Objective To explore the mediating effects of perceived stress and uncertainty tolerance on health literacy and decision satisfaction of decision makers in patient undergoing cardiac macrovascular surgery，and to provide references for improving the satisfaction of decision-making. Methods 260 surgical patient’s decision-makers in the cardiac macrovascular surgery of a hospital in Wuhan were selected by convenience sampling. All Aspects of Health Literacy Scale，Perceived Stress Scale，Intolerance of Uncertainty Scale-12 and decision satisfaction scale were used to investigate. Results 251 valid questionnaires were recovered，with an effective recovery rate of 96.54%. The health literacy score was（23.05±5.61）；the perceived stress score was（20.31±6.08）；the uncertainty tolerance score was（26.41±5.94）；the decision satisfaction score was（43.86±10.54）. The 4 variables were correlated（P<0.001）. The mediating model found that health literacy had a significant direct effect on decision satisfaction. Meanwhile，health literacy also indirectly affected decision satisfaction through 3 paths，including the independent mediating effect of perceived stress（β=0.096，P<0.001），the independent mediating effect of uncertainty tolerance （β=0.093，P=0.001），the chain mediating effect of perceived stress and uncertainty tolerance（β=0.076，P<0.001），accounting for 49.17% of the total effect. Conclusion Perceived stress and uncertainty tolerance play a mediating role in the relationship between health literacy and decision satisfaction of decision makers in cardiac macro-vascular surgery，which can improve decision makers’ health literacy，reduce perceived stress，and help them perceive surgical risks rationally，thus improving decision satisfaction.

Objective We aimed to establish an evaluation index system for health education among patients with nasopharyngeal carcinoma（NPC） who are undergoing radio-chemotherapy. As a theoretical basis,this system may be applied by the clinical nurses to carry out targeted health education and guidance among NPC patients undergoing radio-chemotherapy and to evaluate the effect of health education. Methods From March to July 2021,we constituted a structured multidisciplinary research team,including oncologists,nurse specialists,nutritionists,et al,based on the theory of Knowledge-Belief-Practice. Literature review,semi-structured interviews,as well as the Delphi method and Multi-dimensional Analytic Hierarchy Process,were used to establish a framework of the evaluation index system and set weighted value for each evaluation index. Results The response rates of the 2 rounds of expert consultations are 85.0% and 100%.The expert authority coefficients are 0.932 and 0.935,respectively.The total Kendall harmony coefficients of the 2 rounds of expert consultations are 0.235~0.326 and 0.302~0.419（P<0.01）.As a result,we built up an evaluation index system of health education which comprised 3 first-level indexes,19 second-level indexes and 73 third-level indexes for NPC patients undergoing radio-chemotherapy. Conclusion The evaluation index system may provide evidence and a practice tool for clinical nurses in conducting a comprehensive and efficient evaluation of health education among NPC patients undergoing radio-chemotherapy.

Objective To systematically evaluate the prevalence of frailty in older patients with diabetes and provide evidence for nursing interventions.Methods Systematic review of the literature was conducted in electronic databases,namely PubMed,Embase,Web of Science,CBM,CNKI,VIP and Wan fang Data,and observational studies about the prevalence of frailty in older patients with diabetes published before August 2020 were included. 2 researchers independently screened the literature,extracted the data,and assessed the quality of included studies using Critical Appraisal Tools published by JBI and NOS. The meta-analysis was performed by Stata 15.0 software. Fixed-effect or random-effect models were used to pool data. Egger rank correlation and funnel plot were used to determine publication bias.Results 27 studies were finally included with a total of 8 127 patients. The pooled prevalence of frailty in older patients with diabetes was 30%[95%CI（0.24~0.37）],and it was 44%[95%CI（0.38~0.51）] for pre-frailty. Subgroup analysis showed that the prevalence of frailty in patients with diabetes in female was higher than that in male;the prevalence of frailty in patients with diabetes in hospital was higher than that in community;the prevalence of frailty in patients with diabetes using multidimensional frailty measures to evaluate frailty was higher than that using physical frailty measures;the prevalence of frailty in patients with diabetes in North America was higher than that in Asia and Europe.Conclusion There is a higher prevalence of frailty/pre-frailty in older patients with diabetes. In the future,nursing staff should not only pay attention to the early screening of the frailty of this population,but also strengthen the identification of the pre-frailty,and develop reasonable interventions to improve the prognosis and quality of life of the elderly diabetic patients.

