Effect of the Age-Adjusted Charlson Comorbidity Index on All-Cause Mortality and Readmission in Older Surgical Patients: A National Multicenter, Prospective Cohort Study.

Background: Identifying a high-risk group of older people before surgical procedures is very important. The study aimed to explore the association between the age-adjusted Charlson comorbidity index (ACCI) and all-cause mortality and readmission among older Chinese surgical patients (age ≥65 years). Methods: A large-scale cohort study was performed in 25 general public hospitals from six different geographic regions of China. Trained registered nurses gathered data on clinical and sociodemographic characteristics. All-cause mortality was recorded when patients died during hospitalization or during the 90-day follow-up period. Readmission was also tracked from hospital discharge to the 90-day follow-up. The ACCI, in assessing comorbidities, was categorized into two groups (≥5 vs. <5). A multiple regression model was used to examine the association between the ACCI and all-cause mortality and readmission. Results: There were 3,911 older surgical patients (mean = 72.46, SD = 6.22) in our study, with 1,934 (49.45%) males. The average ACCI score was 4.77 (SD = 1.99), and all-cause mortality was 2.51% (high ACCI = 5.06% vs. low ACCI = 0.66%, P < 0.001). After controlling for all potential confounders, the ACCI score was an independent risk factor for 90-day hospital readmission (OR = 1.18, 95% CI: 1.14, 1.23) and 90-day all-cause mortality (OR = 1.26, 95% CI: 1.16-1.36). Furthermore, older surgical patients with a high ACCI (≥5) had an increased risk of all-cause mortality (OR = 6.13, 95% CI: 3.17, 11.85) and readmission (OR = 2.13, 95% CI: 1.78, 2.56) compared to those with a low ACCI (<5). The discrimination performance of the ACCI was moderate for mortality (AUC:0.758, 95% CI: 0.715-0.80; specificity = 0.591, sensitivity = 0.846) but poor for readmission (AUC: 0.627, 95% CI: 0.605-0.648; specificity = 0.620; sensitivity = 0.590). Conclusions: The ACCI is an independent risk factor for all-cause mortality and hospital readmission among older Chinese surgical patients and could be a potential risk assessment tool to stratify high-risk older patients for surgical procedures.

The association between frailty of older stroke patients during hospitalization and one-year all-cause mortality: A multicenter survey in China.

Objective: Frailty is a common geriatric syndrome defined as multiple deficits, impairing the capacity to figure out insult. Previous studies have reported a significant association between frailty and mortality in stroke patients. This study aimed to explore the association between frailty and mortality among older Chinese stroke patients. Methods: This study was a secondary analysis of a multicenter prospective cohort study conducted in older Chinese inpatients from October 2018 to February 2020, and patients with a primary diagnosis of stroke including hemorrhage and ischemia, were included in our study. Frailty of older inpatients with stroke from six hospitals was measured by the FRAIL scale, and a one-year follow-up was performed by well-trained nurses of these hospitals via telephone. Multivariable logistic regression was used to detect the association between frailty and one-year mortality. Results: A total of 530 stroke patients with an average age of 72.94 (SD = 5.79) years were included in the present study. There were 37 (7.0%) hemorrhagic strokes and 493 (93.0%) ischemic strokes, with 228 (43.0%) females in this population. The prevalence of frailty was 22.5%. In the logistic regression model with adjustment for age, sex, instrumental activities of daily living (IADL), basic activities of daily living (ADL), education, history of falls, BMI, smoking, alcohol consumption, low handgrip strength, type of stroke and polypharmacy, stroke patients with frailty had an increased risk of one-year mortality compared to those without frailty (OR = 3.38, 95% CI: 1.22-9.37, P = 0.019). Conclusion: Our study indicated that frailty was an independent risk factor for one-year all-cause mortality among older stroke patients in China. Frailty may be an essential factor for clinicians to consider before making a comprehensive treatment, and corresponding mixed interventions, including exercise training and nutritional programs, need to be conducted among older stroke patients.

The association between low calf circumference and mortality: a systematic review and meta-analysis.

