To summarize the perioperative nursing experience of a newborn with bacterial corneal ulcer undergoing corneal transplantation. Preoperative nursing points：to strengthen eye observation and protection to avoid corneal perforation；to properly administer systemic and eye medication to control infection. Postoperative nursing points：to closely observe the condition of corneal grafts to prevent postoperative complications；to provide eye drops on time after surgery to ensure medication safety；to emphasize pain management and provide nutritional support；to provide targeted health education to parents to ensure that the patient receives continuous care. Through multidisciplinary team collaboration，meticulous treatment and care，the corneal graft of the patient was clear，the suture was not loose，and there was no bleeding in the anterior chamber after 1 week of corneal transplantation. The vital signs were stable，and the patient was discharged from the hospital，and ophthalmic follow-up was conducted. After 7 weeks of surgery，the suture was successfully removed and the corneal transplantation was successful.

Objective To develop a health-promoting lifestyle scale for women with polycystic ovary syndrome （PCOS），and to test its reliability and validity，and preliminarily apply it. Methods Based on the Pender health promotion model，the item pool of the scale was constructed through literature research，semi-structured interviews and group discussions. After 2 rounds of Delphi expert consultation and pre-survey，the initial scale was formed. From April to July 2022，316 patients with PCOS in the health management center，reproductive medicine center and endocrinology department of a tertiary hospital in Nanjing were selected for item analysis，exploratory factor analysis and reliability test，respectively. From August to October 2022，358 PCOS patients were selected for confirmatory factor analysis. From November 2022 to February 2013，294 PCOS patients were selected，and the scale was used to investigate the status of health-promoting lifestyle in PCOS patients. Results The health-promoting lifestyle scale for PCOS patients included 5 dimensions and 33 items. The total content validity index of the scale was 0.942，and the content validity index of each item was 0.810-1.000. 5 common factors were extracted by 2 exploratory factor analyses，and the cumulative variance contribution rate was 62.399%. Confirmatory factor analysis showed that the model fit was good. The Cronbach’s α coefficient of the total scale was 0.930；the split-half reliability was 0.842；the test-retest reliability was 0.888. The preliminary application results showed that the total score of health-promoting lifestyle in PCOS patients was（96.925±14.273），and the average score of items was （2.937±0.433），which was at a medium level. Conclusion The health-promoting lifestyle scale for PCOS patients has good reliability and validity，which can be used as a tool for medical staff to assess the level of health-promoting lifestyle of PCOS patients，and can help nurses to quickly identify the level and dimensions of health-promoting lifestyle of patients，so as to formulate individualized precise health management plans.

Objective To construct a key nursing technology system for the treatment of patients exposed to nuclear radiation in hospitals，and provide technical guidance and support for emergency nursing rescue in hospitals of nuclear radiation accidents. Methods A research group was composed of a team with rich experience in nuclear radiation accidents. Based on 4 scenarios of nuclear radiation accidents（including external irradiation，internal irradiation，external contamination，internal contamination），the literature search was conducted to form the first draft of the system. Delphi method was used to complete 2 rounds of expert letter consultation，and the final draft of the key nursing technology system for hospital treatment of patients with nuclear radiation exposure was constructed according to the revised opinions of experts. Results A total of 16 experts completed 2 rounds of correspondence. The effective recovery rates were 100% and 80%；the recommendation rates were 65% and 50%；the authority coefficients（Cr） were 0.778 and 0.797；the coefficient of variation（CV） of the 2 rounds of expert letter consultation was≤0.25. Finally，a key nursing technology system for in-hospital treatment of patients with nuclear radiation exposure was formed，including 5 first-level indicators，26 second-level indicators and 74 third-level indicators. Conclusion The constructed key nursing technology system for hospital treatment of patients with nuclear radiation exposure is highly practical and scientific，and it is conducive to the formation of standardized nuclear radiation exposure treatment procedures，and provides a theoretical basis for the training and evaluation of nursing staff related to nuclear radiation exposure.

