To assess career satisfaction among Chinese nurses, explore influencing factors, and examine the mediating role of role breadth self-efficacy (RBSE) in the relationship between subjective age and career satisfaction. A multi-centre, cross-sectional study. Between June and October 2024, 2033 questionnaires were distributed to nurses across seven geographic regions in China, collecting data on demographics, subjective age, RBSE, and career satisfaction. Descriptive statistics, Pearson correlation analysis, multiple linear stepwise regression, and path analysis were used to identify determinants of career satisfaction and test the mediating effect of RBSE. The effective response rate was 97%. Chinese nurses reported moderate-to-high career satisfaction, younger subjective age relative to chronological age, and moderate RBSE levels. Multivariate linear regression analysis identified education level, work institution, salary, weekly working hours, subjective age, and RBSE as significant predictors of career satisfaction. Path analysis revealed a significant negative association between subjective age and career satisfaction (β = -0.23, p < 0.001), which was partially mediated by RBSE (indirect effect = -0.11, 95% CI: -0.18 to -0.05). The career satisfaction of Chinese nurses is at a moderately high level; the influencing factors include the intensity of nursing work and salary levels. There is a certain difference between the subjective age and the chronological age of Chinese nurses. RBSE partly mediates the relationship between subjective age and career satisfaction. Valuing the breadth of nurses' roles, self-efficacy, and subjective age may help improve job satisfaction. What problem did the study address?: This study elucidates the present level of career satisfaction among nurses in China and the variables affecting it. What were the main findings?: The subjective age of Chinese nurses influences career satisfaction, with RBSE partly mediating the connection between subjective age and career satisfaction. Where and on whom will the research have an impact?: This study presents novel variables of subjective age and RBSE in the investigation of factors influencing career satisfaction among Chinese nurses, offering new avenues for enhancing career satisfaction in this demographic in the future. We adhered to STROBE guidelines for cross-sectional research. This study did not include patient or public involvement in its design, conduct, or reporting.

ABSTRACTObjectiveTo generate an in‐depth understanding of the perceptions and experiences of individuals with youth‐onset type 2 diabetes (T2D) to inform knowledge translation initiatives and clinical care.DesignInterpretive descriptive qualitative study.MethodsIndividuals were eligible to participate if they received a T2D diagnosis on or before 18 years of age, resided in Manitoba, and were between 10 and 25 years of age at the time of data collection. Twenty‐two individuals (13 females, 7 males, 2 prefer not to indicate gender; mean age = 19.3 years) participated in 22 semi‐structured interviews (mean length: 29:01 min) remotely using Zoom video conferencing software or by telephone. Data were analysed using inductive thematic analysis.ResultsFour themes were generated: (1) Low public knowledge, misconceptions, and stigma impact youth experiences including those of diagnosis, disclosure, treatment, and supports; (2) shared familial experiences impacts perception of the future; (3) mental and emotional wellness is critically important but requires more attention; and (4) T2D carries unanticipated positive and negative impacts for youth.ConclusionsFindings illustrate the complex interrelationships between public and personal conceptions of T2D, stigma, and T2D navigation, emphasising the centrality of emotional and mental well‐being to participants' T2D experiences and management. This representation of experiences and perceptions of youth onset T2D offers direction for holistic and youth‐centred research and care and highlights areas where further mental health and educational resources would be beneficial.Patient and Public ContributionThe knowledge translation resource being developed from this study involves input from patient and public partners.

To examine the relationships among social support, eHealth literacy and eHealth technology acceptance among patients with chronic illnesses, and investigate whether eHealth literacy plays a mediating role. A cross-sectional correlational study. A total of 202 patients with chronic illnesses were recruited from outpatient clinics and communities in Taiwan. Data were collected via structured questionnaires and analysed using SPSS and PROCESS macro with 1000 bootstrap samples. eHealth literacy was the strongest predictor of technology acceptance. Although social support was positively associated with eHealth literacy, it did not directly predict technology acceptance after controlling for eHealth literacy, indicating a full mediation effect. eHealth literacy is a crucial mechanism through which social support influences health technologies acceptance. Interventions to improve eHealth literacy, particularly those integrated with social support strategies based on different cultural backgrounds, enhance digital engagement among chronic illnesses. Healthcare professionals and policy-makers should design literacy-sensitive interventions that leverage social networks and involve significant others to promote meaningful eHealth engagement in disease management. eHealth literacy fully mediates the relationship between social support and eHealth technology acceptance, proving that social support alone does not directly increase adoption without improving eHealth literacy. eHealth literacy is the strongest predictor of eHealth technology acceptance, emphasising its central role in bridging the gap between social support and eHealth engagement. This study followed the STROBE checklist guideline. No patient or public involvement.

