Objective To develop an evidence-based practice program for the prevention and management of postoperative gastrointestinal dysfunction in patients with hepatocellular carcinoma，based on the best available evidence，and to evaluate the effectiveness of its application. Methods An evidence-based nursing approach was conducted for systematical search，appraisal and summary of the best evidence for the prevention and management of postoperative gastrointestinal dysfunction in postoperative hepatectomy patients. From September 2022 to October 2022，under the guidance of Knowledge to Action Framework，and in combination with clinical scenarios，the best evidence was screened and adjusted，and an evidence-based practice plan was formulated. From November 2022 to March 2023，the plan was implemented in the Department of Hepatobiliary and Pancreatic Surgery of a tertiary A hospital in Hangzhou City，Zhejiang Province，China. We compared the rate of implementation of the measures by healthcare personnel before and after the application of the evidence，the qualified rate of knowledge of perioperative management of gastrointestinal dysfunction，and the incidence of postoperative gastrointestinal dysfunction in postoperative hepatectomy patients，the first time to flatus and bowel，the length of hospital postoperative stays，the BMI and serum albumin level on discharge. Results After evidence-based practice，the implementation of 11 review indicators and knowledge pass rate increased，and the difference was statistically significant（P<0.05）.The incidence of postoperative gastrointestinal dysfunction in patients decreased from 11.9% to 4.0%（P=0.037）. First time to gas and bowel，and the length of hospital postoperative stays were shortened，and the differences were statistically significant（P<0.05）. Conclusion The implementation of clinical evidence-based practice for the prevention and management of postoperative gastrointestinal dysfunction in postoperative hepatectomy patients provided support for clinical decision-making，improved healthcare professional awareness and implementation of review entries. It effectively reduced the incidence of gastrointestinal dysfunction in postoperative hepatectomy patients and accelerated the recovery process.
To summarize the nursing points of enterostomy among 6 children with small intestinal transplantation，which could provide references for clinical nursing. Key points：to set up a multidisciplinary team and develop an observation plan about enterostomy；to monitor the blood circulation of enterostomy closely，so as to identify the vascular complications as soon as possible；to closely observe the excrement of enterostomy and being vigilant for rejection reaction；to select reasonable nursing supplies based on the situation of enterostomy；to treat the abdominal incision fluid leakage timely，and pay attention to protect the skin around the enterostomy and take measures to control infection；furthermore，to attach great importance to continuous nursing care and improve the quality of home care. After above careful treatment，all the 6 children survived；they were discharged from hospital 3~4 months later after the operation of enterostomy restoration. Followed up 2~4 months，6 children recovered well.
The transition for liver transplant recipients from adolescents to adults is a high-risk period for adverse health outcomes. Lack of transition readiness will reduce treatment compliance，lead to high risk of graft function loss and mortality. However，the current transition readiness of adolescent liver transplant recipients is generally low，which seriously affects their long-term prognosis. This paper reviews the current situation，influencing factors and intervention strategies of liver transplant recipients in the transition period from adolescents to adults，so as to provide a reference for future research to ensure the safe transition of liver transplant recipients from adolescents to adults.
To summarize the nursing care of a child with vascular anastomotic thrombosis after living small bowel transplantation. Essentials for nursing care：early identification of vascular anastomotic thrombosis and emergency care；negative pressure occlusion drainage therapy to timely treatment of incision infection；implementing individualized nutrition support programmes to improve nutritional status；dynamic monitoring of immunosuppressant plasma concentration，and being vigilant for rejection reaction；paying attention to the mental health of children and providing psychological support；developing a follow-up plan for continuity of care. After 29 days of careful treatment and nursing care，the child’s condition improved and was successfully transferred to the general ward，and discharged 67 days after surgery. At 2 months of follow-up after discharge，the intestinal function of the child recovered well，and the child can eat by himself presently.
