Objective To understand the active exercise rehabilitation experience of elderly patients with chronic heart failure，and to provide a feasible basis for the construction of exercise rehabilitation intervention programs for elderly patients with chronic heart failure in hospitals. Methods The purpose sampling method is adopted，30 elderly patients with chronic heart failure in a tertiary hospital in Nantong were interviewed by semi-structured interviews，and the data were analyzed by Colaizzi’s seven-step method from October to December 2021. Results After the analysis of the interview data，3 themes were extracted. Cognition is the premise of patients’ exercise rehabilitation，including the transfer of external advantages and actively absorbing new information；belief is the motivation of patients’ exercise rehabilitation，including sports enthusiasm，sports awareness，and sports confidence；behavior is the foundation of patients’ exercise rehabilitation，including personalized formulation of sports prescriptions，enhanced adherence to sports, and positive incentives to exercise experience. Conclusion In the process of exercise rehabilitation，medical staff should actively guide them to form correct exercise cognition，stimulate the motivation of exercise rehabilitation，and ensure the formation and maintenance of exercise behavior.

Objective To investigate the quality of life of patients after fundoplication，and to analyze the influencing factors. Methods The convenience sampling method was used to select 223 patients who were hospitalized in the gastroesophageal reflux disease surgical diagnosis and treatment center of a tertiary hospital in Beijing from March 2021 to December 2022 as the research subjects. General information questionnaire，Quality index，General Hospital Anxiety and Depression Scale，Comprehended Social Support Scale，etc. were employed for investigation. Results A total of 207 valid questionnaires were collected，and the sample loss rate was 7.2%. At 3 months after operation，the physical and psychological quality of life of the patients were significantly improved compared with those before the operation（P<0.05），but were lower than the normative level of the healthy population in China（P<0.05）. Multivariate analysis showed that age，BMI，family per capita monthly income，anxiety，depression，and the number of postoperative complications were the influencing factors of patients’ physical quality of life（P<0.05），and BMI，anxiety，and depression were the influencing factors of patients’ psychological quality of life（P<0.05）. Conclusion 3 months after fundoplication，the quality of life of the patients was significantly improved compared with that before operation，but it did not return to the normal level. Postoperative nursing staff should focus on elderly patients，as well as patients with BMI<18.5，low per capita monthly family income，many postoperative complications，anxiety，and depression. It is recommended to take early intervention measures to promote the early return of patients to society.

Objective To explore the influencing factors of early activities in patients with acute ischemic stroke，and to provide bases for conducting individualized interventions. Methods 15 patients with acute ischemic stroke were interviewed by behavioral event interviews，and then the data were analyzed，and themes were extracted based on the Capacity，Opportunity，Motivation-Behavior（COM-B） system and Colaizzi 7-step analysis method. Results 3 themes of capability，motivation and opportunity were identified containing 12 subthemes：capability（physical dysfunction，perception of "incapacitation"，lack of early activity knowledge）；motivation（expectation of rehabilitation outcome，value perception of early activity，rehabilitation coping style，preference for exercise rehabilitation，early activity experience，rehabilitation self-efficacy）；opportunity（prescription and guidance of early activity，environment nudging，multiple external support）. Conclusion The influencing factors of early activity in patients with acute ischemic stroke are complex and diverse. Medical staff should pay attention to patients’ rehabilitation preference，formulate personalized activity prescription，establish multi-dimensional early activity nudging strategies and multiple external support systems，so as to improve the compliance of early activity，maximize the benefit of exercise rehabilitation，and improve the disease outcome.

Objective To investigate and analyze the gap between the current clinical practice and guidelines of insulin injection knowledge，attitude and practice，and to provide a basis for further construction of an intervention program for insulin injection knowledge，attitude and practice that conform to the actual situation in China. Methods The stratified random convenience sampling method was used to investigate 5550 nurses from 3 primary，7 secondary and 11 tertiary hospitals from July 28 to August 30，2019，using the general information questionnaire and the questionnaire of nurses’ knowledge，attitude and practice on insulin injection.SPSS26.0 was used for independent sample T test，variance analysis and correlation analysis on the influencing factors of knowledge，attitude and practice，and Mplus8.3 was used to analyze the path of influencing factors of knowledge，attitude and practice. Results The scores of nurse knowledge, attitude and practice on insulin injection were 68.17±15.76，87.22±13.34 and 93.74±7.97，respectively. There was a positive correlation between nurses’ insulin injection knowledge and attitude，knowledge and practice，attitude and practice scores（r=0.321，0.298，0.561，P<0.001）. Gender and professional title were the main influencing factors of nurses’ insulin injection knowledge scores. Knowledge，hospital level，number of beds，professional title，department，and the last time you engaged in insulin injection were the main influencing factors of nurses’ attitude score of insulin injection. Hospital level，education，knowledge and belief were the main influencing factors of nurses’ insulin injection practice score. Attitude played a partially mediating role in knowledge and nurses’ insulin injection practice. The total effect value was 0.299；the indirect effect was 0.163；the intermediary effect accounted for 54.5% of the total effect value. Conclusion There is still a big gap between clinical practice and guidelines of nurse knowledge，attitude and practice on insulin injection. Nursing managers should strengthen the evaluation of hospital nurses’ knowledge，attitude and practice of insulin injection，and take intervention measures according to the characteristics and influencing factors of nurses’ knowledge，attitude and practice of insulin injection to improve their knowledge，attitude and practice.

