Social determinants of health and their relation to suboptimal health status in the context of 3PM: a latent profile analysis.

Background: Suboptimal health is identified as a reversible phase occurring before chronic diseases manifest, emphasizing the significance of early detection and intervention in predictive, preventive, and personalized medicine (PPPM/3PM). While the biological and genetic factors associated with suboptimal health have received considerable attention, the influence of social determinants of health (SDH) remains relatively understudied. By comprehensively understanding the SDH influencing suboptimal health, healthcare providers can tailor interventions to address individual needs, improving health outcomes and facilitating the transition to optimal well-being. This study aimed to identify distinct profiles within SDH indicators and examine their association with suboptimal health status. Method: This cross-sectional study was conducted from June 16 to September 23, 2023, in five regions of China. Various SDH indicators, such as family health, economic status, eHealth literacy, mental disorder, social support, health behavior, and sleep quality, were examined in this study. Latent profile analysis was employed to identify distinct profiles based on these SDH indicators. Logistic regression analysis by profile was used to investigate the association between these profiles and suboptimal health status. Results: The analysis included 4918 individuals. Latent profile analysis revealed three distinct profiles (prevalence): the Adversely Burdened Vulnerability Group (37.6%), the Adversity-Driven Struggle Group (11.7%), and the Advantaged Resilience Group (50.7%). These profiles exhibited significant differences in suboptimal health status (p < 0.001). The Adversely Burdened Vulnerability Group had the highest risk of suboptimal health, followed by the Adversity-Driven Struggle Group, while the Advantaged Resilience Group had the lowest risk. Conclusions and relevance: Distinct profiles based on SDH indicators are associated with suboptimal health status. Healthcare providers should integrate SDH assessment into routine clinical practice to customize interventions and address specific needs. This study reveals that the group with the highest risk of suboptimal health stands out as the youngest among all the groups, underscoring the critical importance of early intervention and targeted prevention strategies within the framework of 3PM. Tailored interventions for the Adversely Burdened Vulnerability Group should focus on economic opportunities, healthcare access, healthy food options, and social support. Leveraging their higher eHealth literacy and resourcefulness, interventions empower the Adversity-Driven Struggle Group. By addressing healthcare utilization, substance use, and social support, targeted interventions effectively reduce suboptimal health risks and improve well-being in vulnerable populations. Supplementary Information: The online version contains supplementary material available at 10.1007/s13167-024-00365-5.

The effect of family health on suboptimal health status: The parallel mediation role of sleep quality and health behaviour.

Background: The prevalence of suboptimal health status has been increasing worldwide, posing a significant challenge to public health. Meanwhile, family health has been recognised as an important factor influencing individual health outcomes. However, the mechanisms through which family health affects suboptimal health status remain unclear. We aimed to investigate the parallel mediation role of sleep quality and health behaviour in the relationship between family health and suboptimal health status. Methods: We conducted a cross-sectional online survey with a sample of adults >18 years old from four provinces in China. The survey questionnaires queried their demographic characteristics, family health, suboptimal health status, sleep quality, and health behaviour. We assessed family health by the Family Health Scale-Short Form and suboptimal health status using the Suboptimal Health Status Questionnaire. We employed structural equation modelling to analyse the data and test the proposed mediation model. Results: we collected 4918 valid questionnaires. The mean age of the participants was 30.1 years (standard deviation = 12.5). The correlation analysis demonstrated a significant negative association between family health and suboptimal health status (r = -0.44; P < 0.001). The results of the parallel mediation analysis showed that family health had a significant indirect effect on suboptimal health status through both sleep quality (ß = -0.350; P < 0.001) and health behaviour (ß = -0.137; P < 0.001). The total indirect effect of family health on suboptimal health status through both sleep quality and health behaviour was also significant (ß = -0.569, P < 0.001). Conclusions: This study highlights the significance of family health as a predictor of suboptimal health status and suggests that sleep quality and health behaviour are parallel mediators in this relationship. By understanding the role of family health, sleep quality, and health behaviour, interventions can be targeted to improve overall health outcomes.

Chinese version of Yoon Critical Thinking Disposition Instrument: validation using classical test theory and Rasch analysis.