Objective We conducted a scoping review to systematically review the literature reporting discharge planning,and identify the quality evaluation indicators and its collection time,along with related tools. Then the differences between the quality evaluation indicators for discharge planning at home and abroad were explored. Methods Focusing on the quality evaluation indicators for discharge planning,we systematically searched the relevant databases,guidelines and government websites. The information,including research topic,research type,the first author/institution,year of publication,country,evaluation indicator,participants,collection time and method,evaluation tool,were also extracted and summarized. Results The quality evaluation indicators for discharge planning were divided into 3 dimensions,namely patient-related indicators,medical institution-related indicators,and caregiver-related indicators. A total of 167 papers were included and 26 indicators were extracted. There were 12 patient-related indicators,and the top 5 were readmission rate,patient satisfaction,quality of life,self-care ability and mortality. There were 9 medical institution-related indicators,and the top 3 were length of stay in hospital,frequency of outpatient/emergency visits,and medical expenditure. There were 5 caregiver-related indicators,the most common of which is caregiver satisfaction. The readmission rate,quality of life,self-care ability,frequency of outpatient/emergency visits,and activities of daily living had statistically significant differences among the top 10 evaluation indicators for discharge planning at home and abroad. Conclusion The medical institutions should not only monitor patient outcome indicators,but also audit related indicators of medical institutions and caregivers. The researchers should also unify core evaluation indicators and corresponding measurement tools,select sensitivity indicators,develop indicators that can be extracted by using Electronic Information System in the future.

Objective To investigate the effects of nasogastric tube（NGT） indwelling on postoperative pulmonary complications（PPCs） and prognosis in patients with cardiovascular surgery,in order to reduce PPCs and improve the patients’ prognoses. Methods Retrospective data of patients undergoing cardiovascular surgery in a tertiary hospital in Wuhan from July 2018 to November 2019 was conducted. The baseline data of patients in 2 groups were matched using a propensity score analysis. Results 316 patients were successfully matched,with 158 patients in the nasogastric tube indwelling group and 158 patients in the non-indwelling group. Compared with the patients in the NGT group without indwelling,the incidence of pulmonary infection,atelectasis,pneumothorax and respiratory failure was higher in the NGT group;the length of stay in the hospital and the length of stay in ICU were longer;the outcome was poor,with statistically significant differences（P<0.05）. Conclusion NGT indwelling is associated with the occurrence of pulmonary complications in patients with cardiovascular surgery,and it might prolong the length of stay and affect patient’s outcome.

Objective To select,evaluate and summarize the best available evidence for key tasks of discharge planning in all hospitalized patients,so as to provide references for clinical practice of discharge planning.Methods We searched National Institute for Health and Clinical Excellence,New Zealand Guidelines Group,Scottish Intercollegegiate Guidelines Network,National Guideline Clearinghouse,Guidelines International Network,Joanna Briggs Institute,Registered Nurses’ Association of Ontario,Centers for Medicare Medicaid Services,Health Service Executive,medlive,UpToDate,Cochrane library,CINAHL,Pubmed,CNKI,Wanfang Database,CBM,CQVIP,to collect literature of discharge planning,including standards,guidelines,expert consensuses,government documents,best/recommended practices,summary of evidence,systematic evaluation,systematic reviews. 3 researchers independently evaluated quality of literature and extracted the evidence that met the quality standards.Results 19 articles were enrolled,including 3 standards,5 guidelines,3 expert consensuses,1 expert opinion,2 government documents,1 recommended practice toolkit,1 evidence summary,1 clinical decision,and 2 systematic reviews. Totally 33 pieces of evidence were selected from admission to discharge based on 5 periods of the timeline,including in 24 hours after admission,during hospitalization,in 24 hours before discharge,on discharge day and after discharge.Conclusion This study summarized the best evidence for key tasks of discharge planning for inpatients,and hospitals can develop personalized discharge plans for various diseases to promote safe and effective discharge of patients.

