Objective To clarify and analyze the concept and connotation of the reflective practice in nurses. Methods CNKI，Wanfang，CBM，PubMed，Embase，Scopus，CIHNAL database were searched in relation to reflective practice in nurses. The retrieval period was from the inception to Dec.2022. Walker and Avant’s concept analysis method was used to analyze the connotation. Results A total of 43 articles were retrieved. 6 attributes of reflective practice in nurses were identified，including active engagement，critical thinking，openness and acceptance，making connections with previous knowledge or experiences，external support，dynamic and continuity. Antecedents included internal and external drivers. The reflective practice in nurses ultimately had a vital impact on themselves，patients and organizations. In recent years Reflective Practice Questionnaire has been one of the most commonly used data collection tools to measure the reflective practice in nurses. Conclusion The concept attributes of reflective practice in nurses were identified by concept analysis method，which provides references for nursing educators to cultivate reflective practice ability of nurses. In future research，researchers can combine the connotations of reflective practice for nurses to develop specific assessment tools for testing the level of reflective practice of nurses and construct the local reflective practice intervention scheme for nurses，so as to promote the development of reflective practice in nursing field in China.

Objective To explore the application effect of four-part correction rehabilitation training in patients with vocal cord benign lesions. Methods A total of 106 patients with benign vocal cord lesions undergoing microsurgery under general anesthesia for the first time in the department of otolaryngology of a tertiary A hospital in Tianjin from April 2020 to March 2021 were selected and divided into an experimental group and a control group by random number table method,with 55 patients in the experimental group and 53 patients in the control group. The experimental group was given four-part correction rehabilitation training on the basis of routine nursing,and the control group received routine nursing program. The voice handicap index and multidimensional voice analysis were used for evaluation. The voice impairment index (VHI) and acoustic parameters (NHR),Shimmer,Jitter and MPT were compared and analyzed on the day of admission,the day of discharge,2 weeks and 4 weeks after surgery. Results There was no statistical significance in NHR,Shimmer,Jitter,MPT and VHI values on the day of admission and discharge between the 2 groups (P>0.05). The data of 2 weeks and 4 weeks after surgery were compared between the 2 groups,and the NHR,Shimmer,Jitter and VHI values of the experimental group were lower than those of the control group,while the MPT value was higher. The differences between the 2 groups were statistically significant (P<0.05). Conclusion Four-part correction rehabilitation training can effectively improve the subjective feeling and voice quality of patients with voice disorders after surgery for benign vocal cord lesions,help to change patients’ bad voice habits and behaviors,and promote the rehabilitation of patients.

Objective To investigate the current states of cognitive impairment and to identify the influencing factors associated with cognitive impairment in community-dwelling older adults with chronic diseases. Methods A total of 734 patients aged 60 years or older with chronic diseases were recruited from a community health service center in Shanghai by convenient sampling method. Data on demographics,clinical information and lifestyle were collected. Montreal cognitive assessment basic scale（MoCA-B） was used to measure cognitive function. Results In the sample of 734 elderly patients with chronic diseases,373（50.8%） had cognitive impairment,including 326（44.4%） with mild cognitive impairment and 47（6.4%） with Alzheimer disease. The results of multivariate Logistic regression analysis showed that age,light physical household chores,physical exercise,frequency of playing wechat or computer,hobbies,hearing loss,and history of diabetes are all common influencing factors for mild cognitive impairment patients and Alzheimer disease patients. Low education and family history of dementia（P<0.05） are factors specially associated with mild cognitive impairment. The Kruskal-Wallis analysis showed that the types of chronic diseases had statistically significant differences in the average score of MoCA-B rank（P<0.05）. Conclusion Elderly adults with 4 chronic diseases in the community have a higher prevalence of cognitive impairment than those with single one chronic disease. Health clinicians should screen cognitive function for older adults to identify these vulnerable population as early as possible.