Objective To explore the barriers and facilitators factors of adherence to complete decongestive therapy（CDT） in patients with breast cancer related lymphedema（BCRL）. Methods Based on the Health Action Process Approach theory，from September 2021 to February 2022，12 patients with BCRL undergoing CDT were purposely selected for semi-structured in-depth interviews. Data were collected and analyzed using the Colaizzi seven-step analysis method. Results The extracted barriers of CDT included insufficient risk perception，negative outcome expectation，low self-efficacy，lack of behavioral intention，lack of action and coping plan. The facilitators included perceived benefits of treatment，perceived harm of edema，enhanced self-efficacy，motivation of treatment，and construction of a new normal life. Conclusion The adherence of CDT in patients with BCRL is affected by a series of barriers and facilitators. In the future，targeted intervention strategies can be formulated based on the theory of health action process approach to improve the treatment adherence.

Objective To systematically evaluate the qualitative studies on the care experience of caregivers for primary malignant bone tumors patients，in order to provide references for the construction of bone tumor support care system. Methods The Cochrane Library，PubMed，Embase，CNKI，Wanfang Database，VIP database，and China Biomedical Literature Database were searched by computer to collect qualitative studies on the care experience of caregivers of malignant bone tumors patients from the establishment of the databases to November 2022. The quality of the literature was evaluated using the Joanna Briggs Institute（JBI） Quality Evaluation Criteria for Quality Research in Evidence-Based Health Care Centers（2016），and the results were integrated by a pooled integration approach. Results A total of 12 studies were included；48 themes were extracted and summarized into 9 categories，which were combined into 3 integrated results. Integration result 1 is obvious physical and mental disturbance. Integration result 2 is multiple role maladaptation. Integration result 3 is positive growth after adjustment. Conclusion Caregivers of patients with malignant bone tumors have serious physical and mental burden and are eager for multiple support. It is suggested that medical staff pay attention to the multi-dimensional needs of patients，formulate personalized support strategies，help caregivers adapt and transform their roles，and promote the post-traumatic growth of caregivers.

Objective To explore the effect of preventive swallowing interventions in patients with partial laryngectomy. Methods Using convenience sampling method，75 patients who underwent partial laryngectomy for the first time in a tertiary hospital in Changchun from August 2020 to February 2022 were selected. They were divided into an experimental group（n=38） and a control group （n=37） according to the order of admission time. The control group was given routine care and basic swallowing training. The experimental group was given a combined intervention of Chin tuck against resistance and respiratory-swallowing coordination model on the basis of the control group，combined with in-hospital and out-of-hospital family rehabilitation for 1 month of preventive swallowing exercise. The differences in swallowing safety，swallowing-oral feeding function and quality of life between the 2 groups were compared at a day before enrollment，14 days after operation and 1 month after operation. Results The time，grouping and interaction effect of swallowing safety，swallowing-oral feeding and quality of life in the 2 groups were statistically significant（P<0.05）. The indexes of the experimental group were better than those in the control group at 14 days and 1 month after partial laryngectomy（P<0.05）. Conclusion The combined intervention model of preventive Chin tuck against resistance and respiratory-swallowing coordination exercise can enhance swallowing safety，swallowing function，restore functional oral feeding，facilitate quality of life，and promote early rehabilitation in patients with partial laryngectomy.