Objective To develop the Head Nurse’s Transformational Leadership Self-rating Scale and verify its reliability and validity. Methods The scale was initially developed through literature review,semi-structure interviews and Delphi consultation. A total of 210 head nurses from a tertiary hospital in Wuhan were selected to conduct a pilot test. Item analysis and exploratory factor analysis were used to screen items. A total of 922 nurses from 18 tertiary hospitals in Hubei Province were recruited to conduct the formal test. The reliability analysis and confirmatory factor analysis were conducted using SPSS and AMOS software. Results The Head Nurse’s Transformational Leadership Self-rating Scale contained 4 dimensions and 25 items. The 4 demensions explained 61.092% of the total variance. The Cronbach’s α coefficient of the scale was 0.940,and the split-half reliability coefficient was 0.895. The one-dimension/multi-factor model’s CMIN/DF was 23.251,GFI was 0.919,AGFI was 0.902,CFI was 0.910,TLI was 0.900,and RMSEA was 0.049. Conclusion The Head Nurse’s Transformational Leadership Self-rating Scale can be used to evaluate the head nurse’s transformational leadership in Chinese context with good reliability and validity.

Objective To integrate the relevant research,guidelines and government documents on the practice tools of discharge planning in inpatients by taking scoping reviews. Methods Focusing on the practical tools of discharge planning,we systematically searched the relevant databases,guidelines and government websites,extracted the information including author,year,country,name,applicable object,content introduction,using time and the purpose of the tools. Results Along the time line from admission to discharge of a patient,the discharge planning practice tools were divided into 5 categories：admission - evaluation,hospitalization - implementation,24 hours before discharge - verification,on discharge - referral,and after discharge - follow-up,with a total of 29 tools to promote the smooth implementation of the discharge plan. Conclusion Health care personnel should formulate and develop suitable practice tools of discharge planning based on national conditions and medical environment,so as to effectively promote the implementation of discharge plans with standardized tools,optimize the outcomes of patients,and promote the continuity of medical care services for patients.

Objective To construct an information management system for protective restraint,for guiding clinical nurses to make scientific decisions and use constrained appliances reasonably.Methods Through literature review,expert consultation,group discussion and other methods,main contents of the management system were established. By collaborating with the computer center,a standardized system for assessment,reporting,monitoring for inpatients was built,and put into clinical application after trial operation and clinical debugging.Results The concordance rates for using protective constraint before and after the implementation of information system were 78.102% and 97.321%,respectively,and the rates of protective constraint were 0.906% and 0.799%,respectively,the differences were statistically significant(P<0.05). After the implementation of information system,the accuracy rate of assessment,the execution rate of standardized measures,the rate of dynamic observation,and the rate of shift turnover were getting improved,and the differences were statistically significant(P<0.05).Conclusion The information management system for protective constraint can replace experience management to help nurses scientifically,objectively evaluate and decide on the constraints and timing,regulate body constraint process,and guide nurses to timely report,dynamically monitor and accurately feedback.

Objective To explore effects of application of the rectal cancer surgery decision aid in patients with rectal cancer.Methods A total of 63 patients hospitalized for rectal cancer surgery from June to December,2016, were recruited as the control group,and 63 patients admitted from January to June, 2017, were enrolled as the intervention group. The intervention group received the content of the rectal cancer surgery decision aid apart from routine nursing,while the control group only received routine nursing.Results The correct response rate of rectal cancer surgery decision knowledge in the intervention group was higher than that in the control group（P<0.05）. The level of decision conflict in the intervention group was lower than that in the control group（P<0.05）. More than 92% of the patients in the intervention group believed the decision aid could improve their decision preparation.Conclusion The rectal cancer surgery decision aid can effectively improve the surgical knowledge of rectal cancer patients,reduce their decision conflict,and improve their decision preparation.