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Aim\udTo evaluate the effects of a novel, immersive digital story intervention on empathy.\ud\udDesign\udA randomized trial with three phases.\ud\udResults\udA total of 238 2nd year nursing students were recruited between May 2018 and December 2019. At baseline, no significant differences in empathy between the groups were found (p = .760). However, at post-test, empathy was significantly higher in the intervention group (M: 118.76, SD: 10.65) than it was in the control group (M: 114.60, SD: 15.40) (p = .012). At follow-up, there were no significant differences in empathy between the groups (p = .364).\ud\udConclusion\udThe intervention resulted in an immediate increase in empathy in nursing students. However, further development of effective intervention delivery modes and fundamental redesign of the intervention itself would be needed to sustain this improvement over the long term.

In recent years, the degradation processes of polysaccharides by human gut microbiota are receiving considerable attention due to the discoveries of the powerful function of gut microbiota. Gut mic...

This cluster randomized controlled trial aimed to investigate the effects of an intervention to teach resourcefulness on depression and coping style of patients with coronary heart disease (CHD). A convenience sample of 72 patients in community settings took part. Participants in the intervention group (n = 36) received an 8-week intervention based on the concept of resourcefulness, plus routine health education. Participants in the control group (n = 36) received routine health education only. After the intervention, participants in the intervention group had significantly higher scores on resourcefulness and coping styles, and lower scores on depression than those in the control group (both ps < .001). The findings suggest that a well-developed intervention to teach resourcefulness could help patients with CHD to be more resourceful, improve their level of depression, and choose more effective strategies to cope with stress.

Objective To explore quality of life (QOL) in patients with colorectal cancer and a stoma and factors associated with their QOL. Methods A quantitative cross-sectional study was carried out in the stoma and wound care clinic of a cancer hospital in China. Participants were recruited from clinic patients. Investigators collected demographic data and clinical information; QOL was measured using a Chinese version of the stoma-QOL scale. Results In total, 359 participants took part; 161 (44.8%) had an ileostomy, whereas the others had a colostomy, and about half of the participants (46.5%) had a permanent stoma. The mean age was 57.86 ± 11.92 years. The QOL scores of most participants were poor, with a median value of 49.44. Participants whose stoma was cared for by others had a significantly lower QOL score than those who cared for their own stomas (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.05-2.38; P = .029). Participants with a temporary stoma had a lower QOL score than those with a permanent stoma (OR, 2.08; 95% CI, 1.275-3.40; P = .004). Further, participants with a complication had a lower QOL score than those without (OR, 1.62; 95% CI, 1.07-2.43; P = .022). Conclusions These findings suggest a need for well-developed interventions to improve the QOL of these patients. This study provides valuable insights to inform the development of future clinical practice and research in this area in China and beyond.

Aims Secondary prevention of coronary heart disease is of utmost importance to facilitate people to achieve health outcomes and behaviours. This study was to investigate the effect of a nursing intervention based on Cox's interaction model of client health behaviour to improve health outcomes and behaviours of secondary prevention of coronary heart disease. Design This study is a cluster randomised controlled trial. Methods Participants were recruited between August and November 2019 in two community settings in Hengyang city, Hunan province, China. Participants in the intervention group received a nursing intervention based on Cox's interaction model of client health behaviour and routine health education, while those in the control group received routine health education only. The outcome variables included self-management, physical activity, medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, blood pressure, body mass index (BMI), and low-density lipoprotein cholesterol (LDL-C). The influential statistical tests applied to analyse the data included χ2 tests and t tests. Results Seventy-seven participants completed this study. Compared with the control group (n = 40), the intervention group (n = 37) showed statistically significant better health outcomes and behaviours regarding self-management, physical activity (except for high energy consumption), medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, systolic blood pressure, BMI, and LDL-C. However, there was no statistically significant difference in diastolic blood pressure and high energy consumption for physical activity. Conclusion A well-developed nursing intervention based on Cox's interaction model of client health behaviour could successfully improve health outcomes and behaviours of secondary prevention of coronary heart disease. Such an intervention may be incorporated into community healthcare practice by nurses to improve patient care. Impact This study provides a valuable insight to facilitate further development of effective nursing interventions to improve secondary prevention of coronary heart disease in community settings.