PURPOSE: Low calf circumference is an important indicator of malnutrition and has been widely studied, especially among older adults. However, data on the association between low calf circumference and mortality have been inconsistent. This systematic review was aimed to quantify this association. METHODS: The internet databases (PubMed, Embase, ScienceDirect and Cochrane Library databases) were systematically searched from inception to November 01, 2021 for studies investigating the association between low calf circumference and mortality. A random effects model was adopted to pool the relevant data. RESULTS: Low calf circumference was associated with a higher risk of mortality than normal calf circumference, with a pooled HR of 2.42 (95% CI 1.97-2.97, I2 = 74.3%). In addition, this association between low calf circumference and morality was still statistically significant in the subgroup analysis across different settings, including hospitals (pooled HR = 2.63, 95% CI 1.93-3.58), nursing homes (pooled HR = 2.49, 95% CI 1.76-3.54), and communities (pooled HR = 2.22, 95% CI 1.60-3.07). Other subgroup analyses based on different cutoffs of calf circumference showed that, compared to individual with normal calf circumference, participants with low calf circumference had an increased risk of mortality (pooled HR = 2.66, 95% CI 2.06-3.43) when using the Asian Working Group for Sarcopenia (AWGS) criterion (≤ 34 cm for males and ≤ 33 cm for females). Similar results were found when the Mini Nutritional Assessment (MNA) criterion (≤ 31 cm) was used, with a pooled HR of 2.11 (95% CI 1.59-2.81). CONCLUSION: Calf circumference, which is simple and convenient to measure, could be used to stratify the high-risk group, as low calf circumference was significantly associated with mortality among patients. Interventions, including exercise and nutrition programs, could be conducted promptly once low calf circumference is detected.

Association of polypharmacy with falls among older Chinese inpatients: A nationwide cohort study.

AIM: Polypharmacy is prevalent among older adults and has been mainly reported to be associated with falls among community-dwelling or nursing home residents. Our study aimed to investigate the relationship between polypharmacy and falls among older Chinese hospitalized patients. METHODS: A nationwide prospective cohort study included 9062 participants in six hospitals from China aged ≥65 years, with a 1-year follow-up period. Baseline polypharmacy and other health-related variables were collected when older inpatients were recruited on hospital admission. Polypharmacy was defined as patients who have taken five medications or more. Well-trained nurses assessed falls by telephone at follow up. We used multivariate logistic regression analysis to examine the association between polypharmacy and the risk of falls based on cross-sectional analyses and longitudinal analyses. RESULTS: Of 9062 participants, the mean age was 72.42 years (SD= 5.69), and 5228 (57.69%) were men. After fully adjusted for age, sex, education, depression, cognitive impairment, low handgrip strength, frailty, various hospitals, and nutritional status, the cross-sectional and longitudinal analyses showed that inpatients with polypharmacy had an increased risk of falls (OR 1.37, 95%CI 1.17-1.56 for the cross-sectional association; OR 1.43, 95% CI 1.01-2.03 for the longitudinal association, respectively), compared with those without polypharmacy. In addition, subgroup analyses of the association between polypharmacy and 1-year falls, or history of falls was unchanged. CONCLUSIONS: Polypharmacy was prevalent among older Chinese hospitalized patients and was an independent risk factor of 1-year falls, suggesting that clinicians should make a comprehensive assessment of medications, and deprescribing strategies should be implemented to reduce unnecessary medications for decreasing the rate of falls. Geriatr Gerontol Int 2021; 21: 810-817.

Cognitive Frailty and 30-Day Mortality in a National Cohort of Older Chinese Inpatients.

PURPOSE: Studies exploring the association of cognitive frailty and mortality have been mainly based on community settings or nursing home settings. The aim of our study was to explore the association between cognitive frailty and 30-day mortality among older Chinese inpatients. PATIENTS AND METHODS: A national cohort study was performed in different hospitals in China. A baseline survey was conducted from October 2018 and February 2019. Trained investigators collected the 30-day mortality. Cognitive impairment and frailty were defined by the Mini-Cog and FRAIL scale, respectively. Multivariate regression was used to explore the association between cognitive impairment and frailty status with 30-day mortality. RESULTS: Of these participants, there were 3891 (41.91%) women and 5392 (58.09%) men, with an average age of 72.41 (SD=5.72). The prevalence of cognitive frailty was 5.44%. After adjusting for age, gender, education, depression and activities of daily living (ADL), the odds ratios (ORs) for 30-day mortality among inpatients were 3.43 (95% CI: 1.80-6.55) for cognitive frailty, 1.85 (95% CI: 1.01-3.41) for frailty only, and 1.43 (95% CI: 0.77-2.65) for cognitive impairment only compared to the reference group (neither frailty nor cognitive impairment). In addition, the discrimination of 30-day mortality was higher among patients with cognitive frailty (area under the curve =0.676 [95% CI: 0.621-0.731]) than either frailty (area under the curve =0.644 [95% CI: 0.594-0.694]) or cognitive impairment (area under the curve = 0.606 [95% CI: 0.556-0.655]) separately. Stratified analysis showed that these associations still existed when grouped by gender. CONCLUSION: Our study found that Chinese inpatients with cognitive frailty had a higher risk of 30-day mortality than those without frailty and cognitive impairment, suggesting that clinicians should be encouraged to perform early screening of patients with frailty and cognitive impairment and carry out effective interventions to reverse cognitive frailty syndrome.

Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis.

BACKGROUND: A large number of studies have explored the association between frailty and mortality among COVID-19 patients, with inconsistent results. The aim of this meta-analysis was to synthesize the evidence on this issue. METHODS: Three databases, PubMed, Embase, and Cochrane Library, from inception to 20th January 2021 were searched for relevant literature. The Newcastle-Ottawa Scale (NOS) was used to assess quality bias, and STATA was employed to pool the effect size by a random effects model. Additionally, potential publication bias and sensitivity analyses were performed. RESULTS: Fifteen studies were included, with a total of 23,944 COVID-19 patients, for quantitative analysis. Overall, the pooled prevalence of frailty was 51% (95% CI: 44-59%). Patients with frailty who were infected with COVID-19 had an increased risk of mortality compared to those without frailty, and the pooled hazard ratio (HR) and odds ratio (OR) were 1.99 (95% CI: 1.66-2.38) and 2.48 (95% CI: 1.78-3.46), respectively. In addition, subgroup analysis based on population showed that the pooled ORs for hospitalized patients in eight studies and nursing home residents in two studies were 2.62 (95% CI: 1.68-4.07) and 2.09 (95% CI: 1.40-3.11), respectively. Subgroup analysis using the frailty assessment tool indicated that this association still existed when using the clinical frailty scale (CFS) (assessed in 6 studies, pooled OR = 2.88, 95% CI: 1.52-5.45; assessed in 5 studies, pooled HR = 1.99, 95% CI: 1.66-2.38) and other frailty tools (assessed in 4 studies, pooled OR = 1.98, 95% CI: 1.81-2.16). In addition, these significant positive associations still existed in the subgroup analysis based on study design and geographic region. CONCLUSION: Our study indicates that frailty is an independent predictor of mortality among patients with COVID-19. Thus, frailty could be a prognostic factor for clinicians to stratify high-risk groups and remind doctors and nurses to perform early screening and corresponding interventions urgently needed to reduce mortality rates in patients infected by SARS-CoV-2.

The Association Between Frailty and Delirium Among Hospitalized Patients: An Updated Meta-Analysis.

OBJECTIVE: The aim of our meta-analysis was to update evidence for the association between frailty and delirium in different types of hospitalized patients, given the large volume of new studies with inconsistent results. DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: In this updated meta-analysis, we searched 3 databases (Embase, PubMed, and the Cochrane Library) for observational studies, exploring the association between frailty and delirium from database inception to September 21, 2020, among hospitalized patients. Relevant data were extracted from the studies that were included. A random effects model was conducted to synthesize and pool the effect size of frailty on delirium due to different frailty score instruments, different countries, and various delirium assessments that were used. The participants enrolled in this meta-analysis were hospitalized patients. MEASURES: Delirium risk due to frailty. RESULTS: A total of 30 independent studies from 9 countries, consisting of 217,623 patients, was identified, and the prevalence of frailty ranged from 16.20% to 78.00%. Frail patients exhibited an increased risk for delirium compared to those without frailty [odds ratio (OR) 2.96, 95% confidence interval (CI) 2.36-3.71]. In addition, different types of hospitalized patients had various OR values, which were 2.43 for selective surgical patients (95% CI 1.88-3.14), 3.61 for medical patients (95% CI 3.61-7.89), 3.76 for urgent surgical patients (95% CI 2.88-4.92), and 6.66 for emergency or critical illness patients (95% CI 1.41-31.47). Subgroup analysis based on the frailty score instrument showed the association still existed when using the Clinical Frailty Scale (OR 4.07, 95% CI 2.71-6.11), FRAIL Scale (OR 2.83, 95% CI 1.56-5.13), Frailty Index (OR 6.15, 95% CI 3.75-10.07), frailty phenotype (OR 2.30, 95%CI 1.35-5.66), or Erasmus Frailty Score (OR 2.79, 95% CI 1.63-4.77). However, an association between frailty and delirium was not observed when the Edmonton Frail Scale was used (OR 1.45, 95% CI 0.91-2.30). CONCLUSIONS AND IMPLICATIONS: A 2.96-fold incremental risk of delirium in frail patients underscores the need for early screening of frailty and comprehensive delirium prevention. Appropriate interventions by clinicians should be performed to manage delirium, potentially reducing adverse clinical outcomes for hospitalized patients.

