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Abstract Background Perinatal loss is a severe stressor that usually triggers distressing symptoms of acute grief. Moreover, acute grief can worsen with time and become a chronic debilitating state known as complicated grief. However, there is a lack of comprehensive reviews on this topic. This systematic review aims to synthesize the existing literature on complicated grief following the perinatal loss. Methods We systematically searched PubMed, Embase, Cochrane Library, CINAHL, ProQuest, and Web of Science to identify articles on complicated grief symptoms and influencing factors following perinatal loss. We performed a comprehensive, structured evaluation in full compliance with PRISMA guidelines. Results A systematic search produced 1163 results. Of these, 38 articles met the full-text screening criteria, and 10 pieces of literature met the inclusion criteria. Individuals may experience complicated grief following perinatal loss, manifesting in symptoms such as emotional reactions, physical responses, and social impairments. Furthermore, based on existing evidence, influencing factors include demographic characteristics, reproductive characteristics, marital relationships, social support, and coping strategies. Conclusions Complicated grief following perinatal loss is easily overlooked and has not been adequately studied. Further empirical research is needed to explore the symptoms and factors influencing this condition. A better understanding of complicated grief will help develop and optimize care strategies, informing future clinical practice and improving psychological support for individuals affected by perinatal loss. Trial registration PROSPERO registration number: CRD42023473510.

Abstract Background the salutogenic theory is essential to explain an individual’s ability to maintain health during the perinatal period. While previous studies mainly focused on the perspectives from a family-level orientation and a global orientation, the purpose of the present study was to develop and validate a scale, the childbearing sense of coherence scale (CSOC-scale) from the individual’s perceptions of the stresses, resources, and meaningfulness of childbearing. Methods A total of 3 separate studies contributed to the development of the CSOC-scale between July 2022 and February 2023. In study 1, the initial item pool based on the conceptual framework of the childbearing sense of coherence and the salutogenic theory was developed. Delphi expert consultation was conducted to revise and improve items. Studies 2 and 3 were cross-sectional studies. In study 2, item analysis and explore factor analysis (EFA) (N = 351 for women, N = 256 for men) were used to screen items. In study 3, confirmatory factor analysis (CFA) and reliability analysis (N = 366 for women, N = 308 for men) were used to test the fit indices and reliability of the final scale. Results final analysis suggested the CSOC-scale includes three factors, consisting of 13 items. Confirmatory factor analysis demonstrated good model fit (χ 2 = 157.448, df = 62, χ 2 / df = 2.539, RMSEA = 0.065, CFI = 0.974, TLI = 0.968, SRMR = 0.029 for women; χ 2 = 181.363, df = 62, χ 2 / df = 2.925, RMSEA = 0.079, CFI = 0.968, TLI = 0.960, SRMR = 0.033 for men) and high factor loadings (from 0.751 to 0.929 for women; from 0.746 to 0.947 for men). Internal consistency (Cronbach’s α ranging from 0.895 to 0.933 for women and 0.881 to 0.945 for men in three dimensions; Cronbach’s α was 0.919 for women and 0.821 for men in the entire instrument) and split-half reliability (Spearman-Brown coefficients ranging from 0.876 to 0.921 for women and 0.841 to 0.937 for men in three dimensions; Spearman-Brown coefficient was 0.744 for women and 0.785 for men in the entire instrument) were excellent. Conclusions the CSOC-scale has robust psychometric properties. It is reliable and valid in evaluating the childbearing sense of coherence in women and men during pregnancy. Utilisation of this scale can help healthcare professionals understand the health maintenance competencies of couples during the transition of parenthood and provide health promotion services from a salutogenic perspective.

Objective To examine the relationship between social support and psychological birth trauma among Chinese primiparous women and the mediating effects of childbirth readiness.Design A cross-sectional study was conducted between November 2021 and March 2022.Setting 10 general tertiary hospitals and 3 specialised maternity hospitals in 7 provinces in China.Participants A total of 751 primiparous women were recruited for this study.Outcome measures The questionnaires consisted of questions on demographic characteristics, the Birth Trauma Scale, the Chinese Mandarin version of the Medical Outcomes Study Social Support Survey and the Childbirth Readiness Scale. Hierarchical multiple regression was used to explore the associated factors and mediating role of childbirth readiness in the relationship between social support and psychological birth trauma. The mediating model was examined by the PROCESS macro for SPSS.Results After adjusting for demographic variables, social support was negatively associated with psychological birth trauma (r=−0.242, p

