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    15 August 2019, Volume 54 Issue 8
    Research Paper
    The effects of narrative therapy on stigma of patients with permanent stoma
    ZHANG Kuanxin, QU Qing-rong, SHI Peiyu, WANG Bixuan
    2019, 54(8):  1125-1129.  DOI: 10.3761/j.issn.0254-1769.2019.08.001
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    Objective To explore the effects of narrative therapy on stigma in permanent stoma patients. Methods A total of 47 patients with permanent stoma were recruited from April 2018 to November 2018 in the department of gastroenterology and colorectal surgery,and were given narrative therapy:totally 8 times,30 to 45 mins for each time,once per week,through one-on-one,face-to-face or video call. Social Impact Scale(SIS) and Ostomy Adjustment Inventory-20 were used to evaluate the effects of intervention. Results At the times of one day before discharge,after intervention and one month after intervention,the scores of SIS were 59.64±6.62,53.87±8.78,and 47.98±8.47,the time effect of stigma level in permanent stoma patients were statistically significant,F=179.078,P<0.001. The scores of OAI-20 were 40.49±7.13,45.68±6.87,and 46.70±7.11,and the differences were statistically significant,F=75.295,P<0.001. Conclusion Narrative therapy can reduce the stigma level in permanent stoma patients and improve the level of psycho-social adaptation.

    Symptom clusters and influencing factors in liver transplantation recipients
    CHEN Xiao, ZHANG Yuxia, YU Jingxian, ZHOU Haiying, XIAO Wenjie, ZHAO Yi, WANG Yan
    2019, 54(8):  1130-1135.  DOI: 10.3761/j.issn.0254-1769.2019.08.002
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    Objective To identify types,constitution,distribution of symptom clusters among liver transplantation recipients,and analyze the influencing factors,so as to lay foundation for symptom management. Methods We conducted a cross-sectional study to evaluate 342 liver transplantation recipients’ symptom characteristics using two self-designed questionnaires. We adopted exploratory factor analysis to identify symptom clusters and analyzed the influencing factors by logistic multivariate regression analysis. Results The five most common symptoms of participants were fatigue(38.6%),decreased memory(34.5%),easy wakening up(33.5%),difficulty in falling asleep(31.9%),and dreaminess(28.1%). Three symptom clusters were identified,including sleep-related symptom cluster,nervous system symptom cluster,and reduced activity tolerance symptom cluster. Liver cancer as the primary disease,and disease belief were the independent predictive factors of symptom clusters. Conclusion Liver transplantation recipients experienced complicated symptoms,which were mutually enhanced and existed as symptom clusters.Appropriate intervention should view a symptom cluster as an unit and assist patients to form correct recognition towards disease,to help patients involve disease management into individual and family’s normal activities.

    Development and application of a training system for nurses’ comprehensive emergency response competency
    LIU Hualing, ZHAO Huifen, ZENG Yiming, HUANG Xuejia, WANG Lihui, XIE Ruiyun, FANG Zhumei, CHEN Shuping
    2019, 54(8):  1136-1141.  DOI: 10.3761/j.issn.0254-1769.2019.08.003
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    Objective To construct a training system for nurses’ comprehensive emergency response competency based on clinical needs and evaluate its effects of application. Methods The training system of nurses’ comprehensive emergency response competency was developed by baseline survey and Delphi technique,which was applied in clinical nurses’ training in a tertiary hospital in Fujian Province from August 2017 to May 2018. The effects were evaluated by scores of items before and after the training and scores of nurses’ professional value recognition. Results The established emergency competency training system covered rescue ability,critical thinking ability,communication and coordination ability,humanistic care ability and occupational protection ability of nurses in emergency state,with a total of 44 courses and 40 class hours. The scores of each item after the training were higher than those before the training and the differences were statistically significant(P<0.05). The scores of nurses’ professional value recognition after training were significantly higher than before,and the differences were statistically significant(P<0.05). Conclusion The training system for nurses’ comprehensive emergency response competency is scientific and reliable,which can improve comprehensive emergency competency of clinical nurses and provide reference for clinical nurses’ training.