Objective We aimed to establish an evaluation index system for health literacy among gestational diabetes mellitus（GDM） patients. As a theoretical basis，this system can be applied by the clinical nurses to carry out targeted health guidance among GDM patients and to evaluate health literacy level. Methods Initial indexes were generated through the literature review and semi-structured interviews. 2 rounds of expert consultations and analytic hierarchy process were conducted to establish the evaluation index for health literacy among GDM patients. The convenience sampling method was used to select 15 GDM patients and 15 obstetric medical staff members from a tertiary A hospital in Qingdao as the research subjects in March 2022，and the application effect of the constructed evaluation index system was preliminarily verified by semi-structured interviews. Results The response rates of the 2 rounds of expert consultations are 100% and 94.74%. The expert authority coefficients are 0.924 and 0.942，respectively. The Kendall harmony coefficients of the 2 rounds of expert consultations are 0.123~0.154 and 0.312~0.327（P<0.01）. As a result，we built up an evaluation index system of health literacy which comprised 7 first-level indexes，49 second-level indexes for GDM patients. 86.7% of GDM patients thought that the content of index system was clear，easy to understand，and instructive for daily self-management. 100% of obstetric medical staff were satisfied with the index system，and thought that the content was comprehensive，professional，with applicability and necessity of application. Conclusion The evaluation index system for health literacy among GDM patients is reasonable，scientific and reliable. The index content is specialized and specific，in line with the physical and psychological characteristics of GDM patients.

Objective To analyze the applicability and the optimal cut-off of Braden Scale for the diagnosis of pressure injury in the elderly through the data of multicenter cross-sectional study of pressure injury in the elderly in China，so as to provide bases for the correct use of Braden scale in clinical practice. Methods 1067 trained and qualified nurses from 52 different medical institutions across the country were recruited in a group of 2. They included the inpatients over 60 years old by purpose sampling method，examined the skin and relevant data of patients，and evaluated whether there was pressure injury and its stage，and used the Braden Scale to predict the risk of pressure injury. The statistical software was used to analyze the epidemic characteristics of pressure injury in the elderly，and the area under the working characteristic curve（AUC），sensitivity，specificity and Yoden index of those with pressure injury were predicted and diagnosed by the Braden Scale. Results In the effective data of 3 3769 cases，the total prevalence of pressure injury was 3.12%（n=1 054），of which the incidence of hospital acquired pressure injury was 0.79%（n=267）. Hierarchical analysis showed that the AUC predicted by the Braden Scale for the diagnosis of pressure injury in elderly patients of different ages，gender，races and medical institutions was 0.85~0.96，and the sensitivity and specificity were 0.83~0.96 and 0.71~0.86，respectively. The AUC of the 6 cut-off values of total score≤15，≤16，≤17，≤18，≤19 and ≤20 points was 0.67~0.82; the sensitivity and specificity were 0.67~0.84 and 0.54~0.68，respectively; the Youden index was 0.25~0.49. The Youden index and AUC of ≤20 points was the largest. Conclusion Braden Scale is suitable for elderly patients of different ages，gender，race and medical institutions to assess and predict the risk of pressure injury. The total score of≤20 points can be used as the best cut-off，which can improve the prediction efficiency.

Objective To construct a lifestyle management scheme for infertile women with polycystic ovary syndrome（PCOS） during outpatient medical treatment，and to evaluate its clinical effects. Methods Based on the evidence summary and qualitative interviews，a lifestyle management scheme for infertile women with PCOS during medical treatment was constructed. The infertile women at childbearing age with PCOS from the health management center and reproductive medicine center of a tertiary A hospital in Nanjing were recruited through convenience sampling. 27 patients who visited the above mentioned 2 centers from September 15 to 30，2021 were recruited in an experimental group successively，while another 27 patients who visited there from February 15 to 28，2021 were recruited in a control group successively. Next，the lifestyle management scheme was implemented in the experimental group in 9 key steps，including evaluation，screening，status analysis，formulation of body mass management objectives，diet management，exercise management，behavior management，health guidance，and evaluation. Meanwhile，27 patients in the control group were given the routine healthy lifestyle guidance. After 3 months，the figure of BMI，insulin resistance index，serum testosterone，anxiety，depression and quality of life of the 2 groups were analysed. Results After the intervention，the BMI of the experimental group was 24.43±2.99，which was lower than （26.48±3.49） in the control group. The insulin resistance index was 2.42±0.98，which was lower than 3.52±0.97 in the control group. The level of testosterone was（0.55±0.19） ng/ml，which was lower than（1.20±0.42） ng/ml in the control group. The anxiety level was（5.73±2.13） and the depression level was（5.12±2.66），which were lower than（9.40±2.36） and（10.60±2.58） of the control group. The score of disease-related quality of life was（140.38±7.25），which was higher than（115.56±7.99） of the control group，and the differences were statistically significant （P<0.05）. Conclusion The implementation of the lifestyle management scheme for infertile women with PCOS during medical treatment is conducive to adjust patients’ endocrine and metabolic status，alleviate their anxiety and depression and improve quality of life.

