Table of Content

15 June 2020, Volume 55 Issue 6

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Research Paper

Establishment of sensitive indicators of nursing care quality in post anesthesia care unit

SHENG Lile, LAN Xing, TAN Fang, ZHAO Zhenghua, CHANG Wenli, XIA Haifa, CHEN Qinghong, DU Chongyang, LI Chengying

2020, 55(6):  805-810.  DOI: 10.3761/j.issn.0254-1769.2020.06.001

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Objective To establish sensitive indicators of nursing care quality in post anesthesia care unit（PACU）,and to provide standard and professional quantitative basis for treatment,monitoring and management of patients in PACU. Methods The first draft was formed based on the structure-process-result theory,National Database of Nursing Quality Indicators（NDNQI） and existing research results from domestic and international anesthesia nursing experts. Delphi Method was adopted to conduct 3 rounds of expert consultations,combining with Pareto’s principle to finalize the content of the indicators and scientific measuring methods. Results A PACU nursing care quality sensitive indicators system was built up,including 11 indicators,such as the median recovery time,the proportions of patients from different departments,the effectiveness of hypothermia intervention and the effectiveness of postoperative pain intervention,etc. After 3 rounds of expert consultations,the effective response rates were all 100% with authority coefficients of 0.86,0.84 and 0.90,coefficients of concordance of 0.245,0.256 and 0.356 respectively（P<0.01）. Conclusion The sensitive indicators of nursing care quality in PACU covered the key contents of post anesthesia monitoring,which was highly operable,scientific,practical and distinctive in specialty,and can provide references for data-based continuous quality improvement and improvement of nursing quality in PACU.

Construction of risk prediction model of delirium occurrence in patients with severe trauma

JI Yunlan, XU Xujuan, SHAN Jun, NI Hua, TANG Dandan, WU Yaqin, XUE Huiping, JIANG Daishan

2020, 55(6):  811-816.  DOI: 10.3761/j.issn.0254-1769.2020.06.002

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Objective To explore the risk factors of delirium in patients with severe trauma and develop a nomogram model to predict the occurrence of delirium. Methods 437 patients with severe trauma in ICU from a tertiary hospital were selected by Richmond Agitation-Sedation Scale（RASS）. The delirium group（n=142） and the non-delirium group（n=295） were compared to explore the independent risk factors of delirium through single factor analysis and multivariate logistic regression model. According to the selected independent risk factors,a risk prediction model was established and incorporated into the nomogram,and Bootstrapping method was adopted to verify the prediction effect of the model. Results After multivariate Logistic regression analysis,5 factors were included in the final regression model,including Injury Severity Score（ISS）（>21 points）（OR=39.718）,Acute Physiology and Chronic Health Evaluation（APACHEⅡ） score （>13 points）（OR=20.921）,hospital stay in ICU（>9 days）（OR=4.331）,RASS score（1 point for each increase）（OR=1.823） and dexmedetomidine（OR=0.367）. According to the above 5 risk factors,the prediction ability of delirium occurrence nomogram model of patients with severe trauma was useful,with the C-index of 0.936,the sensitivity of 88.73%,the specificity of 85.42% and the Youden index of 0.742. The results of the external model validation were C-index of 0.917,the sensitivity of 100%,and the specificity of 84.37%. Conclusion The nomogram can effectively predict the occurrence of delirium in patients with severe trauma during hospitalization. The model is valuable for predicting the risk of delirium.

Special Planning—Coronavirus Disease 2019 Nursing

Nursing management in isolation wards for coronavirus disease 2019 in a general hospital under a joint rescue model

FENG Mei, WANG Qian, SU Jie, CAO Xiaoyi, WANG Wenxiu, WU Xiaoling, WU Ying, ZHU Jing, ZHANG Yanlin, LI Lingli, JIANG Yan

