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 integrate the best evidence of non-pharmacological interventions for breast cancer-related lymphedema with evidence-based methods，and to provide evidence-based bases for standardized evaluation and management of lymphedema for clinical medical staff. Methods The best evidence about the prevention and management of lymphedema in breast cancer patients were searched systematically，such as relevant guidelines，expert consensuses，systematic reviews and so on. The retrieval period was from January 2016 to January 2022. Results A total of 25 pieces of the literature were included，including 6 guidelines，4 expert consensuses and 15 systematic evaluations，and 33 pieces of best evidences were integrated from 2 aspects，namely the preventive intervention and therapeutic intervention. Conclusion The summarized evidence can be used for the prevention and treatment of breast cancer lymphedema，and medical staff should provide specific health guidance for patients with lymphedema based on cultural background，clinical situation，and patients’ opinions.

Objective To retrieve,evaluate and summarize the best evidence of self-management of lymphedema of breast cancer patients’,and to provide references for education and evaluation of self-management of patients. Methods We searched relevant guideline networks and association websites,as well as PubMed,Web of Science,Embase,CINAHL,CNKI,VIP,Wanfang,CBM and other databases to collect relevant guidelines,expert consensuses,best practices and recommended practices related to self-management of lymphedema in breast cancer patients published from January 1,2011 to May 31,2021. 2 researchers evaluated the quality of various literature,and extracted relevant evidence from the included literature. Results A total of 24 articles were included,including 7 guidelines,6 expert consensuses,3 best practices and 8 recommended practices. Finally,28 pieces of best evidence including 8 dimensions were summarized,namely learning about lymphedema,exercise,maintaining a healthy weight,protecting the affected limb,promoting lymphatic circulation,self-monitoring,psychological adjustment and role adaptation. Conclusion This study summarized the best evidence of breast cancer patients’ self-management of lymphedema,which can provide references for medical staffs to conduct self-management guidance for patients and dynamically evaluate their self-management status,so as to effectively prevent or control lymphedema.

Objective To establish expert consensus on nursing standard for prevention of adult oral tracheal intubation unplanned extubation.Methods Studies from domestic and foreign were retrieved and the ‘Prevention of Tracheal Intubation Unplanned Extubation Cluster Care Package’ drawn up by Tianjin Nursing Quality Control Center as well as professional experience were taken into consideration. Expert Delphi mail questionnaire was developed according to the key issues of nursing care. Forty experts from Beijing,Tianjin,Shanghai,Guangdong,Sichuan,Hunan and Hebei were invited to complete 3 rounds of Delphi expert consultation and 2 rounds of expert meeting. Each item was revised and adjusted considering objective evidence and expert opinions.Results The positive coefficients of experts in three rounds of Delphi expert consultation were all 100%,and the degrees of expert authority were all 0.87. The average assignment values of experts to the importance of items were 4.86±0.35,4.94±0.27,and 4.97±0.16,and the Kwbdall's W were 0.135,0.174,and 0.262,respectively(all P<0.001). At last,experts agreed on 23 items under 6 dimensions of nursing care.Conclusion The consensus strictly follows the standardized process of literature study--draft construction--Delphi inquiry--onsite meeting,and integrates the resources of nursing quality control centers from several provinces and cities,and multi-disciplinary experts' suggestions. It is professional,scientific,rigorous and authoritative. The consensus can not only provide guidance for clinical nursing practice,but also lay a foundation for the formulation of guidelines and standards in this field. However,further theoretical and empirical studies are needed to verify the consensus.

Objective To develop an enclosed loop system for nursing sensitive quality indicators in Tianjin in order to enhance nursing quality management. Methods Based on National Database of Nursing Quality Indicators,sensitive quality indicators were screened,and the enclosed loop system for nursing sensitive quality indicators in Tianjin was established,and further improved by training and feedback control. Results After implementation of the system,nursing adverse events and infection events in tertiary hospitals were reduced. Conclusion The enclosed loop system for nursing sensitive quality indicators in Tianjin can reduce the rates of nursing adverse events,infection events,and nurse turnover,which can provide reference for nursing quality improvement in other areas.