Objective To translate the Nursing Care Interpersonal Relationship Questionnaire（NCIRQ） into Chinese version，and to test its reliability and validity. Methods Following the Brislin model，the English NCIRQ was translated into Chinese，and back translated and modified for cultural adaptation，and pre-tested to form Chinese version of NCIRQ. Convenience sampling method was used to evaluate the reliability and validity of NCIRQ in 355 patients admitted to a tertiary A hospital in Beijing from August 2022. Results The Chinese version of NCIRQ included 22 items. The Cronbach's α was 0.882 and the test-retest reliability were 0.871. The content validity index of each item is 0.670~1.00. The average content validity index of the scale is 0.947. There were 3 common factors being extracted by exploratory factor analysis，and the cumulative variance contribution rate is 58.944%. Conclusion The Chinese version of NCIRQ has good reliability and validity in hospitalized patients，and it can be used as an evaluation tool to evaluate the relationship of hospitalized patients and nurses in China.

Objective To construct an artificial intelligence follow-up system for multiple myeloma patients based on patient needs，and to evaluate its application effect. Methods From March to May 2022，308 patients with multiple myeloma were selected from 3 tertiary hospitals in Shandong via convenience sampling method，and they were investigated by the cognition and demand content questionnaire of the artificial intelligence follow-up system，and the module of the follow-up system was developed，and its functions were combined with the initial application of the follow-up system for patients with hematologic diseases. From July to December 2022，patients’ symptom management level and satisfaction before and after application of the system were evaluated by the cancer patient self-management assessment scale and the continuous Care Smart platform using the questionnaire. The continuous Care Smart platform was used to evaluate the application satisfaction of medical staff with the questionnaire. Results The artificial intelligence follow-up system for multiple myeloma patients consisted of 2 modules and 9 functions. After the system was applied，the self-management level of 83 patients with multiple myeloma was higher than that before application（P<0.05）；the satisfaction score of patients was （67.36±8.27） points；the timely completion rate of follow-up was higher than that before the application （P<0.01）. The satisfaction of medical staff on the practicability，convenience，reliability and accuracy of the system was more than 95%，and the satisfaction of intelligence was 84.6%. Conclusion The artificial intelligence follow-up system for multiple myeloma patients has a scientific construction process，good practicability and convenience，and patients have high satisfaction with it.

Objective To evaluate the puerperal fatigue status of women at advanced maternal age and to explore its influencing factors. Methods This study included 210 women at advanced maternal age who were reviewed on 42 days postpartum at 4 hospitals in Jinan from December 2019 to October 2020，and clinical data was collected by the General Information Questionnaire，Fatigue Scale，Pittsburgh Sleep Quality Index，Anxiety Self-Rating Scale，Edinburgh Postpartum Depression Scale，and Social Support Rating Scale. Univariate analysis and multiple linear regression were used to analyze the factors influencing the occurrence of puerperal fatigue in women at advanced maternal age. Results The fatigue score during the puerperium for women at advanced maternal age was（6.84±3.11），and the prevalence of fatigue was 94.61%. Multiple linear regression analysis revealed that pregnancy and childbirth history，delivery mode，anxiety，depression，sleep quality，and social support were the main factors influencing their level of fatigue（P<0.05）. Conclusion The puerperal fatigue level of women at advanced maternal age is at a high level. Healthcare workers should pay more attention to the assessment of fatigue levels during the puerperium and provide accurate and individualized postpartum psychological and physiological care.

Objective To translate and revise Hand Hygiene Behaviour Questionnaire（HHBQ） based on COM-B （capability,opportunity,motivation-behaviour） model,and to test its reliability and validity. Methods According to the intercultural debugging guidelines,the Chinese version of HHBQ was prepared by pre-translation,pre-translation synthesis,back-translation,back-translation synthesis,original author review,expert consultation and pre-test. The reliability and validity of Chinese version of HHBQ were evaluated by a survey of 537 medical staff from 3 tertiary A hospitals in Hangzhou from July to October 2021. Results The Chinese version of HHBQ contained 3 dimensions,namely,hand hygiene ability（5 items）,hand hygiene opportunity（7 items）,and hand hygiene motivation （5 items）. The content validity of the total scale was 0.995,and the content validity of each item in the questionnaire was 0.923~1.000. 3 common factors were extracted from exploratory factor analysis,and the cumulative variance contribution rate was 68.741%. Confirmatory factor analysis showed that the model fit well. The Cronbach’s α coefficients of the total amount table are 0.918,and the Cronbach’s α coefficients of each dimension are 0.871~0.906. The retest reliability of the questionnaire was 0.739. Conclusion The Chinese version of HHBQ has good reliability and validity,and it can be used to comprehensively evaluate the influencing factors of medical staff’s hand hygiene.