2020, 55(6):  817-821.  DOI: 10.3761/j.issn.0254-1769.2020.06.003

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Objective To explore modes and effects of emergency nursing management in isolation wards for coronavirus disease 2019（COVID-19） in a general hospital under a joint rescue model. Methods A joint rescue model was carried out in fever wards at a COVID-19 designated hospital in Wuhan after evaluating the wards environment,medical situation,patients’ conditions and the structure of nursing staff. By restructuring the three-level responsibility system of nursing management,COVID-19 wards were reorganized by rapid screening and isolation of suspected patients; advantageous complementarities in nursing schedule,multi-mode standardized training,double insurance of oxygen supplier for patients during oxygen therapy,seamless supervision on hospital infection prevention,emphasis on physical and mental health of nursing staff were conducted. Results With the close cooperation of medical staff,the joint rescue and support model has been carried out smoothly. 97 cases with COVID-19 were treated in wards from January 27 to March 15th,2020; 84 cases（86.59%） were cured and discharged; 1 patient died（1.03%）. There was no nosocomial infection and cross infection among medical staff. Conclusion Amid the COVID-19 epidemic,the number of confirmed cases has risen sharply,while nurses of respiratory and critical care specialty were in shortage in reorganized hospitals. The implementation of the joint rescue model can achieve human resources support and professional technical support,improve the hospital conditions and deficiency of oxygen,increase the cure rate,avoid nosocomial infection,and promote physical and mental health of nursing staff.

Management practice of prevention and control of coronavirus disease 2019 infection in Zhejiang hemodialysis centers

YUAN Jing, ZHANG Ping, YING Jinping, WANG Weina, WANG Chunyan, PAN Mengyan, ZHANG Jiewen, CHEN Jianghua

2020, 55(6):  822-826.  DOI: 10.3761/j.issn.0254-1769.2020.06.004

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

The management for caregivers of inpatients in a general hospital during the coronavirus disease 2019 epidemic

WANG Wei, ZHANG Xiaoman, KONG Dong, ZHOU Wenhong, JIN Lin, WEI Min, YANG Lijuan

2020, 55(6):  827-831.  DOI: 10.3761/j.issn.0254-1769.2020.06.005

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Objective To summarize the management measures for caregivers of inpatients in a tertiary hospital in China during the coronavirus disease 2019（COVID-19） epidemic. Methods The comprehensive management was carried out in caregivers of inpatients from the aspects of quantity control,risk screening,epidemic investigation and notification,double card management of “ID card and companion card”,auxiliary inspection and accompany inspection service,pre-examination and verification of medical insurance,etc. The time point inspection was implemented to evaluate the effects,and the results were fed back by information means to promote the continuous improvement of quality. Results From January 28,2020 to March 2,2020,the ratio of patients and caregivers was 1 ∶ 1.083 and 1 ∶ 1.002 at a week before and after the implementation of the comprehensive management,and the ratios were 1 ∶ 0.988,0.932 and 0.918 at the second to fourth weeks after the implementation. The results of 3 time points inspections showed that the management quality of many items,including the implementation of the access control management,the accompanying staff signing the notice,the routine temperature monitoring twice a day,and no dining out,had been improved continuously（P<0.05）. The implementation rate of the double card management at entrances of elevators was 23%~46%. The accuracy rate of masks wearing at entrances of hospital and elevators was high（91%~100%）,but the accuracy rates of masks wearing in inpatient wards were low with 58.76%,61.54% and 77.69%,respectively at 3 time points inspections. Conclusion It is effective to implement the whole process management measures for the caregivers of inpatients from pre-hospital,in-hospital to post-hospital. The implementation rate of double card management at elevator entrances,the accuracy rate of mask wearing in inpatient wards were relatively lower,which need further improvement.

Hazard vulnerability analysis and management strategies of nursing management during the coronavirus disease 2019

WANG Xia, WANG Zhenhui, SUN Chao, ZHANG Yinghui, YUAN Xiaoning, LI Minmin, ZHAO Peiyu, MIAO Miao

