Table of Content

15 October 2019, Volume 54 Issue 10

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Research Paper

The correlation between complications of bed rest and quality of life after discharge among hospitalized stroke patients

WU Xinjuan, LI Zhen, CAO Jing, JIAO Jing, LIU Ge, LI Jiaqian, LIU Ying, LI Fangfang, LIU Hongpeng, ZHU Chen

2019, 54(10):  1445-1449.  DOI: 10.3761/j.issn.0254-1769.2019.10.001

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Objective To describe the correlation between common complications of bed rest（pressure ulcer,deep vein thrombosis,pulmonary infection,and urinary tract infection） during hospitalization and the health-related quality of life after discharge among bedridden patients with stroke,in order to provide reference to form specific strategies. Methods A total of 3 238 stroke patients from 25 hospitals in 6 provinces or cities were recruited by convenience sampling. Common complications of bed rest during hospitalization were measured by case report form,and quality of life after discharge was measured using the EQ-5D scale by telephone interview. Results Among the 3 238 bedridden stroke patients,626（19.33%） patients experienced at least one of the major complications,including pressure ulcer（80,2.47%）,deep vein thrombosis（29,0.9%）,pulmonary infection（500,15.44%）,and urinary tract infection（91,2.81%）. Patients with any of the four complications during hospitalization reported more problems in all EQ-5D dimensions（Mobility,Self-Care,Usual Activities,Pain/Discomfort,and Anxiety/Depression） and had lower mean EQ-VAS scores than those without any complications. The occurrence of any complication was significantly associated with the proportion of reported problems in all dimensions after adjustment for confounding variables. Conclusion Common complications of bed rest were significantly associated with quality of life among stroke patients. Prevention of complications is vital to improve quality of life and reduce burden of disease for stroke patients.

Construction and application of sequential sputum excretion scheme in pulmonary tuberculosis patients with mechanical ventilation

GONG Beibei, WEI Caiyun, CHEN Yuehua, WANG Lifei, DONG Wenyi, HUANG Xuemei, HONG Yanqun, LIN Yanrong, SUN Liang

2019, 54(10):  1450-1455.  DOI: 10.3761/j.issn.0254-1769.2019.10.002

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Objective To investigate the effect of sequential sputum excretion scheme on pulmonary tuberculosis patients treated with mechanical ventilation.Methods Forty-five pulmonary tuberculosis patients with mechanical ventilation were selected as the experimental group from January to December 2018,and received sequential sputum excretion scheme;while 44 patients were recruited as the control group from January to December 2017 receiving routine sputum management. Breathing rate,mean arterial pressure,blood oxygen saturation,arterial oxygen partial pressure,artery oxygenation index,CO₂ partial pressure,airway peak pressure value,the amount of sputum drainage,effect of sputum excretion,incidence of ventilator-associated pneumonia,length of mechanical ventilation,length of ICU stay,and success rate of ventilator weaning were compared between two groups.Results After 24 hours of intervention,there was significant difference in breathing rate and no significant difference in mean arterial pressure fluctuation before intervention in two groups,but blood oxygen saturation,arterial oxygen partial pressure and oxygenation index in the experimental group were higher than those in the control group and before intervention（P<0.05）. After intervention,the peak airway pressure and arterial CO₂ partial pressure in the experimental group were significantly lower than those in the control group and before intervention（P<0.05）. After 24 hours of intervention,the daily sputum excretion in the experimental group（29.48±4.54） ml was significantly higher than the control group（12.56±2.287） ml（P<0.001）. After 7 days of intervention,the effect of sputum excretion in the experimental group was better than the control group（P<0.05）. Compared with the control group,the incidence of ventilator-associated pneumonia,the length of mechanical ventilation and the length of ICU stay in the experimental group were lower and shorter,and the success rate of ventilator weaning was higher（P<0.05）.Conclusion Sequential sputum excretion scheme can promote the discharge of sputum in pulmonary tuberculosis patients with mechanical ventilation,improve pulmonary function and quality of life,shorten length of stay in ICU and reduce medical burden.

