Objective To explore the nursing effect of the establishment of standard nursing procedures of hemodialysis vascular access in the nursing consortium on arteriovenous fistula in patients with maintained hemodialysis（MHD）. Methods In this study,10 primary hemodialysis centers in the nursing consortium of our hospital were used as pilots from May 2020 to May 2021,and 5 hemodialysis centers were selected as the experimental group by the random number table method,and the remaining 5 were the control group. The experimental group was implemented with the standard nursing process of hemodialysis access established in this study,and the control group received routine arteriovenous fistula nursing. The dialysis adequacy,arteriovenous fistula complications,the self-management ability and other indicators of the 2 groups were compared before the implementation and 3 months,6 months,and 12 months after the implementation. Results 143 cases in the experimental group and 155 cases in the control group completed the study. 3 months,6 months and 12 months after implementation,the kt/V value of the experimental group was significantly higher than that of the control group（P<0.05）;6 months and 12 months after implementation,the QA,URR and self-management ability of the experimental group were significantly higher than those of the control group（P<0.05）. 12 months after the implementation,the incidence of hematoma and stenosis in the experimental group was significantly lower than that in the control group（P<0.05）. Conclusion The establishment of the standard nursing process of hemodialysis access in the nursing consortium can effectively improve the dialysis adequacy of MHD patients,improve the self-management ability of patients with arteriovenous fistula,and reduce the complications of arteriovenous fistula.

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 retrieve the best evidence of management of non-pharmacological labor analgesia for women with trial of labor. Methods We systematically searched National Institute for Health and Clinical Excellence（NICE）,American College of Obstetricians and Gynecologists（ACOG）,the Society of Obstetricians and Gynecologists of Canada（SOGC）,Guidelines International Network（GIN）,Joanna Briggs Institute（JBI）,Uptodate,Cochrane Library,CNKI,Wanfang Database,Pubmed to collect guidelines,best practices,expert consensuses. The retrieval period was from January 2014 to September 2019. 2 researchers with evidence-based nursing background assessed the quality of the literature independently and extracted the evidence. Result A total of 12 articles were included,including 1 clinical guideline,2 clinical decisions,5 systematic reviews and 4 evidence summaries. 33 pieces of evidence were obtained,including the implementation timing,supportive environment,accompany delivery,cold and hot compress,breathing and relaxation techniques,transcutaneous electrical nerve stimulation,water labor,touching and massage,posture and activity. Conclusion This study summarized the best evidence of management of non-pharmacological labor analgesia for women with trial of labor,which can provide evidence-based practice bases for standardized management of non-pharmacological labor analgesia in maternity settings.

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.

Objective To investigate the risk factors of episiotomy and to establish the logistic regression model. Methods Totally 685 women with singleton pregnancy with vaginal delivery in a tertiary hospital were selected from April to August,2018. Multiple indicators of episiotomy group （ n=307） and non episiotomy group （ n=378） were compared. Logistic regression was used to establish a risk prediction model,and the model power and its accuracy were evaluated by receiver operating characteristic. Results The study finally included length of perineum,perineum resilience,perineum edema,colpoperineal laceration,estimation of fetal weight,cooperation of women,uterine contraction and work experience of midwives to construct the risk prediction model. This model's area under curve of receiver operating characteristic was 0.932. When the best predicted probability was 0.496,the sensitivity and specificity of the logistic model were 0.883 and 0.802,respectively. Conclusion The risk prediction model has satisfactory prediction effects and can be completed at the second stage of labor.

Pregnant Women； Nurse Midwives； Parturition； Satisfaction