Objective To explore the application effect of enteral nutrition-related diarrhea in postoperative esophageal cancer patients. Methods Based on literature search and expert meeting，a management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients was constructed. A convenience sampling method was used to select a total of 68 patients with enteral nutrition-related diarrhea after esophageal cancer surgery admitted to the thoracic surgery department of a tertiary A cancer hospital in Jiangsu Province. Among them，patients admitted from January 2022 to December 2022 were set as an experimental group. The experimental group was implemented the management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients. Those admitted from January 2021 to December 2021 were set as a control group with routine nursing. Then，the time of stopping diarrhea，the King’s of Stool Chart（KSC-Tr） diarrhea score，and abnormal incidence of nutrition-related indexes，electrolytes abnormalities（low sodium，low potassium，and low calcium） were compared between 2 groups. Results The time of stopping diarrhea，KSC diarrhea score after 3 days of intervention and the time to achieve target feeding volume of the experimental group were lower than those in the control group，and the difference was statistically significant（P<0.05）. There were no significant differences in hemoglobin，albumin，prealbumin after 3 days of intervention，the incidence of electrolyte abnormalities（low sodium，low potassium，and low calcium） after 3 days of intervention，and the BMI index after 7 days of intervention between 2 groups（P>0.05）. Conclusion The management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients can reduce the time of diarrhea，improve the severity of diarrhea，and shorten the time to achieve the target feeding，but has no significant change in the incidence of electrolyte abnormalities.

Objective To select and summary the best evidence on prevention and management of the skin adverse reactions in patients with targeted tumor therapy,and to provide references for clinical decision. Methods We systematically searched for the evidence on prevention and management of the skin adverse reactions in patients with targeted tumor therapy in BMJ best practice,UpToDate clinical decision system,Joanna Briggs Institute,Guidelines International Network,National Institute for Health and Clinical Excellence,Scottish Intercollegiate Guidelines Network,Yi Maitong Guidelines Network,National Guideline Clearinghouse,the Agency for Healthcare Research and Quality,Registered Nurses’ Association of Ontario,World Oncology Network,National Comprehensive Cancer Network,Lung Cancer Committee of China Anti-Cancer Association,Chinese Anti-Cancer Association Oncologic Nursing Comittee,Cochrane Library,Embase,CHINAL,Web of Science,OVID,PubMed,SinoMed,CNKI,WanFang database,VIP database to collect the literature,including clinical guidelines,evidence summaries,best practice information sheets,recommended practice,systematic reviews and original research. The retrieval period was from January 1,2011 to October 3,2021.There were 2 researchers evaluating the quality of the literature and extracting the data. Results 15 articles were selected,including 3 guidelines,4 evidence summaries,1 systematic reviews,3 randomized controlled trials,1 class experiment and 3 expert consensuses. 19 pieces of best evidence were formed from 6 aspects,including skin evaluation,risk factors,drug therapy,skin care,skin adverse reaction management and health education. Conclusion This study summarizes the best evidence on management and prevention of skin adverse reactions in patients with targeted tumor therapy,and provides evidence-based evidence for clinical workers and managers. It is suggested that clinical staff should combine clinical context,fully assess patient’s skin condition,do a good job of skin health education,examination and care to prevent the occurrence of skin adverse reactions.

Objective To summarize the best evidence of sputum collection methods for patients with pulmonary tuberculosis. Methods We searched websites and databases including, but not limited to, BMJ best practice, UpToDate, World Health Organization, Registered Nurses’ Association of Ontario, National Institute for Health and Care Excellence, Guidelines International Network, Infectious Diseases Society of America,Cochrane Library,CINAHL（EBSCO）, EMBASE（OVID）, PubMed, Web of Science, JBI, CNKI, Wanfang, VIP, and CBM. Guidelines,recommended practices,evidence summaries,expert consensuses, and systematic reviews regarding collection methods of sputum samples for patients with pulmonary were considered. 2 researchers independently assessed methodological quality of included papers and extracted data. Results A total of 13 papers were identified including 6 guidelines, 3 systematic reviews,and 4 expert consensuses. 24 pieces of evidence were categorized into 6 aspects including pre-collection evaluation,pre-collection intervention,collection methods,sputum sample evaluation and transportation,occupational protection, and patient education. Conclusion This evidence summary provided sufficient evidence-based information for healthcare professionals to conduct sputum specimen collection for patients with pulmonary tuberculosis. Healthcare professionals should also consider feasibility, appropriateness, meaningfulness, and effectiveness of evidence in local context before adopting a certain method of sputum collection.

The nursing experience of a patient with paroxysmal nocturnal hemoglobinuria secondary to spleen rupture after cesarean section was summarized. The experience includes rapid establishment of venous access after rupture,close monitoring of blood pressure and intra-abdominal changes;the reduction of blood hemolysis during blood transfusion,the observation and prevention of embolism;management of plasma exchange;the application of ekulimab injection can avoid the occurrence of adverse reactions; carrying out protective isolation to reduce the risk of infection;psychological care and health education for patients to help them build confidence in overcoming diseases. After careful treatment and nursing care,the patient was discharged 16 days after admission.