A trajectory study of sleep and related symptoms in breast cancer patients based on ecological momentary assessment

SHANG Zimo, WU Jing, ZHOU Jie

2019, 54(10):  1456-1462.  DOI: 10.3761/j.issn.0254-1769.2019.10.003

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Objective To construct the Symptom Assessment Platform based on ecological momentary assessment and explore the trajectory and correlation of sleep and symptoms in breast cancer patients during chemotherapy by the platform.Methods We developed the Symptom Assessment Platform based on ecological momentary assessment and analyzed the correlation between sleep and fatigue,anxiety,depression,nausea,vomiting,pain in 60 breast cancer patients by self-monitoring and experience-sampling method.Results Sleep quality,sleep efficiency,number of wake-ups and fatigue,anxiety,depression,nausea,vomiting and pain in breast cancer patients aggravated sharply on the 2nd day,peaked on the 2nd to 4th day,then gradually improved. There were different degrees of correlation between sleep quality,number of wake-ups and symptoms. Number of wake-ups were significantly related to fatigue on day 1 and day 7 during chemotherapy（r=0.613,P<0.01;r=0.780,P<0.01）. Sleep quality（r=-0.439,P<0.05） and sleep efficiency（r=-0.471,P<0.05） were lowly related to anxiety and depression on day 2 during chemotherapy.Conclusion The symptoms of breast cancer patients showed trends which begin with clinical deterioration and turn to be relieved during chemotherapy,and there were different degrees of correlation at different times. The assessment of symptoms based on ecological momentary assessment might be a better way for cancer care.

Construction of post competency index system of quality control nurses

CHENG He, LI Dongmei, LIU Ye, JIANG Yan, HE Qian, YIN Xueyan

2019, 54(10):  1463-1468.  DOI: 10.3761/j.issn.0254-1769.2019.10.004

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Objective To construct a scientific,standardized,comprehensive and applicable quality control nurses' post competency index system,which can provide reference basis for quality control nurses' post admission,qualification certification,ability training,assessment and evaluation system. Methods Based on literature review,behavioral event interviews,semi-structured interviews and Delphi expert inquiries,the factors of job competency of quality control nurses were extracted. Analytic Hierarchy Process（AHP） and average distribution method were applied to quantify the dimensions,items and evaluation indicators of competency,and determine the weight of indicators at all levels. Results Thirty experts were included. The efficiency of two rounds of inquiry papers was 93.3% and 100%,respectively. In the second round Delphi expert inquiry,the familiarity coefficient was 0.878,the judgment basis coefficient was 0.943 and the authority coefficient was 0.911. The finally quality control nurses' post competency index system included six first-level indicators（clinical practice ability,critical thinking ability,quality evaluation improvement ability,organization and communication coordination ability,training guidance ability,scientific research innovation ability）,20 second-level indicators and 62 third-level indicators. Conclusion The competency index system of quality control nurses based on analytic hierarchy process and expert inquiry is scientific,reliable and comprehensive. It can provide quantified basis for admission,certification,training,evaluation and performance of quality control nurses,and has theoretical and practical significance.

Establishment of predictive model of midwives' decision on episiotomy during childbirth

GUO Lin, DING Yan, ZHANG Zheng, GAO Hua, FANG Lu

2019, 54(10):  1469-1474.  DOI: 10.3761/j.issn.0254-1769.2019.10.005

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Objective To investigate the risk factors of episiotomy and to establish the logistic regression model.Methods Totally 685 women with singleton pregnancy with vaginal delivery in a tertiary hospital were selected from April to August,2018. Multiple indicators of episiotomy group （n=307） and non episiotomy group （n=378） were compared. Logistic regression was used to establish a risk prediction model,and the model power and its accuracy were evaluated by receiver operating characteristic.Results The study finally included length of perineum,perineum resilience,perineum edema,colpoperineal laceration,estimation of fetal weight,cooperation of women,uterine contraction and work experience of midwives to construct the risk prediction model. This model's area under curve of receiver operating characteristic was 0.932. When the best predicted probability was 0.496,the sensitivity and specificity of the logistic model were 0.883 and 0.802,respectively.Conclusion The risk prediction model has satisfactory prediction effects and can be completed at the second stage of labor.

