Objective To investigate the current status of grip strength level in elderly patients with mechanical ventilation in ICU,and to explore its influencing factors. Methods The convenient sampling method was adopted to select 218 elderly mechanical ventilation patients in ICU of a tertiary hospital in Zhejiang Province as the research subjects from January 2020 to December,and researchers completed the cross-sectional study by using a general information questionnaire,an electronic grip strength device,and the Nutrition Risk Scaling 2002. Multivariate linear regression was used to analyse the factors influencing the grip strength level of elderly patients with mechanical ventilation. Results The average grip strength level of elderly patients with mechanical ventilation in ICU was（13.8±4.7） kg. Multivariate linear regression analysis showed that gender,age,exercise mode,time of sedative drugs,and score of Nutrition Risk Scaling 2002 were the main factors influencing their grip strength level（P<0.05）. Conclusion Grip strength levels were relatively low in elderly patients with mechanical ventilation in ICU. Grip strength levels were lower in patients with mechanical ventilation who were female,elderly,previously unexercised,the time of using sedation medication for >5 d,and the score of Nutrition Risk Scaling 2002≥3. Nursing staff should strengthen the dynamic evaluation of grip strength in patients with mechanical ventilation and control the related influencing factors.

Objective We conducted a scoping review to systematically review the literature reporting discharge planning,and identify the quality evaluation indicators and its collection time,along with related tools. Then the differences between the quality evaluation indicators for discharge planning at home and abroad were explored. Methods Focusing on the quality evaluation indicators for discharge planning,we systematically searched the relevant databases,guidelines and government websites. The information,including research topic,research type,the first author/institution,year of publication,country,evaluation indicator,participants,collection time and method,evaluation tool,were also extracted and summarized. Results The quality evaluation indicators for discharge planning were divided into 3 dimensions,namely patient-related indicators,medical institution-related indicators,and caregiver-related indicators. A total of 167 papers were included and 26 indicators were extracted. There were 12 patient-related indicators,and the top 5 were readmission rate,patient satisfaction,quality of life,self-care ability and mortality. There were 9 medical institution-related indicators,and the top 3 were length of stay in hospital,frequency of outpatient/emergency visits,and medical expenditure. There were 5 caregiver-related indicators,the most common of which is caregiver satisfaction. The readmission rate,quality of life,self-care ability,frequency of outpatient/emergency visits,and activities of daily living had statistically significant differences among the top 10 evaluation indicators for discharge planning at home and abroad. Conclusion The medical institutions should not only monitor patient outcome indicators,but also audit related indicators of medical institutions and caregivers. The researchers should also unify core evaluation indicators and corresponding measurement tools,select sensitivity indicators,develop indicators that can be extracted by using Electronic Information System in the future.

Objective To select,evaluate and summarize the best available evidence for key tasks of discharge planning in all hospitalized patients,so as to provide references for clinical practice of discharge planning.Methods We searched National Institute for Health and Clinical Excellence,New Zealand Guidelines Group,Scottish Intercollegegiate Guidelines Network,National Guideline Clearinghouse,Guidelines International Network,Joanna Briggs Institute,Registered Nurses’ Association of Ontario,Centers for Medicare Medicaid Services,Health Service Executive,medlive,UpToDate,Cochrane library,CINAHL,Pubmed,CNKI,Wanfang Database,CBM,CQVIP,to collect literature of discharge planning,including standards,guidelines,expert consensuses,government documents,best/recommended practices,summary of evidence,systematic evaluation,systematic reviews. 3 researchers independently evaluated quality of literature and extracted the evidence that met the quality standards.Results 19 articles were enrolled,including 3 standards,5 guidelines,3 expert consensuses,1 expert opinion,2 government documents,1 recommended practice toolkit,1 evidence summary,1 clinical decision,and 2 systematic reviews. Totally 33 pieces of evidence were selected from admission to discharge based on 5 periods of the timeline,including in 24 hours after admission,during hospitalization,in 24 hours before discharge,on discharge day and after discharge.Conclusion This study summarized the best evidence for key tasks of discharge planning for inpatients,and hospitals can develop personalized discharge plans for various diseases to promote safe and effective discharge of patients.