Objective To analyze the prevalence and risk factors of 3 types of skin injuries in the elderly through multicenter cross-sectional survey,so as to provide bases for formulating prevention strategies for skin injuries in the elderly. Methods On March 31,2021,1 067 nurses from 50 hospitals in 16 provinces,2 autonomous regions and 2 municipalities included inpatients over 60 years old and inspected their skin from head to toes to identify pressure injury（PI）,incontinence-associated dermatitis（IAD） and skin tear（ST）,and meanwhile collected demographic,healthcare condition and PI risk assessment data. Statistical software was used for descriptive analysis,Pearson correlation analysis and logistic regression analysis. Results Totally,14 470 cases were obtained. The average age was（73.35±8.90） years old. The total prevalence of skin injuries was 6.69%,and the prevalence of PI,IAD and ST was 3.91%,1.89% and 0.89%,respectively. Logistic regression analysis showed that the risk of PI,inability of self-care,hypoproteinemia and anemia,comorbidity over 2 chronic diseases and ≥70 years old were the independent risk factors of PI in the elderly. The risk of PI,inability of self-care,hypoproteinemia,comorbidity over 2 chronic diseases,length of hospital stay≥8 days and the age of over 80 years were the independent risk factors of IAD in the elderly. The risk of PI and hypoproteinemia were independent risk factors of ST in the elderly. Conclusion Skin injuries of the hospitalized elderly are the result of multiple factors,while PI and IAD are the most typical ones,and the risk factors of different types of skin injuries are also different. When formulating prevention strategies,we should not only pay attention to the independent role of risk factors,but also consider the combined role of risk factors,take comprehensive preventive measures to improve the prevention effect.

Objective From the aspects of parenting style and medication adherence，the influencing factors of asthma symptom control level of school-age children and the impact path of influencing factors were analyzed，so as to provide a basis for the formulation of targeted nursing intervention programs. Methods Using convenient sampling method，from December 2020 to September 2021，we investigated school-age asthmatic children and their parents in pediatric respiratory outpatient departments and wards of 3 tertiary hospitals in Jinan，Shandong province，using the General Demographic Questionnaire，Short-Egna Minnen av Barndoms Uppfostran-Chinese（s-EMBU-C），Medication Adherence Questionnaire and Childhood Asthma Control Test（C-ACT）. Univariate analysis，Pearson correlation analysis and multiple linear stepwise regression analysis were used to analyze the data，and the structural equation model was established. Results A total of 211 school-age children with asthma were enrolled. The score of C-ACT was（19.15±4.27），and the uncontrolled rate was 43.6%（92 cases）. The results of influencing factor analysis showed that the parenting style，medication adherence and asthma history of first-degree relatives were the influencing factors of symptom control level in school-age children with asthma（P<0.05）. Pathway analysis results showed that medication adherence played a partially mediating role between positive parenting style and asthma symptom control level（ES=0.395），with 95%CI（0.273，0.540），accounting for 54.6% of the total effect. The medica-tion adherence played a partially mediating role between negative parenting style and asthma symptom control level（ES=-0.435），with 95%CI（-0.598，-0.254），accounting for 58.8% of the total effect. Conclusion The symptom con-trol of school-age children with asthma is poor. Clinical doctors and nurses should pay attention to the influence of parenting style on children’s symptom control level，guide parents to adopt positive parenting styles，and improve children’s medication compliance，so as to improve their symptom control level.

Objective To systematically review and synthesize the experience of nurses participating in robotic surgery，so as to provide recommendations for clinical practice. Methods The computer retrieval was performed in PubMed，CINAHL（EBSCO），Embase，Web of Science，Scopus，ProQuest Dissertations and Theses，SinoMed，CNKI，Wanfang Data and VIP database from January 1，2000 to November 26，2021，to collect qualitative studies in the experience of nurses participating in robotic surgery. This qualitative systematic review was conducted under the Joanna Briggs Institute guideline. This paper was written according to the enhancing transparency in reporting the synthesis of qualitative research（ENTREQ）. Results A total of 6 qualitative studies were included，and 39 findings were extracted，which were summarized into 8 categories and integrated into 3 synthesized findings. Findings included that nurses play a coordinating role in teamwork and gain a sense of achievement;nurses face multiple challenges and pressures in their work;nurses lack professional knowledge and need technical support and team training. Conclusion The communication and cooperation among members of the robotic surgical team should be strengthened;the management of operation time，operating room space，equipment failure and patient safety should be strengthened;the operation process should be standardized;the legal responsibilities of nurses should be clarified;professional team training and technical support should be provided for nurses.