2020, 55(6):  832-836.  DOI: 10.3761/j.issn.0254-1769.2020.06.006

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Objective To analyze the risks in a temporarily renovated ICU at Tongji Hospital in Wuhan using the Hazard Vulnerability Analysis based on the Kaiser Model,and to propose strategies to respond and manage the risks. Methods The risk management index evaluation system for nursing management was developed based on the Kaiser Model and the status of the temporarily renovated ICU at Tongji Hospital. It was surveyed via web questionnaires during Feb 21st to 25th,2020 among the medical teams in the ICU,and the index risk value and matrix distribution were analyzed. Results The top 13 risk events perceived by the medical team were listed as following.C8 nurses needle stick injury（0.447 6）,B1 patients need to be rescued （0.413 0）,C10 nurses being infected （0.411 0）,B2 patients’ psychological problems（0.407 4）,C9 doctors being infected（0.359 8）,E3 insufficient or interrupted oxygen supply（0.329 1）,D9 drug shortage（0.324 2）,E2 insufficient protective equipment（0.317 9）;C12 doctors and nurses’ absence from work due to emergency illness（0.309 1）,C7 doctors needle stick injury（0.298 2）,E1 insufficient supporting staff in the hospital（0.293 5）,B6 adverse drug reactions in patients（0.292 4）,C6 nurses’ psychological maladjustment（0.289 1）. Conclusion Managers should pay attention to the risk assessment on the status of the temporarily renovated ICU at Tongji Hospital,and then guide the problem solving; at the same time,they should attach great importance to the occupational protection and physical and mental health of medical staff.

Nursing care of 37 imported cases with coronavirus disease 2019 under cross-cultural background

ZHANG Zhigang, CAI Xiaolin, MA Fangli, WU Yuchen, CHEN Ke, FU Xiaoyan, HE Jufang, WEI Huaping

2020, 55(6):  837-840.  DOI: 10.3761/j.issn.0254-1769.2020.06.007

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Objective To analyze the specific therapeutic methods and their effects of 37 imported cases with coronavirus disease 2019（COVID-19） based on the cross-cultural nursing theory. Methods The problems of 37 imported COVID-19 patients with multi-cultural features were analyzed and solved through precise nursing care based on Leininger cross culture theory from March 5th 2020 to March 14th 2020 in a designated hospital in Lanzhou. A comprehensive care plan was formulated based on the respect of patients from the cross-cultural perspective,in order to meet patient needs during hospitalization. Results Based on the model of Leininger cross culture theory,we can meet the multicultural needs of patients,and there is no catering errors,prayer related conflicts,nursing related complications,and nursing disputes and complaints. On the basis of respecting patients’ religious belief,the compliance of patients with treatment and the nursing satisfaction were improved. Conclusion For imported ethnic patients with COVID-19,it is crucial to provide multi-cultural,personalized nursing care based on their cultural needs.

Nursing management of fever clinics during coronavirus disease 2019 epidemic：an expert consensus

WANG Hui, WANG Ying, WU Xinjuan, ZHENG Yining

2020, 55(6):  844-844.  DOI: 10.3761/j.issn.0254-1769.2020.06.009

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Objective To standardize the nursing management of fever clinics during coronavirus disease 2019 （COVID-19） epidemic. Methods The consensus was preliminarily formed by reviewing relevant policies,guidelines,expert consensuses and literature related to the management of COVID-19 and fever clinicsat home and abroad,as well as combining with the clinical management experience. It was finalized by 5 rounds of online discussions and expert consultations. Results The consensus contained 6 aspects,including the basic management?requirements,environment and layout,allocation and management of nursing staff,pre-check and triage,patient management and material management. Conclusion The consensus is scientific and practical,which can provideguidance for nursing managementof fever clinics in all levels of medical institutions during the epidemic of COVID-19.

Special Planning—Oncologic Nursing

Effects of drinking time on peripheral dose equivalent rate in bone imaging patients

YUAN Huiyu, WANG Chunmei, ZHENG Yingying, YANG Zhongyi, LI Yongxia, XUE Jing, XU Xiaoping, ZHANG Yingjian