Background Coronary heart disease (CHD) is one of the leading causes of mortality worldwide. Previous research has demonstrated that resourcefulness interventions can help individuals identify effective coping strategies to manage their conditions, reduce the incidence of depression, and improve their quality of life. However, little is known about such interventions for people with CHD in China. Objective This study aimed to investigate the effects of a resourcefulness training intervention on depression and coping style of patients with CHD in China. Methods A cluster randomized controlled trial design was used. A convenience sample of 72 patients in community settings took part in the study. Participants in the intervention group (n = 36) received an 8-week intervention based on the concept of resourcefulness, plus routine health education. Participants in the control group (n = 36) received routine health education only. Three outcomes (resourcefulness, depression, and coping styles) were measured using the Resourcefulness Scale, Center for Epidemiological Studies Depression Scale, and Medical Coping Mode Questionnaire. Data were collected at baseline and post intervention, and analyzed using frequencies, percentages, means, standard deviations, independent sample t tests, and χ tests. Results After the intervention, participants in the intervention group had significantly higher scores on resourcefulness and coping styles, and lower scores on depression than those in the control group (both Ps Conclusions It is suggested that a well-developed resourcefulness intervention could help patients with CHD in China and beyond to be more resourceful, improve their level of depression, and choose more effective strategies to cope with stress.

In recent years, the degradation processes of polysaccharides by human gut microbiota are receiving considerable attention due to the discoveries of the powerful function of gut microbiota. Gut microbiota has developed a sensitive, accurate, and complex system for sensing, capturing, and degrading different polysaccharides. Among the gut microbiota

Genomic knowledge and technology have developed rapidly over the last decade and increased our capabilities to diagnose and manage rare diseases. However, current genomic datasets lack ethnic diversity as many genomic studies have focused on participants of white European ancestry. Studies, such as the Deciphering Developmental Disorders study, have been available to participants of any ancestry but have been unsuccessful in recruiting diverse populations. The inclusion of diverse populations in exome and genome sequencing is important to ensure that clinical benefits of genomics advances are equally shared among all populations and to advance scientific knowledge. Our clinical and research experience with the British Pakistani population (the largest ethnic minority in Yorkshire and Humber, accounting for 4.3% of the population) has fostered the development of an innovative cultural competence framework to enhance the inclusion of diverse populations in clinical genomic research and service provision. The application of this framework has the potential to guide healthcare professionals to develop a wide range of competences, so they are ready to embrace genomic advances in order to improve health outcomes for all patients. This practice model will inform precision medicine and improve access of diverse populations to genomic studies. Although based upon work with the Pakistani population in the UK, it is anticipated that the model would be broadly applicable to all underrepresented populations across the world.

Objective: As part of a large mixed-method study aimed at capturing understandings of dignity, and care expectations of community dwelling older women from Black and minority ethnic (BME) backgroun...

Drawing on quantitative data from a large study, we explored service providers' perceptions of the care and support provided to older women from Black and minority ethnic backgrounds living in the UK. Analyzing 102 responses to a questionnaire, we found that the care needs of this group of older women were not adequately addressed, with ineffective communication being frequently reported. A number of information pathways and barriers to service provision were identified. More work is needed to explore not only how best to acknowledge diversity in care needs within older populations, but also to design and deliver responsive services accordingly.

