OBJECTIVES: Patients from different social environments and cultural backgrounds have different nursing needs. If nurses ignore the cultural differences of patients, it is easy to lead to the strained nurse-patient relationship, affect the nursing effect and cause harm to patients. Critical cultural competence (CCC) can help nurses to meet the nursing needs of patients from different cultural backgrounds, which is beneficial to building a harmonious nurse-patient relationship and improving the quality of nursing. Almutairi, et al designed the Critical Cultural Competence Scale (CCCS) which can be used to evaluate accurately nurses' CCC. No studies have reported the development of a critical cultural competence measurement tool for nurses or the introduction of foreign scales in China. This study aims to conduct Chinese and cross-cultural debugging and test the reliability of the English version of the CCCS in order to form CCCS suitable for Chinese cultural background and provide an effective evaluation tool for investigating the current situation of clinical nurses' CCC. METHODS: This study used Brislin's back-translation model to translate and back-translation the English version of CCCS. The Chinese version of CCCS was then created through cross-cultural debugging by expert consultation and a pre-survey with a sample size of 30 clinical nurses. From August to October 2019, 580 clinical nurses were surveyed using a whole group sampling method. The participants were randomly divided into 2 groups with a 7꞉3 ratio. One group (n=406) was used for exploratory factor analysis and reliability analysis, while the other group (n=174) was used for confirmatory factor analysis. Six experts used the scale-level content validity index (S-CVI) and the item-level content validity index (I-CVI) to assess content validity. In the exploratory factor analysis, items were screened using the critical ratio method, and were tested using the KMO (Kalser-Meyer-Olkin) index, Bartlett's sphericity test, and principal component analysis. In the confirmatory factor analysis, average variance extracted (AVE), goodness of fit index (GFI), adjusted goodness of fit index (AGFI), and root mean square error of approximation (RMSEA) were used to assess the degree of fit of the constructed model. For the total scale and the 4 subscales, the Cronbach's α coefficient, split-half reliability, and retest reliability were used to assess the scale's reliability. RESULTS: The S-CVI was 0.930, while the I-CVI ranged from 0.833 to 0.944. For all items, the critical ratio exceeded 3, and the difference between the high and low subgroups was statistically significant (P<0.05). Exploratory factor analysis revealed critical knowledge subscale had a KMO value of 0.676, with the total scale and other 3 subscales all having a KMO value >0.8 and a chi-square value of 814.32 to 12 442.45 for the Bartlett's spherical test, with degree of freedom ranging from 21 to 136 (P<0.001), indicating that all items were suitable for factor analysis. The principal component analysis showed that 17, 12, 7, and 7 items were extracted from the 4 subscales, with 4, 3, 2, and 2 components whose eigenvalues were more than 1, and the cumulative variance contribution was 66.0%, 54.3%, 56.6%, and 70.2%, respectively. The confirmatory factor analysis showed that the AVE of the 4 subscales were 0.637, 0.499, 0.560, and 0.565, GFI was 0.904, AGFI was 0.863, and RMSEA was 0.076. The Cronbach's α coefficient for the total scale and subscales ranged from 0.811 to 0.878, the split-half reliability ranged from 0.707 to 0.842, and the retest reliability was 0.827. CONCLUSIONS The Chinese version of the CCCS has good reliability and validity, and it can be used as a valid assessment tool for clinical nurses' critical cultural competence in China.
Humans ; Cultural Competency ; Reproducibility of Results ; Psychometrics/methods* ; Factor Analysis, Statistical ; China