Objective To explore the influencing factors of psychological distress in patients with cancer,to analyze the risk index of patients with psychological distress,and to develop a nomogram model to predict these risks. Methods In this cross-sectional study,a total of 223 patients with cancer from the oncology department of a tertiary A hospital in Jingmen were selected as the research subjects from December 2020 to July 2021,and the independent risk factors of psychological distress through univariate analysis and Logistic regression analysis were explored. According to these selected independent risk factors,a risk prediction model was established and incorporated into the nomogram,and the model power and its accuracy were evaluated by receiver operating characteristic. Results The risk prediction model was constructed based on 8 influencing factors,including pathological stage,primary caregivers,Pittsburgh sleep quality index score >9.5,numerical rating scale score （1 point for each increase）,temperament type,coping style,financial problems and exercise. The area under the predicted ROC curve was 0.924. When the Yoden index was 0.699,the optimal critical value was 0.513,the sensitivity was 0.866,and the specificity was 0.833. The slope of the calibration plot was close to 1. Conclusion The prediction model constructed in this study has good prediction effects which can provide references for medical staff to quickly identify the risk of psychological distress in cancer patients and timely take preventive management measures.

Objective To assess the current status of exercise perception in elderly patients with chronic obstructive pulmonary disease (COPD) and to analyze the influencing factors. Methods Using a convenience sampling method,207 hospitalized elderly COPD patients from 4 tertiary hospitals in Jinan city from December 2018 to June 2019 were selected as participants. The general information questionnaire,Exercise Benefit/Barriers Scale,Breathlessness Beliefs Questionnaire,Self-efficacy Scale and Social Support Rating Scale were used for investigation. Results The total score of exercise benefits/barriers in 207 elderly COPD patients was (127.34±11.71). Exercise perception was negatively correlated with activity-related fear (r=-0.469,P<0.001),and positively correlated with both self-efficacy and social support (r=0.412,P<0.001;r=0.247,P<0.001). Multiple linear regression analysis revealed that activity-related fear,self-efficacy,social support,and the situation of physical activity prior to COPD were the influlencing factors of exercise perception. Conclusion The level of exercise perception in elderly patients with COPD needs to be improved. Strengthening exercise rehabilitation education and guidance for COPD patients and their families,helping patients eliminate or reduce their fear of physical activity,and improving their self-efficacy and ability to access and utilize social support are beneficial to improve their exercise perception.

Objective To collect and summarize the best evidence of perioperative blood glucose management in patients with diabetes at home and abroad. Methods We systematically searched the National Guideline Clearing-house in the United States,Scottish Intercollegiate Guidelines Network,Registered Nurses’ Association of Ontario,Canada,National Institute of Health and Care Excellence in the United Kingdom,Joanna Briggs Institute,Cochrane Library,PubMed,Web of Science,the International Diabetes Federation and American Diabetes Association,Canadian Diabetes Association,Australian Diabetes Association,CNKI,CBM and Wanfang database to collect the literature including guidelines,systematic reviews,best practice information sheets,evidence summaries,expert consensuses,etc. The retrieval period was from the inception of databases to November 29,2019. 6 researchers independently evaluated the quality of the literature,combining with the judgment of professionals,to extract the data from the literature meeting the standards. Results A total of 9 articles were incorporated,including 6 guidelines,2 expert consensuses and 1 systematic review. The best evidence included 33 pieces of evidence in 4 categories,namely glycemic management principles,glycemic monitoring frequency,glycemic control objectives and drug management of glucose control. Conclusion The best evidence should be selected based on the characteristics of the hospital and the clinical environment,to reduce abnormal blood glucose events,reduce postoperative wound infections,and accelerate postoperative wound healing time in patients with diabetes.

Objective To construct a structural equation model of cognitive function of patients with spinal cord injury（SCI） and its influencing factors,and to analyze the path of action of each factor on the cognitive function of SCI patients,so as to provide a basis for targeted cognitive function intervention programs. Methods From October 2019 to November 2020,the convenience sampling method was adopted to include 357 patients with SCI from 8 tertiary hospitals in Anhui Province. The General Situation Questionnaire,the Montreal Congnitive Assessment,and Hamilton Depression Table,Self-Efficacy Rehabilitation Outcome Scale,Social Support Rating Scale,the Revised Piper Fatigtle Scale,Pittsburgh Sleep Index Scale were employed,and a structural equation model was used to analyze the path of action of each influencing factor. Results Depression,self-efficacy,fatigue,sleep,and social support all affect the cognitive function of patients through different pathways. Depression negatively affects cognitive function with the direct and indirect effects of -0.245 and -0.282 respectively;self-efficacy positively affects cognitive function with the direct and indirect effects of 0.503 and 0.012,respectively;fatigue negatively affects cognitive function with a direct effect of -0.131;sleep negatively affects cognitive function with the direct and indirect effects of -0.353 and -0.210,respectively;social support positively affects cognitive function with direct and indirect effects of 0.110 and 0.874,respectively. Conclusion The cognitive function of patients with SCI is affected by the interaction of multiple factors. Medical staff should pay attention to the evaluation of the patient’s cognitive function and its influencing factors in clinical work,and take effective measures to improve the patient’s cognitive function in time.