2020, 55(6):  845-849.  DOI: 10.3761/j.issn.0254-1769.2020.06.010

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Objective To investigate the effects of the starting time of drinking water on peripheral dose equivalent rate in patients undergoing bone scan,in order to further reduce the impact of bone imaging on the public. Methods Sixty hospitalized patients with bone imaging were randomly divided into an experimental group and a control group. The experimental group began to drink water for 1 000 ml at 1 h before injection,and the control group drank water for 1 000 ml at 2 h after injection,both within 1 h to finish. The dose equivalent rates at 0.5 h,1 h,2 h,3 h,6 h,12 h,and 24 h after injection were measured by a radiation dosimeter at 0.5 m,1 m,2 m,and 3 m in front of the subjects. The distance and time were compared between the two groups when the peripheral dose equivalent rate was reduced to 2.5μSv/h. Results There were statistically significant differences in the peripheral dose equivalent rates between the two groups at 5 time points（0.5 h,1 h,2 h,3 h,and 6 h） and different distances（0.5 m,1 m,2 m,and 3 m） after injection（P<0.05）. Also,the peripheral dose equivalent rate in the experimental group was lower than that in the control group. The distance and time of the experimental group were less compared to those in the control group when the peripheral dose equivalent rate was reduced to 2.5μSv/h. The image quality of both groups was satisfactory and met the diagnostic criteria. Conclusion The bone imaging subjects can drink 1 000 ml of water at 1 hour before the injection,in order to accelerate the excretion of the imaging agent while ensuring image quality,and reduce the surrounding dose equivalent rate in 6 hours after the injection. Nurses can use the results of measurement to guide radiation protection for patients,family members and the public.

Study on the status of work engagement and its associated factors among nurses in cancer hospitals

XU Xianghua,CHEN Yongyi,LI Xuying,OU Meijun,HE Ruixian,WU Wanying,LIU Dongying,ZHANG Xi,GUAN Qiongyao

2020, 55(6):  850-855.  DOI: 10.3761/j.issn.0254-1769.2020.06.011

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Objective To explore the status of work engagement and its influencing factors,as well as the impact path of big-five personality and work-related acceptance on work engagement of oncology nurses. Methods Nurses from 6 cancer hospitals in 6 provinces and cities in China were randomly sampled using random number table. They were investigated by the general information questionnaire,the big-five personality questionnaire,the Work-related Acceptance and Action Questionnaire（WAAQ）,and the Utrecht Work Engagement Scale（UWES）. Results The total work engagement score of 1856 nurses from cancer hospitals was 48.55±18.39,with the average item score of 3.24±1.23. Bivariate analysis revealed that work engagement was positively relevant with neuroticism, extraversion, agreeableness, conscientiousness personality, and work-related acceptance（r=0.347,0.237,0.284,0.288,0.541,P<0.01）,but negatively correlated with personality of openness（r=-0.077,P<0.01）. The multivariate linear regression analysis showed that age,work post,reasons for choosing nursing specialty,working department,type of employment,personality of neuroticism,agreeableness,and work-related acceptance were the independent influencing factors of work engagement（P<0.05）,which accounted 37.7% of the total variation. Bootstrap mediation effect analysis demonstrated the partial mediating effect of work-related acceptance between big-five personality and work engagement,which explained 42.11% of the variance. Conclusion The work engagement of nurses from cancer hospitals is at relatively medium level. Hospital administrators should pay attention to the effect of nurses’ personality,promote their work-related acceptance to enhance work engagement.

The psychological experience of caregivers of patients with advanced cancer：a meta-synthesis of qualitative studies

WANG Lifei, KONG Qian, MI Yuanyuan, WANG Mian, FENG Zhixian, WU Yamei, LI Ruiming

2020, 55(6):  856-861.  DOI: 10.3761/j.issn.0254-1769.2020.06.012

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Objective To analyze and evaluate the psychological experience of caregivers of patients with advanced cancer. Methods The Cochrane Library,JBI,Embase,PubMed,PsycINFO,Web of Science,CINAHL,CNKI,Wanfang Data and CBM were searched for qualitative studies on psychological experience of caregivers in patients with advanced cancer,and the retrieval period was from inception to November 2018. The Joanna Briggs Institute Critical Appraisal Tool for qualitative researches（2016） in Australia was used to evaluate quality of the studies. The results were integrated by a meta-synthesis method. Results 8 studies were included in the final review. Totally 44 findings were extracted; 9 new categories were generated; 3 integrated results were synthesized as ① Negative psychological problems of caregivers;② Positive psychological feelings of caregivers;③ Needs of psychological support of caregivers. Conclusion Nurses should pay attention to negative psychological problems of caregivers,exert positive psychological effects,help caregivers strengthen their social support system and meet their needs of psychological support,so as to improve quality of care.