BackgroundThe transition to parenthood, which is influenced a lot by local parenting culture, is a dramatic stress for both men and women. Chinese social and cultural contexts form specific parental culture, shaping the unique experience of transition to parenthood. However, the understanding of the transition to parenthood in mainland China is limited. Additionally, few qualitative studies explored the transition to parenthood from both dyadic perspectives.AimTo explore the first-time transition to parenthood experience among mothers and fathers in mainland China during pregnancy, and compare the similarities and differences between their experiences in this transition period.MethodsA descriptive qualitative study was conducted with 36 parents, including 18 primiparous women and their husbands. Data were analyzed by directed content analysis guided by the Transition Shock Model. The interview texts were first analyzed at individual levels and subsequently at the couple level to identify dyadic themes.ResultsFive themes and thirteen sub-themes emerged from the data analysis, including role integration, health risk, dilemma of preparation, protective isolation, and multi-dimensional expectation. Unexpectedly, the experiences and perspectives of mothers and fathers regarding the transition to parenthood were found to be similar, with the exception of the sub-theme extra-care requirement.ConclusionThe findings shed light on the complex emotional journey and expectations of parents, as well as the challenges they face in terms of physical well-being, limited coping resources, and restricted social connections. Notably, fathers in China often shared the stress of the whole process during the transition period alongside mothers but often lacked accessible avenues for seeking and receiving support. These findings underscore the importance of actively involving fathers as a key support population in perinatal care, as well as the need for comprehensive support systems and tailored interventions to enhance the well-being and adaptation of parents.

Abstract Background Although childbearing health care is wellness-based and promotes normal physiology, it is in a medical model and focuses on risk aversion and disease prevention. The salutogenic theory might provide an alternative perspective to health care concerning childbearing, supporting health-promoting factors, not solely on avoiding adverse events. However, there is a dearth of qualitative research exploring couples’ perceptions of childbearing from the salutogenic lens. This study aimed to explore perceptions and experiences concerning childbearing among couples in the perinatal period and identify salutogenic aspects of it. Methods The qualitative descriptive study adopted a directed content analysis to analyse data from a semi-structured and individual interview with 25 purposively selected Chinese couples between July 2022 and December 2022. The concepts of the sense of coherence (SOC) from the salutogenic theory were used as the theory framework for coding. Results Definitions and content for the salutogenic aspects of Chinese couples’ perception of childbearing sense of coherence were developed. For comprehensibility of childbearing, four subthemes were extracted (the challenge to health and endurance; transition to and identification with the new role; conflict and reconciliation in relationships; resistance and compromise between social culture and personal development). For manageability of childbearing, two subthemes were extracted (helplessness and hope of childbearing; self-doubt and self-assurance of childbearing). For meaningfulness of childbearing, three subthemes were extracted (personal realisation; family bonding and harmony; the continuation of life). Conclusions The findings of this study could give a greater understanding in maintaining couples’ health in the perinatal period from the salutogenic lens and provide a guide to further research that the salutogenic theory could bring a health and wellness-focused agenda in practice and policy-making in the perinatal period.

Abstract Aims To translate and validate the Publication Pressure Questionnaire‐revised (PPQ‐r) among the Chinese nurses. Design A cross‐sectional descriptive study. Methods The classical forward/backward translation of the PPQ‐r was conducted first, and then the psychometric values were tested using the data collected in September, 2021 among 924 Chinese nurses from a university hospital in China by calculating its content validity index, construct validity, both convergent and discriminant validity, and internal consistency reliability following the COSMIN guidelines. Results The proposed three‐factor structure of original PPQ‐r cannot be confirmed in present study. With exploratory factor analysis, a new two‐factor structure with 9 items was extracted, accounting for 62.718% of the variance. Confirmatory factor analysis indicated satisfactory goodness of all fit index values: χ2 = 75.53; df = 23; χ2/df = 3.28; CFI = 0.973; TLI = 0.958; RMSEA = 0.07 and SRMR = 0.047. Both sub‐scales yielded good internal consistency with Cronbach's alpha being 0.845 and 0.876, respectively. The Chinese version of PPQ‐r could be accepted as a reliable and valid tool to measure the Chinese nurses' publication pressure. Patient or Public Contribution Participation of nurses in this study was limited to the data provided through participant survey.