Objective To explore the status and development trend of kinesiophobia after percutaneous coronary intervention（PCI） in patients with acute myocardial infarction（AMI）,and to provide evidence for the best intervention time point of kinesiophobia. Methods From November 2020 to June 2021,a total of 105 patients with AMI after PCI admitted to the Department of Cardiology of tertiary A general hospitals in Hangzhou were selected by convenience sampling method. The general data questionnaire,tampa scale of kinesiophobia-heart and cardiac anxiety questionnaire were used to investigate and observe the degree of kinetophobia and psychogenic anxiety at 3 time points（within 1 week of hospitalization,2 weeks after discharge and 3 months after discharge）. Results The kinesiophobia scores of AMI patients at 3 time points after PCI were（40.82±5.40）,（41.90±4.60）,（37.40±3.35）,which were higher than the norm（32.20±7.40）. The results of repeated measure ANOVA showed that different time,different age groups and cardiac anxiety significantly affected the score of kinesiophobia（P=0.022,P=0.048,P<0.001）. After the control for covariates,different time had a significant interaction with age（P=0.013）,T1 and T2 time had significant interaction with cardiac anxiety（P=0.001,P<0.001）. Conclusion Due to the interaction of time, age and cardiac anxiety, the level of kinetophobia in AMI patients was higher after PCI and within 3 months after discharge. At T2 time point, the score of kinesiophobia and cardiac anxiety in the young and middle-age groups was significantly higher than those in the elderly group. The trajectory of kinesiophobia showed a slight increase in acute convalescence period,and a natural trend of gradual decrease in middle and post convalescence period. The kineophobia kinesiophobia of AMI patients after PCI lasts for a long time with a wide impact,so it is necessary to timely carry out interventions.

Objective To improve the subcutaneous tunnel needle and the method of establishing subcutaneous tunnel for PICC,and to explore its application effect. Methods The improved subcutaneous tunnel needle consists of 3 parts,including needle handle,solid needle core and needle head. The needle head has an arc chamfering structure,which can realize the stable connection between the catheter and the needle head. Patrticipants from a tertiary hospital in Guangdong Province were selected by convenience sampling. 97 tumor patients from November 2019 to January 2021 were allocated into an experimental group,while 115 tumor patients from August 2018 to October 2019 were in the control group. The experimental group received the improved subcutaneous tunnel needle via a 30°~45° degree with venipuncture for PICC catheterization under B-ultrasound,while the control group was treated with Seldinger technique for PICC catheterization under B-ultrasound. The amount of bleeding and the highest pain score,the incidence of bleeding and exudation at the puncture point 24 hours after the operation,the incidence of catheter prolapse within a month after the operation,the incidence of allergic dermatitis,the incidence of mechanical phlebitis,and the comfort of the patients’ arms at a month after the operation were compared between the 2 groups. Results The amount of bleeding and the highest pain score in the experimental group were higher than those in the control group,and the difference was statistically significant（P<0.001）. The incidence of bleeding and exudation at the puncture point 24 hours after the operation,the incidence of catheter prolapse within a month after operation and the incidence of allergic dermatitis in the experimental group were lower than those in the control group（P<0.05）,but the incidence of mechanical phlebitis within a month after operation in the 2 groups was not statistically significant（P=0.484）;a month after operation,the arm comfort of the experimental group was higher than that of the control group,and the difference was statistically significant（P<0.001）. Conclusion The improved subcutaneous tunnel needle and subcutaneous tunnel establishment method can reduce the incidence of blood and fluid leakage,catheter prolapse and allergic dermatitis at the puncture point,and improve the postoperative arm comfort of patients,but they could not increase the incidence of mechanical phlebitis.

This article is to summarize the postoperative nursing experience of a patient with tracheal rupture caused by automobile accident,who underwent tracheal rupture repair and was assisted by ECMO （extracorporeal membrane oxygenation）. Nursing points include as the following. The first is to strengthen airway management and prevent anastomosis from accidentally rupturing again. Secondly,to monitor oxygenation index to ensure the normal operation of ventilator and ECMO. The third one is to prevent and control infection to avoid difficult healing of cracks. Fourthly,systemic anticoagulation is monitored dynamically in order to reduce bleeding. Finally,analgesic sedative drugs are properly used,so as to reduce the occurrence of complications. Doctors successfully completed the tracheal rupture repair with the assistance of ECMO. After careful treatment and nursing care,the patient was disengaged from medical machines 5 days later,and was transferred to cardiothoracic surgery department 28 days later for further treatment. He recovered and was discharged from the hospital 53 days later.