Patient empowerment has been shown to have some positive impacts on self-efficacy, self-esteem, and recovery. However, information about the empowerment needs of patients after a percutaneous coronary intervention is scarce. The aim of this study was to develop a Chinese-language instrument to measure empowerment needs of such patients. The initial instrument was generated based on a literature review and interviews with patients after a percutaneous coronary intervention procedure. Content validity was tested with a panel of experts using the Delphi method. In total, 226 patients were recruited for psychometric tests using the revised instrument. Expert authority coefficient was 0.92, and content validity index was 0.95. The internal consistency reliability was demonstrated by Cronbach's α coefficients (0.86 for the total score, 0.66-0.74 for the dimensions). The newly developed 19-item, five-dimension instrument has shown satisfactory validity (face/content validity and construct validity) and internal consistency reliability. The instrument could help clinical nurses who have close contact with patients after a percutaneous coronary intervention to gain a better understanding of their empowerment needs and could help develop appropriate health education to address such needs.

The study is to develop a bioprocess to depolymerize curdlan for production of β-1,3 oligosaccharides with a uniform size. A codon-optimized Streptomyces laminarinase was expressed in an E. coli system, resulting in an enzyme preparation (19.1 U/L) highly active on solid curdlan substrate without any pre-treatment. In a preparative scale reaction at pH 5.5 and 55°C, 90% conversion and a product concentration close to 27 g/L were achieved within 6 hours. The major product was identified as β3-glucan pentasaccharide based on HPLC, TLC, and MS analyses. A single-enzyme based bioprocess was highly efficient in deriving β3-glucan pentasaccharide from solid curdlan. Enzyme to curdlan ratio and reaction time are critical parameters for high-yield production of β3-glucan pentasaccharide from curdlan.

Maize (Zea mays, L.) cultivation has expanded greatly from tropical to temperate zones; however, its sensitivity to chilling often results in decreased germination rates, weak seedlings with reduced survival rates, and eventually lower yields. We conducted germination tests on the maize-282-diverse-panel (282 inbred lines) under normal (25 °C) and chilling (8 °C) conditions. Three raw measurements of germination were recorded under each condition: 1) germination rate, 2) days to 50% germination, and 3) germination index. Three relative traits were derived as indicators of cold-tolerance. By using the 2,271,584 single nucleotide polymorphisms (SNPs) on the panel from previous studies, and genome-wide association studies by using FarmCPU R package to identify 17 genetic loci associated with cold tolerance. Seven associated SNPs hit directly on candidate genes; four SNPs were in high linkage disequilibrium with candidate genes within 366 kb. In total, 18 candidate genes were identified, including 10 candidate genes supported by previous QTL studies and five genes supported by previous gene cloning studies in maize, rice, and Arabidopsis. Three new candidate genes revealed by two associated SNPs were supported by both QTL analyses and gene cloning studies. These candidate genes and associated SNPs provide valuable resources for future studies to develop cold-tolerant maize varieties.

An acidic polysaccharide, named as p-LBP, was isolated from Lycium barbarum L. by water extraction and purified by decoloration, ion exchange chromatography, dialysis and gel chromatography, successively. The primary structure analysis was determined by HPAEC-PAD, HPSEC, FT-IR, GC-MS, and NMR. The results showed p-LBP was a homogeneous heteropolysaccharide as a pectin molecule with an average molecular weight of 64kDa p-LBP was an approximately 87nm hollow sphere in 0.05mol/L sodium sulfate solution determined by HPSEC-MALLS, DLS and TEM. A discussion of degradation patterns gave the detailed structural information of p-LBP. Therefore, the results from degraded fragments elucidated that the backbone of p-LBP was formed by →4-α-GalpA-(1→, repeatedly. Partial region was connected by →4-α-GalpA-(1→ and →2-α-Rhap-(1→, alternatively. On the C-4 of partial →2-α-Rhap-(1→ residues existed branches forming by →4-β-Galp-(1→, →3-β-Galp-(1→ or →5-α-Araf-(1→, while on the C-6 of partial →3-β-Galp-(1→ residues existed secondary branches forming by terminal-α-Araf, terminal-β-Galp or →3-α-Araf-(1→.

