Factors influencing caring behaviour among registered nurses during the COVID-19 pandemic in China: A qualitative study using the COM-B framework.

AIM: The aim of this work is to explore the influencing factors of nurses' caring behaviour during the COVID-19 pandemic based on the Capability, Opportunity, Motivation as determinants of Behaviour (COM-B) theoretical framework. BACKGROUND: Nurse caring behaviour is vital to reduce and speed up the healing process of COVID-19 patients. It is important to understand the factors that influence caring behaviour among nurses during the COVID-19 pandemic. Research suggests that when it comes to understanding behaviour, using a theoretical framework is likely to be most effective, and the COM-B framework is a recommended approach. METHODS: Semistructured interviews with 42 nurses working in 11 Chinese cities were conducted, and their verbatim statements were transcribed and analysed using thematic analysis. The results were mapped to COM-B framework. RESULTS: Ten key themes emerged: Capability (professional knowledge and skills, emotional intelligence, cross-cultural care competence); opportunity (resources, organizational culture, social culture); motivation (past experience, character, role, beliefs). CONCLUSIONS: Ten factors were found to influence nurses' caring behaviour. This study added two new influencing factors, social culture and past experiences, that further contributed to the understanding of nurses' care behaviours. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses' caring behaviour is influenced not only by themselves but also by institutions and society, so interventions aiming to improve their caring behaviour should consider these elements. The negative impact of the pandemic on capability factors that influence nurses' caring behaviour should be counteracted as soon as possible.

Identification of serum metabolites enhancing inflammatory responses in COVID-19.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by a strong production of inflammatory cytokines such as TNF and IL-6, which underlie the severity of the disease. However, the molecular mechanisms responsible for such a strong immune response remains unclear. Here, utilizing targeted tandem mass spectrometry to analyze serum metabolome and lipidome in COVID-19 patients at different temporal stages, we identified that 611 metabolites (of 1,039) were significantly altered in COVID-19 patients. Among them, two metabolites, agmatine and putrescine, were prominently elevated in the serum of patients; and 2-quinolinecarboxylate was changed in a biphasic manner, elevated during early COVID-19 infection but levelled off. When tested in mouse embryonic fibroblasts (MEFs) and macrophages, these 3 metabolites were found to activate the NF-κB pathway that plays a pivotal role in governing cytokine production. Importantly, these metabolites were each able to cause strong increase of TNF and IL-6 levels when administered to wildtype mice, but not in the mice lacking NF-κB. Intriguingly, these metabolites have little effects on the activation of interferon regulatory factors (IRFs) for the production of type I interferons (IFNs) for antiviral defenses. These data suggest that circulating metabolites resulting from COVID-19 infection may act as effectors to elicit the peculiar systemic inflammatory responses, exhibiting severely strong proinflammatory cytokine production with limited induction of the interferons. Our study may provide a rationale for development of drugs to alleviate inflammation in COVID-19 patients.

The application of digital technology in gambling industry

PurposeThe study aims to integrate the insights gained from the gambling industry into a value creation conceptual framework for analyzing the influence of digital technology application. Both primary and secondary data from industry practitioners are examined and discussed.Design/methodology/approachIn-depth interviews covering top management from six major casinos in Macau were conducted with industry experts, who provided the pioneering feedback on digitalization technology implemented with examples from major casino cities, including Macau, Las Vegas, Monte Carlo, Singapore, Seoul and some others.FindingsThe study provides an overview of the current status of the application of digital technology in the gambling industry and the level of the feasibility, practicability and profitability of this development on the casino floor. Digital technologies are found to augment the gambling industry in aspects of the product, service and operational structure. Research also discovers that benefits and values gained by the casino can be categorized in three dimensions: (1) value perceived by the customer, (2) value obtained from the customer and (3) value gained by the firm.Originality/valueThe research serves as a reference for Macau policymakers regarding regulations on emerging digital technologies in the gambling industry, as well as for casino management seeking to understand new potential business opportunities and future developments in digitalization.

Nurses Who Are More Willing to Participate in the Fight against COVID-19: Evidence from China.

When facing an infectious disease disaster, nurses' willingness to work is critical. Nurses' lack of willingness to work during a pandemic may worsen the shortage of health care personnel. The purpose of this study is to assess the willingness of nurses to participate in the fight against COVID-19 in China and to identify factors associated therewith. This cross-sectional study examines nurses working in 11 Chinese cities including Macau, Hong Kong, Shenzhen, Dongguan, Huizhou, Guangzhou, Zhaoqing, Foshan, Jiangmen, Zhongshan, and Zhuhai. Questionnaires were collected from 19 May to 7 August 2020. A total of 8065 questionnaires were received, of which 8030 valid questionnaires were included for analysis. A total of 53.4% of participants reported that they had signed up to support the COVID-19 pandemic response. Multivariate logistic regression analysis revealed that being single (OR = 0.72, 95% CI: 0.60-0.87), having no children (OR = 0.81, 95% CI: 0.68-0.97), possessing higher professional qualifications (OR = 1.25, 95% CI: 1.14-1.37), having a more prestigious professional title (OR = 1.68, 95%CI: 1.50-1.90), being an administrative supervisor (OR = 0.53, 95% CI: 0.45-0.63), having a higher caring dimensions inventory score (OR = 1.01, 95% CI: 1.01-1.01), working in a hospital (OR = 0.53, 95% CI: 0.39-0.72), and receiving employer-provided care training (OR = 0.77, 95% CI: 0.68-0.87) were predictive of nurses' willingness to participate in the fight against COVID-19. We suggest that unmarried nurses should be given priority when recruiting to fight an epidemic and, for married nurses with children who are recruited to fight an epidemic, supporting measures should be provided for childcare. We suggest strengthening workplace training of caring for nurses in order to better retain and recruit qualified support for an epidemic outbreak of infectious diseases.