    Special Planning-Diabetes Care
    Consensus on medical protocol prescription for blood glucose monitoring in adult inpatients with hyperglycemia
    MO Yongzhen, ZHAO Fang, YUAN Li, XING Qiuling, ZHANG Mingxia, ZHAO Chunyan
    2019, 54(8):  1142-1146.  DOI: 10.3761/j.issn.0254-1769.2019.08.004
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    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.

    The application of preoperative oral glucose intake in thyroid cancer patients with diabetes
    ZENG Dingfen, JIANG Yanhua, JIANG Man, YANG Jing, TIAN Rendi, FAN Yuxia, JIANG Hua, ZHANG Tian, LI Chao, ZHOU Yuqiu
    2019, 54(8):  1147-1151.  DOI: 10.3761/j.issn.0254-1769.2019.08.005
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    Objective To explore the feasibility of oral glucose intake before surgery in thyroid cancer patients with diabetes for the purpose of decreasing complications and increasing comfort. Methods Between January 2017 and July 2018,98 patients with thyroid cancer and diabetes were selected as the experimental group,and were further randomly divided into two subgroups:experimental group 1 and experimental group 2. Fifty-two patients diagnosed between January 2016 and December 2016 were selected as the control group. Experimental group 1 received preoperative warm water intake,experimental group 2 had preoperative oral 5% glucose intake,and the control group was traditionally abstinent from food and water before surgery. Blood glucose,C reactive protein,throat pain,incision infection,incision healing,indwelling time of plasma drainage tube,thirsty score among three groups were compared. Results For blood glucose,there was significant difference between experimental group 1 and 2(P<0.001),and there were no differences for the rest. For C reactive protein,there were significant differences among three groups(P<0.05),a significant difference was found between the control group and experimental group 1 and 2(P<0.05). For throat pain,there were significant differences between the control group and experimental group 1 and 2,but no significant difference was found between experimental group 1 and 2(P>0.05). For complications,there were significant differences among three groups in delayed incision healing and thirst(P<0.05),and no significant difference was found in incision infection(P>0.05). Conclusion Preoperative oral 5% glucose intake doesn’t increase postoperative blood glucose level among thyroid cancer patients with diabetes,relieves throat pain and thirst,reduces postoperative stress,decreases chances of delayed incision healing.

    Characteristics and causes of dietary behavior changes for women with gestational diabetes:a qualitative stuy
    ZHU Shurong, WEI Birong, WANG Zhiping, GUO Shengbin, LIN Ying
    2019, 54(8):  1152-1156.  DOI: 10.3761/j.issn.0254-1769.2019.08.006
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    Objective To explore the characteristics and causes of dietary behavior changes in women with gestational diabetes. Methods Purposive sampling method was used to select pregnant women with gestational diabetes from July to August 2018 in one obstetric clinic of a tertiary hospital in Putian for semi-structured interviews. Golaizzi’s analysis method was used to transcribing interviews,constantly compare and summarize data and generate themes. Results Four themes emerged include lack of knowledge and cognition about the disease,active control and passive eating emotions and attitudes,active coordination and passive coping with eating behavior,and multiple influencing factors of dietary behavior changes. Conclusion In the process of adapting to diabetic diet,pregnant women with gestational diabetes have positive or negative emotional attitudes and behaviors,which are influenced by many factors.