Objective To search,evaluate and summarize the best evidence of the related operation techniques for electronic measurement of central venous pressure（CVP）. Methods According to the “6S” pyramid model,the computer literature retrieval was carried out by using evidence-based nursing method,including guidelines,recommended practices,evidence summaries,expert consensuses,randomized controlled studies,etc. The search time is from 1 January 2005 to 31 December 2020. 2 researchers independently evaluated the literature quality using the appraisal of guidelines for research and evaluation Ⅱ and the corresponding evaluation standard（2016） of JBI Evidence-based Health Care Center in Australia. Combined with the judgment of professionals,the qualified literature was extracted and graded according to JBI Evidence Pre-grading System（2014 edition）. Results A total of 28 pieces of literature were included,including 2 guidelines,4 expert consensuses,4 systematic reviews,13 randomized controlled studies,1 diagnostic test and 4 descriptive cross-sectional studies. Evidence was summarized from 7 aspects,including access selection,elimination of other interference factors,patient position,sensor zero calibration and position,analysis of waveform and accurate reading,equipment management and personnel training,and 30 pieces of best evidence were formed. Conclusion This paper summarizes the best evidence of relevant operating techniques of CVP electronic measurement,which provides an evidence basis for improving the accuracy and operation standardization of clinical CVP measurement.

Objective To analyze and evaluate the psychological experience of caregivers of patients with advanced cancer. Methods The Cochrane Library,JBI,Embase,PubMed,PsycINFO,Web of Science,CINAHL,CNKI,Wanfang Data and CBM were searched for qualitative studies on psychological experience of caregivers in patients with advanced cancer,and the retrieval period was from inception to November 2018. The Joanna Briggs Institute Critical Appraisal Tool for qualitative researches（2016） in Australia was used to evaluate quality of the studies. The results were integrated by a meta-synthesis method. Results 8 studies were included in the final review. Totally 44 findings were extracted; 9 new categories were generated; 3 integrated results were synthesized as ① Negative psychological problems of caregivers;② Positive psychological feelings of caregivers;③ Needs of psychological support of caregivers. Conclusion Nurses should pay attention to negative psychological problems of caregivers,exert positive psychological effects,help caregivers strengthen their social support system and meet their needs of psychological support,so as to improve quality of care.

Objective To retrieve,appraise and integrate the available evidence of exercise regimens for gestational diabetes mellitus patients,and to provide foundation for decision-making in clinical nursing practice. Methods We searched the BMJ Best Practice,UpToData,Guidelines International Network（GIN）,Registered Nurses’ Association of Ontario（RNAO）,American Diabetes Association（ADA）,Chinese Medlive Guidelines Network,Cochrane Library,PubMed,CNKI,Wanfang Date to collect all articles on exercise regimens for gestational diabetes mellitus,including guidelines,systematic reviews,evidence summaries,recommended practice and expert consensuses. The retrieval period was from the inception to May 2019. JBI evidence appraisal and recommendation system was used to evaluate quality of studies and level of evidence. Results Totally 16 articles were selected,and a total of 31 items of best evidence were summarized from 8 aspects,including applicable population of gestational diabetes exercise interventions,benefits,risks,assessments,types,intensity,time and precautions. Conclusion Moderate exercise is safe and effective for patients with gestational diabetes. Clinical nurses should guide patients to exercise moderately during pregnancy by applying the best evidence with scientific nursing intervention.

Objective To establish an evaluation index system of nursing quality in neurosurgery ICU in accordance with China’s conditions,in order to provide a scientific reference for the evaluation and monitoring of nursing quality in neurosurgery ICU. Methods Based on the three-dimensional quality model of “structure-process-outcome”,the domestic and foreign literatures were retrieved;clinical practice and individual needs of patients were integrated;the index entry pool was set;the inquiry content was determined by semi-structured interview method. Finally,the index system and its weight were determined by Delphi method and analytic hierarchy process. Results The recovery rates of two rounds of expert consultation were 96.67% and 100%;the authority coefficients were 0.8975 and 0.900;the judgment coefficients were 0.956 and 0.962;the familiarity coefficients were 0.838 and 0.837,and the Kendall harmony coefficients were 0.219 and 0.226,respectively. The final evaluation index system of nursing quality in neurosurgery ICU included three first-level indicators,namely,structure indicators,process indicators and outcome indicators,17 second-level indicators and 104 third-level indicators. Conclusion The evaluation index system of nursing quality in neurosurgery ICU established in this study is comprehensive and practical,which can provide objective and quantitative quality evaluation tools for nursing managers,guide the clinical practice of nurses,and promote continuous nursing quality improvement in neurosurgery ICU.