Special Planning-Hematologic Disease Nursing

Establishment and practice of the operating model of incompatible blood transfusion in patients after allogeneic stem cell transplantation

TIAN yuan, CAI Xuejiao, SUN lan, LIN Xiaofei

2019, 54(10):  1475-1481.  DOI: 10.3761/j.issn.0254-1769.2019.10.006

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Objective To establish and apply the heterotypic blood transfusion mode for patients with incompatible blood transfusion after allogeneic hematopoietic stem cell transplantation.Methods A retrospective analysis was conducted on 993 cases of heterotypic blood transfusion in our department from 2015 to 2017. We established a working group on heterotypic blood transfusion. From March to August 2018,based on the characteristics of heterotypic blood transfusion,the steps of heterotypic blood transfusion were refined on the basis of transforming the working mode of homotypic blood transfusion,and the program of improving nursing workflow of heterotypic blood transfusion was constructed. It was implemented in nurses of hematology ward and changed weekly according to feedback.Results After the construction and practice of allogeneic hematopoietic stem cell transplantation in patients with blood incompatibility,the incidence of distribution error（P<0.01）,medical order error（P<0.01） and transfusion reaction（P<0.05） were significantly reduced.Conclusion The safe and efficient operating mode of heterotypic blood transfusion not only improves the nursing efficiency,but also prevents the occurrence of nursing errors,which is worthy of reference and promotion.

Development of evaluation index system for health education among adult acute leukemia patients with chemotherapy

LUO Ruzhen, XIE Wenjun, LIU Yudian, ZHANG Xiaohong, LIU Yanhui

2019, 54(10):  1482-1487.  DOI: 10.3761/j.issn.0254-1769.2019.10.007

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Objective To develop the evaluation index system for health education in adult patients with acute leukemia treated by chemotherapy,which can provide references for clinical nurses to evaluate effects of health education and carry out targeted health education and guidance among adult acute leukemia patients with chemotherapy. Methods Guided by Knowledge Attitude Practice Model,through literature research,semi-structured interviews,Delphi method and analytic hierarchy process,the framework of the evaluation index system for health education in adult patients with acute leukemia chemotherapy and the weight value of each evaluation index were constructed. Results The recovery rates for the first and second rounds of the study were 80.00% and 93.75%,respectively. The expert judgment coefficient was 0.86,the degree of expert familiarity was 0.78,and the degree of expert authority was 0.82. Finally,the index system contained 3 first-level indicators,16 second-level indicators,and 65 third-level indicators. Conclusion The evaluation index system for health education in adult patients with acute leukemia treated by chemotherapy can provide unified standard for clinical nurses to conduct comprehensive and efficient health education evaluation.

Evidence summary of management of nutrition support for adult patients underwent hematopoietic stem cell transplantation

FANG Yun, LIU Minjie, WU Yaohui, ZHANG Weiwei, CHENG Si, CAO Lanyan

2019, 54(10):  1488-1494.  DOI: 10.3761/j.issn.0254-1769.2019.10.008

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Objective To retrieve,appraise and synthesize the best available evidence on management of nutrition support in adult patients underwent hematopoietic stem cell transplantation（HSCT）. Methods Websites of the Cochrane Library,PubMed,Medline,Embase,CINAHL,CNKI,Wanfang,the National Guideline Clearinghouse,Scottish Intercollegiate Guidelines Network,National Institute for Health and Clinical Excellence,BMJ Best Practice,International Practice Guideline Registry Platform（Chinese）and Clinicalkey were searched to collect literatures. Results Seven articles including 4 clinical practice guidelines,1 evidence summary,and 2 systematic reviews. A total of 20 items of best evidence were summarized regarding 6 aspects,which were nutrition screening and assessment,dietary counseling and nutrition education,enteral nutrition and parenteral nutrition,nutrition selection,nutrition support for patients with graft-versus-host disease（GVHD）,efficacy evaluation and follow-up of nutrition support. Conclusion Nursing staff should pay attention to nutrition management of patients underwent HSCT. Available best evidence of nutrition screening and nutrition support therapy are recommended to use according to characteristics of the hospital and clinical environment and patients' preference,in order to improve malnutrition and reduce negative clinical outcomes due to long-term malnutrition.