    Qualitative study on caring experience of main caregivers of elderly with type 2 diabetes mellitus in Hui ethnic group
    ZHANG Zehan, HAO Wennü, LI Xinxia
    2019, 54(8):  1157-1160.  DOI: 10.3761/j.issn.0254-1769.2019.08.007
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    Objective To understand caring experience of main caregivers of elderly patients with type 2 diabetes in Hui ethnic group,and to provide reference for nursing program suitable for Hui culture. Methods Fifteen main caregivers of elderly patients with type 2 diabetes mellitus of Hui ethnic group were interviewed by semi-structured in-depth interviews. Results Four themes were extracted:experience of love,heavy burden of elderly and female caregivers,influence of Hui culture and living customs on diseases,and gratitude and expectation of social support system. Eight sub-themes:perspective from husband and wife:gratitude,caring as a practice;perspective from children:feeding back,love feedback;neglect of own health in elderly caregivers;more devotion from women;unique view of life and death,sadness no longer as the main theme;conflicts between customs and health;gratitude to the country,lighter burden for seeing a doctor;low rate of disease awareness,and desire to receive professional care support. Conclusion The perceived burden of main caregivers of elderly patients with type 2 diabetes mellitus in Hui ethnic group is not heavy.The elderly and female caregivers have heavy burden of care. Caring experience and behaviors are influenced by Hui culture and customs. Main caregivers have inadequate disease related knowledge,traditional culture and healthy eating habits have conflicts,and nursing support in line with cultural characteristics is appreciated.

    Standards
    Expert consensus on clinical application of disposable absorbent care products for adults with incontinence
    GAO Yanhong, WU Xinjuan
    2019, 54(8):  1165-1169.  DOI: 10.3761/j.issn.0254-1769.2019.08.009
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    Objective To form an expert consensus on the clinical application of disposable absorbent care products for adult incontinent patients. Methods Through systematically reviewing domestic and foreign literatures as well as combining with laboratory results,domestic experts were invited for evaluation,expert meeting method and Delphi expert consultation method were used to form the consensus combined with laboratory data and expert opinions,and all items were modified and improved. Results A total of 20 items were agreed on the index requirements and clinical application on disposable absorbent care products for adults with incontinence. Conclusion The established consensus can provide guidance on assessment,utilization,and evaluation of disposable absorbent care products for adult incontinent patients during hospitalization,and can provide clinical standardized guide for skin environmental protection for hospitalized incontinent patients.

    Specialist Pratice and Research
    Design and application of ICU transitional care checklist
    WEI Xiuxia, ZHANG Yajun, LI Qinghe, YIN Qin, YUAN Tiantian
    2019, 54(8):  1170-1174.  DOI: 10.3761/j.issn.0254-1769.2019.08.010
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    Objective To explore the effects of ICU transitional care checklist in patients undergoing cardiac surgery. Methods Totally 156 patients were recruited in a tertiary hospital in Yancheng from January 2017 to December 2018. Eighty-one patients recruited from January to December 2018 were selected as the experimental group and applied with ICU transitional care checklist combined with routine care,whereas 75 patients recruited from January to December 2017 were selected as the control group and received only routine care. The outcomes were transfer time,degree of postoperative pain at rest,incidence of postoperative complications,time of early ambulation,cost of hospitalization,length of hospitalization,and satisfaction. Medical staff were interviewed for attitude towards the checklist. Results After application of the checklist,ICU transfer time in the experimental group was significantly reduced(t=2.16,P<0.05). There was no difference between two groups in pain degree at rest 48 hours after operation and before transferring from ICU(P>0.05). The pain degree at rest a week after transferring from ICU,incidence of postoperative complications,and first time of early ambulation in the experimental group decreased significantly(P<0.05). There was no significant difference in time and cost of hospitalization between two groups(P>0.05). Patients satisfaction of the experimental group was significantly higher than that in the control group(P<0.05). Medical staff’ satisfaction was over 96%. Medical staff were satisfied with application of the checklist. Conclusion The ICU transitional care checklist can reduce ICU transfer time,improve postoperative stress and complications in patients during cardiac perioperative period,and improve patients’ and medical staffs’ satisfaction.