Objective To establish a consensus on perioperative urospesis nursing of patients with intracavitary surgery for urinary tract calculi. Methods A consensus developing group was established,and the first edition of the "Expert consensus on perioperative urosepsis nursing of patients with intracavitary surgery for urinary tract calculi"（hereinafter referred to as the "consensus"） was formed after a large amount of literature review and collation,online expert consultation and group discussion. Domestic medical experts from urology,minimally invasive operating rooms and intensive care units were invited to discuss and revise the "consensus" for 2 rounds,and then peer review was conducted,and finally the "consensus" was completed. Results The final version of the "consensus" comprises 3 major sections,namely the preoperative,intraoperative and postoperative,which covers high-risk factors,prevention,identification,condition monitoring and nursing intervention,with a total of 21 items. The positive coefficients for the 2 rounds of consultations were 100%. The coefficients of judgment,familiarity and authority in the 2 rounds of consultations were 0.975,0.960 and 0.968,respectively. In the 2 rounds of expert consultations,the importance assignments of each items were（4.847±0.304） and（4.888±0.212）,and the overall Kendall’s coefficients were 0.232 and 0.287,respectively. Conclusion The "consensus" integrates the suggestions of multidisciplinary experts with a certain degree of practicality,representativeness and scientificity. It can provide guidance for clinical nursing practice of patients with perioperative urosepsis of intracavitary surgery for urinary tract calculi.

Objective To investigate the status of insulin injection management in hospitals at all levels in 31 provinces and autonomous regions,so as to provide references for promoting standardized and homogenized management of insulin injection in hospitals. Methods Nursing managers in 1 075 hospitals in 31 provinces,municipalities and autonomous regions were surveyed by stratified random cluster sampling from January to February 2019 with a self-designed questionnaire. Results A total of 1 075 valid questionnaires for nursing managers from nursing departments,and 1 5794 valid questionnaires for nursing managers from clinical departments were collected. 976（90.79%） surveyed hospitals manage insulin as a high-risk drug. More than 80% surveyed hospitals formulated insulin injection specifications at the hospital level or department level,provided regular training and assessment,and organized insulin injection training for new nurses. 828 hospitals（77.02%） regularly carried out insulin management quality control. More than 80% of the departments are equipped with multiple types of cardinal insulin and placed in special places,stored insulin in use in special places,stored opened insulin at room temperature. 90.53% of the doctors in the department prescribed injection orders for patients with self-provided insulin;insulin management institution and insulin management status of departments in different levels of hospitals,and insulin management status in different departments showed statistically significant differences （P<0.001）. Insulin management was more standardized in hospitals with regular quality control of insulin management（P<0.001）. Conclusion Insulin management institution in hospitals at different levels in China needs to be improved,and the quality of insulin management in departments needs to be improved. Insulin management in different hospitals and departments needs to be homogenized. It is necessary to strengthen the insulin injection management in primary hospitals and non-endocrinology departments. Relevant academic organizations should issue the standard of insulin injection management in hospital to promote the standardized management of insulin injection in hospitals.

Objective To compare the screening ability of the Timed Up and Go Test (TUG),Berg Balance Scale (BBS),Single Leg Stance (SLS) and Brief-Balance Evaluation Systems Test (Brief-BESTest) for fall risk in people with chronic obstructive pulmonary disease (COPD),and to provide references for clinical selection of appropriate screening tools for balance function. Methods From February 2020 to February 2021,a total of 86 COPD patients hospitalized in the department of respiratory and critical care medicine of a tertiary hospital in Guangdong were selected by convenience sampling method. Their balance abilities were assessed using the TUG,BBS,SLS and Brief-BESTest. Taking 3-month history of falls as the diagnostic standard,the identification ability of the 4 scales for falls was compared by Bayes discriminant analysis and the area under the receiver operating characteristic curve (AUC). Results The cross-validation accuracy of TUG,BBS,SLS and Brief-BESTest were 60.47%,68.60%,51.16% and 72.09%. The Brief-BESTest showed the biggest area under ROC curve (0.818),compared with BBS (0.758),TUG (0.686) and SLS (0.568). At the cutoff score of 14,the Brief-BESTest demonstrated a positive test accuracy of 0.786 with the sensitivity of 0.739,the specificity of 0.825. Conclusion Among the 4 balance function tests,brief-BESTest was the best at screening a history of falls in COPD patients. Brief-BESTest was recommended for clinical staff to assess balance and predict fall risk in patients with COPD.