BackgroundPsychological birth trauma has been associated with a variety of negative consequences for mothers, partners, newborns, and midwives. While prior research has identified demographic and clinical factors that may contribute to the development of psychological birth trauma, interventions targeting these factors can prove challenging. Therefore, the aim of this study was to explore how psychological birth trauma is influenced by psychosocial factors including Sense of Coherence, Childbirth-related Fear, Social Support and Childbirth Readiness.MethodsA cross-sectional study was conducted in 13 tertiary or secondary hospitals in mainland China from November 2021 to June 2022. One thousand three hundred and sixty-six women were recruited totally. Data regarding basic characteristics, Sense of Coherence (SOC, Sense of Coherence Scale-3), Childbirth-related Fear (CBRF, Fear of Childbirth Scale), Social Support (SS, Medical Outcomes Study Social Support Survey), Childbirth Readiness (CR, Childbirth Readiness Scale) and Psychological Birth Trauma (PBT, Psychological Birth Trauma Scale) were collected. Parallel mediation analysis was adopted to identify the underlying mechanisms between study variables.ResultsIt was found that: (1) SOC has been found to have both direct and indirect effects on PBT. Women with higher level of SOC tend to report lower level of PBT; (2) the indirect effect of SOC on PBT was significantly exerted through CBRF, SS and CR; (3) CBRF was found to weaken the protective effect of SOC, whereas SS and CR were found to enhance it. No significant difference was found in contracts of the three specific indirect effects.ConclusionSOC, CBRF, SS, and CR should be paid enough attention when designing intervention programs for women who might experience PBT. Interventions targeting SOC and CR are more likely to yield positive outcomes.

Abstract Background Fertility intentions have been proved to be a reliable predictor of actual fertility behaviour. Also, childbirth-related fear (CBRF) has been proven to be negatively associated with childbirth readiness and fertility intentions among women, while childbirth readiness was positively related to fertility intentions. However, the associations and potential mechanisms between CBRF, childbirth readiness, and fertility intentions remain unknown. This study aimed to investigate the unique association between CBRF, childbirth readiness, and fertility intentions and whether childbirth readiness would mediate the relationship between CBRF and fertility intentions. Method A cross-sectional study of women (N = 1119, aged 16–53 years) who gave birth within 72 h was conducted. Using a convenience sampling, women were recruited from obstetric wards—10 comprehensive hospitals and 3 specialized hospitals in 7 provinces in mainland China. Pearson correlation was used to examine the relationship between CBRF, childbirth readiness, fertility intentions, and social support. Multivariate linear regression was further used to analyze the association between demographic and personal characteristics, CBRF, childbirth readiness, and fertility intentions. Mediation analysis was used to examine whether childbirth readiness mediates the relationship between CBRF and fertility intentions. Results Women with high childbirth readiness (β = 0.09, P = 0.002) had higher fertility intentions. However, women with high CBRF (β = − 0.17, P

Abstract Background Gestational diabetes mellitus (GDM) threatens GDM mothers and their offspring’s health and breastfeeding is one of the most effective ways to decrease the risk. However, the prevalence of breastfeeding among GDM mothers is far from optimal and how GDM mothers develop their feeding behavior is still unclear. Thus, this study aimed to explore the formation of GDM mothers’ breastfeeding behaviors based on the health belief model (HBM). Methods A questionnaire survey was conducted on 324 GDM mothers who have given birth within 6 months from January 1 to February 6, 2022. According to HBM, GDM mothers’ knowledge, the perceived threat from GDM, the perceived value of breastfeeding, self-efficacy, social support and GDM mothers’ breastfeeding behavior were measured. Exclusive breastfeeding (EBF) was defined as an infant who received only breast milk in the past 24 h before the survey. Structural equation modeling (SEM) was applied to explore how GDM mothers form their breastfeeding behaviors based on HBM. Results The prevalence of EBF among GDM mothers was 33.95%. GDM mothers had limited knowledge of GDM (average 63.14% correct answer to 7 questions), especially poor on the long-term effect of GDM (39.81%) and protective effect of breastfeeding (34.57%-45.99%). Although GDM mothers showed high perceived benefits (Mean: 3.35, SD: 0.46), high self-efficacy (Mean: 3.43, SD: 0.97) and high level of social support for breastfeeding (Mean: 3.74, SD: 0.74), the various barriers (Mean: 2.20, SD: 0.47) hindered their success in EBF. The SEM results showed that a higher level of social support and more self-efficacy of breastfeeding resulted in a higher likelihood of EBF, while the higher level of knowledge of GDM, perceived higher barriers and benefits of breastfeeding and higher susceptibility to GDM consequences led to less EBF. Conclusion To promote EBF, physicians’ education, emphasizing the protective effect of breastfeeding and how to correct breastfeeding, is highly recommended. In addition, social support for GDM mothers is also important to reduce their barriers to breastfeeding and help enhance self-efficacy in breastfeeding.