    Implementation of best evidence on early mobilization among patients after liver resection
    SONG Jianping, LU Fangyan, WU Xiaoyan, XU Caijuan, FENG Xiuqin, LU Jienan, YANG Jing, HE Feng, JIN Jingfen
    2019, 54(8):  1175-1179.  DOI: 10.3761/j.issn.0254-1769.2019.08.011
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    Objective Based on best evidence summary on early mobilization among patients after liver resection, evidence-based quality examination criteria were established, and barrier factors for early mobilization after liver resection were analyzed and corresponding countermeasures were implemented. Methods Carry out the training and examination for all medical staff, set up goals for daily activities and standard operating procedure, strength preoperative education, choose the best timing for early mobilization, assess postoperative pain during activities dynamically, use self-oriented assistant equipment, encourage patients to leave the beds, systematically and regularly review the compliance and clinical results. Results The countermeasures were able to improve knowledge in medical staff, make an earlier mobilization after surgery in patients, improve the completion rate of daily activities, make an earlier initial anal exhaust, decrease the incidence of severe pain(pain scored≥4). Conclusion Evidence-based practice ensure a safe and rapid recovery.

    Correlation between exercise compliance after discharge and health belief in patients underwent hip arthroplasty:a longitudinal study
    LI Xinxin, Lü Qiyuan, LI Jiangzhen, ZHANG Meifen
    2019, 54(8):  1180-1183.  DOI: 10.3761/j.issn.0254-1769.2019.08.012
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    Objective To describe the dynamic change of exercise compliance after discharge and health belief among patients underwent hip arthroplasty at different stages and explore the correlation. Methods A prospective study was employed. Convenience sampling was used to recruit 195 cases of patients underwent hip arthroplasty,and the self-designed questionnaire of exercise compliance and new Health Belief Scale were used for investigation. Results At 1,3,6 months after arthroplasty,patients’ exercise compliance was at moderate level and showed a descending trend. The rates of exercise compliance were(62.60±11.87)%,(57.47±11.16)%,(52.67±10.33)%,respectively. Patients’ health belief scores were(153.72±17.60),(151.01±14.53),(150.05±12.83),respectively,which were above the average and showed a descending trend. Exercise compliance after discharge was correlated with health belief(r=0.354~0.491,P<0.01). Conclusion Higher level of patients’ health belief was related to better exercise compliance after discharge. Medical staff should provide corresponding appropriate intervention for patients based on defects in their health belief to improve exercise compliance after discharge.

    The status and influencing factors of physical activity among early pregnancy women
    FENG Yahui, Lü Yan, MA Shuai, WU Sansan, SHEN Zhongzhou, WANG Yawen, MA Liangkun, JIANG Yu
    2019, 54(8):  1184-1188.  DOI: 10.3761/j.issn.0254-1769.2019.08.013
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    Objective To study the status quo and influencing factors of physical activity among pregnant women in the first trimester. Methods From July 2017 to July 2018,7 976 women in early pregnancy from 24 hospitals across 15 provinces were enrolled. General information questionnaire and International Physical Activity Questionnaire-Short(IPAQ-S) were used. Results Among 4 837 early pregnant women who had completed IPAQ-S clearly and effectively,68.5% didn’t have sufficient physical activity. Logistic regression analysis showed that age,education and occupation were associated with insufficient physical activity in early pregnancy. Conclusion Physical activity of pregnant women in the first trimester was insufficient,which needs to be further improved. Health care workers should strengthen health education of pregnant women,especially for younger,lower educated and unemployed women,and promotethe early development of good habits.