Prevalence of Depressive Symptoms Among Pregnant and Postpartum Women in China During the COVID-19 Pandemic.

OBJECTIVE: According to recent studies, the COVID-19 pandemic has been associated with an increased risk of mental health problems across many subpopulations including pregnant and postnatal women. This study examined the prevalence and correlates of depressive symptoms (depression hereafter) in Chinese pregnant and postpartum women during the COVID-19 pandemic. METHODS: This was a multicenter, cross-sectional study comprising 1309 pregnant and postpartum women across 12 provinces in China during the COVID-19 pandemic. Depression was assessed using the nine-item Patient Health Questionnaire. Univariate analyses and multivariate logistic regression analyses were conducted. RESULTS: The prevalence of depression in pregnant and postpartum women was 27.43% (95% confidence interval [CI] = 25.01%-29.85%). Women who were worried about themselves or their babies being infected with COVID-19 (odds ratio [OR] = 2.562, 95% CI = 1.670-3.929), and those who had delayed regular medical checkups (OR = 2.434, 95% CI = 1.580-3.750) were at higher risk of depression. Compared with those living in central and western parts of China, women living in northern (OR = 0.513, 95% CI = 0.326-0.807) and southeastern parts of China (OR = 0.626, 95% CI = 0.463-0.846) were less likely to have depression. CONCLUSIONS: The COVID-19 pandemic was associated with an increased likelihood of mental health problems among pregnant and postnatal women. Over a quarter of the pregnant and postpartum women in China had depression during the COVID-19 pandemic. Considering the negative health impact of depression, preventive measures, regular mental health screening, and medical checkups are needed with the goal to reduce the risk of depression in this vulnerable population during a pandemic.

Chinese orthopaedic nurses' knowledge, attitude and venous thromboembolic prophylactic practices: A multicentric cross-sectional survey.

BACKGROUND: Venous thromboembolism is a severe preventable complication among orthopaedic surgical patients. Integrating therapeutic guidelines into clinical practice can help improve patient safety and reduce the burden of this pathology. Improving the quality of patient care is important for bridging the gap between the prophylaxis for venous thromboembolism and therapeutic guidelines. OBJECTIVES: This study aimed at evaluating the knowledge, attitude, and venous thromboembolism and prophylaxis practices of Chinese orthopaedic nurses to guide quality care improvements. METHODS: The data used in this study are secondary data obtained from a multicentric survey. An anonymous questionnaire was used to measure the attitude and knowledge of venous thromboembolic prophylaxis among orthopaedic nurses. VTE prophylactic practices were extracted from medical records within the electronic case report form immediately after the nurses' investigations. The STROBE statement for observational studies was applied. RESULTS: Results indicated that although 94.0% of the responding nurses had attended training courses in their wards, a majority of them (68.9%) achieved a median knowledge score of 7 points or below (range 0-9). Knowledge regarding the proper use of prophylaxis, identification of risk factors, signs and symptoms for pulmonary embolism was limited. Self-reported attitudes underestimate the relationships between venous thromboembolism and low-quality nursing care. Pharmacological prophylaxis was highly used (90.9%), while the utilisation of mechanical prophylaxis and its proper use was relatively low. CONCLUSIONS: Chinese orthopaedic nurses demonstrated enthusiasm for venous thromboembolism and prophylaxis. Their knowledge needs to be improved, including the proper use of prophylaxis, identification of risk factors, signs and symptoms. Mechanical prophylaxis practice for VTE prevention after THA and TKA surgical procedures is not optimistic. Further studies should analyse the causes from multiple perspectives, including the availability of resources, the knowledge and attitude of doctors, nurses and patients. RELEVANCE TO CLINICAL PRACTICE: The findings from this study can be used to develop and implement interventions for venous thromboembolism after orthopaedic surgery.