Objective To further understand the dilemma experience of self-management in patients with hemophilic arthropathy（HA）,so as to provide references for the development of self-management intervention programs that meet the needs of patients. Methods With phenomenological research methods,a semi-structured in-depth interview was conducted among 13 patients with HA who were scheduled to undergo joint replacement surgery in an orthopedic ward of a tertiary Level A hospital in Beijing. Colaizzi 7-step analysis method was used to collect the data,to analyze and refine the theme. Results The self-management difficulty of HA patients mainly includes 2 factors,namely internal factors and external factors. The internal factors include the lack of attention on self-management of disease,differences in knowledge acquisition approaches,and high economic pressure. The external factors include the uncertainty about the disease,limited coverage of social support,poor drug accessibility,and response to the public health emergencies. Conclusion Patients with HA still have many problems and obstacles in self-management. Health care workers can help patients correctly understand and implement disease management through health education in multiple ways,and meanwhile give full play to the role of the family. Furthermore,the telemedicine platform could also be utilized to explore a new mode of disease self-management for patients with rare diseases.

Objective To understand the work content of deep vein thrombosis （DVT） preventive care after hip and knee replacement,and to clarify the gap between the current practice and the best evidence. Methods From June to October 2019,we used the field research methods to conduct a 5-month participatory observation about the nursing work in the joint surgery ward in a level A tertiary hospital in Beijing. We used the three-level coding method of qualitative research to conduct field notes analysis. Results Through the care experience of participating in 391 cases of preventing DVT after hip and knee replacement,this study clarified the work content of preventive care,and extracted 4 work content themes,namely Education,Enforcement,Evaluation and E-recording,which fit with the best evidence. However,there is a partial gap between the implementation effect and the best evidence,and it still needs further development in enhancing health education and early activities promotion. Conclusion Through the field research,we have learned about the nursing work content in preventing DVT after hip and knee replacement,and the gap between the present situation and the best evidence and the possible reasons. Carrying out evidence-based nursing research and constructing scientific,normative and clinically feasible standardized preventive nursing plans are the best ways to prevent DVT after hip and knee replacement.

Objective To construct a clustering solution for preventing the ventilator associated pneumonia（VAP）based on micro-aspiration,and to provide specific procedures for the airway care of mechanically ventilated patients in the intensive care unit. Methods Considering the 2016 version of "clustered nursing package for clinical strategies of preventing ventilator-associated pneumonia" by Tianjin Nursing Quality Control Center as the prototype,we formulated the airway management plans following evidence of domestic and foreign literature,and obtained expert opinions by the Delphi approach. Results 2 rounds of consultations have been taken from 17 experts from October to December 2019,and their positive coefficients were both 100%. The familiarity of the 2 rounds were 0.92 and 0.96,and the authoritative coefficients were 0.82 and 0.89. The coordination coefficients were 0.088~0.485,with variation the coefficients ranged from 0 to 0.239,all of which were statistically significant（P<0.01）. Finally,a clustering plan with 10 strategies and 38 specific measures was constructed. Conclusion The clustering solution to prevent the VAP based on micro-aspiration was constructed in this research on the basis of the old package,but the concept of "aspiration" was updated to prevent "micro-aspiration". It was a scientific,reliable and practical program which would be beneficial for the clinical nursing in the intensive care unit.

Objective The purpose is to translate the Quality of Discharge Teaching Scale-New Mother Form（OB-QDTS）,and to test the reliability and validity of the Chinese version of the scale and to evaluate the feasibility of applying this scale in the field of domestic science. Methods According to the Brislin model to translate and back-translate the original English version,the Chinese version of the scale was determined after cultural adjustment and pretesting on the scale. According to the survey criteria,195 postpartum mothers in Qingdao were selected to evaluate the reliability and validity of the scale from October 2019 to January 2020. Results The Chinese scale retains 27 items,and 2 common factors were extracted after exploratory factor analysis. The cumulative variance contribution rate reached 69.562%. The item-level content validity index of the Chinese OB-QDTS is 0.83~1.00;the scale-level content validity index is 0.96;the Cronbach’s α coefficient of the total table is 0.953;the split-half reliability is 0.889.Conclusion The Chinese version of OB-QDTS has good reliability and validity,and it can be used to evaluate the quality of postpartum mothers discharge guidance in the context of Chinese culture.