Standards

Expert consensus on cognitive training nursing clinic

Neurology Nursing Committee of Beijing Nursing Association, Internal Medicine Nursing Committee of Chinese Nursing Association, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University（Writing Committee:CHANG Hong, QIAO Yuchen）

2019, 54(10):  1504-1508.  DOI: 10.3761/j.issn.0254-1769.2019.10.012

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Objective To establish a consensus of nursing experts on cognitive training nursing clinics.Methods Literatures at home and abroad were retrieved and key informant interviews were conducted. Expert Delphi mail questionnaire was developed according to the key issues of nursing care. Using 2 rounds of Delphi expert consultation and expert meetings,each item was revised and adjusted combined with the objective evidence and expert opinion.Results The experts reached a consensus on 4 dimensions of cognitive training nursing clinics：setup,contents,management,and personnel education,including 15 indicators.Conclusion The expert consensus on cognitive training nursing clinic was reliable and applicable,which can provide guidance for cognitive nursing clinics and promote regulated development of cognitive training.

Specialist Practice and Research

The establishment and practice of postoperative hypothermia rewarming program for severe burn patients

XU Caijuan, SHEN Mingyan, LU Fuchang, CHEN Huaqing, FU Yahong, HU Yan

2019, 54(10):  1509-1513.  DOI: 10.3761/j.issn.0254-1769.2019.10.013

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Objective This article summarized experiences of postoperative hypothermia management for severe burn patients. Methods We established multidisciplinary management team and formulated postoperative hypothermia rewarming program for severe burn patients based on evidence,including set-up of rewarming unit,clarification of starting and ending criteria of rewarming,the method and frequency of core temperature monitoring,complex rewarming interventions for burn patients,management of rewarming equipment,training and evaluation of nurses' rewarming skills. Results The continuation time of hypothermia was decreased from（274.38±149.43） min to（107.89±65.39） min. The compliance of complex rewarming interventions increased from 21.88% to 83.33%. The accuracy rate of core temperature monitoring was improved from 18.75% to 97.22%. Conclusion The postoperative hypothermia rewarming program of severe burn patients is beneficial to improve the quality of nursing care.

Construction and application of post-hospital rehabilitation management platform for patients with gynecological malignant tumor

ZENG Lihua, ZHU Zhu, QIAO Chengping, ZHAO Lei, GAO Yue, XU Ying

2019, 54(10):  1514-1518.  DOI: 10.3761/j.issn.0254-1769.2019.010.014

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Objective To construct a system of post-hospital health management for patients with gynecological malignant tumor and provide corresponding evidence. Methods The post-hospital rehabilitation management platform for patients with gynecological malignant tumor included four parts：electronic information system,online APP learning platform,WeChat doctor-patient communication platform and offline health management center. The use of platform from January 1,2018,to April 30,2019,online doctor-patient interaction,offline service status and patients' satisfaction with the platform were calculated. Results The platform had 9 registered medical staff,and 188 patients with gynecological malignant tumor. Averagely each individual logged in the platform for 8.98 times,read for 17.1 articles,and each article was read by 91.89 times. There were doctor-patient interactions for 928 times,381 questions were asked,355 problems were solved,93.17% of problems were solved online,the average waiting time for online response was 19.6 hours. There were offline services for 22,169 times,waiting time of offline reservation was 3.1 days. Conclusion Post-hospital rehabilitation management platform for patients with gynecological malignant tumor has five characteristics：scientific,professional,practical,dynamic and convenient. It can promote patients' participation in rehabilitation management and rehabilitation after hospital,improve the efficiency of rehabilitation management,improve patients' rehabilitation experience.

Construction of hospice care model for critical pediatric patients

WANG Wenchao, HU Jing, GU Ying, LU Guoping, ZHANG Yuxia

2019, 54(10):  1519-1523.  DOI: 10.3761/j.issn.0254-1769.2019.10.015

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Objective To establish a scientific and clinical hospice care model for critical pediatric patients.Methods Twenty-four experts from eight children's hospitals in China were selected for two rounds of inquiries,and relevant experts in the fields of medicine,nursing,psychology,nutrition and social work were invited to conduct focus group interviews.Results Through two rounds of inquiries and expert focus group interviews,the hospice care model for critical pediatric patients was initially determined,including the initiation of hospice care,and holistic care of hospice children which further included pain management,nutrition management,comfort care and psychological intervention,and hospice care of hospice children.Conclusion The model of hospice care for critical pediatric patients is scientific and reliable,which provides a reference for nursing of critically ill children.

