Objective To explore the mediating effects of perceived stress and uncertainty tolerance on health literacy and decision satisfaction of decision makers in patient undergoing cardiac macrovascular surgery，and to provide references for improving the satisfaction of decision-making. Methods 260 surgical patient’s decision-makers in the cardiac macrovascular surgery of a hospital in Wuhan were selected by convenience sampling. All Aspects of Health Literacy Scale，Perceived Stress Scale，Intolerance of Uncertainty Scale-12 and decision satisfaction scale were used to investigate. Results 251 valid questionnaires were recovered，with an effective recovery rate of 96.54%. The health literacy score was（23.05±5.61）；the perceived stress score was（20.31±6.08）；the uncertainty tolerance score was（26.41±5.94）；the decision satisfaction score was（43.86±10.54）. The 4 variables were correlated（P<0.001）. The mediating model found that health literacy had a significant direct effect on decision satisfaction. Meanwhile，health literacy also indirectly affected decision satisfaction through 3 paths，including the independent mediating effect of perceived stress（β=0.096，P<0.001），the independent mediating effect of uncertainty tolerance （β=0.093，P=0.001），the chain mediating effect of perceived stress and uncertainty tolerance（β=0.076，P<0.001），accounting for 49.17% of the total effect. Conclusion Perceived stress and uncertainty tolerance play a mediating role in the relationship between health literacy and decision satisfaction of decision makers in cardiac macro-vascular surgery，which can improve decision makers’ health literacy，reduce perceived stress，and help them perceive surgical risks rationally，thus improving decision satisfaction.

Objective To monitor the quality of intravenous infusions in a constructed closed-loop tracking system，and to discuss its application effect. Methods The information program is reinvested in a team for the closed-loop tracking system of the intravenous infusion. There are modules of processing medical orders，pharmacy preparations，execution procedures with the doctor’s orders，as well as the computing module. The system was put into clinical trial operation in November 2021 and officially applied in January 2022. Specifically，the number of infusion-related adverse events/red-light alert is recorded and compared before（January to December 2021） and after（January to December 2022） the application of the system. Random sampling method has been performed in a ward to investigate the amount of abnormal infusion for the comparison. Results It is shown that it occurred 3 times for the infusion-related adverse events before the operation of the system，and a time after that. In the neurological inpatients，we observe the amount of red-light alert as 5，120.25±775.82 before the system operation，and 1，518.25±74.77 after that. It is shown to decline by 70.35% on average with statistical significance on the total difference（P<0.001）. Monthly amount of infusion in the ward is 5，184 with 155 times of overfast（2.99%）for 775 minutes in total，and with 207 times of slow（3.99%） for 1，035 minutes in total. The average handling time per contact is 5 minutes. Conclusion The closed-loop tracking system for intravenous infusion quality monitoring can track and record the whole process of intravenous infusions. It is expected to provide accurate and objective data for closed-loop quality inspection on clinical nursing practice，which is conducive to nursing managers for any potential problems during infusion processing timely，to promote standardized nursing operations，and to further improve the safety of inpatients with intravenous infusion and medication.

Objective To explore effect of an intervention program based on co-parenting theory. Methods By judgment sampling method，90 parents of premature infants and their parents admitted to neonatal intensive care unit in a tertiary A hospital in Yangzhou，Jiangsu Province from June to December 2021 were selected as the research subjects. They were divided into a control group and an experimental group with 45 pairs in each group. In addition to routine nursing，the experimental group received co-parenting breastfeeding support based on co-parenting theory. The control group only adopted routine nursing. The 2 groups of premature infants were measured by mothers’ perception of co-parenting，family support for breastfeeding，breastfeeding attitudes，breastfeeding rate and duration of exclusive breastfeeding before discharge，2 weeks，4 weeks and 6 weeks after discharge. Results 12 pairs of preterm infants dropped，and 38 pairs were included in the experimental group and 40 pairs in the control group at last. Scores of mothers’ perception of co-parenting，family support for breastfeeding，breastfeeding attitudes in the experimental group were higher than those in the control group 2 weeks，4 weeks and 6 weeks after discharge，and the difference was statistically significant（P<0.05）. The exclusive breastfeeding rate of the experimental group was higher than that of the control group 4 weeks and 6 weeks after discharge（P<0.05）. The duration of exclusive breastfeeding after discharge in the experimental group was higher than that in the control group，and the difference was statistically significant（P=0.003）. Conclusion The breastfeeding support program based on co-parenting theory implemented in NICU hospital-family transitional period of preterm infants can improve mothers’ perceptions of co-parenting，perceptions of breastfeeding family support and attitudes towards breastfeeding，increase exclusive breastfeeding rates and extend the duration of exclusive breastfeeding.

Objective To develop an assessment scale of discharge planning demand for hospitalized elderly patients,and to test its reliability and validity. Methods The assessment scale draft was constructed by the literature analysis method and 2 rounds of Delphi consultations. The data of 242 hospitalized elderly patients was collected from October 2020 to July 2021,and the content validity,inter-rater reliability and predictive validity of the scale for unplanned readmission within 31 days were further tested. Results The scale contains 34 items in 9 dimensions. The content validity index of the scale was 0.933;the area under the ROC curve was 0.975;the confidence interval of 95% was 0.958~0.992（P<0.001）;the optimal critical value was 5.5;the corresponding sensitivity was 0.972 and specificity was 0.903;the inter-rater reliability was 0.951. Conclusion The scale of discharge planning demand for hospitalized elderly patients has good reliability and validity,and it can be used in clinical practice to assist in the identification and prediction of high-risk elderly patients for unplanned readmission.