Abstract Background The unmet needs of older adults in nursing homes could result in their poor health status physically and psychologically. The aim of this study was to understand the characteristics of unmet needs of older adults residing in nursing homes in China, and to probe into the contributing factors. Methods In this cross-sectional design, the demographic and health status questionnaire, Modified Barthel Index, the Numerical Rating Scale for pain assessment, Geriatric Depression Scale, Camberwell Assessment of Need for the elderly were employed to survey older adults living in 38 nursing homes in 13 cities in China from July 2017 to June 2018 through a multi-stage, stratified sampling scheme. The Short Portable Mental Status Questionnaire was adopted to exclude participants with severe cognitive impairment. Aside from descriptive analysis, a raft of hierarchical logistic regression models were run by sequentially controlling for the independent variables at 5 levels (demographic characteristics, health status, pain, ADL, and depression), aiming to identify the influencing factors of the unmet needs of the residents. Results The effective sample size involved 2063 older adults (63.4% female versus 36.6% male), with a response rate of 98.5%. The median and inter-quartile range of the total needs and unmet needs of the sample was 3(1, 4) and 0(0, 1) respectively, with 122 older participants having more than 3 unmet needs (high unmet need category) versus 1922 older ones having ≤ 3 unmet needs (low unmet need category). The unmet needs of older adults in nursing homes mainly fell into social domains. Gender, religion, educational background, marital status, living condition before admission, room type, incomes, staffing, number of diseases, pain, Barthel Index, and depression were contributive to unmet needs of older adults in long-term care facilities in the final model that was adjusted for all levels of variables (all p

Abstract Objectives Perceived organizational support was a benefit for the work performance of nurses, which may affect emotional labor and the development of professional values. This study aimed to explore the relationship between nurses’ perceived organizational support and professional values, and investigate the mediating role of emotional labor. Methods This was a cross-sectional study. The study was conducted in 3 tertiary hospitals in Wuhan from October 2020 to January 2021. The data were collected by a questionnaire consisting of demographic characteristics, the Emotional Labor Scale for Nurses, the nurses’ Perceived Organizational Support Scale, and the Nursing Professional Values Scale (NPVS-R). A convenience sample of 1017 nurses responded to the questionnaire survey. Pearson’s correlation analysis was used to test the relationship between variables. Predictor effects were tested using hierarchical multiple regressions. The structural equation model (SEM) was used to test the mediation effect of emotional labor on the pathway from perceived organizational support to professional values. Results A positive moderate correlation was observed between the perceived organizational support and emotional labor (r = 0.524, P

IntroductionWomen with overweight or obesity and gestational diabetes mellitus (GDM) are at a high risk of developing type 2 diabetes mellitus (T2DM) and other metabolic diseases. Healthy postpartum lifestyles in women with GDM are important for effectively preventing early T2DM occurrence; however, few studies and guidelines focus in China on this issue.AimsThis qualitative study aimed to understand the puerperium experience and lifestyle of women with overweight/obesity and GDM.MethodsA face-to-face, in-depth, and semi-structured interview was conducted using a hermeneutical phenomenology method to collect data that were analyzed through thematic analysis.ResultsOut of 61 recruited women with overweight/obesity and history of GDM, 14 women underwent an interview and provided detailed descriptions of their lifestyle experiences during puerperium. The interview data were used to generate four themes—puerperium dietary behavior, weight perception and “confinement” behavior, family support, disease knowledge, and perceived risk—and nine sub-themes.ConclusionUnhealthy lifestyles, misconceptions about food, the conflict between physical activity and confinement behavior, a lack of social and family support, and low awareness of disease risk are all common among overweight/obese women with a history of GDM. Thus, we emphasized that healthcare providers should provide continuous preventive care from pregnancy to postpartum and promote long-term health in high-risk populations with a history of GDM associated with overweight/obesity.