Objective:To explore the effects of online and offline peer support on the quality of life in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM) in the community.Methods:Two sub-communities were selected from a community health service center in Hengyang, Hunan province, and randomly divided into the control community and the intervention community by coin tossing. From November 2018 to March 2019, totally 40 middle-aged and elderly T2DM patients who met inclusion criteria were enrolled from the control and intervention communities and included into the control group and the intervention group, respectively. Patients in the control group received routine community care, while patients in the intervention group received online and offline peer support for 6 months on the basis of routine care. The quality of life, body mass index (BMI) and fasting blood glucose (FBG) were compared between the two groups before intervention, 3 months and 6 months after intervention.Results:After 3 months of intervention, the psychological function, social relationship, quality of life scores of the intervention group were lower than those of the control group, and the differences were statistically significant ( P< 0.05) ; after 6 months of intervention, the psychological function, social relationship, quality of life, BMI and FBG of the intervention group were lower than those of the control group, and the differences were statistically significant ( P< 0.01) . Conclusions:Online and offline peer support can decrease the FBG, improve psychological function and social relationship of middle-aged and elderly T2DM patients in the community, and improve their quality of life.

Objective? To explore the current situation of health empowerment of elderly fragility fracture patients and to analyze its influencing factors. Methods? We selected four Class Ⅲ Grade A hospitals randomly in Hengyang. From October 2017 to February 2018, a total of 176 elderly fragility fracture inpatients were investigated with the self-designed general information questionnaire, Elderly Frailty Assessment Scale, Osteoporosis Self-Efficacy Scale (OSES), Health Empowerment Scale for Elderly Patients with Chronic Disease. Multiple linear regression analysis was used to explore the influencing factors of health empowerment of patients. Results? The score of health empowerment of elderly fragility fracture patients was (89.00±14.31) and responsibility belief dimension was with the highest score (3.74±0.88). Patients' health empowerment had a negative correlation with the frailty (r=-0.576, P＜0.01) and had a positive correlation with the self-efficacy (r=0.496, P＜ 0.01). Multiple linear regression analysis showed that the main influencing factors of health empowerment of patients included ages, education levels, medical payment methods, frailty and self-efficacy (P＜0.05). Conclusions? Nurses should pay attention to patients' health empowerment ability and provide the individualized nursing to strengthen the health empowerment ability of elderly fragility fracture patients.

Objective To discuss applicability of Emotional and Social Dysfunction Scale in Chinese stroke patients. Methods The Chinese version of Emotional and Social Dysfunction Scale was translated and revised, design the questionnaire to conduct two rounds of consultation on 16 experts, and the positive coefficient, the degree of coordination and the degree of authoritativeness of expert opinions were statistically analyzed. Results The positive degree of two rounds consultation were higher. The expert authority coefficient was 0.89. The expert coordination coefficient were 0.375 and 0.571 (P<0.01 for both). Preliminary revised scale contained 6 dimensions and 27 items. Conclusions Emotional and Social Dysfunction Scale is highly reliable and represent, and it can be used as a tool for Chinese stroke patients to assess emotional and social dysfunction,which can provide references for medical staff and patients′ family members to conduct targeted psychological intervention.

Objective To explore the nursing undergraduates' learning experience on the application of formative assessment in 'Basic Nursing Skills of Fundamental Nursing'. Methods A total of 362 nursing undergraduates for the class of 2014 from School of Nursing in University of South China were selected as study subjects by the method of purposive sampling. The formative assessment was used in the course 'Basic Nursing Skills of Fundamental Nursing'. The satisfaction of student nurses with learning this course and learning self-assessment were investigated with the self-designed learning experience questionnaire in the term end. Results The degree of satisfaction of student nurses with course teaching was high. A total 83.7% of them were satisfied with formative assessment. However,49.7% of them were satisfied with personal learning management. The highest degree of learning self-assessment was finding their own shortcomings(84.3%). The second was consolidating what they had learned(83.5%),and the lowest was promoting autonomic learning(71.5%). Conclusions Most of the student nurses recognise the formative assessment of this course with high satisfaction with the course learning and a good learning self-assessment. Teachers should pay attention to improving the independent learning ability of students in teaching.

Multicultural nursing starts late in our country. At present, the domestic scholars′research is focusing on the influencing factors of multi-cultural nursing ability and cultivating mode. There are few studies pay attention to the cultural competency assessment tool which is limited to nursing students in school. I believe that establishing evaluation tools that suit our national condition, efficient and comprehensive will help reflecting the multicultural nursing ability and the training effect objectively and also promoting the development of multi-cultural care in China.