The outbreak of coronavirus disease 2019（COVID-19） brought severe challenges to the management of large general hospitals. The Nursing Service Department of our hospital fully executed its functional authority to establish a three-level echelon of sustainable support,allocate the human recourses dynamically,organize pre-service training,supervise the key working steps,formulate positive incentive methods,use and deploy medical supplies scientifically and so on. By taking these strategies,our hospital effectively improved the coping capacity of the nursing team and played a positive role in the prevention and treatment of COVID-19. However,there were still several deficiencies such as insufficient predictive ability and strategic awareness of preparation for emergencies,ineffective reserve system of adequate medical materials,and a lack of specialized emergency nursing teams. The deficiencies indicated that the hospital needs to establish an efficient emergency management system,and pay attention to the practice of nursing emergency plans to enhance coping capacities in public health emergencies.

Objective To develop the Head Nurse’s Transformational Leadership Self-rating Scale and verify its reliability and validity. Methods The scale was initially developed through literature review,semi-structure interviews and Delphi consultation. A total of 210 head nurses from a tertiary hospital in Wuhan were selected to conduct a pilot test. Item analysis and exploratory factor analysis were used to screen items. A total of 922 nurses from 18 tertiary hospitals in Hubei Province were recruited to conduct the formal test. The reliability analysis and confirmatory factor analysis were conducted using SPSS and AMOS software. Results The Head Nurse’s Transformational Leadership Self-rating Scale contained 4 dimensions and 25 items. The 4 demensions explained 61.092% of the total variance. The Cronbach’s α coefficient of the scale was 0.940,and the split-half reliability coefficient was 0.895. The one-dimension/multi-factor model’s CMIN/DF was 23.251,GFI was 0.919,AGFI was 0.902,CFI was 0.910,TLI was 0.900,and RMSEA was 0.049. Conclusion The Head Nurse’s Transformational Leadership Self-rating Scale can be used to evaluate the head nurse’s transformational leadership in Chinese context with good reliability and validity.

Objective To integrate the relevant research,guidelines and government documents on the practice tools of discharge planning in inpatients by taking scoping reviews. Methods Focusing on the practical tools of discharge planning,we systematically searched the relevant databases,guidelines and government websites,extracted the information including author,year,country,name,applicable object,content introduction,using time and the purpose of the tools. Results Along the time line from admission to discharge of a patient,the discharge planning practice tools were divided into 5 categories：admission - evaluation,hospitalization - implementation,24 hours before discharge - verification,on discharge - referral,and after discharge - follow-up,with a total of 29 tools to promote the smooth implementation of the discharge plan. Conclusion Health care personnel should formulate and develop suitable practice tools of discharge planning based on national conditions and medical environment,so as to effectively promote the implementation of discharge plans with standardized tools,optimize the outcomes of patients,and promote the continuity of medical care services for patients.

Objective To investigate symptom clusters and quality of life（QOL） in patients with lung cancer during perioperation at different time points,and to analyze the correlation between 2 variables,so as to provide a basis for guiding clinical dynamic management of symptom clusters and improving patients’ QOL. Methods From January to September 2019,a longitudinal study was conducted among 217 lung cancer patients during perioperation from a thoracic department at a tertiary first-class hospital in Hefei City,Anhui Province. Patients were investigated by a demographic questionnaire,Chinese Version of M.D. Anderson Symptom Inventory-Lung cancer（MDASI-L） and Chinese version of Functional Assessment of Cancer Therapy-Lung scale（FACT-L） on the first day of admission,2~4 days post-operation,and 1 month post-operation. Symptom clusters were extracted by the knowledge-based complex systems’ entropy partition method,and the correlations between symptom clusters and QOL were analyzed by Spearman correlation analysis. Results At the first day of admission,4 symptom clusters（respiratory,pain-fatigue-sleep disturbance,psychosomatic,and neurological） were found in all the respondents;at 2~4 days post-operation and 1 month post-operation patients had increased gastrointestinal symptom cluster,and there were totally 5 symptom clusters. The symptoms included in the corresponding symptom clusters differed significantly over the treatment time. At different time points,the differences in QOL scores and all dimension scores（except social/family well-being） of lung cancer patients were statistically significant（P<0.001）. At the first day of admission,severity scores of the respiratory symptom cluster was negatively correlated with QOL scores and all dimension scores of patients（P<0.01）. At 2~4 days post-operation,severity scores of respiratory and pain-fatigue-sleep disturbance symptom clusters in patients were negatively correlated with QOL scores（P<0.05）. At 1 month post-operation,severity scores of 5 symptom clusters of patients were negatively correlated with QOL scores（P<0.01）. Conclusion Lung cancer patients have multiple stable symptom clusters during chemotherapy which is negatively correlated with their quality of life. Dynamic management of symptom clusters by medical staff is expected to improve the quality of life of lung cancer patients during perioperation.