BACKGROUND: Despite the availability of a wide range of critical thinking instruments, there was no original design for nurses that has been translated into Chinese. However, only instruments designed specifically for the nursing discipline would be reliable. This study aimed to translate, culturally adapt, and validate the Yoon Critical Thinking Disposition Instrument in the Chinese context. METHODS: A four-step translation process was implemented according to Word Health Organization guidelines, which included forward translation, expert panel review, backward translation, and pre-testing. Experts and nursing students participated in testing the validity and reliability of the Chinese version. RESULTS: The translation of the instrument went smoothly. According to a confirmatory factor analysis, there was an acceptable fit for the seven-factor model. Content validity indices ranged from 0.6 to 1 at item level, and 0.94 at scale level. In addition, there was extremely high internal consistency and test-retest reliability in the translated instrument. There was a good fit for the items with both person and item reliabilities greater than 0.6 and a separation index of 2.19, respectively. The item location was identified from the wright map as not covering person ability, but the scale did not have a gender-related differential item functioning. CONCLUSIONS: In this study, a critical thinking disposition instrument for nursing students was translated into Chinese for the first time. This translated instrument is a reliable tool with satisfactory validity and reliability. It could provide opportunities for building a cross-cultural understanding of critical thinking disposition.

Gender similarities and differences in the perception of caring among nurses during the COVID-19 pandemic: a mixed-methods study.

BACKGROUND: Caring is the essence and core of nursing. Current studies on the effect of gender on nurses' perception of caring have been inconsistent. Most of these studies were quantitative and conducted before the COVID-19 pandemic. The study aimed to explore the gender similarities and differences in nurses' perception of caring during the COVID-19 pandemic. METHODS: In 2020, a cross-sectional mixed-method study was conducted in 11 cities in China using structured online questionnaire (n = 8030) and face-to-face individual interview (n = 42). Data collection tools included the Caring Dimensions Inventory and semi-structured interview. RESULTS: In stepwise multivariable linear regression analysis, female nurses scored 1.93 points higher on caring than male nurses, after completely controlling for the other factors. The interview results showed that both male and female nurses agreed that caring was to deal with three kinds of relationships, namely nurses and people, nurses and themselves, nurses and society. There were gender differences in the connotation of caring between nurses and themselves, but not in the connotations of caring between other relationships. The ranking of the importance of caring connotations among these relationships showed no gender difference except between nurses and themselves. CONCLUSION: The quantitative findings suggest that gender influences nurses' perception of caring. The qualitative findings demonstrate that nurses regard themselves as both recipients and implementers of caring. The qualitative results indicate nurses of different genders have similarities and differences in their perception of caring, and the biggest difference lies in the relationship between nurses and themselves.

The mediating effect of critical thinking between interest in learning and caring among nursing students: a cross-sectional study.

BACKGROUND: Previous studies have explored the influence of interest in learning on caring and critical thinking, as well as the relationship between caring and critical thinking. However, the mediating effect of critical thinking in interest learning and caring among nursing students has not been clarified. METHODS: Nursing students who enrolled for the 2021/2022 academic year in diploma, undergraduate, or graduate programs in five provinces of China (Guangdong, Sichuan, Jiangsu, Hunan and Macao). An online survey with a convenience sampling method was employed to collect data. The questionnaires were administered to 692 participants between January 20 and 26, 2022. Amos 26.0 was employed to establish the structural equation modelling and analyze the mediating effect of critical thinking on interest in learning and caring. RESULTS: The first regression equation showed that interest in learning significantly influenced caring (ß = 0.339, p <  0.001). The third regression equation showed that critical thinking significantly influenced caring (ß = 0.494, p <  0.001). The effect of interest in learning on caring was less in the third equation than in the first equation (ß = 0.154 vs ß = 0.339), which indicates partial mediation. Furthermore, interest in learning had an indirect positive effect (ß = 0.186, p <  0.001) on caring mediated by critical thinking, with 95% confidence interval of 0.142 to 0.233. CONCLUSIONS: Critical thinking was a significant mediator of the relationship between interest in learning and caring. It is suggested that nursing colleges and instructors should take into account students' interest in learning and critical thinking as potential intervention elements to enhance caring.

Impact of scenario validity and group size on learning outcomes in high-fidelity simulation: A systematics review and meta-analysis.

OBJECTIVES: To determine the effects related to scenario validity and group size in high-fidelity simulation among undergraduate nursing students. DESIGN: A systematic review and meta-analysis of randomized controlled trials and quasi-experiment. DATA SOURCES: Embase, PubMed, Web of Science, Wangfang database, and Cochrane Library, China National Knowledge Infrastructure were searched from the start of each database to February 22, 2022. The references and citations lists were manually screened to find additional references. REVIEW METHODS: Screening and quality assessment of the retrieved studies were conducted independently by two authors. Discussions with a third author sorted out any discrepancies between the two authors. Using meta-analysis procedures based on a random-effect model, outcome data were synthesized and standard mean difference was computed with a 95 % confidence interval. RESULTS: Thirty-three studies were included. A total 4077 undergraduate nursing students were recruited, of which 2068 participated in experimental groups. High-fidelity simulation with scenario validity was better than high-fidelity simulation without scenario validity in cultivating undergraduate nursing students' knowledge (p = 0.03), and they were equivalent in improving students' skills (p = 0.75). Groups of six or fewer students in each high-fidelity simulation tend to be more effective at promoting knowledge (standard mean difference = 0.98) and skill (standard mean difference = 1.00), but the differences were not statistically significant. CONCLUSIONS: High-fidelity simulation with scenario validity and with less than six students in each group can be more effective in cultivating knowledge and skills among undergraduate nursing students. For high-fidelity simulation to be as effective as possible, nursing instructors should ensure scenario validity and limit the number of students in each group to under six.