China is the most populated of any country in the world. Social norms and values pertaining to love and marriage have changed considerably since the launch of its open-door policy and economic reforms of the 1980s. Attitudes to sex have become more open, while the negative consequences of early sexual intercourse have become issues of health and social concern. The aim of this study is to provide an overview of the teenage sexual attitudes and behaviour in contemporary China. A literature review was conducted between 2000 and 2010, using both English (Medline, CINAHL, PsycINFO, ASSIA) and Chinese language databases (China National Knowledge Infrastructure, Wanfang database). Thirty-six studies were included and reviewed. It was found that young people reported poor sexual knowledge, especially in relation to reproductive matters and sexually transmitted infections. The media, such as television, magazines and the Internet, were seen as their main sources of information on sex. Despite the frequently reported liberal attitudes to sexual behaviour, only a small number of young people had already lost their virginity or been involved in pregnancies. Young men were more likely than young women to report having had sex, while respondents at vocational high schools were less likely to remain virgins than those at common/key high schools. Although the prevalence of sexual intercourse among Chinese teenagers was still lower than that reported in studies conducted in most western countries, the findings do reflect some changes in sexual values and behaviour of young people within the country. They also suggest the need to develop more comprehensive sex education programmes in co-operation with young people, schools, health organisations, families and communities and to make sexual and reproductive health services accessible to teenagers and unmarried young people throughout China.

Antenatal screening has become standard practice in many countries. However, not all pregnant women choose to be tested. In the UK, the incidence of some birth defects is found to be higher in babies of Asian women than in those of women from other ethnic groups, while there is some evidence suggesting that ethnic minorities, especially Asian women, are less likely to undergo antenatal screening and prenatal diagnosis, the reasons for which are unclear. This study aims to identify and describe the literature on issues around antenatal screening and prenatal diagnostic testing for genetic disorders among women of Asian descent in western countries. The Medline, CINAHL, ASSIA and PsycInfo databases were searched for the period of 1995 and 2010. Twenty-one studies met the inclusion criteria and were therefore reviewed. In general, Asian women were found to hold favourable attitudes towards testing. However, they reported a poorer understanding of testing than white women and not being offered a test, and were less able to make informed choices. Asian women in the UK and Australia were found to be less likely than their white counterparts to have undergone prenatal diagnosis, while such differences were not found in the USA and Canada. The equity of access to quality antenatal care, alongside comprehensive well thought out antenatal screening programmes, can be assured if strategies are in place which actively involve all ethnic groups and take account of social and cultural appropriateness for the population served. An understanding of broad factors that inform women's decision-making on test uptake would help health professionals provide women and their families with more culturally sensitive information and support that they may additionally need to make more informed choices.

There is an increasing interest in the use of stories in healthcare practice and education. However, there are few stories from young people concerning health and little is known about their views on sharing such stories on the Internet. The aim of this study was to explore young people's perspectives in this area. A qualitative method was used and a project website was purposely built to facilitate data collection. An online focus group with 13 young people was carried out in an asynchronous format. Participants valued highly the therapeutic effect of storytelling and the use of digital stories to share feelings and experiences with a wide range of audiences, suggesting that well-produced stories could be a useful learning resource. A number of concerns were also raised, including embarrassment, reaction of other people and online safety. Having stories available on the Internet can be beneficial; however, concerns especially about safety associated with Internet use and support for storytellers should be taken into consideration. A better understanding of young people's perceptions can provide valuable insights for future work with this age group on storytelling.

Traditional Chinese sexual values and morality are mainly based on the Confucian and Taoist traditions which overwhelmingly stress the reproductive function of sex and its role in cementing family and societal structures. In recent years attitudes towards sex love and marriage have changed dramatically since Chinas open-door policy and the economic reforms of the 1980s. Sexual attitudes become more open while the negative consequences of early sexual initiation increasingly become issues of social and health concern. In this paper the author provides an overview of the current literature relating to the sexual behaviour of adolescents and young people in contemporary China and suggests ways forward to positively promote the sexual health of its population. The results show that teenage sex and premarital sex are no longer disapproved of by the young. Some young people lost their virginity while still at high school and the rate of sexual initiation was generally higher among those who had left school and those at university. The take up of contraceptives was found to be low and multiple sexual partners casual sex pregnancies sexually transmitted infections and sexual abuse were also reported. These rapid changes in sexual values and behaviour call for the introduction of comprehensive sex education programmes and their associated services which are inclusive accessible and available to all adolescents and unmarried young people in China.