Survey on perioperative period blood glucose management among surgical nurses

ZHAO Fang, ZHANG Mingxia, MO Yongzhen, YUAN Li, XING Qiuling, ZHOU Yingxia, WANG Qun, JIA Yun

2019, 54(10):  1524-1528.  DOI: 10.3761/j.issn.0254-1769.2019.10.016

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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.

Nurses' knowledge,attitudes,and behaviors toward the ABCDE Bundle nursing for sedation and analgesia in Intensive Care Units

HOU Chunlei, ZHANG Die, DENG Ying, SU Dan

2019, 54(10):  1529-1533.  DOI: 10.3761/j.issn.0254-1769.2019.10.017

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Objective To explore the knowledge,attitudes,and behaviors towards the ABCDE Bundle nursing for sedation and analgesia among clinical nurses in intensive care units（ICUs）,and to analyze the factors affecting the ABCDE Bundle nursing in clinical practice.Methods A self-designed internet-based questionnaire was delivered to the nurses working at the ICUs of five tertiary hospitals in Beijing.Results From March to June 2018,282 nurses completed the questionnaires. The scores of knowledge,attitudes,and behavior were（6.01±2.06）,（6.78±2.60） and（11.40±3.64）,respectively,and the total score was （24.18±5.72）. Knowledge scores were different among nurses with different job titles（P<0.05）. The attitudes were associated with nurses' ICU types significantly（P<0.05）. Nurses' behaviors were associated with age,job titles,educational level,years of nursing work,ICU types,years of ICU work （P<0.05）. Multiple logistic regression analysis showed that years of nursing work and ICU types were influencing factors for the total scores of knowledge,attitudes,and behaviors（P<0.05）.Conclusion Nurses who work at the ICUs have a low level of knowledge on the ABCDE Bundle for sedation and analgesia. Their attitudes towards the ABCDE Bundle for sedation and analgesia is positive,while their behaviors are still lacking. The general level of knowledge,attitudes,and behaviors of nurses in neurological intensive care units and those with less than 5 years of nursing experience were higher than other nurses. Nursing administrators should establish and improve the training system of the ABCDE Bundle for sedation and analgesia and strengthen the knowledge and behaviors of nurses. It is imperative to strengthen training to enhance their knowledge,attitudes and behaviors.

Nursing Management

Investigation on the current situation of nursing human resources and training needs in neonatal departments in Guangxi

HU Qinyan, WEI Qin, HUANG Xiaobo, WEN Yan, LIANG Jie, YANG Shaoli, LI Yanqing

2019, 54(10):  1534-1539.  DOI: 10.3761/j.issn.0254-1769.2019.10.018

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Objective To investigate the current situation and training demands of nursing human resources in neonatal departments in Guangxi,which can provide a reference for further adoption of targeted interventions. Methods Questionnaire on the Status Quo and Needs of Newborn Capacity Building in the Western Region developed by the Western Nursing Alliance was used to conduct a comprehensive investigation on the current situation and training needs of nursing human resources in newborn from secondary and above medical institutions. Results The allocation of nursing human resources：the ratio of beds to nurses was 1：0.73~0.83 in general hospitals,1：0.56~0.81 in maternal and child health hospitals,1：0.5~0.59 in hospitals of traditional Chinese medicine. The proportion of medium grade and senior professional titles of nurses was 13.76%~22.02% in tertiary medical institutions and 6.25%~22.22% in secondary medical institutions. The proportion of nurses with bachelor's degree or above in neonatal department was only 7.41% in secondary Grade B maternal and child health care hospitals,while it was 22.2%~65.4% in other medical institutions. There were 169 specialist nurses for newborns,accounting for 6.71%. In terms of training needs of nurses,there was no significant difference in needs between tertiary medical institutions and secondary medical institutions（P>0.05）. The higher training needs were：critical illness care ability,first aid capability,new concept of nursing. Conclusion Human resources construction in Guangxi for neonatal care has achieved certain results. The educational background of nurses has been greatly improved but the allocation of nursing human resources in traditional Chinese medicine hospitals is lower. The overall professional title is lower. The level of nursing research needs to be improved and the training needs are high. It is suggested to strengthen the construction of nursing team in neonatal departments in Guangxi,meet the needs of nurse training,and pay attention to the training of specialist nurses to promote the development of neonatal nursing in Guangxi.