Quality appraisal of clinical guidelines for venous thromboembolism prophylaxis in patients undergoing hip and knee arthroplasty: a systematic review.

INTRODUCTION: Venous thromboembolism (VTE) occurs in up to 40%-80% of patients after hip and knee arthroplasty. Clinical decision-making aided by guidelines is the most effective strategy to reduce the burden of VTE. However, the quality of guidelines is dependent on the strength of their evidence base. The objective of this article is to critically evaluate the quality of VTE prevention guidelines and the strength of their recommendations in VTE prophylaxis in patients undergoing hip and knee arthroplasty. METHODS: Relevant literature up to 16 March 2020 was systematically searched. We searched databases such as Web of Science, PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature, China National Knowledge Infrastructure and WanFang and nine guidelines repositories. The identified guidelines were appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation II and appraised the strength of their recommendations independently. Following quality assessment, a predesigned data collection form was used to extract the characteristics of the included guideline. RESULTS: We finally included 15 guidelines. Ten of the included guidelines were rated as 'recommended' or 'recommended with modifications'. The standardised scores were relatively high in the domains of Clarity of Presentation, and Scope and Purpose. The lowest average standardised scores were observed in the domains of Applicability and Stakeholder Involvement. In reference to the domains of Rigour of Development and Editorial Independence, the standardised scores varied greatly between the guidelines. The agreement between the two appraisers is almost perfect (intraclass correlation coefficients higher than 0.80). A considerable proportion of the recommendations is based on low-quality or very-low-quality evidence or is even based on working group expert opinion. CONCLUSIONS: In summary, the majority of the recommendations are based on low-quality evidence, and further confirmation is needed. Furthermore, guideline developers should pay more attention to methodological quality, especially in the Stakeholder Involvement domain and the Applicability domain.

Association of insomnia disorder with sociodemographic factors and poor mental health in COVID-19 inpatients in China.

PURPOSE: To examine insomnia disorder and its association with sociodemographic factors and poor mental health in 2019 novel coronavirus (COVID-19) inpatients in Wuhan, China. DESIGN: and Methods: A total of 484 COVID-19 inpatients in Wuhan Tongji Hospital were selected and interviewed with standardized assessment tools. Insomnia disorder was measured by the Chinese version of the Insomnia Severity Index (ISI-7), a total score of 8 or more was accepted as the threshold for diagnosing insomnia disorder. RESULTS: The prevalence of insomnia disorder in the whole sample was 42.8%. Binary logistic regression analysis revealed that female gender, younger age, and higher fatigue and anxiety severity were more likely to experience insomnia disorder. CONCLUSION: Given the high rate of insomnia disorder status among COVID-19 inpatients in Wuhan, China, and its negative effects, follow-up assessments and appropriate psychological interventions for insomnia disorder are needed in this population.

Incidence and Related Factors for Hospital-Acquired Pneumonia Among Older Bedridden Patients in China: A Hospital-Based Multicenter Registry Data Based Study.

Objective: To identify the incidence and related factors for hospital-acquired pneumonia (HAP) among older bedridden patients in China. Study design and setting: This multicenter registry data-based study conducted between November 2015 and March 2016 surveyed 7,324 older bedridden patients from 25 hospitals in China (six tertiary, 12 non-tertiary, and seven community hospitals). The occurrence of HAP among all participants was monitored by trained investigators. Demographics, hospitalization information and comorbidity differences were compared between patients with and without HAP. A multilevel regression analysis was used to explore the factors associated with HAP. Results: Among 7,324 older bedridden patients, 566 patients were diagnosed with HAP. The incidence of HAP in this study was 13.9 per 1,000 person-days. There were statistical differences in gender, age, length of bedridden days, BMI, smoking, department, undergoing general anesthesia surgery, ventilator application, Charlson comorbity index (CCI) score, disturbance of consciousness, tranquilizer use, glucocorticosteroid use, and antibiotic use between patients with HAP and patients without HAP (all p < 0.05). Multilevel regression analysis found no significant variance for HAP at the hospital level (0.332, t = 1.875, p > 0.05). There were significant differences for the occurrence of HAP among different departments (0.553, t = 4.320, p < 0.01). The incidence density of HAP was highest in the ICU (30.1‰) among the selected departments, followed by the departments of neurosurgery (18.7‰) and neurology medicine (16.6‰). Individual patient-level factors, including older age, disturbance of consciousness, total CCI score, ICU admission, and glucocorticoid and antibiotic use, were found to be associated with the occurrence of HAP (all p < 0.05). Conclusion: A relatively high incidence density of HAP among older bedridden patients was identified, as well as several factors associated with HAP among the population. This suggests that attention should be paid to the effective management of these related factors of older bedridden patients to reduce the occurrence of HAP.