BackgroundFear of birth (FOB) is becoming increasingly recognized as a mental health issue that may endanger maternal and infant health and affects women’s subsequent fertility desires. It has also been shown to be related to the choice of delivery mode. Given the differences in healthcare systems and policies between countries, and the gaps in the exploration of women’s experience of fear of birth and its association with the delivery mode in the Chinese cultural context, this study thus attempt to understand Chinese women’s experience with fear of birth and their preferences for delivery mode through a qualitative study.MethodsA descriptive qualitative research was performed among twenty pregnant women from the obstetric outpatient of a tertiary hospital in China. Colaizzi’s method was used to analyze the participants’ data.ResultsWe proposed three themes and nine subthemes on the participants’ experience with fear of birth: (1) an invisible dilemma: trapped in lingering fear (fear of all sides, the untold loneliness, and ambivalence with mixed feelings); (2) an unexpected decision: choose to give birth naturally (initiative selection and passive acceptance); and (3) A strength to confront challenges head-on: move forward with fear (awaken of maternal spirit, hope in bloom, Chinese tolerance culture, and obstetric analgesia).ConclusionFear of birth is a complex emotion, accompanied by feelings of loneliness and ambivalence in addition to fear. We found that women with fear of birth in this study prefer vaginal birth, and it was revealed to be the result of a combined action of intrinsic and extrinsic factors.

Background and aimNurses' professional quality of life (ProQOL) is closely related to nursing life, and it is essential to clarify the professional quality of life of nurses and enhance it effectively. We aimed to explore the influence of family care and organizational support on the professional quality of life of clinical nurses and to improve the theoretical basis for improving the professional quality of life of clinical nurses in China.MethodsA single center, descriptive, cross-sectional design was used in this study. From February to April 2,022, 2,200 nurses from Tongji Hospital were selected as the study population, using the General Information Form, Family Care Scale, Professional Quality of Life Scale, Nurses' Sense of Organizational Support Questionnaire, and Work-Family Conflict Scale, and analyzing the relationship between professional quality of life and family care and organizational support among clinical nurses for correlation analysis as well as multiple linear regression to determine the factors affecting participants' Factors affecting ProQOL. P < 0.05 values were considered statistically significant.ResultsThe Cronbach coefficients of the scales were generally above 0.8, with good validity. All nurses had empathic satisfaction, burnout, and secondary trauma scores of 28.74 ± 3.83, 30.82 ± 3.45 and 29.40 ± 3.69, respectively, and correlation analysis, as well as multiple linear regression results, showed that the three dimensions of nurses' professional quality of life were associated with family care and organizational support (P < 0.05).ConclusionsThe professional quality of life of nurses deserves to draw focused attention. The degree of family care and organizational support are predictive of professional quality of life, and nursing managers should pay attention to rationalizing tasks, pay attention to the physical and mental health of nursing staff, and improve the quality of life of nurses.

BackgroundPsychological birth trauma is widespread in postpartum women, and its harms are serious to mothers’ health. Existing tools rely on posttraumatic stress disorder to evaluate, which cannot effectively evaluate its connotation. The aim of this study was to develop a new instrument for use to comprehensively assess the psychological birth trauma level of women after birth and test the scale’s psychometric properties.MethodsThe scale was developed and evaluated through item generation, expert consultation, pre-survey, and psychometric evaluation. A literature review, focus group, and individual deep semi-structured interviews were utilized to identify the scale items. The expert consultation evaluated the content validity. Psychometric testing was conducted in a convenience sample of 712 mothers within the first 72 h postpartum who were recruited from three hospitals in China.ResultsThe total Cronbach alpha coefficient of the scale was 0.874. Exploratory factor analysis supported that the final scale consisted of four dimensions and fifteen items. The explanatory variance of the four factors was 66.724%. The four dimensions are named “being neglected,” “out of control,” “physiological emotional response,” and “cognitive behavioral response.” The results of the confirmatory factor analysis showed that the fit indices were all at acceptable and good levels.ConclusionThe 15-item Birth Trauma Scale is a valid and reliable tool to evaluate the psychological trauma of mothers who experienced spontaneous childbirth. The scale is a maternal self-assessment scale that can help women understand their mental health. Healthcare providers can identify key populations and intervene with them.