Objective To retrieve,evaluate and integrate the relevant evidence of prevention of medical adhesive-related skin injury in elderly patients at home and abroad,and to summarize the best evidence. Methods We systematically searched for evidence on prevention of medical adhesive-related skin injury in BMJ,UpToDate,JBI,RNAO,SIGN,CGC,Cochrane Library,PubMed,EMbase,INS,ISTAP,CBM,Wanfang,CNKI,Taiwan academic literature database of China,including guidelines,systematic reviews,best practices information sheet,evidence summary,expert consensus and original research. The retrieval period was from the inception of databases to May,2019. Results A total of 11 articles were included,including 3 guidelines,1 evidence summary,3 expert consensus,3 randomized controlled trials and 1 cohort study. Six aspects were summarized：skin evaluation,skin protection,operational readiness,manipulation,observation and maintenance,supervision and training. Twenty items of best evidence were included. Conclusion Nurses should standardize the methods of medical adhesives sticking and removing,accurately identify high-risk groups,and take skin protection measures. In the application of evidence,the best evidence should be selected according to the clinical situation,so as to reduce the incidence of skin injury related to medical adhesives and improve the quality of nursing.

Objective To establish an evaluation index system for quality of parenteral nutrition nursing for hospitalized patients,to ensure the safe implementation of parenteral nutrition and promote health of patients.Methods Databases were systematically searched including Chinese Guideline Network,Up To Date,ASPEN,ESPEN,JBI,etc. All studies were screened and evaluated strictly. The initial questionnaire was developed combining the best evidence,and clinical data analysis of our hospital in the past two years. Two rounds of Delphi survey were conducted among 30 experts to determine the content and importance of each indicator. Analytic hierarchy process was used to determine the weight of each indicator.Results Nine studies were included,including 2 clinical decisions,1 evidence summary,2 guidelines and 4 expert consensuses. After two rounds of expert consultation,rates of parenteral nutrition criteria implementation focusing on process quality were determined：4 first-level indicators including rate of nutritional risk nursing assessment implementation,rate of parenteral nutrition assessment implementation,rate of parenteral nutrition solution preparation criterion implementation,and rate of parenteral nutrition infusion nursing criterion implementation,and 17 second-level indicators.Conclusion The evaluation index system of patient on parenteral nutrition is scientific,practical and operational,and can effectively guide nurses’ correct behavior and evaluate quality of parenteral nutrition nursing.

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.

Objective To select and obtain the best evidence for deep venous thrombosis（DVT） prophylaxis in spinal surgery patients after operation so as to provide reference for clinical practice to decrease the rate of DVT. Methods Using the method of evidence-based nursing,clinical question of DVT prevention in spinal surgery patients was raised. Relevant research was retrieved by computer search. JBI evidence appraisal and recommendation system were used to evaluate quality of studies and level of evidence. Results Combined with judgment of clinical professionals,totally 27 evidences selected,including DVT assessment,diagnosis and screening,intervention strategies,prevention time and methods,health guidance,etc. Conclusion This study summarized the best evidence for prevention and management of deep venous thrombosis after spinal surgery,and help clinical nurses and nursing admi-nistrators decision-making,ultimately through adapting the best evidence and using scientific nursing methods to solve the clinical problems and improve nursing quality.

Objective To select and obtain the best evidence of prevention and management of feeding intolerance（FI） in critically ill patients with enteral nutrition support so as to provide guidance for clinical practitioners to reduce the incidence rate of FI. Methods Using the method of evidence-based nursing,clinical question of FI prevention and management in critically ill patients with enteral nutrition support was raised. Relevant research was retrieved by computer search. JBI evidence appraisal tools and recommendation system were used to evaluate quality of studies and level of evidence. Results Combined with the judgment of clinical professionals,totally 22 items of evidence were selected,including FI assessment,risk factors of FI,enteral formula management,enteral feeding pathway,position management,gastric residual quantity monitoring,drug administration,intra-abdominal pressure monitoring and traditional Chinese medicine therapy,etc. Conclusion This study summarized the best evidence for prevention and management of FI in critically ill patients with enteral nutrition support and help clinical nurses and nursing administrators with decision making,ultimately through adapting the best evidence and using scientific nursing methods to cope with the clinical problems and improve nursing quality.

Objective To systematically review the experience and coping behaviors of work stress among ICU nurses,provide evidence for understanding the experience of work-related stress in ICU nurses and helping them dealing with it better. Methods Chinese and English databases including PubMed,PsycINFO,Cochrane Library,Web of Science,CNKI,Chinese biomedical literature database（CBM）,VIP,and WanFang Data were searched for qualitative studies on ICU nurses' work stress from inception to September 2018. The JBI Critical Appraisal Tool for qualitative studies in Australia （2016 edition） was used to evaluate the quality of studies. The results were synthesized by using Integration Methods . Results A total of 48 findings were extracted from 7 qualified studies. The 48 findings were integrated into 9 new categories and finally 3 synthesized results were summarized：the sources of work stress,the physical and mental experience of work stress,and the coping behaviors of work stress in ICU nurses. Conclusion Nurses themselves and nursing managers should pay attention to the sources of stress,physical discomfort and negative emotions caused by stress,and adopt a variety of interventions to cope with stress actively,so as to reduce the stress and improve the quality of nursing.