The negative consequences of teenage sexual behaviour are issues of concern in Britain and many other western countries. Over one-quarter of British young people are reported to become sexually active prior to the age of 16 and the rate of teenage pregnancy remains one of the highest in Western Europe. Current UK Government policy on sex education highlights the provision of skills for ‘safe sex’ at school to reduce teenage pregnancy rates. This paper argues that school cannot alone provide sufficient guidance to change teenage sexual behaviour, as school, family, religion, peers and media all have their part to play. Cooperation between schools, young people, their families and communities is crucial to enhance the effectiveness of sex education and to promote positive sexual health.

People of Chinese origin are a growing population group in western countries. The community is seen to be marginalised, under-researched and neglected, in fact the least understood ethnic minority. This paper reports on a systematic review of sexual attitudes and behaviour among ethnic Chinese young people (mainly aged 13-25 years) living in western countries. An extensive literature search was conducted to cover the period of 1989 and 2009 using Medline, CINAHL, PsycINFO and ScienceDirect databases. There has been a dearth of literature in this area. However, results from existing literature show that ethnic Chinese youth reported poorer sexual health knowledge than white young people in their host countries, while they were found to be more likely to disapprove of uncommitted sex, be virgins, lose their virginity at a later age and have fewer sexual partners. Factors associated with their sexual attitudes and behaviour have also been identified. Countries like the United Kingdom, United States and Canada have become multicultural societies with many diverse ethnic groups. Without doubt educators and sexual health professionals need to provide sex education and services which should be culturally appropriate to people from diverse ethnic backgrounds. An understanding of their sexual values, sexual behaviour and associated factors is the first step towards achieving this goal.

This study aimed to examine the psychometric properties and performance of a Chinese version of the Female Sexual Function Index (FSFI) among a sample of Chinese women with cervical cancer.A cross-sectional survey design was used. The respondents included 215 women with cervical cancer in an oncology hospital in China. A translated Chinese version of the FSFI was used to investigate their sexual functioning. Psychometric testing included internal consistency reliability (Cronbach's alpha coefficient and item-total correlations), test-retest reliability, construct validity (principal component analysis via oblique rotation and confirmatory factor analysis), and variability (floor and ceiling effects).The mean score of the total scale was 20.65 ± 4.77. The Cronbach values were .94 for the total scale, .72-.90 for the domains. Test-retest correlation coefficients over 2-4 weeks were .84 (p .05) for the total scale, .68-.83 for the subscales. Item-total correlation coefficients ranged between .47 and .83 (p .05). A five-factor model was identified via principal component analysis and established by confirmatory factor analysis, including desire/arousal, lubrication, orgasm, satisfaction, and pain. There was no evidence of floor or ceiling effects.With good psychometric properties similar to its original English version, this Chinese version of the FSFI is demonstrated to be a reliable and valid instrument that can be used to assess sexual functioning of women with cervical cancer in China. Future research is still needed to confirm its psychometric properties and performance among a large sample.

Diabetes mellitus is a group of complicated metabolic disorders characterized by high blood glucose level and inappropriate insulin secreting capacity due to decreased glucose metabolism and pancreatic β cell mass or dysfunction of β cells. Thus, improving glucose metabolism and preserving β cell mass and function might be useful for the treatment of diabetes. In this study, a novel acidic polysaccharide LBP-s-1 extracted from Lycium barbarum L. was obtained by purification using macroporous resin and ion-exchanged column. Monosaccharide composition analysis indicated that LBP-s-1 was comprised of rhamnose, arabinose, xylose, mannose, glucose, galactose, galacturonic acid in the molar ratio of 1.00:8.34:1.25:1.26:1.91:7.05:15.28. The preliminary structure features of LBP-s-1 were investigated by FT-IR, (1)H NMR and (13)C NMR. In vitro and in vivo hypoglycemic experiments showed that LBP-s-1 had significant hypoglycemic effects and insulin-sensitizing activity through increasing glucose metabolism and insulin secretion and promoting pancreatic β cell proliferation. Preliminary mechanisms were also elucidated.

