaluation of experiential dimensions of palliative care in China, providing a scientific and feasible measurement tool for the continuous improvement of services. Impact: This study addresses the critical gap of a culturally adapted, patient experience‐centred tool for evaluating palliative care service quality in China. Its core finding is the successful development and full psychometric validation of the 13‐item Palliative Care Experience Scale (PCES). This research provides a reliable tool for palliative care clinical practice and academic research to capture patients' care experience, offers clinicians and administrators a practical instrument to identify service gaps and guide quality improvement, and delivers foundational reference data for policymakers to advance patient‐centred palliative care development in China. Reporting Method: We adhered to the relevant EQUATOR reporting guidelines. The development and validation process followed the COSMIN framework for patient‐reported outcome measures. Patient or Public Contribution: Patients receiving palliative care and familes played an integral role in designing and conducting this study. In Phase I, qualitative data from semi‐structured interviews with 14 patients and 16 families helped define core thematic constructs and develop the initial item pool, which ensured the scale's content validity were based on their real‐life experiences. In Phase III, we recruited a new, independent cohort of participants to complete the psychometric testing of the scale, providing key data for its validation.

Background: Work–family behavioral role conflict (WFBRC) is an important stressor in the nursing work environment and may be associated with turnover intention. However, the roles of role overload, presenteeism, and (PsyCap) in this relationship have rarely been examined simultaneously among Chinese clinical nurses. Aims: Guided by the Conservation of Resources (COR) theory, this study aimed to examine the relationship between WFBRC and turnover intention among Chinese clinical nurses, as well as the mediating and moderating roles of role overload, presenteeism, and PsyCap. Methods: This was a multicenter cross‐sectional study. A total of 1225 registered nurses from 12 tertiary hospitals in China completed validated instruments assessing WFBRC, role overload, presenteeism, PsyCap, and turnover intention. Data were analyzed using descriptive statistics, Pearson correlation analysis, and bias‐corrected bootstrap analyses with 5000 resamples to test mediation and moderated mediation effects. Sensitivity analyses were conducted after controlling for demographic and occupational covariates. Results: WFBRC was positively associated with role overload, presenteeism, and turnover intention and negatively associated with PsyCap. Parallel mediation analyses showed that role overload, presenteeism, and PsyCap jointly mediated the association between WFBRC and turnover intention, with role overload showing the strongest indirect effect, followed by presenteeism, whereas PsyCap showed a smaller but significant indirect effect. A significant serial pathway through role overload and presenteeism was also identified. Moderated mediation analyses suggested that PsyCap may buffer the associations of role overload and presenteeism with turnover intention in separate second‐stage models; however, this pattern was not retained when both moderated pathways were entered simultaneously. Conclusion: WFBRC was significantly associated with nurses’ turnover intention through both direct and resource‐related pathways. Role overload and presenteeism were the primary mediators, whereas PsyCap showed a smaller indirect effect and limited buffering effects in selected models. Implications for Nursing Management: Organizations and nursing managers should address WFBRC proactively. Routine assessment of role overload and presenteeism can enable early detection of risk and timely intervention, while efforts to strengthen nurses’ PsyCap may further help break the resource‐loss process and support workforce retention.

Background: Digital exclusion has been linked to adverse health outcomes among older adults. However, its relationship with health literacy, a midstream determinant of health outcomes in aging populations, remains insufficiently explored. Aim: To investigate the relationship between digital exclusion and health literacy among older adults, and to assess the mediating effects of social support and self‐efficacy. Design: A cross‐sectional study. Methods: Data from the 2021 Psychology and Behaviour Investigation of Chinese Residents (PBICR) survey were used. Digital exclusion was assessed through self‐reported non‐use of computers or smartphones. Health literacy, social support and self‐efficacy were measured using the Short‐Form Health Literacy Instrument, the 12‐item Perceived Social Support Scale and the New General Self‐Efficacy Scale. Generalised linear models (GLM) were employed to examine the relationships between digital exclusion and health literacy, while mediation analysis with bootstrapping assessed the mediating roles of social support and self‐efficacy. Results: A total of 1147 older adults participated in the study, with 27.64% identified as digitally excluded and a moderate level of health literacy. GLM analysis identified several significant factors influencing health literacy, including digital exclusion, social support, self‐efficacy, higher education levels, household monthly income per capita > 3000 RMB, non‐agricultural hukou, chronic conditions and medication use. Mediation analysis revealed that digital exclusion negatively impacted health literacy. Social support and self‐efficacy partially mediated the relationship between digital exclusion and health literacy. Conclusion: Digital exclusion is negatively associated with health literacy among older adults, with social support and self‐efficacy partially mediating the relationship. Implications for the Profession and/or Patient Care: This study underscores the importance of addressing digital exclusion, as well as promoting social support and self‐efficacy to enhance health literacy in ageing populations. Impact: This study provides insights into the relationship between digital exclusion and health literacy among older adults, as well as the mediating effects of social support and self‐efficacy, offering potential targets for health literacy improvement. Reporting Method: STROBE Statement (STrengthening the Reporting of OBservational studies in Epidemiology). Patient or Public Contribution: No patient or public contribution was involved.

