Objectives To investigate the prevalence and severity of symptoms in nasopharyngeal carcinoma patients during radiotherapy, to construct a network of radiotherapy-related symptoms for this group of population to identify symptom clusters, core symptoms and bridge symptom, and to provide reference for precise symptom management. Methods From November 2023 to August 2024, we recruited 210 nasopharyngeal carcinoma patients by using convenience sampling from a tertiary grade-A hospital in Guangzhou. General Information Questionnaire and Anderson Symptom Assessment Scale Head and Neck Module were used to investigate the patients. Exploratory factor analysis was used to extract symptom clusters. A symptom network based on R packages was constructed; centrality indicators and core symptoms and bridge symptoms were analyzed and determined. Results The most common symptom of nasopharyngeal carcinoma patients undergoing radiotherapy was oral or pharyngeal mucus (99.5%); The most serious symptom was dry mouth; Four symptom clusters were identified: oropharyngeal symptom cluster, mood sleep symptom cluster, gastrointestinal symptom cluster and nerve-related symptom cluster, which could explain 69.163% of the total variance. In symptom network, difficulty swallowing or chewing had the greatest strength and expected influence (r_s=1.400, r_E=1.398); fatigue had the greatest closeness and bridge strength (r_c=0.004,r_bs=0.610). Conclusion Oropharyngeal symptom cluster is the core symptom cluster; difficulty swallowing or chewing is the core symptom, and fatigue is the most important bridge symptom in the symptom group of patients with nasopharyngeal carcinoma undergoing radiotherapy. Nursing staff can develop individualized interventions for core symptom and bridge symptom to improve the efficiency of symptom management in patients undergoing radiotherapy for nasopharyngeal carcinoma.

Objective To gain an in-depth understanding of the current status of marital life experience of breast cancer patients at reproductive age based on ecosystem theory, and to provide reference for clinical support of breast cancer patients at reproductive age in a targeted manner. Methods Purposive sampling was used to select 15 married breast cancer patients from October 1 to December 1, 2024 to conduct in-depth interviews. Directed content analysis and NVivo software were used to analyze the interview data. Results Three themes and 12 sub-themes were summarized: marital anxiety (somatic anxiety activation, increased self-blame and guilt, self-reflective retrospection, and negative avoidance tendencies); couple interaction (increased emotional dependence, adequate emotional support, effective provision of caregiving support, and deepened marital estrangement); and family change (increased role conflict, children's health concerns, increased burden of living, and activation of resilience adjustment). Financial stress and role conflict were particularly prominent for patients with low-income. Conclusion This study innovatively reveals the multilevel and interactive nature of marital life experiences of low-income breast cancer patients at reproductive age. Anxiety emerges as the core distress (micro level); spousal support serves as the critical buffer for marital quality maintenance (meso level), and financial strain and family role imbalance constitutes pervasive and burdensome stressors (macro level). This suggests that clinical staff need to identify problems at different levels, with particular attention to the socioeconomic and role dilemmas faced by low-income patients. An integrated, tiered marital support program should be implemented, incorporating psychological counseling, spousal communication facilitation, and family resource linkage to improve patients’ overall marital quality of life.

Objective To establish standardized norms for Depression Anxiety and Stress Scale of nurses in tertiary grade-A hospitals in China, and to provide reference for evaluating nurses' depression, anxiety and stress. Methods With stratified cluster random sampling, the study selected 3,352 nurses from 18 tertiary grade-A general hospitals from March to April 2024, and the nurses were surveyed using the Depression Anxiety and Stress Scale (simplified Chinese version) developed by Lovibond in 1995 and revised by Gong Xu et al. in 2010. The research established mean norms, percentile norms, classification norms, and demarcation norms. Results The mean norm of the total score for the depression, anxiety stress scales of nurses in tertiary grade-A hospitals in China was 35.97±13.41. Eight categorical factors were identified: age, number of children, years of nursing experience, average monthly income, work intensity, frequency of night shifts, health status, and whether having self-care training or not. The percentile norms for depression, anxiety, and stress subscales and total scale were established at 5% intervals; Using x̅-s, x̅-0.5s, x̅+0.5s and x̅+s as the cut-off points, the depression-anxiety-stress level was categorized into lower, low, medium, higher, and high level. Conclusion This study establishes norms for the depression and anxiety stress scales for nurses nationwide, providing a theoretical foundation for effective evaluation and identification of nurses' depression, anxiety, and stress.

Objective To provide a scoping review of studies on nurses’ self-efficacy regarding end-of-life communication, and to summarize its assessment tools, current status, influencing factors, and intervention strategies. Methods We retrieved literature from Chinese and English databases including PubMed, Embase, CINAHL, Medline, PsycINFO, Web of Science, Cochrane Library, ProQuest, CNKI, and CBM, with a retrieval time spanning from the inception of the databases to September 2024. The included literature was analyzed and discussed. Results Twenty studies were included, including 11 cross-sectional studies, 4 class-experimental studies, 2 randomized controlled trials, and 3 mixed studies. Nurses' self-efficacy regarding end-of-life communication was assessed by the following instruments: The Communication Subscale of the Hospice Self-Efficacy Scale, a self-designed questionnaire, instruments adapted from those used in other survey-type or intervention studies, an item in the Attitudes to Caring for Patients with a Sense of Meaninglessness Scale on communication self-efficacy, etc. Totally, 38.00% to 54.53% of nurses reported low self-efficacy regarding end-of-life communication. Demographic factors, work experience, work environment, psychological characteristics, and hospice-related experiences affected nurses' self-efficacy regarding end-of-life communication. Intervention strategies for nurses' self-efficacy regarding end-of-life communication were multidisciplinary and with diverse forms. Conclusion Nurses' self-efficacy regarding end-of-life communication needs further improvement, with complex and multidimensional influencing factors, a lack of specific assessment tools and intervention strategies requiring further improvement.