China is the most populated of any country in the world. Social norms and values pertaining to love and marriage have changed considerably since the launch of its open-door policy and economic reforms of the 1980s. Attitudes to sex have become more open, while the negative consequences of early sexual intercourse have become issues of health and social concern. The aim of this study is to provide an overview of the teenage sexual attitudes and behaviour in contemporary China. A literature review was conducted between 2000 and 2010, using both English (Medline, CINAHL, PsycINFO, ASSIA) and Chinese language databases (China National Knowledge Infrastructure, Wanfang database). Thirty-six studies were included and reviewed. It was found that young people reported poor sexual knowledge, especially in relation to reproductive matters and sexually transmitted infections. The media, such as television, magazines and the Internet, were seen as their main sources of information on sex. Despite the frequently reported liberal attitudes to sexual behaviour, only a small number of young people had already lost their virginity or been involved in pregnancies. Young men were more likely than young women to report having had sex, while respondents at vocational high schools were less likely to remain virgins than those at common/key high schools. Although the prevalence of sexual intercourse among Chinese teenagers was still lower than that reported in studies conducted in most western countries, the findings do reflect some changes in sexual values and behaviour of young people within the country. They also suggest the need to develop more comprehensive sex education programmes in co-operation with young people, schools, health organisations, families and communities and to make sexual and reproductive health services accessible to teenagers and unmarried young people throughout China.

Antenatal screening has become standard practice in many countries. However, not all pregnant women choose to be tested. In the UK, the incidence of some birth defects is found to be higher in babies of Asian women than in those of women from other ethnic groups, while there is some evidence suggesting that ethnic minorities, especially Asian women, are less likely to undergo antenatal screening and prenatal diagnosis, the reasons for which are unclear. This study aims to identify and describe the literature on issues around antenatal screening and prenatal diagnostic testing for genetic disorders among women of Asian descent in western countries. The Medline, CINAHL, ASSIA and PsycInfo databases were searched for the period of 1995 and 2010. Twenty-one studies met the inclusion criteria and were therefore reviewed. In general, Asian women were found to hold favourable attitudes towards testing. However, they reported a poorer understanding of testing than white women and not being offered a test, and were less able to make informed choices. Asian women in the UK and Australia were found to be less likely than their white counterparts to have undergone prenatal diagnosis, while such differences were not found in the USA and Canada. The equity of access to quality antenatal care, alongside comprehensive well thought out antenatal screening programmes, can be assured if strategies are in place which actively involve all ethnic groups and take account of social and cultural appropriateness for the population served. An understanding of broad factors that inform women's decision-making on test uptake would help health professionals provide women and their families with more culturally sensitive information and support that they may additionally need to make more informed choices.

There is an increasing interest in the use of stories in healthcare practice and education. However, there are few stories from young people concerning health and little is known about their views on sharing such stories on the Internet. The aim of this study was to explore young people's perspectives in this area. A qualitative method was used and a project website was purposely built to facilitate data collection. An online focus group with 13 young people was carried out in an asynchronous format. Participants valued highly the therapeutic effect of storytelling and the use of digital stories to share feelings and experiences with a wide range of audiences, suggesting that well-produced stories could be a useful learning resource. A number of concerns were also raised, including embarrassment, reaction of other people and online safety. Having stories available on the Internet can be beneficial; however, concerns especially about safety associated with Internet use and support for storytellers should be taken into consideration. A better understanding of young people's perceptions can provide valuable insights for future work with this age group on storytelling.