Objectives To examine the relationship between hearing impairment and cognitive function and the mediating role of social isolation and depression. Methods: Data came from the 2018 China Health and Retirement Longitudinal Study wave. A self-reported item, a composite index, the 10-item Center for Epidemiological Studies Depression Scale, and the Mini-Mental State Exam were used to measure hearing impairment, social isolation, depression, and cognitive function, respectively. Mediation analysis was performed. Results: 6799 participants were included. For participants reporting mild hearing impairment and severe hearing impairment, there were significant direct and indirect effects on cognitive function. Social isolation mediated 2.75% and 6.33% of the relationship between mild hearing impairment, severe hearing impairment, and cognitive function, respectively. The direct effect of hearing impairment outweighed the mediation effect of social isolation on cognitive function. Conclusions: Decreased cognitive function linked to hearing impairment might benefit from addressing hearing impairment and social isolation in older adults.

Background: Delirium is frequently disproportionately under‐recognized despite its high prevalence, detrimental impact, and potential lethality. Informant‐based delirium detection tools can offer structured assessment and increase the timeliness and frequency of detection. We aimed to examine the diagnostic accuracy of the Family Confusion Assessment Method (FAM‐CAM) for delirium detection. Methods: We systematically searched the MEDLINE, EMBASE, PsycINFO, CINAHL, CNKI, WANFANG, and SinoMed databases from January 1988 to December 2022. Two reviewers independently screened studies and evaluated methodological quality using the revised quality assessment of diagnostic accuracy studies (QUADAS‐2) tool. A bivariate random effects model was undertaken, and univariable meta‐regression was carried out to explore heterogeneity. Results: Seven studies with 483 dyads of participants and family caregivers were identified. Pooled sensitivity and specificity were 0.74 (95% CI: 0.59, 0.86) and 0.91 (95% CI: 0.83, 0.95), respectively, with an area under curve (AUC) of 0.91. The positive likelihood ratio was 8.27 (95% CI: 3.97, 17.25), and the negative likelihood ratio was 0.28 (95% CI: 0.16, 0.50). Settings impacted specificity ( p = 0.02). Conclusions: Available evidence indicates that FAM‐CAM exhibits moderate sensitivity and high specificity for delirium screening in adults. The FAM‐CAM is concise and easy to use, making it appropriate for routine clinical practice, which might benefit early delirium detection and potentially foster delirium management. PROSPERO Registration Number: CRD42022378742.