To summarize the perioperative nursing experience of a child with erythropoietic protoporphyria who underwent liver transplantation and splenectomy. The key points of preoperative care include implementing diversified interventions to reduce the accumulation of porphyrin in the body； actively controlling pain and improving the comfort of children； early debridement and treatment，and good care of solar allergic dermatitis. The key points of postoperative care include protecting the transplanted liver and preventing the deposition of protoporphyrin； strengthening respiratory management to control lung infection； psychological counseling throughout the process to reduce negative emotions； individualized follow-up management to prepare for bone marrow transplantation. After careful treatment and nursing，the child recovered smoothly and was discharged from the hospital. A follow-up visit after 1 month discharge showed a good recovery.
The evaluation of the return-to-work status of organ transplant patients can timely understand the return-to-work ability，psychosocial adjustment ability and readiness level of the patients，help medical staff to formulate and implement a vocational rehabilitation program for the patients，increase the rate of return-to-work，and develop the physique and mentality. This paper reviews the major contents，characteristics，advantages and limitations of the assessment tools for organ transplant patients，and compares the basic conditions and clinical applications of the scales. It aims to provide references for clinical nurses to choose appropriate assessment tools. Meanwhile，it provides some theoretical bases for clinical nurses to create a program of vocational rehabilitation for organ transplant patients.
This article summarizes a series of organization and contingency management strategies of convertible ICU in severe rescue of COVID-19. Based on the 4S management model，focusing on the 4 core issues of space，staff，system，and supplies，the convertible ICU was quickly established through rapid transformation and expansion，overall sharing of equipment，and visual management of material placement. Personnel management includes establishing 3 reservoirs and 4 echelons，carrying out severe illness training，and carrying out classification authorization and combined shift scheduling. At the system level，a multidisciplinary collaboration mechanism was established and the ventilation gateway was moved forward in the prone position to improve the success rate of critical care. At the supply level，the key configuration of the intelligent monitoring system enabled efficient care，and psychological counseling support was provided to maintain employee’s mental health. During the period of the convertible ICU of rapid establishment and operation，through the implementation of these strategies，the timely，orderly，safe and efficient treatment of critically ill patients was ensured. The experience and theoretical basis were provided for the establishment and transformation of convertible ICU for other institutions in emergency situations.
This paper summarizes the nursing experience of a child with lung infection complicated with intracranial hemorrhage after the parental liver transplantation. Nursing points：early identification of changes in the condition and improvement of risk prediction ability;treatment of intracranial hemorrhage and closely observing the occurrence of vascular complications;restarting anticoagulation treatment to prevent secondary bleeding;implementing cluster intervention measures to prevent infection worsening;taking various forms of psychological nursing care for children and their families based on music therapy and narrative nursing;developing an individualized discharge follow-up plan to establish a long-term follow-up program. After active treatment and care,the patient was in stable condition and safely discharged. Followed up for 6 months,the child was in fair condition.
Objective To develop a quality evaluation indicator system for perioperative nursing in pediatric liver transplantation,and to provide standard and professional quantitative bases for monitoring and management of perioperative nursing quality.Methods This study was conducted from January to June 2021 based on the frame work of the three-dimensional“structure-process-outcome” quality model,using literature review,Delphi method and analytic hierarchy process（AHP） to determine the content of the system,and the weight of each index.Results The effective recovery of 2 rounds of expert consultations were 95.2% and 100%. The authority coefficients were 0.88 and 0.89. The variation coefficients of each item ranged from 0.05 to 0.19 and from 0.06 to 0.23. The Kendall harmony coefficients were 0.128 and 0.184. The final quality evaluation indicator system for perioperative nursing in pediatric liver transplantation was established,including 3 first-level indicators,14 second-lever indicators and 61 third-level indicators.Conclusion The quality evaluation indicator system for perioperative nursing in pediatric liver transplantation was scientific,reliable,comprehensive and specialized,which can provide references for the evaluation of perioperative nursing quality in pediatric liver transplantation.
