Objective To develop an evidence-based practice program for ICU eye care and evaluate its application effect using Stetler model of research utilization. Methods The systematic search was carried out in domestic and foreign guidelines，systematic reviews，evidence summaries，expert consensuses on eye care for ICU patients. The quality of the included literature was evaluated and the evidence was summarized. The evidence based on expert advice，clinical context and stakeholder opinions was screened. According to Stetler model of research utilization，the evidence translation/application was formulated from 3 aspects，including method，level and type of evidence application，and the evidence translation was implemented using a stepwise trial design. Five ICUs in a tertiary hospital in Zhejiang Province were selected，and the order of enrollment of each ICU was determined by computer-generated random numbers from April to september，2022. In the first month，all ICUs were in pre-evidence-based practice period，and in the second month，an ICU was trained and entered the evidence-based practice period. Until the 6th month，all ICUs entered the evidence-based practice period. Then the rate of ocular symptoms and implementation rate of eye care measures were compared before and after EBP. Results A total of 1 540 patients were included. With regard to the implementation rate of eye care measures，the rate of lubricant use and suspected ocular infection management in patients at high risk for ocular complications in evidence-based practice period was significantly higher compared with pre-evidence-based practice period（P<0.001），and no statistically significant difference was found in the rate of eyelid closure. The incidence of conjunctival exposure，subconjunctival hemorrhage，conjunctival congestion，and ocular discharge in non-neurology critical care patients decreased compared with pre-evidence-based practice period（P<0.05），and the incidence of conjunctival edema and conjunctival congestion in NICU patients decreased compared with pre-evidence-based practice period as the intervention continued（P<0.001）. Conclusion Evidence-based practice in eye care for ICU patients using Stetler model of research utilization can standardize the practice of eye care for ICU patients and improve the quality of care.

Objective To investigate the current social network status of pregnant women with gestational diabetes mellitus（GDM） and analyze the influencing factors to provide a reference for improving the health status of pregnant women with GDM. Methods The convenience sampling method was used. 315 pregnant women with GDM from 4 tertiary hospitals in Qingdao City were selected as study respondents from June to October 2022. The General Condition Questionnaire，Name Generator Questionnaire，and Self-Management Ability Questionnaire for Patients with Gestational Diabetes Mellitus were used to conduct the survey. Univariate analysis and multiple linear regression were used to analyze the influencing factors of the social network of GDM pregnant women. Results 306 valid questionnaires were collected. The size of the structural network of the social network of pregnant women with GDM was（8.24±1.81） persons，and the size of the functional network was（11.90±2.39） persons. The results of multiple linear regression analysis showed that in the structural network of the pregnant women with GDM，the score of self-management level，age，economic activity，and education level were the influencing factors（P<0.05）. In the functional network，the place of residence，age，and public welfare activities were the influencing factors（P<0.05）. Conclusion The overall social network level of pregnant women with GDM is intermediate. Nursing clinical work should focus on the blood glucose management of young pregnant women who have low education，live in rural areas，have insufficient self-management levels，and have low participation in social activities，and at the same time，help this kind of pregnant women to improve the ability of acquiring and utilizing the social network and social support.

Objective To retrieve，extract，evaluate，and integrate the relevant evidence of postoperative pulmonary rehabilitation management in patients with lung cancer complicated with chronic obstructive pulmonary disease，so as to provide an evidence-based basis for improving the quality of postoperative pulmonary rehabilitation. Methods Relevant literature on postoperative pulmonary rehabilitation of lung cancer complicated with chronic obstructive pulmonary disease were searched by computer from clinical decisions，guideline websites，professional association websites，and comprehensive databases. The types of the literature included clinical decisions，guidelines，expert consensuses，evidence summaries，systematic reviews，meta-analyses，and randomized controlled trials. The retrieval time limit was from the establishment of the database to September 2023. Results A total of 19 articles were included，including 4 clinical decisions，3 guidelines，6 expert consensuses，1 evidence summary，3 systematic reviews，and 2 randomized controlled trials. Through reading，extraction and classification，23 pieces of best evidence were finally formed，including multidisciplinary cooperation，evaluation，pulmonary rehabilitation strategies and health education. Conclusion This study summarizes the best evidence for postoperative lung rehabilitation management in patients with lung cancer and chronic obstructive pulmonary disease. Clinical medical staff can implement practical evidence for postoperative lung rehabilitation based on actual situations，and promote the transformation of evidence-based knowledge into practice.