BackgroundGestational diabetes mellitus (GDM) is a condition in which women develop hyperglycemia during pregnancy, and is associated with long-term health burden on both mother and their offspring, such as future type 2 diabetes mellitus (T2DM). Although breastfeeding was expected to mitigate metabolic sequelae for both mothers and their newborns, the prevalence of breastfeeding in GDM mothers are sub-optimal worldwide.ObjectiveTo explore the experience of disease among mothers with GDM and how they develop feeding behaviors.MethodsThis study was conducted in three branches of an integrated tertiary hospital in the central area of China. Mothers who were diagnosed with GDM, had no other complications, and gave birth before no more than 6 months were approached based on a purposive sampling. GDM mothers’ experience of the disease and breastfeeding were collected via in-depth interviews. A theory-driven thematic analysis based on Health Belief Model (HBM) was applied for data analysis. Inductive reasoning was used to identify emerging themes which were not included in HBM.Results16 GDM mothers were included in the current study, with nine using breastfeeding, six mixed feeding and one artificial feeding, respectively. Nine themes were identified, including: 1) GDM diagnosis and severity; 2) information searching and GDM knowledge;3) GDM management; 4) perceived susceptibility of future diabetes;5) perceived severity of future diabetes;6) perceived benefits of breastfeeding;7) perceived barriers of breastfeeding;8) decision making process of feeding and social support. Generally, mothers with GDM lack reliable sources of information, considered the disease as a minor and transient illness during pregnancy, and failed to realize the long-term risk of GDM and the protective effect of breastfeeding to themselves and their babies. They rarely considered GDM in their feeding decision. Instead, the formation of feeding behaviors depends on the balance between the benefits and barriers of breastfeeding as well as the level of social support.ConclusionTo promote breastfeeding, a multi-facet intervention targeted on healthcare providers (HCPs), GDM mothers and their networks was important to help GDM mothers better and correctly understand the disease and breastfeeding, and increase their capacity of breastfeeding.

Abstract Background The psychological birth trauma is a universal phenomenon in childbearing women. The influences could extend in a wide range, which includes the mothers’ health, mother-infant relationship, partner relationship. The medical staff could even choose to quit playing their part in the birthing process. The phenomenon has gradually garnered attention around the world. However, it has rarely been discussed under Chinese special conditions. The study was to explore Chinese women’s lived experiences of psychological birth trauma during labor and birth. Methods A descriptive phenomenological approach was adopted in this study. Twenty-four women were recruited, who reported having experienced psychological birth trauma. In-depth interviews were conducted within 1 week after birth. Colaizzi’s method was used to analyze the data. Results Twenty-four women participated in the study. Four themes emerged to describe the women’s experience of psychological birth trauma: “How am I supposed to relieve the endless pain?” “ Can’t I be weak?” “Am I not important?” “What uncertainties are waiting for me?” Conclusions The findings provide deep insight into Chinese women’s unique experience of psychological birth trauma. The social and health system could prevent psychological harm during birth and promote maternal health by measures of pain management, thoughtful attention, adequate caring, and prenatal preparation.

Purpose: Elder self-neglect is a global public health issue and should be taken seriously at large. Nurses, usually working directly with elderly patients, have a better understanding of what factors may cause elder self-neglect. In this qualitative study, we explored the influencing factors of elder self-neglect from the perception of nurses in the context of Chinese culture. Methods: Face-to-face, in-depth interviews were conducted from November 2018 to December 2018. Purposive sampling was used. Twenty one participants recruited from eight geriatric wards of a general hospital located in Wuhan were interviewed. A content analysis of qualitative nature was performed to analyze the data. Results: Our conceptual model illustrated the findings based on the three themes of the conflict between personal recognition and social judgment, the choice between current needs and individual beliefs, as well as the compromise between insufficient abilities and limited resources. Conclusion: Nurses together with family members and social workers can help older adults improve their awareness of self-neglect to bridge the gap with social judgment, learn to focus on their own needs, as well as seek as much support as possible. Nurses should also respect the autonomy and self-determination of elder self-neglecters because self-neglect is related to older adults' values. Furthermore, larger studies are needed to quantitatively test and refine the model.

Objective: To standardize the holistic care for patients with severe coronavirus disease 2019 (COVID-19) in China. Methods: The consensus was preliminarily formed by combining relevant literature findings and frontline medical working experiences, and it was eventually confirmed by five rounds of online discussions and expert consultations. Results: This consensus included nursing assessment, nursing priorities, nursing goals, and thirteen key points of nursing procedures such as oxygen therapy and respiratory nursing, etc. Conclusion: This scientific and practical consensus guideline can provide clinical guidance on the holistic nursing care of patients with severe COVID-19.