The evaluation of the family discharge readiness of hospitalized children can timely understand the care needs of the family,help nursing staff to formulate and implement personalized follow-up plans for the children after discharge,and reduce the rate of readmission and unplanned visit of children. This paper reviews the major contents,characteristics,application and limitations of the discharge readiness assessment tools in family with hospitalized children at home and abroad. It aims to provide references for the localization of the development of discharge readiness assessment tools in family with inpatient children and clinical nurses to select appropriate assessment tools. Meanwhile,it provides some useful information for the improvement of the discharge planning for hospitalized children.
To summarize the nursing experience of a child with hepatolenticular degeneration complicated by renal failure undergoing liver transplantation. The main points of nursing include strict monitoring of kidney function,good anticoagulation management,timely adjustment of treatment plans,personalized rehabilitation and diet guidance,strict implementation of disinfection and isolation measures throughout the process,close monitoring of transplanted liver function,and provision of a hospital-family-social support system. After careful treatment and care,the child was discharged on foot 55 days after the operation. The patient was followed up for 6 months and recovered well.
To summarize the perioperative nursing experience of a child with ornithine transcarbamlase deficiency after liver transplantation. Key points of nursing care：blood purification care were taken in the acute stage of high blood ammonia;predictive care were adopted during the remission period of high blood ammonia;early sequential anticoagulation treatment was carried out and supplemented by bleeding observation and nursing;early progressive rehabilitation training were taken to promote the growth and development of the child;psychological counseling was applied through the whole process to relieve the negative emotions of the child and their parents;personalized discharge guidance and continuous rehabilitation care were provided. After 20 days of treatment and care,the child recovered and was discharged,followed up for 4 months and recovered well up to now.
Objective To understand the caring experience of donors and caregivers of pediatric living related liver transplantation. Methods Using descriptive phenomenological research method,in-depth interviews were conducted with 11 donors and caregivers of pediatric living related liver transplantation from liver transplantation center of a tertiary hospital in Hangzhou from May to August 2021. Colaizzi 7-step analysis method and Nvivo software were used to analyze and extract the topics. Results 4 themes were extracted,including obvious physical and mental distress（significant physical symptoms and heavy psychological burden）,adaptation conflict of multiple roles （adaptation conflict of donor and caregiver role,adaptation conflict of child caregiver and other family member caregiver role,adaptation conflict of family and social role）,contentment and coping positively,gratitude and feedback to the society. Conclusion Donors and caregivers of pediatric living related liver transplantation have both burden and positive feelings throughout the care process. Medical staff should take targeted intervention measures to reduce the burden of feeling,inspire positive experience,guide coping positively,so as to improve the quality of life of donors and caregivers of pediatric living related liver transplantation,and then improve the quality of care.
This article summarized the postoperative nursing experience of 6 children with classic maple syrup urine disease undergoing liver transplantation. Key points of nursing care included：precisely take immunosuppressants to prevent acute rejection;early rehabilitation exercises to promote the development of the nervous system;closely observe changes in the condition and do emergency care for gastrointestinal bleeding;structured skin care to reduce diaper dermatitis;provide multiple forms of support to relieve family pressure;implementation of the "Internet +" follow-up model,continuous family rehabilitation care. After careful treatment and care,the 6 children recovered and were discharged after surgery. They were followed up for 15 days to 4 months and recovered well up to now.
Objective To develop a multidisciplinary nursing program for recipients of living small bowel transplantation and to evaluate its effectiveness. Methods A multidisciplinary team was set up,consulting the guidelines,operation specifications and related literature according to the nursing difficulties. A multidisciplinary nursing program was developed,including nutrition management,infection prevention and control,rejection monitoring,immunosuppression,rehabilitation exercise,psychological interventions and continuous care. 6 adult recipients of living small bowel transplantation admitted to a level A tertiary hospital from August 2019 to March 2020 were selected, to carry out a multidisciplinary nursing program and to evaluate their postoperative rehabilitation. Results Among 6 recipients in this group,1 case was diagnosed enterococcus faecium infection with ascites culture. The infection was controlled after active interventions,and there was no acute rejection case. The 6 recipients were discharged from the hospital after their condition was stable,and the stoma was completed as scheduled within 3 months after the operation. The follow-up compliance after discharge reached 100%;blood drug concentration was well controlled. Conclusion The application of the multidisciplinary nursing program can reduce the incidence of complications,accelerate the process of postoperative rehabilitation,and ensure the safety of recipients during the transition period from hospital to family.
