{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T03:59:35Z","timestamp":1792123175459,"version":"4.4.0"},"reference-count":48,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Nursing"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>It is extremely significant to explore the relationship between ruminative thinking and breathlessness catastrophizing among elderly COPD patients. However, the impact of self\u2010efficacy on this relationship is still unclear. This study attempted to explore the mediating role of self\u2010efficacy between ruminative thinking and breathlessness catastrophizing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A cross\u2010sectional study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study was conducted between 10 November 2024 and 25 January 2025, with 225 patients. Data were collected using the valid and reliable instruments, including the Ruminative Response Scale (RRS), the COPD Self\u2010Efficacy Scale (CSES) and the Breathlessness Catastrophizing Scale (BCS). Additionally, IBM SPSS v28.0 software was used to explore the mediating effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The scores for BCS of most patients were at moderate and high levels. Scores for the RRS and CSES were significantly correlated with the BCS. The analysis of the mediating effect demonstrated that ruminative thinking has a direct predictive effect on breathlessness catastrophizing. Additionally, ruminative thinking can also predict breathlessness catastrophizing indirectly through the mediation of self\u2010efficacy. The direct effect accounted for 64.4% of the total effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This research revealed that self\u2010efficacy played a partial mediating role in the relationship between ruminative thinking and breathlessness catastrophizing. Specifically, patients who were trapped in ruminative thinking were more likely to experience heightened breathlessness catastrophizing, but this relationship was mitigated by their level of self\u2010efficacy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications for the Profession and\/or Patient Care<\/jats:title><jats:p>This finding underscores the significant psychological burden that accompanies the physical symptoms of COPD in this demographic. It is imperative that nurses adopt a holistic approach in the management of elderly COPD patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patient or Public Contribution<\/jats:title><jats:p>Voluntary patients with elderly COPD hospitalised in the pneumology department were included in the study.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocn.17768","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T01:23:38Z","timestamp":1744766618000},"page":"4854-4864","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of Ruminative Thinking on Breathlessness Catastrophizing With Elderly <scp>COPD<\/scp> Patients: The Mediating Role of Self\u2010Efficacy"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0393-3344","authenticated-orcid":false,"given":"Yuye","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Nursing and Health Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiufang","family":"Li","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaokai","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianci","family":"Xiao","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenmeng","family":"Wei","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Song","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lamei","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/jehp.jehp_752_19"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033\u2010295x.84.2.191"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00628\u20102021"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00408\u2010024\u201000757\u20104"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.20542"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2013.09.015"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2214\u2010109x(23)00217\u20106"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.2196\/51150"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.4040\/jkan.22062"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.13416"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.00821"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2017.00617"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022\u20103514.50.5.992"},{"key":"e_1_2_14_15_1","volume-title":"Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression\u2010Based Approach","author":"Hayes A. 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