Objective To explore latent class of psychological distress among the elderly with multiple chronic conditions in the community and to analyze differences in demographic and alexithymia characteristics across class. Methods A total of 685 urban and rural elderly with chronic disease co-morbidities in 6 prefecture-level cities in Jiangsu Province were selected for the study using the General Information Questionnaire，the Depression Anxiety and Stress Scales-21，and the Toronto Alexithymia scale from November 2022 to March 2023 using a convenience sampling method. Results A total of 662 older adults with multiple chronic conditions were finally investigated with a total psychological distress score 30.00（16.00，52.00）. Psychological distress manifested itself in 4 different potential categories named “stress-depressive”（19.9%），“low distress”（26.0%），“stress-anxiety”（23.4%），and “overall high distress”（30.7%）. The comparison of the different psychological distress categories with respect to age group，marital status，residential status，financial stress of illness，acute events within 1 year，and self-perceived health status showed statistically significant differences（P<0.05）. The comparison of alexithymia scores for the 4 potential categories showed statistically significant differences（F=136.544，P<0.001）. Conclusion Psychological distress in older adults with multiple chronic diseases has distinct categorical features，and alexithymia varies across different categories of psychological distress. Healthcare professionals can adopt targeted interventions according to different categories of chronic disease co-morbidities in order to reduce their psychological distress，and at the same time they should focus on older adults with the alexithymia of “stress-depressive” and “overall high distress”.

Objective To systematically review the incidence of peripherally inserted central catheter（PICC）-related thrombosis in Chinese adult cancer patients. Methods PubMed,Embase,the Cochrane Library,Web of Science,CBM,CNKI,WanFang Data and VIP databases were electronically searched to collect studies on the incidence of PICC-related thrombosis in Chinese adult cancer patients from inception to May,2021. 2 reviewers independently screened the literature,extracted the data and assessed the risk of bias of included studies,and then the meta-analysis was performed by Stata 14.0 software. Results A total of 23 pieces of the literature involving 15 066 cancer patients were included. Meta-analysis results showed that the total incidence of PICC-related thrombosis in Chinese adult cancer patients was 8.82%[95%CI（5.93%~12.18%）]. Subgroup analysis showed that the incidence of PICC-related thrombosis was higher in the publication year from 2019 to 2021. The incidence was also higher in patients with age≥ 60 years old,BMI>25,cephalic vein puncture,traditional puncture method,the number of punctures more than 1,catheter size of 5 Fr,lung cancer,cancer stage of Ⅲ~Ⅳ,diabetes mellitus,history of PICC catheterization,history of venous thrombosis,fibrinogen content≥4 g/L before catheterization and D-dimer level≥0.5 mg/L before catheterization. Conclusions The incidence of PICC-related thrombosis in Chinese adult cancer patients is high,so health workers should pay more attention to early screening and prevention of high-risk patients.

Objective To explore the mediating effect of self-esteem on the relationship between stigma and psychological distress in young and middle-aged maintenance hemodialysis patients，and the moderating effect of family cohesion. Methods The Stigma Scale，Self-esteem Scale，Family Cohesion Scale and Psychological Pain Thermometer were used to investigate 382 young and middle-aged maintenance hemodialysis patients from 4 hospitals in Fuzhou and Putian by convenience sampling from June to December，2021. The correlation analysis was carried out by SPSS 26.0 software. Model 4 in PROCESS macro program was used to analyze the mediating effect and Model 58 was used to analyze the moderating effect. Results The detection rate of psychological distress was 59.7% in young and middle-aged maintenance hemodialysis patients. There were significant correlations among stigma，self-esteem，family cohesion and psychological distress（P<0.001）. Self-esteem partially mediated the relationship between stigma and psychological distress（β=-0.22，t=-3.85，P<0.001），and family cohesion moderated the mediating effect（β=0.19，t=5.08，P<0.001）. High family cohesion weakened the effect of stigma on self-esteem，and vice versa. Conclusion Stigma is not only a direct positive predictor of psychological distress，but also has an indirect effect on psychological distress through self-esteem，and family cohesion moderates this process. Narrative family therapy can be used to reduce stigma，improve family cohesion，protect patients’ self-esteem and alleviate the psychological pain of young and middle-aged maintenance hemodialysis patients.

Objective To evaluate the effect of upper limb rehabilitation exercises on maintenance hemodialysis patients. Methods A total of 77 patients who received maintenance hemodialysis treatment in the blood purification center from October to December 2021 were selected and divided into a control group（n=39） and an experimental group（n=38） according to random number table. The experimental group received the upper limb rehabilitation training on the basis of routine nursing care，and the control group only received routine nursing care. The hand grip strength，range of shoulder motion，arteriovenous fistula blood flow，and cephalic vein diameter on the non arteriovenous fistula side were compared between the 2 groups before and 3 months after the intervention. Results Before the intervention，there was no significant difference between the 2 groups in hand grip strength，range of shoulder motion，blood flow of arteriovenous fistula and the diameter of cephalic vein on the non arteriovenous fistula side（P>0.05）. After the intervention，the grip strength on the side of arteriovenous fistula（t=-2.350，P=0.022），grip strength on the side of non arteriovenous fistula（t=-3.693，P<0.001），abduction of shoulder joint on the side of arteriovenous fistula（t=-2.468，P=0.016），external rotation（t=-5.167，P<0.001），internal rotation（t=-2.059，P=0.043），blood flow of arteriovenous fistula（t=-2.020，P=0.047） and diameter of cephalic vein on the side of non arteriovenous fistula（t=-5.229，P<0.001） in the experimental group increased，compared with those in the control group，and the difference was statistically significant. Conclusion Rehabilitation exercises for upper limbs can help to improve the upper limb function and maintain arteriovenous fistula in maintenance hemodialysis patients.

