Purpose: Nurses are undertaking considerable emotional and physical work, which may lead to unrecoverable fatigue. This study aimed to evaluate the level of chronic fatigue and explore its associated factors among Chinese nurses in the hope of providing scientific evidence for fatigue-reduction strategies. Methods: This cross-sectional study was carried out in Liaoning Province, China in 2018. The study recruited 700 nurses and collected 566 effective respondents. Chronic fatigue, demographic factors, job conditions, and emotional intelligence were assessed through questionnaires. Chronic fatigue was assessed with the Fatigue Scale 11, occupational stress with the Effort–Reward Imbalance Questionnaire, and emotional intelligence with the Wong and Law Emotional Intelligence Scale. Hierarchical multiple regression was used to explore factors related to chronic fatigue and to test the moderating effect of emotional intelligence on the association between occupational stress and chronic fatigue. Simple slope analysis was conducted to visualize the interaction. Results: The mean score of chronic fatigue among the Chinese nurses was 17.14±6.16. Being married, having long weekly work time, working night shifts, and discontent with the nurse–patient relationship were positively associated with chronic fatigue. Effort:reward ratio, overcommitment, and emotional intelligence were important factors related to chronic fatigue. Emotional intelligence played a moderating role in the relationship between the effort:reward ratio and chronic fatigue. When emotional intelligence was higher, the effect of the effort:reward ratio on chronic fatigue became weaker. Conclusion: Most nurses surveyed in China might have relatively high levels of chronic fatigue. Our results highlight the importance of interventions on these factors for the reduction of fatigue among nurses in China. Providing more opportunities and support and developing emotional intelligence are crucial strategies to reduce chronic fatigue among nurses in China.

Background The outbreak of COVID-19 began in 2019 and is expected to impact the psychological health of college students. Few studies have investigated the associations among health risk communication, social media, and psychological symptoms during a major pandemic. Objective The aim of this research was to assess the prevalence of psychological symptoms among college students and explore their associations with health risk communication and social media. Methods A web-based survey was distributed through the Wenjuanxing platform among Chinese college students from March 3-15, 2020. In addition to demographics, information on health risk communication and social media was collected, and the Symptom Checklist 90 Phobia and Health Anxiety Inventory subscale was used to assess psychological symptoms among 1676 college students in China. Multivariable logistic regression was performed to examine these independent risk factors. Results The prevalence of panic and health anxiety was 17.2% (288/1676) and 24.3% (408/1676), respectively. Regarding risk communication, understanding the risk of COVID-19 (odds ratio [OR] 0.480, 95% CI 0.367-0.627) was a protective factor against panic. Knowledge of prognosis (OR 0.708, 95% CI 0.551-0.910), preventive measures (OR 0.380, 95% CI 0.195-0.742), and wearing face masks (OR 0.445, 95% CI 0.230-0.862) were shown to be protective factors in predicting health anxiety. Perceived lethality (OR 1.860, 95% CI 1.408-2.459), being affected by the global spread (OR 1.936, 95% CI 1.405-2.669), and impact on social contacts (OR 1.420, 95% CI 1.118-1.802) were identified as significant risk factors associated with health anxiety. In terms of social media, trust in mainstream media (OR 0.613, 95% CI 0.461-0.816) was considered to be a protective factor against health anxiety. Conclusions There was a high prevalence of psychological symptoms among college students. Health risk communication and social media use were important in predicting psychological symptoms, especially health anxiety. Scientific and evidence-based information should be reported by social media platforms. Web-based consultation and intervention measures should be the focus of future studies.