Objective To investigate the impact of a multi-component exercise program based on Wechat applet on improving exercise adherence and the frailty state. Methods 95 pre-frailty of the elderly in a community in Beijing were randomly divided into 2 groups. On the basis of explanation and demonstration，the Wechat applet group used the multi-component exercise course of Wechat applet. The health education group used the way of explanation and demonstration to carry out multi-component exercise health education. The exercise adherence，frailty state and physical function were compared between the 2 groups. All subjects received 3-month intervention. Results 89 participants completed the study. The implementation of the multi-component exercise programs，the improvement of frailty and the improvement of walking speed in the Wechat applet group were better than those in the health education group（P<0.05），but there was no significant difference on grip strength，SPPB and TUGT between 2 groups（P>0.05）. Conclusion The multi-component exercise intervention based on Wechat applet is helpful to enhance the exercise adherence and improve frailty state of the elderly.

Objective To explore the perceptions and suggestions of nurses in long-term care of older patients with mild cognitive impairment（MCI） on the participation of these patients in shared decision making,and to provide references for promoting the implementation of shared decision making. Methods Using the descriptive phenomenological research method,semi-structured interviews were conducted from November 2020 to February 2021 with nurses from 3 tertiary hospitals in Beijing who had the experience of providing health-care services to older patients with MCI,and Colaizzi 7-step analysis method was used to analyze the data. Results Perception of nurses on elderly MCI patients’ participating in shared decision making can be summarized into 5 themes：①respect for patients’ preferences,②guarantee of comprehensive improvement of nursing quality,③limitations by patients’ decision-making ability,④negative emotional coping affected patients’ participation,⑤clinical implementation was restricted. Suggestions from nurses were as follows：①further inspire patients’ decision-making awareness,②call for family support,③expect to improve the implementation conditions. Conclusion Shared decision making has important practical significance,but there were some obstacles in its clinical implementation. In the future,it is necessary to strengthen the decision-making consciousness of patients,cultivate the decision-making ability of nurses,improve the implementation conditions of shared decision making,so as to give full play to the guiding role of nurses.

Objective To construct a clinical nursing practice plan of discharge planning for elderly patients with chronic heart failure based on the best evidence,and to evaluate its application effects. Methods Evidence-based methods were used to systematically retrieve and summarize the best evidence for the application of discharge planning for elderly patients with chronic heart failure. Based on the best evidence,review indicators were formulated and baseline review was conducted,and promoting and inhibiting factors were analyzed. Implementation rates of review indicators,the knowledge of nurses,and the discharge readiness and self-management ability of patients were compared before and after the application of the evidence-based practice plan. Results After the application of the evidence-based practice plan,the discharge readiness scores of patients increased from（168.74±32.26） to（192.94±21.20）;the self-management scores of patients increased from（46.03±13.47） to（57.87±9.22）. The knowledge scores of nurses increased from（56.67±11.00） to（71.56±15.33）. Except for the review indicator 4 and 10,the implementation rate of the review indicators were all increased to more than 90%. Conclusion Evidence-based nursing practice can standardize the implementation of discharge planning,improve the knowledge of nurses,and contribute to the improvement of discharge readiness and self-management ability of elderly patients with chronic heart failure,which is beneficial for patients to cope with post-hospital rehabilitation.

Objective To summarize the experience of prevention and control management in a hemodialysis centers during the coronavirus disease 2019（COVID-19） epidemic,and to improve the effects in order to reduce the occurrence of COVID-19 infection. Methods Through developing the standards for prevention and control of COVID-19 in hemodialysis centers,267 hemodialysis centers in Zhejiang province were trained in the aspects of organization management,prevention and control procedures,patient education and management,staff training and management. We also standardize the diagnosis procedures of hemodialysis during the COVID-19 epidemic,and standardize the isolated hemodialysis procedures of confirmed cases,suspected cases and patients observed at home. Results There were 2 confirmed COVID-19 cases out of 32071 hemodialysis patients in Zhejiang Province,and 10 hemodialysis patients in close contact with them were also taking isolation dialysis. No COVID-19 infection occurred after medical observation of 14 days. There were also no infections after 14 days’ medical observation among 8 suspected cases and 78 home observation patients who were treated with standard isolation dialysis or continuous renal replacement therapy. None of the 4 700 medical staff suffered from the nosocomial infections of COVID-19. Conclusion The practice in hemodialysis centers is effective in preventing and controlling the COVID-19 infection in the provincial hemodialysis centers, which can reduce or even block the infection in hemodialysis patients

Frailty is a common geriatric syndrome that seriously affects the quality of life and health outcomes of the elderly. However,frailty is a reversible process,and it can be delayed or improved by effective interventions. At present,non-pharmacological intervention is the most important intervention. This paper reviews the research progress of exercise intervention,nutrition intervention,multi-factor intervention and other intervention methods in recent years,so as to provide references for management of frail elderly. Meanwhile,it summarizes the effect evaluation indexes of non-pharmacological intervention,in order to provide the basis for carrying out related research and exploring effective non-pharmacological interventions for the frail elderly.