Objective To investigate the impact of a multi-component exercise program based on Wechat applet on improving exercise adherence and the frailty state. Methods 95 pre-frailty of the elderly in a community in Beijing were randomly divided into 2 groups. On the basis of explanation and demonstration，the Wechat applet group used the multi-component exercise course of Wechat applet. The health education group used the way of explanation and demonstration to carry out multi-component exercise health education. The exercise adherence，frailty state and physical function were compared between the 2 groups. All subjects received 3-month intervention. Results 89 participants completed the study. The implementation of the multi-component exercise programs，the improvement of frailty and the improvement of walking speed in the Wechat applet group were better than those in the health education group（P<0.05），but there was no significant difference on grip strength，SPPB and TUGT between 2 groups（P>0.05）. Conclusion The multi-component exercise intervention based on Wechat applet is helpful to enhance the exercise adherence and improve frailty state of the elderly.

Objective The quality evaluation and content analysis of the existing guidelines concerning management of patient-controlled analgesia（PCA） in adult patients with postoperative acute pain were conducted to provide recommendations for its management. Methods Evidence-based guidelines involving recommendations of PCA management with postoperative pain were searched in guidelines networks,websites of pain management and anaesthesiology,and databases from inception to April 2021. AGREE Ⅱ was used to appraise the quality of guidelines;the recommendations related to PCA management of postoperative pain were synthesized. Results A total of 783 pieces of the literature were initially detected,and finally 9 evidence-based guidelines were included,among which 3 were rated as A and 6 were rated as B,with the relatively high quality. 23 recommendations were extracted and summarized from 9 guidelines,involving 6 domains,namely organization management,education and training,analgesia mode selection,patient education,preoperative assessment,and postoperative monitoring and assessment. Conclusion The guidelines are of high quality in total,providing recommendations on PCA management of postoperative pain;however,the independence and applicability of the guidelines need to be improved. The recommendations of PCA management are scattered in different guidelines and lack targeted specific PCA management strategies.

Objective To establish the pre-discharge ward for premature infants based on family integrated care（FIC） model and evaluate its effects of application.Methods Families with premature infants admitted to a PICU in a tertiary hospital from January,2016 to January,2018 were recruited. Based on FIC model,48 families were transferred to pre-discharge ward and provided with comprehensive interventions （establishing multi-disciplinary team,providing supports of equipment and environment,professional training of caregivers,and providing discharge plan and support）. As the control group,48 families with premature infants matched with the experimental group were enrolled and provided with routine care. Care ability,anxiety,and infection rate were compared between two groups.Results Care ability of caregivers in pre-discharge ward was better than that in the control group,and anxiety was lower as well with significant differences（P<0.05）. No infant developed infection during hospitalization in the experimental group.Conclusion Pre-discharge ward based on FIC model can improve care ability and decrease anxiety of the caregivers,which can be promoted considering the present situation in China and health care system.

Objective To construct nursing-sensitive indicators system of enteral nutrition for hospitalized adult patients,so as to provide scientific,objective and quantitative monitoring standards for nursing quality of enteral nutrition.Methods Evidence synthesis was conducted based on Johns Hopkins evidence-based nursing method for laying the foundation for nursing-sensitive quality indicators system of enteral nutrition. Through group discussion,appropriate indicators feasible to application were determined,and nursing-sensitive quality indicators,calculation formulas and data collection methods were preliminarily decided. Through two rounds of expert consultation,the nursing-sensitive quality indicators system of enteral nutrition was improved and established.Results The constructed nursing-sensitive quality indicators system of enteral nutrition included 3 first-class indicators,6 second-class indicators,and 17 third-class indicators. Positive coefficients of two rounds of expert consultation were 92% and 100%,authority coefficients were 0.915 and 0.925,respectively,and the coordination coefficients were 0.124~0.242.Conclusion The nursing-sensitive quality indicators system was scientific and practical and it was beneficial to improve the nursing quality of enteral nutrition.