Purpose Fatigue undermines nurses’ well-being and work performance worldwide. Work stress is a critical factor that causes nurses’ fatigue, but the solutions are not well known. This study aimed to identify the moderated mediation model of fatigue involving effort-reward imbalance (ERI), resilience and perceived organizational support (POS) in Chinese nurses. Methods In a cross-sectional investigation conducted in Liaoning Province of China, 996 nurses completed the self-administered measurements of fatigue, ERI, resilience and POS. Moderated mediation was tested using the PROCESS procedure. The “pick-a-point” method was adopted to assess conditional effect on fatigue. Results The indirect effect of ERI on fatigue through resilience was significant (a×b = 0.119, BCa 95% CI: 0.094 to 0.146), indicating a partial mediation of resilience. POS moderated the association of resilience with fatigue ( β = −0.056, p = 0.006). The higher the level of POS was, the stronger the resilience-fatigue association became. Thus, the mediating role of resilience in the ERI-fatigue association was gradually increased with the increase of POS level (low POS: 0.073; moderate POS: 0.095; high POS: 0.116). Conclusion Resilience could partially mediate the ERI-fatigue association. POS could act as a moderator that enhanced the association of resilience with fatigue. A moderated mediation model of fatigue was demonstrated in Chinese nurses. Managers should establish a balanced social reciprocity, and improve nurses’ resilience and POS in order to decrease nurses’ fatigue.

PurposeCortisol in fingernails could retrospectively reflect cumulative stress over a long period. However, the association between fingernail cortisol and perceived stress needs to be validated. This exploratory study aimed to investigate the associations of perceived stress with the present and subsequent cortisol levels in fingernails of the subjective stress measurement among medical students.MethodsStudents were recruited from a medical university in Shenyang, China. The final sample consisted of 51 students (16 men, 35 women). On the Day 30 of our data and fingernail collection procedure, the 10-item Perceived Stress Scale was used to measure perceived stress. Fingernail samples were collected twice, on Days 15 (denoted as FD15) and 45 (denoted as FD45) of the procedure, and participants were asked to grow fingernails for 15 days in each collection. Cortisol was determined by an enzyme immunoassay method using the ELISA kit. Multiple linear regression was performed to examine the association between perceived stress and cortisol level. The Bonferroni correction was made for multiple comparisons.ResultsThe level of cortisol was 5.65 pg/mg (SD =1.88) for FD15 and 5.41 pg/mg (SD =1.63) for FD45. Perceived stress was not associated with the cortisol level of FD15 (β=−0.014, P=0.924), but it was significantly and positively associated with the cortisol level of FD45 (β=0.436, P=0.003), which remained significant after Bonferroni correction. The associations between fingernail cortisol and demographic variables (gender, age, BMI, and physical activity) were not significant.ConclusionThis study was the first to investigate fingernail cortisol in China. Perceived stress was positively associated with the subsequent cortisol levels in fingernails, but not the present. The findings suggested that fingernail cortisol could indicate stress exposure in the past. Furthermore, a simple and easy self-reported measure could reflect cumulative stress as measured by fingernail cortisol.

ObjectiveThis study aimed to investigate the status quo and the influencing factors of fatigue and professional identity among the Centers for Disease Control and Prevention (CDC) workers in China during the pandemic.DesignA cross-sectional design.SettingCDC workers employed by the Liaoning CDC system were enrolled (administrative staffs were excluded).Participants1020 CDC workers.Primary outcome measuresFatigue scores and professional identity scores.Secondary outcome measuresPostcompetency scores, respect scores, occupational stress scores, resilience scores and self-efficacy scores.ResultsThe average scores of fatigue and professional identity were 8.23, 38.88, respectively. Factors including perceived public respect (β=−0.129, p<0.01), resilience (β=−0.104, p<0.05) and self-efficacy (β=−0.22, p<0.01) were negatively associated with fatigue. Educational background (bachelor vs junior college or below) (β=0.105, p<0.01), (master or above vs junior college or below) (β=0.092, p<0.05), workplace (county vs district) (β=0.067, p<0.05), (city vs district) (β=0.085, p<0.05), fighting the COVID-19 on the front line (β=0.059, p<0.05) and occupational stress (β=0.166, p<0.01) were positively correlated with fatigue. Educational background (bachelor vs junior college or below) (β=−0.097, p<0.01), (master or above vs junior college or below) (β=−0.114, p<0.01), workplace (city vs district) (β=−0.114, p<0.01), fighting the COVID-19 on the front line (β=−0.047, p<0.05) and occupational stress (β=−0.105, p<0.01) were negatively associated with professional identity. Factors including postcompetency (β=0.362, p<0.01), perceived public respect (general vs low) (β=0.219, p<0.01), (high vs low) (β=0.288, p<0.01), resilience (β=0.097, p<0.05) and self-efficacy (β=0.113, p<0.01) were positively connected with professional identity.ConclusionThe fatigue among the CDC workers was at a higher level. The level of professional identity was high, and administrators should take measures to alleviate fatigue and maintain professional identity. In addition, methods aiming to attenuate occupational stress, and improve resilience and self-efficacy should be immediately put into action.