Objective The research aims to develop and apply clinical nursing skills training software to explore new methodology in clinical nursing practice. Methods Based on the gamified learning theory,combined with integrations of knowledge concerning clinical nursing skills,a mobile teaching software compatible with a variety of operating system was developed. The software was divided into 2 ports,consisting of 6 modules,covering 13 clinical nursing skills operations. All undergraduate students majoring in nursing,who took internships in 2 hospital districts labeled as A and B of an affiliated hospital of university in Qingdao from May to July in 2020,were selected as research subjects by cluster sampling,with 276 students in district A as the experimental group and 293 students in district B as the control group. The experimental group was trained by the game software for clinical nursing skills training on the basis of traditional teaching approaches,while the control group was only implemented with traditional teaching means. The performance evaluations of clinical skills between the 2 groups were compared separately before-post and after two-month internships. Degrees of satisfaction of teachers and students in the experimental group was investigated after using the software for 2 months. Results The average evaluation scores of 13 clinical skill operations in the experimental group were significantly higher than those in the control group after two-month internships（P<0.001）,and the mean scores of 13 clinical skills operations in the experimental group were also considerably higher than those before-post（P<0.001）. Student satisfaction with the whole software ran at 94.81% and teacher satisfaction achieved 91.33%. Conclusion The application of the software could effectively enhance training outcomes of clinical skills for students and profoundly enrich the methodology of teaching clinical nursing skills. The software was rated highly by students and teachers from all and each dimensions.

Objective To evaluate the value of oscillatory positive expiratory pressure device（OPEPD）combined with incentive spirometer（IS）and active cycle of breathing techniques（ACBT） in pulmonary rehabilitation for patients with lung cancer after surgery. Methods 87 patients with lung cancer undergoing single-hole thoracoscopic radical resection of lung cancer from January 2018 to August 2019 in a Level A tertiary hospital were randomly divided into an intervention group and a control group. 43 patients in the control group received ACBT training, while 44 patients in the intervention group received OPEPD combined with IS approach for lung rehabilitation. Both groups were trained for 5 days, and the incidences of complications, 6-minute walk distance（6MWD）, vital capacity（VC）, Borg dyspnea scores, quality of life（QLQ-LC29） for lung cancer patients, weakness（Frail）scale and satisfaction of rehabilitation nursing were compared between 2 groups. Results There was no significant difference between 2 groups in age, gender, acute physiology and chronic health evaluation（APACHE Ⅱ）, lung cancer stage and baseline of complications（P>0.05）;6MWD and VC in the intervention group were higher than those in the control group（P<0.05）;the complication of respiratory insufficiency, Borg dyspnea scores, QLQ-LC29 and Frail scale in the intervention group were lower than those in the control group（P<0.05）;the satisfaction degree of rehabilitation were higher than that in the control group（P=0.034）. Conclusion OPEPD combined with IS cannot only reduce weakness and complications, but also improve lung capacity, tolerance for exercises, and nursing satisfaction for patients with lung cancer after surgery.

Objective Using bioelectrical impedance method to evaluate the volume of hemodialysis patients and provide a new method for evaluating volume.Methods From December 2016 to October 2017,108 maintenance hemodialysis patients from three tertiary hospitals in Jiangsu Province were selected. Patients were randomly divided into the experimental group and the control group. The volume of patients in the control group was evaluated by clinical assessment method,and the experimental group was evaluated by bioelectrical impedance assessment. Before and half a year after follow-up,blood pressure,rate of reaching the standard of family blood pressure,rate of volume control,and left ventricular mass index(LVMI) were compared between two groups.Results Diastolic blood pressure, compliance rate of volume control and left ventricular mass index before dialysis showed no significant difference between the two groups(P>0.05).Three months and 6 months after intervention,the systolic blood pressure before dialysis and rate of reaching the standard of family blood pressure in the experimental group were significantly higher than those in the control group(P<0.05).Conclusion Bioelectrical impedance assisted assessment can improve systolic blood pressure and rate of reaching the standard of family blood pressure.