    Symptom clusters in esophageal cancer patients after surgery
    GUO Min, YIN Xiumin, WANG Cui, NIE Li-ting, WANG Gongchao
    2019, 54(8):  1189-1193.  DOI: 10.3761/j.issn.0254-1769.2019.08.014
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    Objective To describe the symptoms in esophageal cancer patients three months after surgery and to explore the type and quantity of symptom clusters. Methods A convenience sample of 119 esophageal cancer patients were followed up at three months after surgery. Participates completed the Chinese version of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(QLQ-C30) and Quality of Life Questionnaire Esophageal Cancer-Specific(QLQ-OES18) to assess the symptoms. Results The most severe symptoms were fatigue,appetite loss,reflux and eating difficulties,respectively. Exploratory factor analysis revealed 4 symptom clusters,which were disease behavior symptom cluster,chemoradiotherapy side-effect symptom cluster,eating disorders symptom cluster,and digestive tract reconstruction symptom cluster. The variation contribution rate was 71.15%. Conclusion Patients with esophageal cancer experience various symptom clusters. Symptoms should be assessed timely and when a symptom is present,other symptoms in the same cluster should also be monitored,in order to effectively manage the patients’,symptoms and improve quality of life.

    Exploration of timing of respiratory function exercise in patients after lung cancer surgery
    WANG Xinyue, ZHANG Mingna, ZHU Xiaohong
    2019, 54(8):  1194-1196.  DOI: 10.3761/j.issn.0254-1769.2019.08.015
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    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.

    The mediating effect of resourcefulness between perceived pressure and depression in newly diagnosed breast cancer patients
    GUO Yuru, LIU Yanjin, GUO Lina, WANG Jing, YU Suyuan, ZHU Yiru, WEI Miao, LI Lifeng, ZHAO Jie
    2019, 54(8):  1197-1200.  DOI: 10.3761/j.issn.0254-1769.2019.08.016
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    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.

    Nursing care of patients with deep ulcer of extremities after cobra injury repaired with skin flaps
    LUO Haiyan, LIU Mingjiang, XIE Songlin, PENG Fangli, ZHU Min, CHEN Yanming
    2019, 54(8):  1201-1204.  DOI: 10.3761/j.issn.0254-1769.2019.08.017
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    This article summarized the perioperative nursing experience of 21 patients with free anterolateral femoral perforating flap in repairing deep ulcer of limbs caused by cobra injury. Nursing key points included:before surgery,adequate wound preparation,ultrasound positioning of blood vessels in the donor site,and effective closed drainage with negative pressure,and psychological care;during surgery,pay attention to temperature monitoring and blood pressure control,accurately cooperate for anastomosis of arteries and veins,and prevention of intraoperative arterial crisis;after surgery,pay attention to nursing care of skin flaps,observation of blood supply of flaps,prevention and timely management of vascular crisis of flaps,regulated usage of sensitive antibiotics during all procedures,and early rehabilitation training. There were no necrosis or partial necrosis of the skin flap in 21 patients.Perioperative precise nursing is an important guarantee for the success of free anterolateral femoral perforating flap in repairing the deep ulcer of limbs caused by cobra injury.

    Nursing Management
    A qualitative research of nurses’ intention for selecting department after standardized training
    YAO Lin, ZHAO Jing, WANG Wei, LIU Qingxia
    2019, 54(8):  1205-1209.  DOI: 10.3761/j.issn.0254-1769.2019.08.018
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    Objective To understand the real experience and influencing factors of newly employed nurses on intention for selecting department who received standardized training. Methods Using semi-structured interviews,11 new nurses from 3 tertiary hospitals in Beijing were interviewed. Interviews were analyzed using thematic analysis. Results The good organizational atmosphere during rotation,especially the interpersonal relationship,positive support,and head nurses’ humanistic management philosophy were the most important factors for department selection. The importance of the salary in the department and work intensity was weaker than the organizational atmosphere. Nurses rarely considered about their professional development and work goals. Conclusion Clinical nursing management departments should pay more attention to interpersonal relationship,positive support,and head nurses’ humanistic management philosophy in the organizational atmosphere. At the same time,performance appraisal of the department should be balanced,nurses should be guided to consider future career development.