The impact of caring for COVID-19 patients on nurse professional identity: A cross-sectional study using propensity score analysis.

Objective: To examine the impact of caring for COVID-19 patients on the professional identity of nurses. Methods: An online survey was conducted between 19 May and 7 August 2020 in 11 Chinese cities, including Dongguan, Foshan, Guangzhou, Hong Kong, Huizhou, Jiangmen, Macao, Shenzhen, Zhaoqing, Zhongshan, and Zhuhai. Propensity score matching was used to adjust for confounding variables between nurses with and without experience caring for COVID-19 patients. To analyze the impact of caring for COVID-19 patients on nurses' professional identity, a nominal logistic regression model was used rather than an ordinal regression model because the parallel regression assumption was violated. Results: After propensity score matching, the final sample contained 1,268 participants, including 634 nurses who cared for COVID-19 patients. During the COVID-19 outbreak, 88.6% of nurses had high levels of professional identity. Nurses who cared for COVID-19 patients had the lowest percentage of high score level on the professional identity subscale for "sense of organizational influence," as did nurses who did not care for COVID-19 patients. The findings indicated that nurses who cared for COVID-19 patients were 17.95 times more likely to have a high professional identity than a low professional identity (95% CI 2.38-135.39, p = 0.005), after completely controlling for the other factors. There were significant differences between nurses who cared for COVID-19 patients and those who did not in scores on the subscales of professional identity, except for the subscales "sense of self-decision-making" (χ2 = 4.85, p = 0.089) and "sense of organizational influence" (χ2 = 4.71, p = 0.095). Conclusion: Nurses' professional identity is positively impacted by their experience caring for COVID-19 patients. Caring for COVID-19 patients should be highlighted as an opportunity to enhance nurses' professional identity. To further enhance the professional identity of nurses, we call for visible nursing leadership during the COVID-19 pandemic and improve their working environment.

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.

Prebriefing for high-fidelity simulation in nursing education: A meta-analysis.

BACKGROUND: Briefing, scenario development, and debriefing of high-fidelity simulation (HFS) have been widely discussed in the past, but less attention is given to prebriefing, and its role in learning outcomes. The prebriefing engages students and equips them with the knowledge and skills they need for a successful simulation. OBJECTIVES: To identify the effectiveness of prebriefing of HFS in Bachelor of Science in Nursing (BSN) students. DESIGN: A meta-analysis of randomized controlled trials and quasi-experiment. DATA SOURCES: The Web of Science, PubMed, Embase, Cochrane Library, WANFANG, and CNKI were for randomized controlled and quasi-experimental studies published in English or Chinese up to June 26, 2022. REVIEW METHODS: Two authors independently screened the literature, extracted data and evaluated the quality of the included studies. The standardized mean difference with a 95 % confidence interval was used to facilitate direct comparisons between studies. All statistical tests were conducted with Review Manager 5.4 software. RESULTS: This meta-analysis included 17 randomized controlled studies and 25 quasi-experimental studies involving 4926 BSN students. No significant differences in knowledge (p = 0.58), skill (p = 0.67), satisfaction (p = 0.84), critical thinking (p = 0.56), caring (p = 0.11), learning interest (p = 0.85), and self-confidence (p = 0.21) between HFS with and without prebriefing were found in subgroup analyses. HFS with prebriefing generated larger effect for collaboration (0.82 vs 0.27, p = 0.004). CONCLUSION: HFS with prebriefing facilitates collaboration of BSN students more effectively, and it has an equivalent effect to HFS without prebriefing on fostering BSN students' knowledge, skills, critical thinking, caring, learning interest, and self-confidence.

High-fidelity simulation duration and learning outcomes among undergraduate nursing students: A systematic review and meta-analysis.