To co-produce a prototype intervention to help nurses improve the assessment and care of the sexual health needs of men with inflammatory bowel disease. Inflammatory bowel disease can have a significant impact on the sexual health and well-being of men, but has largely been neglected in research and clinical guidelines. Men with the disease report that sexual health is not discussed during consultations, while healthcare practitioners describe a lack of confidence to initiate sexual health assessments. At present, no evidence-based tool exists to support nurses in detecting, assessing, and providing care for the sexual health of men with the disease. A mixed-methods study shaped by phase 1 of the Medical Research Council's framework for the development of complex interventions. (1) Cross-sectional surveys of (i) men with inflammatory bowel disease, (ii) nurses, and (iii) inflammatory bowel disease services to determine the current state of sexual health provision across the UK National Health Service. (2) Semi-structured interviews with men and the partners of men with IBD and asynchronous focus groups with health professionals to explore appropriate and acceptable ways to provide sexual healthcare. (3) Three consecutive co-production workshops inclusive of men with the disease, healthcare professionals, and stakeholders to formulate a prototype intervention. This study will create an evidence-based prototype intervention that will provide nurses with the knowledge and skills required to effectively assess the sexual health needs of men with inflammatory bowel disease and provide appropriate, patient-centred care. The study design was supported by a patient group. The study delivery will be supported by a patient co-investigator and stakeholder group inclusive of men with lived experience of the disease. This report adheres to the SPIRIT 2013 checklist for standard protocol items for clinical trials. clinicaltrials.gov ID: NCT06562751.

To propose the collaging integration procedure for linking literature and theory to research data in mixed methods research (MMR) and illustrate its application in two mixed methods studies. Discussion paper/research methodology. The collaging technique was used and developed based on two exploratory sequential nurse-led mixed-methods studies. The collaging technique entails using multiple artefacts (data fragments, figures and textual information) within one figure. Collaging can generate relevant pre-post linkages, create meaning and refine inferences and meta-inferences. This paper offers a novel integration technique for meaningful integration of the literature review and theoretical dimensions in the integration trilogy. Nurse researchers can use the collaging integration procedure for effective integration for conducting rigorous mixed-methods research. Collaging is a straightforward yet effective technique for enhancing integration in the literature review and theoretical dimensions in MMR. Linking literature review, theory and research data facilitates a more meaningful interpretation of research findings. While researchers may be able to create a more fully integrated MMR design by integrating multiple dimensions of the study, to date, most of the empirical and methodological literature on MMR has focused on integration at the design, fieldwork, analysis and interpretation dimensions, ignoring others, such as the literature review and theoretical dimensions. Collaging enables intensive analysis of the raw data and embeds the insights gained from literature and theory throughout the data analysis and presentation, thereby avoiding neglecting insights which could have been gained by back-and-forth comparison and integration of literature review and theoretical underpinnings. No direct patient or public contribution.

To develop a structured intervention aimed at enhancing family communication to reduce relapse in adolescents with depression. This study follows a multi-stage process guided by the Intervention Mapping procedure with the Medical Research Council framework, assessing the layers of complexity. Its design comprises four interrelated stages to construct a family communication intervention, culminating in a pilot randomised controlled trial. The program has four stages: (1) Identifying family interaction gaps through literature review and expert input; (2) Investigating communication needs of depressed adolescents and their families via a mixed methods study to develop a model intervention; (3) Refining the intervention with focus groups and expert e-Delphi; and (4) Finalising the intervention based on pilot randomised controlled trial outcomes. The research will be conducted in Greater Accra, Ghana. The process will result in a family communication intervention tailored to the needs of adolescents with depression and their families. It will be pilot tested, and the results will inform a nationwide efficacy trial. This research integrates qualitative and quantitative data to inform the development of an evidence-based family communication intervention. The program will carefully examine data integration and contextual challenges encountered during its implementation. The intervention has the potential to enhance family communication, thus playing a crucial role in adolescent depression recovery by reducing relapse rates. Healthcare professionals will benefit from a structured, evidence-based communication tool that can be used in clinical settings. The study focuses on improving communication between families of adolescents with depression, aiming to develop a family communication package for clinical and community use. This intervention may enhance recovery outcomes and reduce relapse risk for adolescents. This study adhered to the GUIDED guideline for reporting intervention development studies. No Patient or Public Contribution.