    A qualitative study on nursing managers’ attitudes towards the second victim in adverse medical events
    Lü Yongli, WANG Peihong, LI Shasha, LI Xia
    2019, 54(8):  1210-1213.  DOI: 10.3761/j.issn.0254-1769.2019.08.019
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    Objective To investigate the status of the attitude among nursing managers towards the second victim in adverse medical events,and to provide the basis for the support strategy and system in medical institutions for the second victim. Methods We used qualitative method to conduct semi-structured in-depth interviews among 9 nursing managers in a tertiary hospital from May to August,2018,and adopted Colaizzi 7-step analysis method for data analysis. Results Nursing managers had insufficient knowledge of the second victim. Participants had different opinions on whether a second victim should be responsible for adverse medical events,and whether accountability and punishment was needed. Participants admitted that the second victim was under psychological pressure,but humanistic care measures were insufficient. Conclusion Nursing managers have insufficient knowledge of the second victims,they and medical institutions should pay attention to the medical adverse events. Nursing managers should formulate corresponding preventive measures according to the causes,reduce and control the occurrence of medical adverse events,and reduce the harm to the second victims.

    Investigation on the current situation of medical equipment management in operating rooms in China
    QIAN Wenjing, WANG Wei, QIAN Qianjian
    2019, 54(8):  1214-1219.  DOI: 10.3761/j.issn.0254-1769.2019.08.020
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    Objective To investigate the current situation of medical equipment management in operating rooms in Chinese hospitals,and to provide basis for improving and perfecting the management methods of medical equipment in operating rooms. Methods Using stratified sampling method,chief head nurses,head nurses,key nurses,directors of nursing department,and professionals in equipment management in 513 hospitals in China were selected to complete a questionnaire survey. The self-designed questionnaire included general information and the status quo of equipment management in operating room. Results In the investigated 513 hospitals,269(52.44%) of the hospitals had no benefit evaluation of equipments,220(42.88%) of the hospitals had no management system for idle equipment,162(31.58%) of the operating room nurses did not participate in the pre-use training of new equipment,400(77.97%) of the hospitals still had manufacturer guidance;205(39.96%) of the hospitals’ equipments exceeded the service life according to the instructions,161(31.38%) of the hospitals did not record the usage process,192(37.43%) of the hospitals have no full-time staff for daily regular maintenance,only 50(9.75%) of the hospitals realized equipment information management,273(53.22%) of the hospitals had no retrospective management of equipments. Hospital level had influence on six dimensions,which were purchase management,benefit evaluation management,use process management,information management,maintenance management and retrospective management of medical equipment in operating room(P<0.05). Operating room size had an impact on four dimensions,which were purchase management,benefit evaluation management,information management and maintenance management of medical equipment in operating room(P<0.05). Conclusion Each hospital is not perfect in purchase management,benefit evaluation management,information management and retrospective management of medical equipment in operating room,and is lacking professional training and effective preventive maintenance of equipment usage. Each hospital needs to carry out management of medical equipment in operating room in different levels and in a planned way in accordance with different medical needs,so as to ensure smooth surgery process and patient safety.

    Vascular Access Nursing
    Investigation of shoulder joint movement in patients with peripherally inserted central catheters
    LI Xueping, WEI Wenwu, WU Yan, LIU Weiquan, ZHANG Fengqin
    2019, 54(8):  1220-1223.  DOI: 10.3761/j.issn.0254-1769.2019.08.021
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    Objective To understand the status of decreased shoulder joint function and analyze the influencing factors through investigation of shoulder joint movement during catheter indwelling in patients with PICC. Methods From February to May 2018,patients with PICC were investigated with clinical data questionnaire and shoulder joint function rating scale. Results A total of 208 patients with PICC were included. Shoulder joint function score was 98.99±4.68,and shoulder joint function decreased in 18 cases with an incidence of 8.6%. Single factor analysis showed that catheter type,decreased limb movement at the side of catheter placement,no functional exercise,and pain-related complications were associated with the decline of shoulder joint function(P<0.05). Multiple linear regression analysis showed that major factors of affecting shoulder joint function was functional exercise and pain-related complications. Conclusion Patients with PICC who had reduced shoulder joint function,no functional exercise and occurrence of pain-related complications could lead to the decline of shoulder joint function. Medical and nursing staff should strengthen the evaluation of shoulder joint function in patients with PICC,focus on and screen influencing factors,so as to reduce the decline in shoulder joint function and improve their quality of life.