Quality index management system for head nurse's decision based on business intelligence

LI Ping, SHI Tingqi, LU Yao, CHENG Jianping, LIU Jingjing

2019, 54(10):  1540-1544.  DOI: 10.3761/j.issn.0254-1769.2019.10.019

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Objective To develop a quality index management system based on business intelligence for decision making of head nurses,so as to provide a new tool for improving fine management of nursing quality.Methods Quality indicators were selected scientifically from the perspective of the head nurses,and the optimal dimensions,thresholds and human-machine interaction interfaces were designed. The information was converted into value information through data acquisition,cleaning and modeling,and then presented to the head nurse by means of visual view to make quality management decisions.Results Data of the system showed that the average monthly number of head nurses logging into the system was increased by 38%,and the average monthly login frequency was increased by 29%. The cross-sectional survey showed that the system availability,data reliability,system support,user usage intention,overall user satisfaction and net income were all high.Conclusion The nursing quality index management system can provide visual data support for scientific management of head nurses,help them to carry out quality management more directly and effectively,and promote nursing quality management from “system management” to “data management”.

Community Care

Application of peer support in community mental health services to patients with schizophrenia

Yan Fang, Yao Feng-ju, Li Shuan-rong, Zhang Yan-ping, Wang Su-hong, Wang Jing-hua, Zhang Chao-hui

2019, 54(10):  1545-1550.  DOI: 10.3761/j.issn.0254-1769.2019.010.020

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Objective To explore the effects of application of peer support rehabilitation model in community mental health services to patients with schizophrenia. Methods A hundred community patients with schizophrenia selected from the National Severe Mental Disorders Information Systems in Xinxiang city were randomly assigned to the experimental group（n=50） and the control group（n=50）. The experimental group received 6-month peer support services and routine drug treatment and regular visits，whereas the control group received routine drug treatment and regular visits. Patients were evaluated using the Brief Psychiatric Rating Scale，the Insight and Treatment Attitude Questionnaire and the Morningside Rehabilitation Status Scale before and after intervention. Results Forty-nine patients in the experimental group and 47 in the control group completed the study. After intervention，the scores of BPRS and MRSS in the experimental group were significantly lower than those in the control group，and the scores of ITAQ were significantly higher than those in the control group，and the differences were significant（all P<0.001）. Conclusion Peer support can improve clinical symptoms of community patients with schizophrenia，boost patients' cognition to disease and attitude to treatment，promote the recovery of social functions.

Vascular Access Nursing

Safety of three different implantation pathways for implantable venous access port：A meta-analysis

WU Xiaohong, CHEN Xisui, ZHANG Hong, ZHANG Tiantian

2019, 54(10):  1551-1557.  DOI: 10.3761/j.issn.0254-1769.2019.10.021

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Objective To explore the safety of three different implantation pathways in the implanted intravenous infusion port,and to provide evidence for choosing the best implantation pathway.Methods We searched VIP,PubMed,Web of Science,etc.,for articles involving implanting the intravenous infusion port in the internal jugular vein,the subclavian vein,and the upper arm vein.Results A total of 22 articles were selected with 9193 subjects. Meta-analysis showed that：compared with the subclavian vein group,the incidence of catheter displacement was significantly lower in the internal jugular vein group（P<0.001）. There were no significant differences in incidence of infection,thrombosis,etc.,between two groups（all P>0.05）. Compared with the upper arm vein group,the incidence of foundation exposure was significantly lower（P=0.002） in the subclavian vein group,and artery injury was significantly lower（P=0.03） in the upper arm vein group than the subclavian vein group. However,the differences in incidence of infection,thrombosis,etc.,were not statistically significant between two groups（all P>0.05）. The differences in incidence of complications between the upper arm vein group and the internal jugular vein group were not statistically significant（all P>0.05）.Conclusion The rates of complications in the internal jugular vein group are lower than those in the subclavian vein group. The incidence of artery injury in the upper arm vein group is lower than the subclavian vein group,however the incidence of foundation exposure in the subclavian vein group is lower than the upper arm vein group. The best implantation pathway is the internal jugular vein.