Abstract Background Vitamin D deficiency has been linked to the risk of frailty. However, there are limited methods for evaluations of the potential association of vitamin D with frailty in a longevous (80+) population. The aim of this study was to examine the association between plasma 25-hydroxyvitamin D [25(OH)D] levels and the risk of frailty among the Chinese community based oldest-old. Methods Secondary analysis of data compiled in the 2011 wave of the Chinese Longitudinal Healthy Longevity Survey (n = 1324) was performed. Frailty was assessed by the Study of Osteoporotic Fractures (SOF) index. Multivariate logistic regression and spline smoothing with threshold effect analysis were performed to investigate the association between 25(OH) D level and the risk of frailty after adjusting for socio-demographic variables, health characteristics and confounding biomarkers. Results The mean age was 92.89 ± 7.92 years, and 844 (63.7%) participants were women. In all, data from 426 (33.2, 95% confidence interval, CI: 29.66–34.69) frail participants were recorded. After adjustment for confounding covariates, the level of 25(OH) D was significantly related to frailty. By spline smoothing with threshold effect analysis, a monotonically negative association between 25(OH) D and frailty was identified. Subgroup analyses revealed that the association did not differ by sex or age. Conclusions The 25(OH) D level was inversely associated with the risk of frailty among the Chinese community-based oldest-old.

This article introduces safety management strategies of nasopharyngeal specimen collection from suspected cases of coronavirus disease 2019 in a tertiary designated hospital. The key points include establishing a special sampling room, strict sterilization of the entire environment, training of professional nurses, enhancement of personal protection, standardization of methods and processes for swab collection, and a timely and safety sample submission. More than 11,000 nasopharyngeal specimens were collected by eight nurses, with an average of 1,375 specimen swab collections each nurse, and no one was infected.

Objectives: To evaluate the effect of nonpharmacological interventions on the mental health of high-risk pregnant women. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA) statement. The Cochrane Library, Embase, CINAHL, PubMed and Web of Science databases were systematically searched for randomized controlled trials and quasi-randomized controlled trials from inception to April 2021. The quality of the studies was assessed using the Cochrane Risk of Bias Tool 2.0. Data were independently extracted and narratively synthesized. Results: Fifteen studies involving 1723 pregnant women were selected. Nonpharmacological interventions included cognitive behavioral interventions, yoga, relaxation interventions, psychological and educational support interventions, and acupressure. Cognitive behavioral interventions and yoga for high-risk pregnant women had potential benefits on the symptoms of anxiety, stress and depression. There was insufficient evidence that relaxation interventions, psychological and educational support interventions and acupressure had positive effects on these women’s mental health. Conclusions: This review showed that cognitive behavioral interventions and yoga during pregnancy may benefit women with high-risk pregnancies. However, due to methodological limitations of this review, further studies with robust methodological designs are needed to verify the efficacy.

Purpose: As midwives witness and attend the whole process of childbirth, they have a better understanding of which factors may cause traumatic childbirth. However, because most of the studies paid their attention on mothers, little is known about psychological birth trauma from the perspective of midwives. This study aims to gain a full understanding of which factors may contribute to psychological traumatic childbirth from the perspective of midwives. Methods: A qualitative research was conducted using in-depth interviews, which involved fourteen midwives from the maternal ward of a tertiary hospital. The interviews were recorded and transcribed, and then, Colaizzi's method was used to analyze the contents of the interviews. Results: We proposed four themes and eight subthemes on the influencing factors of psychological traumatic childbirth from the perspective of midwives: low perceived social support (lack of support from family and lack of support from medical staff), hard times (protracted labor in the first stage and futile efforts during the second stage), poor birth outcomes (poor birth outcomes of the mother and poor birth outcomes of the baby), and excruciating pain (unbearable pain of uterine contraction and labor pain was incongruent with the mother's expectations). Conclusion: Medical staff should pay attention to psychological traumatic childbirth and its effects, and emphasis on the screening and assessment of birthing women with negative feelings so that their psychological traumatic childbirth can be prevented and decreased. Keywords: labor pain, midwifery, natural childbirth, psychological trauma, social support