    Research on the starting time of perioperative functional exercise in patients with arteriovenous fistula
    Lü Zhongmei,ZHU Yamei,GU Yanhong,WANG Xu
    2019, 54(8):  1224-1228.  DOI: 10.3761/j.issn.0254-1769.2019.08.022
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    Objective To explore the starting time of perioperative functional exercise in patients with arteriovenous fistula. Methods It was a randomized controlled trial. Totally 43 patients with arteriovenous fistula were randomly divided into A,B and C groups,starting to guide functional exercise 3 days after surgery(Group A),12 hours after surgery(Group B),and 2 weeks before surgery(Group C). Internal diameter of cephalic vein was compared among three groups at 2 weeks,1 day before surgery,as well as 2 weeks,4 weeks and 8 weeks after surgery;anastomotic blood flow was compared among three groups at 2 weeks,4 weeks and 8 weeks after surgery;maturation time and complications of arteriovenous fistula of three groups were compared. Results Internal diameter of cephalic vein gradually widened with time after surgery among three groups,and the difference was statistically significant (P<0.05);the widening speed of internal diameter of cephalic vein in Group A and B were both lower than Group C(P<0.05) at 2 weeks,4 weeks and 8 weeks after surgery;internal diameter of cephalic vein 1 day before surgery in Group C was greater than 2 weeks before surgery(P<0.05). The anastomotic blood flow in Group A and B were increased rapidly(P<0.05) after surgery;the anastomotic blood flow in Groups A and B was significantly lower than Group C,and the difference were statistically significant(P<0.05) at 2 weeks,4 weeks and 8 weeks after surgery. Maturity time of Group C was shorter than Group A and B(P<0.05). There was no statistically significant difference in complications among 3 groups(P>0.05). Conclusion The functional exercise of lateral limbs in patients with arteriovenous fistula before surgery and early after surgery can increase internal diameter and blood flow of blood vessels,improve blood vessel conditions and shorten maturation time of arteriovenous fistula under the premise of ensuring safety of arteriovenous fistula.

    Evidence Synthesis Research
    Risk factors of 6~8 weeks postpartum pelvic floor dysfunction:a meta-analysis
    LI Jie, LIANG Yi, ZHOU Nan, YIN Shaohua, GONG Jingjing, LU Hong
    2019, 54(8):  1241-1247.  DOI: 10.3761/j.issn.0254-1769.2019.08.027
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    Objective To systematically review the risk factors of 6~8 weeks postpartum pelvic floor dysfunction,provide theoretical basis for nurses to evaluate and identify high risk groups of diseases in advance for guidance. Methods We searched PubMed,EMbase,Cochrane Library,CINAHL,CNKI,WanFang Data and SinoMed databases and professional websites from inception to July 31,2018. Two reviewers independently screened literature,assessed the quality of included studies using Critical Appraisal Tools published by JBI and extracted the data. Then meta-analysis was performed using RevMan 5.3 software. Results Eighteen studies were included. The results of meta-analysis showed that parturients aged over 35,antenatal urinary incontinence,after vaginal delivery and with episiotomy were at high risk of postpartum urinary incontinence(P<0.05). Parturients with multiple deliveries and after vaginal delivery were at high risk of postpartum pelvic organ prolapse(P<0.05). Conclusion Age≥35,antenatal urinary incontinence,vaginal delivery and episiotomy are risk factors of postpartum urinary incontinence. Multiple deliveries and vaginal delivery are risk factors of postpartum pelvic organ prolapse.