探索体外循环下心血管手术患者的术后谵妄（postoperative delirium, POD）与亚谵妄综合征（subsyndromal delirium, SSD）发生情况及影响因素。 收集2022年5–9月湖北省某三甲医院体外循环下心血管手术患者的一般资料、围手术期血常规及生理生化指标、手术及治疗情况等，采用护理谵妄筛查量表评估结局指标即POD和SSD发生情况，不同组别的影响因素分析采用无序多分类logistic回归。 202例患者中，SSD、SSD进展为POD、直接发生POD的发生率为13.4%、6.4%、34.2%。回归分析显示，以无POD或SSD组为对照，术前血糖〔比值比（odds ratio, OR）=0.38，95%置信区间（CI）：0.19～0.76）〕、术中输注血小板（OR=0.37，95%CI：0.15～0.92）、术中依托咪酯剂量（OR=0.93，95%CI：0.87～0.98）、术后总胆红素水平（OR=1.04，95%CI：1.01～1.07）是SSD的影响因素；年龄（OR=1.09，95%CI：1.01～1.17）、ASA分级为Ⅳ级及以上（OR=10.72，95%CI：1.85～62.08）、术中右美托咪定剂量（OR=1.01，95%CI：1.003～1.02）、机械通气时长（OR=1.04，95%CI：1.01～1.07）是SSD进展为POD的影响因素；年龄（OR=1.06，95%CI：1.02～1.10）、初中或高中学历（OR=0.35，95%CI：0.15～0.83）、机械通气时长（OR=1.04，95%CI：1.01～1.07）是直接发生POD的影响因素。 年龄、受教育程度、ASA分级、术前血糖、术中输注血小板、术中依托咪酯剂量、术中右美托咪定剂量、术后总胆红素和机械通气时长是体外循环下心血管手术患者POD和SSD发生情况的影响因素，且不同组别的影响因素存在差异，应精准评估和干预不同组别的危险因素，预防或遏制POD或SSD的发生和发展，促进患者加速康复。

Aims and Objectives: To examine knowledge, attitude, and practice regarding postoperative delirium and the relationships among cardiac surgery nurses in China.Background: Postoperative delirium is a prevalent and devastating complication following cardiac surgery. Nurses play a part in multi‐disciplinary collaboration for preventing and managing postoperative delirium, of whom knowledge, attitude, and practice are essential.Design: A cross‐sectional multi‐centre study.Methods: Nurses from cardiac surgery wards and intensive care units of five tertiary hospitals in Wuhan, Hubei Province, China were enrolled. Data were gathered online using a self‐administered questionnaire. Student's t‐test, or analysis of variance, or non‐parametric tests were performed to compare differences across groups. Bootstrapping mediation analysis was conducted to examine the relationship between knowledge, attitude, and practice. The STROBE checklist was used for the reporting of this study.Results: Of 429 nurses, a moderate level of knowledge and high levels of attitude and practice regarding postoperative delirium were revealed. Nurses with higher education, higher academic title, 5–10 years of practice in nursing and cardiac surgery nursing exhibited increased knowledge. With advanced age, practice in a specialised hospital, and training experience, nurses reported a better degree of practice. Attitude played a full mediating effect in the relationship between knowledge and practice, accounting for 81.82% of the total effects.Conclusions: Knowledge, attitude, and practice regarding postoperative delirium are promising among Chinese cardiac surgery nurses, with knowledge of screening tools and perioperative nonpharmacological interventions and practice of screening in need of enhancement. Attitudes act as an intermediary between knowledge and practice regarding postoperative delirium.Relevance to Clinical Practice: Innovative and stratified in‐service education is warranted to address knowledge enhancement. Meanwhile, organisations are suggested to make efforts to foster nurses' positive attitudes, particularly in creating a favourable culture and developing institutional protocols for postoperative delirium management to improve practice.No Patient or Public Contribution: This study is focused on cardiac surgery nurses' knowledge, attitude, and practice regarding postoperative delirium, and the research questions and design are from clinical nursing practice, literature review, and expert panel review, in which the patient or public is temporarily not involved.

Objectives: This study aimed to investigate the associations between social isolation, loneliness, and motoric cognitive risk syndrome (MCR) among older adults in China.Methods: Data were obtained from the China Health and Retirement Longitudinal Study in the 2011 and 2015 waves. Social isolation and loneliness were measured by an index and an item, and MCR was defined as subjective cognitive complaints and slow gait. Multivariable logistic regression analyses were performed to examine the associations between social isolation, loneliness, and MCR by gender.Results: Of 3251 eligible participants, the incidence of MCR was 10.03%. Social isolation and loneliness were not significantly associated with incident MCR in men. Loneliness was positively associated with incident MCR in women (OR: 1.45, 95% CI: 1.05, 2.01), while social isolation was not.Conclusions: Loneliness is associated with incident MCR among female older adults in China. More attention is advised to be paid to loneliness among female older adults, to hold promise for the prevention and reduction of MCR.