Objective To explore the effects of double subjects health education based on online maternal school combined with teach-back in pregnant women with gestational diabetes mellitus（GDM） and their spouses. Methods Convenient sampling method was adopted to select pregnant women with GDM and their spouses attending the antenatal clinic at a tertiary general hospital in Quanzhou City from January to June 2021. They were randomized into an experimental group（n=65） or a control group（n=65）. The experimental group received online maternal education combined with teach-back method，while their counterparts in the control group were given routine maternal education. Self-management scale，quality of life questionnaire，blood glucose level，positive aspects of caregiver scale，and rate of macrosomia were measured and compared between the 2 groups before and after the intervention. Results After the intervention，the score of self-management scale was（85.22±2.91） in the experimental group，and it was（59.00±3.18） in the control group，and the difference was statistically significant（t=46.851，P<0.001）；the score of quality of life questionnaire was（78.68±3.36） in the experimental group，and it was（48.00±2.58） in the control group，and the difference was statistically significant（t=55.990，P<0.001）. The score of spouse positive aspects of caregiver scale in the experimental group was（42.02±2.89），and（28.77±3.43） in the control group，with statistically significant between the 2 groups（t=-22.779，P<0.001）. The level of fasting blood glucose（t=-15.881，P<0.001），2 h postprandial blood glucose（t=-12.308，P<0.001） and rate of macrosomia in the experimental group were significantly lower than those in the control group（ χ2=5.783，P=0.016）. Conclusion Double subjects health education based on online maternal school combined with teach-back can activate the support of spouse，improve self-management ability and quality of life of pregnant women with GDM，achieve blood glucose control and reduce the rate of macrosomia.
Objective To establish and validate a risk prediction model for cognitive frailty in community elderly. Methods 526 elderly people taking physical examinations were recruited in a community health service center in Guangzhou by convenience sampling from August 2020 to July 2021. They were divided into a modeling group （368 cases） and a validation group（158 cases）. Data were collected by a general information questionnaire and cognitive frailty assessment tools. Logistic regression was used to determine the influencing factors,and R software was used to establish a nomogram model for predicting the risk of cognitive frailty. Bootstrap method was used for internal validation of the model,and the validation group was used for external validation. C statistic and calibration curve were used to evaluate the prediction performance of the model. Results The model variables included IADL,self-rated health,daytime mental state,the number of chronic diseases,age,nutritional status and physical exercise. The AUROC of the model was 0.920（95%CI：0.892~0.947）,the best cutoff value was 0.401;the sensitivity was 79.7%;the specificity was 89.1%;The C statistics of internal and external validation were 0.910 （95%CI：0.863~0.936） and 0.850（95%CI：0.785~0.915）,respectively;calibration curve and Brier score showed good fit. Conclusion The prediction model has a good degree of discrimination and calibration,which can intuitively and easily screen the elderly at high risk of cognitive frailty in the community,and provide references for early screening and intervention.
Objective To understand the inner feelings and grief experience of hospice nurses who experienced the death of patients. Methods Using the method of objective sampling combined with snowball sampling,15 hospice nurses from 4 community health service centers and 2 hospitals in Guangzhou were selected for semi-structured in-depth interviews from November 2020 to March 2021. The interview data were analyzed by interpretative phenomenological analysis to refine the themes. Results The grief experience of hospice nurses in patients’ death events can be summarized into 3 themes,namely characteristics of grief（disenfranchised grief,and grief is easily recalled）,coping style,long-term effect（job burnout,growth）. Conclusion Disenfranchised grief is common among hospice nurses,which is usually easy to be recalled. Grief has the characteristics of concealment,long-term and accumulation. Nurses have both negative and positive ways for adjustment of grief. The harvesters and the people who are job burnout both exist in the group. It is suggested that in the future formal education and support for professional grief should be provided to the hospice nurses,to guide their correct expression and promote their growth.
Objective To identify all guidelines on perinatal bereavement care and to synthesize the recommendations of guidelines based on the critical appraisal of their methodological quality. Methods We conducted a systematic retrieval of the relevant guidelines on perinatal bereavement care published or updated from January 2010 to August 2020 in authoritative domestic and foreign guideline development websites,professional association websites,Chinese and English databases and Google search engines. The quality of the guidelines meeting inclusion and exclusion criteria was assessed independently by 4 appraisers using the Appraisal of Guidelines for Research and Evaluation Instrument Ⅱ. The recommendations related to caring for families experiencing perinatal death were synthesized. Results A total of 5 guidelines were included in this study. The average standardized scores of quality evaluation for the 6 areas were 91.11% for scope and purpose,90.55% for involved stakeholder,73.24% for rigor of development,81.67% for clarity of presentation,60.00% for application,and 60.83% for editorial independence.For overall quality,a guideline was Grade A and 4 were Grade B. After extraction and integration,5 stages and 32 recommendations related to caring for families experiencing perinatal death were concluded. Conclusion There is still a lack of guidelines for perinatal bereavement care at home and abroad,and the overall quality of developed guidelines needs to be improved,and contents need to be refined. We can combine the international guidelines with the domestic clinical situations,screen and localize the evidence-based recommendations to guide the development of domestic perinatal bereavement care.
Objective To explore midwives' inner feelings and experience of providing bereavement care for women experiencing perinatal death. Methods Study participants were recruited through purposive sampling. Semi-structured interviews were conducted between October and December 2019 in 18 midwives from 11 tertiary hospitals in Guangdong,China. Transcripts of interviews were analyzed using Colaizzi 7-step analysis method. Results 3 themes were extracted,including the suffering from negative emotions of midwives,the co-existence of positive and negative coping,and the expectation to receive organizational support. Conclusion When caring for bereaved women,midwives had negative emotional reactions and adopted negative coping styles,which could not ensure the quality of maternal care. It is suggested that hospitals and relevant departments can provide emotional support and training for midwives,and encourage midwives to respond positively. At the same time,formulation of evidence-based nursing pathway and establishment of multi-disciplinary professional teams are necessary,so as to promote the development of perinatal bereavement care services.