ObjectiveFatigue is a common problem among nurses, and patient/visitor incivility is thought to lead to nurses’ fatigue. However, the mechanism by which patient/visitor incivility leads to nurses’ fatigue has not been well studied. The aim of this study is to examine whether the association between patient/visitor incivility and fatigue among Chinese nurses is mediated by emotional labour strategy.DesignA cross-sectional study.MethodsIn November 2019, a stratified cluster sample of 1207 nurses from two hospitals in China was used to collect data on fatigue, patient/visitor incivility and emotional labour strategy through online questionnaires. Emotional labour strategy has three dimensions: surface acting (SA), deep acting and natural acting. Complete responses were provided by 1036 (85.8%) participants. Student’s t-test, one-way analysis of variance, Pearson correlation analysis and the PROCESS procedure (A modeling macro installed in SPSS to analyse mediation.) were adopted to analyse the data.ResultsPatient/visitor incivility and SA were positively related to fatigue (p<0.01), while natural acting was negatively related to fatigue (p<0.01). SA played as a mediator in the association between patient/visitor incivility and nurses’ fatigue (95% CI 0.047 to 0.113, p<0.05).ConclusionPatient/visitor incivility could contribute to Chinese nurses' fatigue. When nurses were exposed to patient/visitor incivility, they were more likely to use the SA emotional labour strategy, which would lead to fatigue. Nursing administrators should be aware of the seriousness of nurses’ fatigue.

BACKGROUND The outbreak of novel coronavirus disease (COVID-19) in 2019 would be expected to impact the psychological health of college students. Few studies have investigated associations between health risk communication, social media and psychological problems throughout a major pandemic. OBJECTIVE The aim of this research was to assess the prevalence of psychological problems and explore the association with health risk communication and social media. METHODS An online survey was distributed through Wenjuanxing platform among Chinese college students during March 3, 2020 to March 15, 2020. Besides demographics, health risk communication, social media, the Symptom Checklist 90 (SCL-90) subscale Phobia and Health Anxiety Inventory (HAI) were used to assess the psychological problems among 1667 college students in China. Multivariable logistic regression was performed to examine these independent risk factors. RESULTS The prevalence of panic and health anxiety was 17.2% and 24.3%, respectively. In aspect of health risk communication, understanding about the risk of COVID-19 (OR, 0.480; 95% CI, 0.367-0.627) was a protective factor against panic. Knowledge of prognosis (OR, 0.708; 95% CI, 0.551-0.910) and preventive measures (OR, 0.380; 95% CI, 0.195-0.742), wearing face masks (OR, 0.445, 95% CI, 0.230-0.862) were shown as protective factors in predicting health anxiety. Perceived lethality (OR, 1.860; 95% CI, 1.408 -2.459), affected by the global spread (OR, 1.936; 95% CI, 1.405-2.669), and impact on social contacts (OR, 1.420; 95% CI, 1.118-1.802) were identified as significant risk factors associated with health anxiety. In aspect of social media, trusted mainstream media (OR, 0.613; 95% CI, 0.461-0.816) was considered as a protect factor of health anxiety. CONCLUSIONS There was a high prevalence of psychological problems among college students. Health risk communication and social media were important in predicting psychological problems, especially health anxiety. Scientific and evidenced based information should be reported by social media. Online consultation and intervention measures should be implemented for college students during the global pandemic outbreak.