Objective To summarize assessment tools for the acceptance of digital mental health interventions at home and abroad, and to provide reference for future research. Methods Systematic searches were conducted in both Chinese and English databases from inception to June 2024. Literature was systematically retrieved, collected, extracted, and synthesized using assessment tools meeting the inclusion criteria. Results A total of 127,773 articles was collected, and 10 articles and 10 assessment tools were included according to the inclusion criteria, of which 9 tools were for the assessment of patients and 1 tool for healthcare professionals. Conclusion Although a variety of assessment tools have been developed in the field of digital mental health interventions, there is still a need for further optimization and standardization of these tools to enhance the validity and reliability. A systematic summary of these assessment tools will help facilitate future research and provide reference for intervention design in related fields.

Objective To explore the application effect of discharge readiness services based on the intelligent rehabilitation follow-up platform for patients with head and neck cancer undergoing tracheostomy. Methods Eighty-four patients with head and neck cancer undergoing tracheostomy were selected. Forty-two patients in the control group received routine nursing guidance and follow-up, and another 42 patients in the observation group had discharge preparation service based on the intelligent rehabilitation follow-up platform. The discharge readiness of patients and their caregivers, patients' quality of life, readmission rate and tracheostomy complication rate within three months after discharge were compared between the two groups. Results Both patients and their caregivers in the observation group had significantly higher scores of Discharge Readiness Scale (P<0.05). The quality of life in the observation group was markedly improved (P<0.05), and the readmission rate and complication rate within three months after discharge were significantly lower than those in the control group (P<0.05). Conclusion The establishment and application of discharge readiness service based on the intelligent rehabilitation platform can effectively reduce readmission rate and home adverse event incidence in patients with head and neck cancer undergoing tracheostomy after discharge, while simultaneously improving discharge readiness and quality of life.

Objective To evaluate the efficacy of generative AI (Gen-AI) in enhancing innovative entrepreneurship among nursing students in the teaching of Fundamentals of Nursing. Methods Cluster randomized sampling was employed to select second-year nursing students from a medical college in Guangxi and the students were divided into control group and experimental group. The control group received conventional teaching integrated with AI-related educational philosophy. The experimental group performed a teaching reform incorporating Gen-AI into traditional teaching, structuring the reform around three modules (concept inspiration, demand guidance, and improvement of existing tool), and four sessions (three class hours/120 minutes each) were dedicated to fostering innovation and entrepreneurship skills in the experimental group. The scores of innovation and entrepreneurship and course test before and after the intervention were compared between the two groups. Results Statistically significant differences were found between the two groups in overall innovative entrepreneurship, goal-setting, communication and collaboration, opportunity recognition, risk prevention, and resilience in adversity (P<0.05). However, no significant differences were observed in the scores of action planning or decisive decision-making (P>0.05). Additionally, no significant difference (P>0.05) was found in course performance between the two groups. Conclusion The integration of Gen-AI into the teaching of Fundamentals of Nursing demonstrates certain advantages in enhancing nursing students' innovative entrepreneurship. However, its implementation requires reinforced guidance, AI tool supervision, and rigorous evaluation to ensure teaching efficacy and safety.

Objective To investigate the current status of nurse’s perceived ethical leadership and organizational silence, and to analyze the influence of ethical leadership on nurse’s organizational silence. Methods A stratified sampling method was used to select 896 nurses from 11 tertiary general hospitals in Henan Province as the study subjects, and the General Information Questionnaire, Ethical Leadership at Work Questionnaire, and Nurse’s Organizational Silence Measurement Questionnaire were applied to conduct the questionnaire survey. Results The total score of nurse’s perceived ethical leadership was 148.14±22.92, and that of organizational silence 46.91±17.16. Multiple linear regression analysis showed that education background, professional title, monthly income, and ethical leadership were influencing factors of nurse’s organizational silence (P<0.01), which explained 38.2% of the total variation (P<0.05). Conclusion Nurse’s perceived ethical leadership is at a high level and the organizational silence is at an intermediate level, with a negative correlation between the two. Organizational silence is more prevalent among nurses with lower educational levels, job title, and monthly income. Ethical leadership may reduce the occurrence of organizational silence among nurses.

Objective To construct an indicator system for the self-management manual of patients living with ostomy based on the Information-Knowledge-Attitude-Practice (IKAP) theory. Methods Guided by IKAP theory, an initial draft was developed through literature review and semi-structured interviews. Delphi method was employed to conduct two rounds of expert consultation with 20 specialists to optimize the indicators. Results The response rates for the two rounds of consultation were 90.9% and 100% , respectively. The authority coefficients were 0.920 and 0.915,and Kendall’s coefficients of concordance 0.125 and 0.149, respectively (P<0.001). The final system consisted of 4 first-level, 16 secondary-level, and 63 third-level indicators. Conclusion The constructed indicator system is scientific and systematic, with strong specialty relevance and practicality. It provides reference for the self-management of patients living with ostomy and the standardization of nursing practices.