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Ying Wang,* Jinghan Liu,* Yunxian Zhou School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yunxian Zhou, School of Nursing, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, Zhejiang, 310053, People’s Republic of China, Tel +86 571 86633121, Fax +86 571 86613674, Email yunxianzhou@zcmu.edu.cnBackground: High levels of disease acceptance are important predictors of improved psychological well-being, treatment outcomes, and enhanced quality of life. Relatively few studies have focused on the process of disease acceptance in patients with Crohn’s disease (CD), particularly those who are newly diagnosed.Purpose: To explore the disease acceptance process in newly diagnosed CD patients.Patients and Methods: A descriptive qualitative approach was employed. Sixteen CD patients from 2 tertiary hospitals in Hangzhou, Zhejiang were recruited through purposive sampling using a maximum variation strategy. Semi-structured interviews were conducted. The interviews were transcribed verbatim and analysed using conventional content analysis.Results: Five phases of the psychosocial process of the “acceptance journey” of newly diagnosed CD patients emerged from the data analysis: (1) praying for the illness to not be CD; (2) not being able to accept CD; (3) having to accept CD; (4) knowing that CD should be acceptable; and (5) starting to accept CD. Patients at the stage of “starting to accept CD” are more proactive and motivated to face the disease, and their overall acceptance of the disease is higher than that of the previous stages. However, by the end of the interview, 2 patients remained at the stage of “having to accept CD”, and 3 patients remained at the stage of “knowing that CD should be acceptable”. Two patients entered the stage of “starting to accept CD” and then reverted back to

Fen Xu,1,* Juping Tang,1,* Zhiping Zhu,2 Yan Chen,3 Wen Hu,4 Sha Lu,5 Yunxian Zhou,6 Ding Lin7 1Department of Nursing, Hangzhou Third Hospital, Hangzhou, People’s Republic of China; 2Department of Vascular Surgery, Hangzhou Third Hospital, Hangzhou, People’s Republic of China; 3Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 4State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 5Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, People’s Republic of China; 6School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 7Department of Cardiovascular Medicine, Hangzhou Third Hospital, Hangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yunxian Zhou, School of Nursing, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, Zhejiang, 310053, People’s Republic of China, Tel +860571-86633121, Email yunxianzhou@hotmail.com Ding Lin, Department of Cardiovascular Medicine, Hangzhou Third Hospital, No. 38 Xihu Road, Hangzhou, Zhejiang Province, 310009, People’s Republic of China, Tel +860571-87827512, Email linting11222021@163.comPurpose: To investigate the current state of medication adherence among patients with inflammatory bowel disease (IBD) in China and analyze the influencing factors.Patients and Methods: We recruited as many eligible subjects as possible and a total of 105 patients with IBD finished this cross-sectional survey. The General

Transnational nurse migration is a growing phenomenon. However, relatively little is known about the experiences of immigrant nurses and particularly about non-English speaking background nurses who work in more economically developed countries. Informed by a symbolic interactionist framework, this research explored the experience of China-educated nurses working in the Australian health care system. Using a modified constructivist grounded theory method, the main source of data were 46 face to face in-depth interviews with 28 China-educated nurses in two major cities in Australia. The key findings of this research are fourfold. First, the core category developed in this study is reconciling different realities, which inserts a theoretical understanding beyond the concepts of acculturation, assimilation, and integration. Second, in contrast to the dominant discourse which reduces the experience of immigrant nurses to language and culture, this research concludes that it was not just about language and nor was it simply about culture. Third, rather than focus on the negative aspects of difference as in the immigration literature and in the practice of nursing, this research points to the importance of recognising the social value of difference. Finally, the prevailing view that the experience of immigrant nurses is largely negative belies its complexities. This research concludes that it is naïve to define the experience as either good or bad. Rather, ambivalence was the essential feature of the experience and a more appropriate theoretical concept. This research produced a theoretical understanding of the experience of China-educated nurses working in Australia. The findings may not only inform Chinese nurses who wish to immigrate but also contribute to the implementation of more effective support services for immigrant nurses in Australian health care organisations.

The last decade has seen an increase in research on the experience of immigrant nurses. There are two prevailing approaches in this body of work. One is a focus on the positive or negative aspects of the experience, and the other, a depiction of the experience as a linear movement from struggle to a comfortable state. Based on our study findings on the experience of China educated nurses working in Australia, this study proposes that the concept of ambivalence is more appropriate in portraying the experience of immigrant nurses. Several sources of ambivalence experienced by the participants are represented: a disparity between expectation and reality, conflicting social and cultural norms, the dual reference points of comparison, divergent interests within families, and a sense that although it is unsatisfactory, it is hard to go back. We argue that immigration generates various forms of ambivalence and immigrant nurses must live with more or less ambivalence. The notion of ambivalence can explain a range of behaviours and situations beyond the scope of rational-choice explanations. To date, ambivalence as a theoretical concept in understanding the experience of immigrant nurses has been either ignored or insufficiently addressed in the literature.