In May 2025, Kim et al. published an article in the Journal of Advanced Nursing entitled ‘Factors Affecting the Quality of Life of Parents of Children With Spina Bifida: The Mediating Role of Family Resilience’ (Kim et al. 2025). This study offered valuable insights into how daily catheterisation and enema procedures, parental depression, and family resilience collectively shape the quality of life of Korean parents caring for children with spina bifida (SB). We commend the authors for their significant contribution to the field. Based on their findings, we propose several future research directions and practical strategies aimed at reducing caregiving burdens, alleviating parental depression, strengthening family resilience, and ultimately enhancing the well-being of families raising children with SB. Although the study highlights the burden of procedural care—such as clean intermittent catheterization (CIC) and enemas—on parental depression and quality of life, it is critical to clarify the bidirectional relationship among caregiving demands, parental mental health, and children's self-care skill development during the transition of responsibility. Understanding these mechanisms is essential for designing effective interventions. Previous research indicates that depression and anxiety are highly prevalent among parents of children with chronic care needs and represent strong predictors of suicidal ideation (Logan et al. 2020). Such psychological distress often arises from the chronic stress of daily caregiving: multiple catheterizations and enemas, persistent concerns about urinary tract infections and bowel complications, and the absence of predictable personal time. Furthermore, inadequate school restroom facilities and fear of stigma often compel parents to intervene during school hours, compounding social isolation and feelings of helplessness (Lim et al. 2023). Parental psychological distress may reduce motivation to maintain behavioural training and transfer self-care responsibilities, thereby delaying children's acquisition of independent skills. This delay perpetuates a vicious cycle: heavy caregiving burdens increase depression, which hampers skill transfer, ultimately leading to heightened caregiving demands (Campbell et al. 2019). In addition, children's experiences of shame and self-blame due to prolonged dependence on parental care may intensify parental distress through emotional contagion (Schäfer et al. 2017). To break this cycle, a more nuanced understanding of the caregiving process is needed to inform an integrated care model. Such a model should simultaneously promote children's skill development, support parental mental health, and address environmental barriers in school settings. Implementation should involve a multidisciplinary team—including paediatric urology nurses, occupational therapists, school psychologists, and policy advocates—organised around three core dimensions: Future research should employ longitudinal designs to monitor trajectories of children's skill acquisition, parental mental health, and school support systems. Advanced modelling techniques, such as cross-lagged panel analysis, may help quantify bidirectional dynamics and guide targeted interventions. Promising strategies include phased skill training programmes for children with SB, evidence-based counselling services for parents, and policy-driven improvements in school restroom facilities. Importantly, Kim et al. reported that parents of low-income children with SB in South Korea experience significantly higher depression levels and lower quality of life compared with those from middle- and high-income families. This socioeconomic disparity underscores how resource scarcity exacerbates caregiving stress, accelerates functional decline, and erodes family well-being in disadvantaged groups. Addressing this inequity requires context-sensitive, stepped-care interventions such as hybrid cash-and-in-kind subsidies, flexible parental leave policies, peer-led storytelling initiatives, and community-based support groups. Prioritising the most vulnerable SB families is essential to ensure equitable health outcomes and advance. We thank you for considering our comments and look forward to further advancements in this important field. The authors declare no conflicts of interest. The authors have nothing to report.