Objective To develop Community Home Mutual Pension Demand Scale and test its validity and reliability.Methods Firstly,the theoretical dimension of Community Home Mutual Pension Demand Scale was constructed by means of literature analysis and resident interview.Secondly,the scale with five dimensions containing 29 items was formed after small range of questionnaire survey.Finally,the data from 384 elderly people in 4 communities of Hengyang city were analyzed by using SPSS17.0 and AMOS17.0 to test its validity and reliability.Results The model consisted of 4 dimensions and 21 items,which explained 69.911％ of the total variance.x2/df=2.097,Tac ker Lewis index (TLI)=0.959,non normed fit index (NNFI)=0.959,relative fit index (RFI)=0.924,goodness-of-fit index(GFI)=0.921,comparative fit index (CFI)=0.966,normed fit index (NFI)=0.938,incremental fit index (IFI)=0.967,root-mean square error of approximation(RMSEA)=0.054;Cronbach α of the total scale was 0.932,Cronbach α of each dimension was 0.801-0.954.The correlation coefficient between dimensions was 0.241-0.592,P＜0.01.Conclusions The scale has good reliability and validity in the measurement of the mutual pension demand of elderly.

Objective To investigate the level of self-perceived burden(SPB) and analyze the influencing factors in continuous ambulatory peritoneal dialysis(CAPD) patients.Methods One hundred and ten CAPD patients were investigated by a self-designed demographic questionnaire and Self-Perceived Burden Scale (SPBS).Results The total score of SPBS was (30.27±7.88) points,being in a middle level,and 85.45％ of the patients showed different levels of burden.Single factor analysis showed the influencing factors of self-perceived burden were marital status,family per capita income,the main caregivers and selfcare ability.Conclusions Most CAPD patients have obvious self-perceived burden,nursing staff should use the relevant nursing measures to reduce the SPB with CAPD patients and improve their quality of life.

graduate from self-study examination of nursing,the quality evaluation scale for graduation thesis of undergraduate from serf-study examination of nursing was developed.Methods The quality evaluation scales,which involving the scale using for faculty advisers,the scale using for reviewing teachers and the scale using for thesis defense teachers,for graduation thesis of undergraduate from self-study examination of nursing were constructed by adopting literature method,and so on.The scales were evaluated by reliability analysis,validity analysis,correlation analysis and factor analysis.Results The scale using for faculty advisers included 5 first-level indicators and 16 second-level indicators.The scale using for reviewingteachers included 4 first-level indicators and 14 second-level indicators.The scale using for thesis defense teachers included 5 first-level indicators and 14 second-level indicators.Their content validity indexes were respectively 0.909,0.952 and 0.864.Their construct validity cumulative contribution rates of the dimensions factors were respectively 72.77％,66.19％ and 63.79％.Their internal consistency reliability coefficients Cronbach α were respectively 0.953,0.810 and 0.926.The correlations between each factor and total score were significant.Conclusions three evaluation scales have good reliability and validity,which could be used to evaluate graduation thesis quality of undergraduate from self-study examination of nursing.

Objective To know about the influences of KTH integrated intervention on the blood pressure and quality of life of elderly patients with essential hypertension so as to explore the effective model of health education suitable for them. Methods 120 elderly hypertensive patients recruited from the community in Hengyang city were randomly divided into the experimental group and the control group, each group had 60 patients. The experimental group accepted KTH integrated intervention weekly, and control group was accepted routine hypertension education monthly. The blood pressure was taken before, during and after intervention. Meantime the quality of life was surveyed with WHOQOL- 100 questionnaires before and after the intervention. Results The systolic pressure and diastolic pressure in the experimental group were more lower than those before intervention and those of the control group after intervention. The hypertension of the experimental group was more stable as the time passed. There were distinguished differences between two groups in the quality of life, physical, psychological, social relationships, environmental and spirituality domain. However, there was no distinguished differences between two groups in the domain of independence. Conclusions KTH integrated intervention can make elderly hypertensive patients to keep blood pressure stable and improve their quality of life.