Objective To explore the home rehabilitation experience of individuals with spinal cord injuries. Methods From June 2020 to April 2021,12 individuals with spinal cord injury during postoperative rehabilitation period were recruited from a tertiary hospital in Anhui Province by purposive sampling. Semi-structured interviews were performed to collect data,and qualitative content analysis was conducted to analyze the data. Results 3 themes regarding the experience of home rehabilitation for individuals with spinal cord injury were extracted,including the attitude towards rehabilitation（more inclined to home rehabilitation and the attitude towards rehabilitation exercise）,problems and coping styles in home rehabilitation（existing problems and coping styles）,the need for home rehabili-tation（the need for continuity of care services,the need for emotional relief,the need for external support）. Conclusion The choice of rehabilitation modes and the attitude of rehabilitation exercise of individuals with spinal cord injury are affected by many factors,and there are many problems and needs in the process of home rehabilitation. Medical staff should explore effective methods to help patients improve the quality of home rehabilitation based on their problems and needs. The improvement of continuous care system for individuals with spinal cord injury is the focus of future attention.

Objective To improve the project of reducing the incidence of catheter-associated urinary tract infection（CAUTI）through the management by objectives（MBO）,so as to enhance the quality by setting,implementing and completing goals. Methods The data of patients with indwelling catheters hospitalized in a tertiary Grade A General Hospital from April 2020 to September 2020 were analyzed. The project objectives and plans were developed through MBO. Besides,the project was implemented according to the plans,and an assessment of the process was carried out. Actions were taken to improve the project based on the feedback of assessment results. A month is set as a quality cycle. The quality of the first cycle is the baseline,and then the quality of each cycle is compared with the baseline data and the quality of the previous cycle. Results Compared with the baseline quality of 12 process indexes,6 indexes were statistically significant in the second cycle（P<0.05）. The results that were better than the baseline quality and the quality of the second cycle were statistically significant,compared with the baseline quality（P<0.001）. The baseline completion rate of 5 process indexes has reached a greater extent. Similar measurement data were obtained after that,indicating that high-quality nursing care was given. The indexes of the incidence of CAUTI at the end of the project were statistically significantly lower than the baseline（P<0.05）. The completion rate of the process indexes was over 95%,indicating that objectives were met. Conclusion MBO can be used for improvement in projects and goal-oriented management of indexes. It can also verify the effectiveness and further improve the quality by objectively measuring and scientifically comparing the quality of nursing care.

Objective To investigate the current states of cognitive impairment and to identify the influencing factors associated with cognitive impairment in community-dwelling older adults with chronic diseases. Methods A total of 734 patients aged 60 years or older with chronic diseases were recruited from a community health service center in Shanghai by convenient sampling method. Data on demographics,clinical information and lifestyle were collected. Montreal cognitive assessment basic scale（MoCA-B） was used to measure cognitive function. Results In the sample of 734 elderly patients with chronic diseases,373（50.8%） had cognitive impairment,including 326（44.4%） with mild cognitive impairment and 47（6.4%） with Alzheimer disease. The results of multivariate Logistic regression analysis showed that age,light physical household chores,physical exercise,frequency of playing wechat or computer,hobbies,hearing loss,and history of diabetes are all common influencing factors for mild cognitive impairment patients and Alzheimer disease patients. Low education and family history of dementia（P<0.05） are factors specially associated with mild cognitive impairment. The Kruskal-Wallis analysis showed that the types of chronic diseases had statistically significant differences in the average score of MoCA-B rank（P<0.05）. Conclusion Elderly adults with 4 chronic diseases in the community have a higher prevalence of cognitive impairment than those with single one chronic disease. Health clinicians should screen cognitive function for older adults to identify these vulnerable population as early as possible.

Objective This study aims to investigate risk factors associated with early-onset peritonitis（EOP）. Methods 243 patients with peritoneal dialysis,admitted from 1 June 2009 to 28 February 2017,were enrolled and followed until March 31,2018. Logistic regression model was used to evaluate risk factors associated with EOP. Results There were 74 patients with EOP. A multivariate logistic regression analysis showed that catheter exit-site infection was significantly associated with EOP（OR=2.635,95%CI=1.289~5.388,P=0.008）. The most commonly causative pathogens of EOP were gram-positive organism with 11 Cases（68.75%）. The most common causes of EOP were contamination of improper operation with 6 cases（8.1%）,diarrhea or constipation with 6 casews（8.1%）,and respiratory infections with 6 casews（8.1%）. Conclusion Catheter exit-site infection was the independent risk factor associated with EOP in peritoneal dialysis patients. In addition,gram-positive organisms were the most commonly causative pathogens of EOP,and improper operation,diarrhea or constipation,and respiratory infections were the most common causes of EOP.