OBJECTIVES: To explore the effects of different lengths of the three key steps (prebriefing, simulation, and debriefing) of high-fidelity simulation (HFS) on the knowledge and skills of undergraduate nursing students. DESIGN: A systematic review and meta-analysis. DATA SOURCES: A systematic search was conducted for Chinese and English publications from the Web of Science, PubMed, Embase, Cochrane, and two Chinese databases (Wanfang and CNKI) up to November 24, 2021. REVIEW METHODS: Two independent raters screened the retrieved studies and extracted data based on a coding protocol from the studies that met the inclusion criteria. Data were synthesized using meta-analytic procedures based on a random-effect model and computing effect sizes by standard mean differences (SMD) with a 95% confidence interval (CI). RESULTS: Forty-four studies were included, and 23 studies were analyzed. High-fidelity simulation (HFS) with debriefing of 10 min or less (SMD = 1.18), simulation of 15-20 min (SMD = 1.43), and debriefing of 11-30 min (SMD = 1.19) showed larger effect sizes for knowledge, while HFS with debriefing of >10 min (SMD = 0.91), simulation of 15 min or less (SMD = 0.89), and over 30 min of debriefing cultivation (SMD = 0.84) showed larger effect sizes for skill. CONCLUSIONS: During the prebriefing, simulation, and debriefing, shorter sessions are more effective for improving knowledge in BSN students, whereas longer sessions are most effective for improving skills in BSN students. Nurse educators can schedule HFS to meet the expectations of learning outcomes based on the actual situation.

High-fidelity simulation in undergraduate nursing education: A meta-analysis.

OBJECTIVES: To explore the effectiveness of high-fidelity simulation (HFS) in undergraduate nursing education. DESIGN: A meta-analysis of randomized controlled trials and quasi-experiment. DATA SOURCES: Web of Science, PubMed, Embase, Cochrane Library, WANFANG, and CNKI were searched for eligible articles published in English and Chinese until May 28, 2021. REVIEW METHODS: The Quality Appraisal Check-list for Quantitative Intervention Studies was applied to the quality evaluation. Standard mean differences (SMD) were pooled using a random effects model. The results of the individual and combined intervention effects estimation of was displayed in a forest plot, with weight, SMD, its corresponding 95% confidence interval (CI), Z-test, p, I2. RESULTS: Thirty-eight studies were included and 37 were analyzed. High-fidelity simulation (HFS) revealed significantly larger effect sizes for knowledge (SMD = 0.89, 95% CI [0.54 to 1.23]), skill (SMD = 0.93, 95% CI [0.69 to 1.17]), collaboration (SMD = 0.52, 95% CI [0.26 to 0.78]), caring (SMD = 1.40, 95% CI [0.23 to 2.58]) and learning interest (SMD = 0.85, 95% CI [0.00 to 2.04]) when compared with other teaching methods. However, no significant difference between HFS and other teaching methods in critical thinking (SMD = 0.46, 95% CI [-1.12 to 1.58]), self-confidence (SMD = 0.22, 95% CI [-0.32 to 0.75]) and learning satisfaction (SMD = 0.58, 95% CI [-0.25 to 1.41]) was shown. CONCLUSIONS: High-fidelity simulation (HFS) can more effectively cultivate knowledge, skills, collaboration, caring, and learning interest of undergraduate nursing students. Since the effect of HFS is equivalent to other teaching methods in cultivating undergraduate nursing students' critical thinking, self-confidence and learning satisfaction, nursing educators can choose the most appropriate methods to achieve the intended learning outcomes according to the actual situation.

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.

A Chinese Version of the Caring Dimensions Inventory: Reliability and Validity Assessment.

Caring is central to nursing practice. Chinese nurses take care for the health of about 20% of the world's population and their perception of caring is critical. However, until recently, instrument specifically designed to measure the caring of nurses in China was not found. Caring dimensions inventory (CDI) is one of the most frequently used instrument when measuring caring and is applicable to nurses from different cultures. The aim of this study is to test the validity and reliability of the Chinese version of the 25-item CDI. The English version of CDI was translated into Chinese according to the guidelines of the World Health Organization. Content validity was conducted among seven senior nurses from different institutions in different cities in China. A convenience sample of nurses from 11 cities in China was employed. Exploratory factor analysis and confirmatory factor analysis of the CDI was carried out using a sample of 880 nurses. The overall content validity index was 0.98. Three factors (Nurturance, Collaboration, Skill) were identified in exploratory factor analysis and were confirmed by confirmatory factor analysis. The three-factor solution explains 70.15% of the total variance. The Cronbach alpha for overall the CDI was 0.97. This study demonstrated that the Chinese version of the CDI showed satisfactory reliability and validity, indicating that it could be a useful measurement to assess nurses' perception of caring in China.