Objective To translate and revise the Father Support Breastfeeding Self-Efficacy Scale-Short Form（BSES-SF）,and to test its reliability and validity. Methods By using the Brislin translation model to interpret the scale into Chinese,the experts modified it based on Chinese culture and 34 maternal spouses were selected to pre-investigate and modify some items. Clinically,210 postnatal mothers and their spouses were selected to test the reliability and validity of the scale. Results There were 14 items in the Chinese FBSES-SF scale. One factor was extracted after the exploratory factor analysis,and the factor cumulative variance contribution rate was 55.038%. The result of confirmatory factor analysis has showed that the total scale and subscales fitted well with the structure model. The Cronbach’s α coefficient of the total scale was 0.935;the half-fold reliability of the total scale was 0.930;the test-retest was 0.811. The Scale-Content Validity Index（S-CVI） was 0.976;the Item-Content Validity Index（I-CVI） ranged from 0.83 to 1.00;the correlation coefficient between each factor ranged from 0.389 to 0.643;the correlation coefficient between each factor and the total score of the scale ranged from 0.633 to 0.798. All of the analysis above showed statistical significance（P<0.01）. Conclusion The Chinese version of FBSES-SF scale is an effective tool for assessing father’s self-confidence in maternal breastfeeding. The scale score can predict the maternal feeding pattern. The low score exhibits a dangerous signal to stop breastfeeding earlier in the postpartum period. It helps clinical experts to increase maternal feeding confidence by intervening the attitudes of new fathers.

Objective To understand the current situation of perioperative hypothermia management in 85 hospital operating rooms in Guangdong Provinces,so as to find out the deficiencies and provide references for the nursing practice in operating rooms. Methods A convenient sampling method was used to conduct a questionnaire survey on all the members of the Operating Room Professional Committee of Guangdong Nursing Association in February 2019. A self-developed questionnaire was used,including general information and the current management of perioperative hypothermia. Results A total of 85 valid questionnaires were received,with an effective recovery rate of 98.84%. 23（27.06%） hospitals have implemented pre-warming;Only 6 hospitals（7.06%） carried out perioperative hypothermia risk assessment. 21（48.84%） tertiary hospitals and 9（25.71%） secondary hospitals have established hypothermia emergency plans,with statistical differences（ χ ²=4.359,P=0.037）;in 25（58.14%） tertiary hospitals and 1（2.86%） secondary hospitals,the core temperature was measured by the same method before operation,and the difference was statistically significant（ χ ²=24.106,P<0.001）. 34（40.00%） hospitals required temperature handover after operation. 20 hospitals（23.53%） paid attention to the temperature regulation of patient transferring environment after operation. Conclusion Perioperative temperature management in 85 hospitals in Guangdong Province was incomplete. The implementation rates of pre-warming,risk assessment of hypothermia and establishment of emergency procedures,the same temperature measurement method of preoperative and intraoperative temperature,postoperative handover temperature,adjustment of the post-transport environment temperature are not high. Perioperative hypothermia prevention knowledge training and practice need to be strengthened and promoted.

Objective To establish a nursing guideline for needle-free injection to diabetics. Methods The nursing problems in the needle-free insulin injection process were listed based on systematic literature research and references to experts’ clinical experience. A questionnaire to experts was designed. Based on Delphi Technique and expert meeting results,each item was modified and improved after objective evidence and expert opinions were summarized. Results A consensus was reached on 4 major themes: needle-free injection procedure,common problems and solutions,quality control and management,and health education. Conclusion Work guidelines for needle-free insulin injection to diabetics can provide the clinical nursing staff with some references on implementation of needle-free insulin injections.