Evidence Synthesis Research

Bedside screening accuracy for elderly patients with dysphagia：a network meta-analysis

ZHENG Xiaona, CHEN Qiuhua, SHAO Tingfang, LIN Shuo

2019, 54(10):  1561-1565.  DOI: 10.3761/j.issn.0254-1769.2019.10.023

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Objective To evaluate the diagnostic value of bedside screening tools for elderly patients with dysphagia and provide evidence for standardized nursing.Methods Pubmed,Cochrane Library,Embase,CNKI,VIP database,and Wanfang database were electronically searched for literature about bedside screening tools for elderly patients with dysphagia. After literature screening,quality appraisal,data extraction,meta-analysis was performed using stata 15.0 software.Results A total of 16 English and 4 Chinese articles were included with 1970 subjects. Meta-analysis results showed that compared with the gold standard,the consolidation point of the diagnostic sensitivity of the bedside screening tool was estimated to be[ES=1.503,95%CI（1.033,1.973）,P<0.001];the specificity of the combined point was estimated as[ES=1.074,95%CI（0.633,1.515）,P<0.001]. SROC curve and rank ordering showed there existed differences in diagnostic sensitivity and specificity of different tools. The top three screening tools with strong sensitivity were Two-Step Thickened Water Test,Barnes-Jewish Hospital Stroke Dysphagia Screen and Cough Test,while the top three screening tools with strong specificity were Eating Assessment Tool-10,Two-Step Thickened Water Test and Cough Test.Conclusion Among bedside screening tools,the sensitivity of Two-Step Thickened Water Test is highest,while the specificity of Eating Assessment Tool-10 is strongest. The results still need to be validated by large-sample,multi-center studies.

The experience and coping behaviors of work stress among ICU nurses：a meta-synthesis of qualitative studies

WANG Lifei, MI Yuanyuan, JIN Jing, ZHANG Jianchun, LI Ruiming, FENG Zhixian

2019, 54(10):  1566-1571.  DOI: 10.3761/j.issn.0254-1769.2019.10.024

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Objective To systematically review the experience and coping behaviors of work stress among ICU nurses,provide evidence for understanding the experience of work-related stress in ICU nurses and helping them dealing with it better. Methods Chinese and English databases including PubMed,PsycINFO,Cochrane Library,Web of Science,CNKI,Chinese biomedical literature database（CBM）,VIP,and WanFang Data were searched for qualitative studies on ICU nurses' work stress from inception to September 2018. The JBI Critical Appraisal Tool for qualitative studies in Australia （2016 edition） was used to evaluate the quality of studies. The results were synthesized by using Integration Methods .Results A total of 48 findings were extracted from 7 qualified studies. The 48 findings were integrated into 9 new categories and finally 3 synthesized results were summarized：the sources of work stress,the physical and mental experience of work stress,and the coping behaviors of work stress in ICU nurses.Conclusion Nurses themselves and nursing managers should pay attention to the sources of stress,physical discomfort and negative emotions caused by stress,and adopt a variety of interventions to cope with stress actively,so as to reduce the stress and improve the quality of nursing.

A best-evidence summary of prevention strategies for perioperative delirium in elderly patients with hip fractures

LU Fengjuan, Lü Hong, SONG Yuzhi, ZHANG Hao, WEI Min, WANG Chuanxia, YANG Lijuan

2019, 54(10):  1572-1577.  DOI: 10.3761/j.issn.0254-1769.2019.10.025

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Objective According to evidence-based methods and requirements,to summarize the best evidence for prevention of perioperative delirium in elderly patients with hip fractures. Methods The domestic and foreign databases such as JBI,NGC,NICE,RNAO,Up to Date,Cochrane Database,PubMed,ANZSGM,ASPN,ESA,IDP,AAOS,ESTES,Wanfang were searched. The publication time of literature was from January 2014 to March 2019. Two researchers independently appraised articles,and extracted data for eligible studies according to the judgment of professionals. Results A total of 9 related articles were enrolled,including 4 clinical practice guidelines,2 systematic reviews,2 expert consensuses and 1 best practice recommendation. Totally 13 items of best evidence were summarized from six aspects：assessment of delirium risk factors,delirium screening,delirium prevention,patient and family health education,medical worker training and evaluation. Conclusion Medical staff should receive regular training on delirium prevention,and select structured tools for delirium risk assessment. Before application,best evidence should be selected according to the environment and characteristics of the hospital to reduce the incidence of postoperative delirium in elderly patients with hip fracture.