Nurses' objective knowledge regarding venous thromboembolism prophylaxis: A national survey study.

Venous thromboembolism (VTE) is a common vascular disorder with high mortality and morbidity. Clinical nurses are a pivotal group that can serve as first-line health care providers. Lack of knowledge about VTE is an important barrier to effective nursing performance. This study aimed to determine nurses' knowledge of VTE prophylaxis through a nationwide survey across China, to understand gaps between current knowledge, and guidelines, and to help improve clinical nursing.The survey included 5 topics with 68 items on VTE, including basic knowledge, risk assessment, basic prophylaxis, physical prophylaxis, and pharmacological prophylaxis.The survey was distributed to 106 AAA-grade hospitals throughout China; 5218 valid questionnaires were submitted for analysis. There were 5097 women and 121 men respondents, with average age 30.29 ±â€Š8.60 years. The average rate of correct responses regarding VTE knowledge was 59.90 ±â€Š15.63%; 77.81% of subjects answered more than half of the survey items correctly. Better knowledge about thromboprophylaxis was observed among nurses who were more highly educated, more experienced, had received continuing education, intensive care unit (ICU), and lead nurses. Correct response rates were 68.39 ±â€Š17.03%, 60.35 ±â€Š21.01%, 75.51 ±â€Š22.85%, 41.72 ±â€Š17.47%, and 46.01 ±â€Š21.22% for basic knowledge, risk assessment, basic prophylaxis, physical prophylaxis, and pharmacological prophylaxis, respectively.Respondents showed satisfactory results regarding basic prophylaxis, basic knowledge, and risk assessment for VTE; respondents had poorer knowledge regarding physical and pharmacological prophylaxis. Better mastery of knowledge about thromboprophylaxis was observed among nurses who were more highly educated, more experienced, had received continuous education, ICU, and lead nurses.This study suggested that nurse trainers should develop comprehensive educational programs that focus on low correct rate aspects. Higher-level continuous education could improve nurses' knowledge of thromboprophylaxis.

Spiritual intelligence of nurses in two Chinese social systems: a cross-sectional comparison study.

BACKGROUND: The spirituality of healthcare providers and their clients is becoming a crucial issue in a world increasingly preoccupied with material issues. In light of such, how do nurses enhance their spiritual intelligence against such materialist pressures? After a 60-year separation of Chinese on both sides of the Taiwan Strait and the rancor between their two governments, what are the similarities and the differences in nurse spirituality profiles between these two different societies? With increasing contact between the two, this issue should be examined and explored, as it has the potential to become an essential unspoken element underpinning holistic care quality. PURPOSE: The purpose of this study was to compare spiritual intelligence between nurses in two different Chinese societies. METHODS: A cross-sectional descriptive and inferential study was conducted at five medical centers in China and Taiwan. A total of 524 registered hospital nurses were recruited as participants. We used R. N. Wolman's (2001) self-reported PsychoMatrix Spirituality Inventory to measure participant levels of spiritual intelligence. The PsychoMatrix Spirituality Inventory incorporated seven factors, including divinity, mindfulness, extrasensory perception, community, intellectuality, trauma, and childhood spirituality. RESULTS: Results showed that social systems did have an impact on nurses' spiritual intelligence. Childhood spirituality and religious beliefs and activities greatly affected and effectively predicted nurses' spiritual intelligence. Nurses on either side of the Taiwan Strait all reported a need to deal with their daily lives pragmatically, objectively, and rationally and relied on empirical evidence in work settings. CONCLUSIONS: As social and economic contacts increase across the Taiwan Strait, it is imperative that nurses adopt cultural awareness and sensitivity as they provide holistic care to clients. This study opens doors to dialogue about and a better understanding of nurses' spiritual intelligence in Taiwan and China.