Objective To investigate the status of training of diabetes specialist nurses（DSN） in different provinces and cities nationwide in China. Methods Totally 3918 DSN in China were investigated by a self-designed questionnaire via WJX platform in October 2018 by convenience sampling. Results After training of DSN,theoretical knowledge received the most improvement of（4.70±0.54）,and scientific research ability had the least improvement of（3.83±1.06）. The overall capacity improvement of DSN in eastern region was significantly better than that in western region（ P<0.05）. Conclusion The training of DSN in different regions is relatively good,but there is still much room for improvement in scientific research ability,and the overall ability of DSN has obvious regional differences. It is recommended to form national standardized DSN training system,expand and standardize regional DSN training programs to improve the construction of talent teams of DSN.

Objective To investigate the clinical safety of pulling peripheral venous indwelling needle according to clinical indications,and compare its effect with conventional indwelling needle extraction. Methods A multicenter randomized controlled trial was conducted with a total of 3,669 patients in 12 tertiary general hospitals from March 2019 to July 2019. The patients were randomly allocated into the observation group（group A） and the control group （group B） by the random number table. The puncture methods were consistent between the two groups. Researchers compared the indwelling time,the incidence of catheter-related complications within 96 hours,and the risk ratio of catheter-related complications during the entire indwelling period（phlebitis,occlusion,and infiltration,suspected infection） between two groups,among which phlebitis was the primary outcome indicator and other complications as secondary outcome measures. Results A total of 3,642 patients were enrolled in the study with 1,803 cases in group A and 1,839 cases in group B. The indwelling time of group A was（85±52）h and it was longer than that of （71±30） h in group B with a statistical difference（P<0.001）. Within 96 h of indwelling time,there was no statistical differences in the risk of phlebitis,infiltration and suspected infection between two groups（P>0.05）. During the entire indwelling period,the risk of occlusion in group A was higher than that in group B with a statistical difference（P<0.05）. The other indicators showed no statistical difference. Conclusion The placement of indwelling needle based on clinical indications can prolong the indwelling time without increasing the risk of phlebitis,infiltration and suspected infection,but the risk of occlusion will increase. If the catheter is removed according to clinical indications,monitoring and evaluation of occlusion should be strengthened.

Objective To explore the timing of early postoperative respiratory function training in patients with lung cancer. Methods Thirty patients admitted to hospital from March to April 2018 were enrolled in the control group for routine respiratory function training. Thirty patients admitted to hospital from April to May 2018 were selected as the experimental group and received early respiratory function training when nebulization and analgesics treatments were effective. Pain level and exercise compliance of two groups were compared. Results The pain score of the experimental group was significantly lower than that of the control group（P<0.001）. The exercise compliance in the experimental group was significantly higher than that of the control group（P<0.001）. Conclusion Respiratory function training for patients after lung cancer surgery when nebulization and analgesics treatments are effective,can effectively alleviate the pain caused by respiratory function exercise and improve exercise compliance.

Objective To establish expert consensus on medical protocol prescription for blood glucose monitoring in hospitalized adult patients with hyperglycemia. Methods Targeting key issues in blood glucose monitoring among hospitalized adult patients with hyperglycemia,literatures at home and abroad were retrieved,and clinical experience of medical and nursing experts were taken into consideration,to design expert questionnaire. Each item was revised and improved through two rounds of Delphi expert consultation and expert meeting. Results Consensus on medical protocol prescription included four aspects：prescription for blood glucose monitoring,glycemic control goals,health education for blood glucose monitoring,and quality control for blood glucose monitoring. Conclusion The consensus has strong reliability and practicability,which is helpful to guide development of clinical systematic and standardized monitoring program,improve quality of clinical management,lay a solid foundation for the development of nurses’ prescription in China.

Objective To investigate perioperative period blood glucose management and cognition among surgical nurses,and analyze the influencing factors. Methods A self-designed questionnaire was carried out online from May 2016 to May 2018,including general information,basic information of departments,and knowledge of perioperative period blood glucose management. Totally 1819 surgical nurses in 69 secondary and tertiary hospitals were included. Results The nursing standards for diabetic patients in surgical department were not complete,and the surgical nurses' cognition of perioperative period blood glucose management was at a low level. The correct number of the 10 questions was 2.00（1.00,3.00）,and their mastery of relevant knowledge was far lower than their self-evaluation level. Hospital grade,education,professional title,position,“diabetes contact nurse in the department” and “participated in inpatient diabetes management training” could improve the number of correct number of answers. Conclusion The blood glucose management of surgical departments needs to be strengthened,surgical nurses have poor knowledge of perioperative period blood glucose management. The surgical department should actively carry out construction of blood glucose management,such as setting up diabetes contact nurses,strengthening the training of perioperative period blood glucose management,etc.,to improve the diabetes prevention and treatment ability of medical institutions and the level of diabetes care and management.