We read with great interest the recent study highlighting the critical issue of patient-initiated violence in emergency departments (EDs), with a particular focus on the relationship between ED crowding and increased aggression toward ED nurses (Xie et al. 2025). While this research provides valuable insights into the relationship between ED crowding and violent behaviour, we believe that certain aspects warrant further exploration and refinement to deepen our understanding of this complex issue. Specifically, a more nuanced approach is needed to assess how crowding triggers violent behaviour, understand patients' cognitive and emotional responses, and improve reporting mechanisms for violent incidents. First, the study highlights that ED crowding is multifaceted, encompassing input, throughput, and output phases. However, a clearer distinction between how these phases influence patient aggression could improve targeted interventions. For example, the “input” phase, characterised by high patient volume, may lead to different psychological stressors for patients than the “output” phase, where delays in bed availability and patient transfers become more pressing. Future research should attempt to unpack these stages more systematically to identify which specific factors—whether it be prolonged waiting times or high patient expectations—are most likely to lead to aggressive behaviour. The notion that crowding increases dissatisfaction and perceptions of injustice among patients is consistent with relative deprivation theory, which suggests that individuals who feel they are being treated unfairly are more likely to act out. However, future studies could focus on how these perceptions vary across different patient demographics, such as age, comorbidities, and cultural background, to refine the prediction of violent tendencies. Second, the review draws attention to the vulnerability of certain patient populations, including those with severe symptoms or lower triage categories. The stress faced by critically ill patients is likely to be exacerbated by their urgent need for care and longer waiting times, which may increase frustration. However, it would be valuable to explore the emotional and psychological impact of crowding on these patients and their families. Research that examines the interplay of family expectations and their potential to escalate tensions could lead to more comprehensive prevention strategies. In addition, patient perceptions of “unfairness” often stem from a lack of clarity or understanding of the operational constraints of the ED. Addressing these cognitive biases by promoting better communication about wait times and care priorities could potentially reduce aggressive incidents. Furthermore, while the study suggests that crowding is associated with physical violence, it is important to consider that non-physical aggression, such as verbal abuse, may be underreported due to the cultural normalisation of such behaviours in ED settings. A change in the way ED staff perceive and report violence—coupled with better reporting systems—could ensure a more accurate reflection of the prevalence and nature of violent incidents. This would not only provide a clearer picture of the extent of the problem, but also facilitate the development of more effective intervention strategies. Finally, the issue of systemic violence in emergency settings requires a broader cultural shift. Although the study calls for better reporting mechanisms, it also highlights the need for organisational support and policy changes to combat the normalisation of violence as an inevitable part of ED work. This includes fostering an environment where ED nurses feel empowered to report incidents without fear of stigma or retaliation and where leadership actively promotes a zero-tolerance policy for violence. In addition, implementing training programmes that focus on de-escalation techniques and providing adequate psychological support for ED staff could help mitigate the negative impact of violence on nurses' mental health and improve retention rates. In conclusion, this study makes a compelling case for the urgent need to address ED crowding as a key factor in patient-initiated violence against emergency nurses. By refining the theoretical framework, incorporating more comprehensive assessments of crowding, and addressing patient perceptions, healthcare systems can better mitigate the risks of violence in these high-pressure environments. In addition, fostering a cultural shift in how violence is perceived and reported, while providing better psychological and operational support for nurses, is critical to ensuring both the safety and well-being of healthcare workers in emergency settings. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.

To explore mental health help-seeking behaviours among East Asian American dementia caregivers and construct a theory grounded in their behaviour patterns. Qualitative using constructivist grounded theory design. We recruited 20 East Asian American dementia caregivers between August 2023 and March 2024 using purposive sampling. We conducted one-on-one interviews and analysed the data using constructivist grounded theory coding. We constructed a theory including six concepts and 22 categories. While 'providing care', caregivers manage caregiving tasks and personal life, experiencing caregiving challenges. 'Individual capacity' is a key to perceiving caregiving situations and 'considering seeking support'. Various factors can affect 'using support'. Different types of support can be used separately or in combination. When receiving adequate support, caregivers can 'gain benefits from support'. These benefits, alongside individual capacities, can shape caregivers' 'outlook on the present and the future'. This study explains the mental health help-seeking process within East Asian culture, broadening perspectives on diverse populations and highlighting insights into culturally tailored services. This study offers clinicians and communities insights into the mental health help-seeking process among East Asian American dementia caregivers and highlights strategies to encourage their use of mental health services. This theory incorporates aspects of East Asian culture, addressing a research gap in studies of Asian Americans. It may enhance understanding of culturally tailored approaches and facilitate future funding for research and services, considering cultural diversity. The Standards for Reporting Qualitative Research. No Patient or Public Contribution.

Management of patients with psychiatric disorders by non-psychiatric nurses presents unique challenges, as they may lack specific mental health training. This study explores the experiences of non-psychiatric nurses who face challenges in caring for patients with psychiatric disorders, with regard to violent incidents. A meta-synthesis of qualitative studies was conducted. Five electronic databases were searched and additional searches were manually conducted. The analysis included nine articles, and the quality of data were assessed using the Critical Appraisal Skills Program checklist. Schutz's analytical method was applied to analyse and synthesise the data. Three main themes were identified: 'Safety concern,' 'Nurse's emotional and ethical challenges in managing patients with psychiatric disorders' and 'Improper environment and system for psychiatric patient.' From a safety perspective, specialised training is essential to identify psychiatric-specific indicators of violence and enhance nurses' ability to manage violent situations involving patients with psychiatric disorders. Emotionally, confidence-building training, addressing stigma and providing support for ethical dilemmas and burnout related to restrictive interventions are crucial. From a systemic perspective, establishing clear guidelines and standardised protocols, and implementing a collaborative care model are essential for safe and effective management of violence. Comprehensive mental health training and better support systems are essential for non-psychiatric nurses. Improving protocols, risk assessments and collaboration can enhance the quality of care and nurse safety.