Title. Evaluation of empathy measurement tools in nursing: systematic review. Aim. This paper is a report of a systematic review conducted to analyse, evaluate and synthesize the rigour of measures used in nursing research to assess empathy, in order to identify a ‘gold standard’ for application in future studies. Background. Empathy is considered essential to the provision of quality care. We identified 20 different empathy measures used in nursing research. There are inconsistencies between tools, indicating both the inherent complexity of measuring empathy and the need to evaluate the rigour of the measures themselves. Data sources. An extensive search was conducted for the period 1987 and 2007 using the Medline, CINAHL and PsycINFO databases and the keywords ‘empathy’, ‘tool’, ‘scale’, ‘measure’, ‘nurse’ and ‘nursing’. Twenty-nine studies were identified as relevant, in which 20 different empathy measurement tools were used. Twelve tools met the inclusion criteria for this review. Method. Twelve measures were critically reviewed and analysed. A 7-criterion framework was developed to appraise the rigour of the empathy measures, with a score range of 0–14 for each measure. Results. Quality scores obtained were low (2–8 of 14). Validity and reliability of data were commonly reported, but responsiveness to change was tested in only three measures. None of the measures were psychometrically robust or covered all the domains of empathy. User involvement was limited and only five were developed in nursing settings. Conclusion. Most measures have undergone rigorous development and psychometric testing, although none is both psychometrically and conceptually satisfactory. Empathy measures need to cover all relevant domains reflecting users’ own perspectives and be tested with appropriate populations in relevant care settings.

Title. Measurement of empathy in nursing research: systematic review. Aim. This paper is a report of a systematic review to identify, critique and synthesize nursing studies of the measurement of empathy in nursing research. Background. The profound impact of empathy on quality nursing care has been recognized. Reported empathy levels among nurses range from low to well-developed and there is clearly debate about what constitutes empathy and how it can be measured and improved. Data sources. Searches were made of the CINAHL, MEDLINE and PsycINFO databases, using the terms ‘empathy’, ‘tool’, ‘scale’, ‘measure’, ‘nurse’, and ‘nursing’, singly or in combination to identify literature published in the English language between 1987 and 2007. Methods. A systematic review was carried out. The included papers were critically reviewed, relevant data were extracted, and a narrative synthesis was conducted. Results. Thirty papers representing 29 studies met the inclusion criteria. Three types of studies were identified: descriptive studies (n = 12), studies of empathy and patient outcomes (n = 6), and evaluational studies (n = 11). Twenty scales were used, with more than one tool being applied in some studies, suggesting the need for a systematic review of empathy measures in nursing research. A range of settings were studied but some, such as genetic healthcare, have been neglected. Conclusion. Despite numerous tools being used in nursing research to assess empathy, there appears to be no consistency, suggesting the need to evaluate the rigour of empathy tools appropriately, either to inform education or for application in clinical settings.

Qualitative approaches have been increasingly used to explore ethnic differences in teenage sexual behavior, and methodological issues of conducting such research often remain unaddressed. This article discusses issues related to sampling, rapport, language, and ethnical considerations arising while undertaking research on attitudes toward teenage sexual behavior held by Chinese British families. It highlights the value of using snowball sampling, the importance of establishing rapport, and some advantages of matching the ethnic background between researcher and participants. The researcher's gender and social and cultural backgrounds affect research processes and findings, and this itself merits further reflection.

This paper explores the influence of ethnicity on attitudes towards sexual behavior of British-born Chinese teenagers. Using an ethnographic approach and snowball sampling, data were collected through in-depth interviews with 20 British-born Chinese teenagers and 20 Chinese-born parents. The parents highlighted the influence of Chinese culture and religion on their sexual values and wanted to convey these values to their children. Although direct communication about sex-related topics was rare within these families because of a number of barriers, the parents used other strategies to pass on their values. The paper concludes that sexual values within families and the influence of culture need to be considered in order to provide culturally competent health services. Chinese parents need extra support and help to discuss sex-related topics and pass on their values, which encourage teenage sexual abstinence. Considering the fundamental influence of the parents, this support will be crucial.