Objective To explore the mechanism of resourcefulness between perceived pressure and depression in newly diagnosed breast cancer patients,and to provide a reference for psychological intervention of breast cancer patients from a new perspective. Methods From May to November 2018,510 newly diagnosed breast cancer patients from a tevtiary hospital in Henan Province were investigated with the Resourcefulness Scale,the Chinese version of the Perceived Stress Scale,and the Hamilton Depression Scale. Results Perceived stress,depression and resourcefulness were negatively correlated,and perceived stress was positively correlated with depression（P<0.01）. The mediating effect of resourcefulness on perceived stress and depression was 0.203,accounting for 36.8% of the total effect. Conclusion Resourcefulness is a mediator between perceived stress and depression in newly diagnosed breast cancer patients,suggesting that medical staff should pay attention to the level of resourcefulness of breast cancer patients and actively evaluate the resourcefulness level of newly diagnosed patients in order to redule patient stress and depression levels.

Objective To explore the effects of application of experiential learning in training of protective constraint skills among psychiatry junior nurses.Methods The training of experiential learning was performed in 60 psychiatry junior nurses for 8 weeks,according to Perception-Experience-Sharing-Communication-Integration-Application. The nursing care behavior scale and patient care perception questionnaire were used to evaluate nurses and patients before and after the training,and the clinical practice effect was investigated after 3 months,compared with the same period last year.Results The score of nursing care behavior scale was significantly higher than that before the training（P<0.001）,and the score of patients’ care perception questionnaire was significantly higher than that before the training （P<0.001）. After training,the restraint rate of patients decreased,but there was no significant difference. The incidence of restrictive nursing complications was significantly lower than that before training,and the difference was statistically significant（P<0.05）.Conclusion Experiential learning can improve the ability of humanistic care,reduce the incidence of restraint and restraint nursing complications.

Objective To analyze the related factors of abuse tendency among caregivers of elders with dementia in long-term care facilities,and to construct a risk assessment model,so as to provide evidence for early identification of abusive population in high-risk and formulation of intervention measures to prevent elder abuse.Methods A total of 307 caregivers of elders with dementia in 8 long-term care facilities were conveniently sampled and investigated from July to December 2018 by general information survey questionnaire,the Caregiver Abuse Screen for the Elderly(CASE),Neuroticism Extraversion Openness Five-Factor Inventory(NEO-FFI),Simplified Coping Style Questionnaire(SCSQ),Positive Aspects of Caregiver(PAC),General Health Questionnaire(GHQ-12).Results Self-rated difficulty of care and care recipients’ psycho-behavioral symptoms were the risk factors of abuse tendency among caregivers(OR=8.668,4.412). The protective factors of abuse tendency among caregivers were their agreeableness and openness(OR=0.888,0.940). The risk assessment model was Y=15 × X₁+10 × X₂-8 × X₃-4 × X₄(X₁：self-rated difficulty of care;X₂：psycho-behavioral symptoms;X₃：agreeableness;X₄：openness). The area under ROC curve was 0.856,the sensitivity was 81.0%,the specificity was 68.2%,the total coincidence rate was 74.6%. Hosmer-Lemeshow goodness of fit test showed that P=0.515 and the model fit was good.Conclusion Various related factors are involved in the occurrence of caregivers’ abuse tendency. The risk assessment model is effective in predicting caregivers’ abuse tendency,and has certain clinical application value.

Objective To establish a homogenized nursing linkage mode for wound care in the region to promote the homogenization of wound knowledge and skills in the region,and provide homogenized wound care for patients.Methods We developed a management software system for diagnosis and treatment collaboration for wound care in the region,and investigated the level of wound nursing care of nurses in Yangpu district,Shanghai,using self-designed survey questionnaire. From November to December,2016,seven international stoma therapists in Yangpu district were selected to form the team of teachers. From January to June,2017,30 nurses from six community health service centers engaged in wound care were selected as the experimental group,and received homogenized training. Thirty-two nurses from specialist team of a tertiary hospital were selected as the control group,and received routine specialist training. The differences in specialist theory,operation,and clinical practical nursing ability between two groups were compared.Results The results of baseline survey showed that the score of wound stoma team members was higher than that of community nurses, and the difference was statistically significant（t=-672.27,P<0.01）.There were no significant differences in scores of specialist theoretical knowledge and operational skills between community nurses receiving homogenized training and specialist team in tertiary hospital（P>0.05）. There was no significant difference in the clinical practical nursing ability between community nurses and specialist team in tertiary hospital（P>0.05）,the special nursing capacity in the two groups tend to be homogeneous.Conclusion The homogenized nursing linkage mode for wound care in the region is conducive to promoting the homogenization of specialized nursing capacity among different medical institutions.