Evaluation of sedation level guides sedation behavior and it is an important basis for formulating sedation management plans for children. This paper mainly reviews the contents,features,advantages and limitations of the assessment tools for pediatric sedation,compares the basic conditions and clinical applications of the scales,and attempts to provide a reference for clinical nurses to choose appropriate assessment tools and improvement of sedation assessment accuracy.
This study summarized the postoperative nursing experience of 6 children suffered from end-stage liver disease with congenital heart disease undergoing liver transplantation. The key points of nursing care include:the strict implementation of prevention and control measures to prevent pulmonary infection;the refined fluid management to prevent heart failure;the formulation of a reasonable nutrition plan to meet the needs of the body;the strict implementation of anticoagulation therapy to prevent vascular complications;the accurate use of immunosuppressive agents to prevent acute rejection;the attention to psychological care to reduce negative emotions in children and information-based follow-up management to track the changes in patients’ condition after discharge from the hospital.With our careful care,all of the 6 patients recovered well and were discharged after the operation,and the prognosis shows good with the follow-up of 1~6months.
Objective To retrieve the best evidence on early enteral nutrition in patients after pancreaticoduodenectomy（PD）and to summarize the best available evidence for clinical nurses to provide evidence-based guidance for the management. Methods All evidence on early enteral nutrition in patients after PD was retrieved from databases and websites including UpToDate,BMJ Best Practice,JBI Library,Cochrane Library,NICE,ASPEN,ESPEN,PubMed,CBM,VIP,CNKI and Wanfang. The retrieved evidence included guidelines,expert consensuses,evidence summaries,systematic reviews,meta-analysis and related original studies. The retrieval period was from the inception of databases to June 15,2020. 2 researchers with evidence-based nursing background assessed the quality of the literature independently,combined with the opinions of professionals,extracted and summarized the evidence of the literature that met the quality standards. Results A total of 281 references were obtained from the initial search,and 12 pieces of literature were included,including 4 guidelines,1 expert consensus,2 systematic evaluations and 5 meta-analysis. Finally,totally 11 pieces of best evidence were summarized from 4 aspects on indications and safety assessment of early enteral nutrition,timing of early enteral nutrition,route selection and target nutrient requirement management. Conclusion Early enteral nutrition after PD is safe and feasible. Evidence users should select best evidence based on the clinical context,the promoting factors and the obstacles and willingness of patients,so as to form a scientific and evidence-based practice plan for early enteral nutrition after PD management,and to accelerate patients’ recovery and improve nursing quality.
This paper reviewed the patient-reported outcomes and assessment tools for patients with pancreatic cancer and summarized the characteristics and application of generic and specific patient-reported outcome measures. We also proposed and analyzed the existing problems and put forward related suggestions for patient-reported outcome measures, so as to provide references for the localized development of patient-reported outcome measures in patients with pancreatic cancer and for clinical nurses to select appropriate assessment tools and carry out related research.
Objective Based on best evidence summary on early mobilization among patients after liver resection, evidence-based quality examination criteria were established, and barrier factors for early mobilization after liver resection were analyzed and corresponding countermeasures were implemented. Methods Carry out the training and examination for all medical staff, set up goals for daily activities and standard operating procedure, strength preoperative education, choose the best timing for early mobilization, assess postoperative pain during activities dynamically, use self-oriented assistant equipment, encourage patients to leave the beds, systematically and regularly review the compliance and clinical results. Results The countermeasures were able to improve knowledge in medical staff, make an earlier mobilization after surgery in patients, improve the completion rate of daily activities, make an earlier initial anal exhaust, decrease the incidence of severe pain（pain scored≥4）. Conclusion Evidence-based practice ensure a safe and rapid recovery.
Construction and application of online rapid pre-screening and triage system during epidemic of coronavirus disease 2019