A comparative study on the rehabilitation effects of non-pharmacological interventions in patients with breast cancer:Pa network meta-analysis

ZHU Wenmin, WEI Xiaolong

2020, 55(6):  862-867.  DOI: 10.3761/j.issn.0254-1769.2020.06.013

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Objective To assess and compare effectiveness of non-pharmacological interventions on depression,sleep,and quality of life in breast cancer survivors. Methods The published literature that correlated with non-pharmacological interventions in breast cancer survivors in PubMed,Web of Science,MEDLINE,Embase,CNKI,Wanfang,CBM and VIP were collected. With formulated inclusion and exclusion criteria,the literature was screened,and the information was extracted;the bias risk assessment tools of Review Manager 5.3 were applied in the quality evaluation of these documents;the network relations among the studies were performed by STATA 15.0,thereby the publication bias was analyzed. The measurement of convergence was conducted;the Bayesian models were established;the probabilities of the interventions to become the best one were performed by the area under curve in the accumulative ranking probability chart. Results An amount of 22 available documents referring to 2,739 breast cancer survivors were included in this study,and we have found cognitive behavioral therapy to be the best intervention of improving depression,sleep and quality of life with the probabilities of 72%,59% and 41%. Conclusion Cognitive behavioral therapy has the best effect on the improvement of depression,sleep,and quality of life in patients with breast cancer in convalescence. It can be preferred in care intervention on breast cancer survivors.

Specialist Practice and Research

Study on the current situation and risk factors of minimal hepatic encephalopathy in patients with liver cirrhosis

QIAN Zhuping, YANG Yan

2020, 55(6):  872-876.  DOI: 10.3761/j.issn.0254-1769.2020.06.015

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Objective To investigate the current status of minimal hepatic encephalopathy（MHE） of patients with liver cirrhosis and to explore its risk factors. Methods From June 2017 to December 2018,totally 300 patients with liver cirrhosis were selected from a tertiary hospital in Shanghai via convenience sampling method,and were screened for MHE by psychometric hepatic encephalopathy score. Clinical data was analyzed by logistic regression model to determine the risk factors of MHE. Results The incidence of MHE was 48.67%（146 cases） in 300 liver cirrhosis inpatients;the logistic regression model showed that age（OR=1.032）,INR（OR=2.434）,blood ammonia（OR=1.793）,infection（OR=2.152）,renal insufficiency（OR=1.904）,nutritional risk（OR=2.104） were significant risk factors（P<0.05）. Conclusion Liver cirrhosis patients with older age,higher INR,higher blood ammonia,concurrent infection,renal insufficiency and nutritional risk are at high risk of developing MHE. Early detection and symptomatic interventions should be carried out.

Analysis of the status and influencing factors of adverse dietary reactions in patients during hemodialysis

GUO Gui, ZHANG Hailin, YIN Lixia, ZHANG Yongping, DU Xiaoju

2020, 55(6):  877-883.  DOI: 10.3761/j.issn.0254-1769.2020.06.016

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Objective To investigate the current situation of adverse dietary reactions in patients during hemodialysis and to analyze the influencing factors. Methods A cross-sectional survey was conducted on 368 hemodialysis patients in 4 tertiary hospitals in Lianyungang City by the general data questionnaire and dietary behavior questionnaire,and the influencing factors of adverse dietary reactions were analyzed. Results Among the 81.8%（301 cases） of patients who ate during dialysis,14.0%（42 cases） had hypotension; 4.7%（14 cases） had cough; 1.7%（5 cases） had nausea. Logistic regression analysis results showed that diabetes mellitus,dialysis duration,mealtime,and pre-dietary systolic blood pressure were the influencing factors of hypotension（P<0.05）. The results of single factor analysis showed that age and diet position were influencing factors of cough（P<0.05）,and pre-dietary systolic blood pressure was influencing factor of nausea（P<0.05）. Conclusion During hemodialysis,most of patients who have dietary behaviors are prone to suffer from adverse dietary reactions. Medical staff should pay more attention to patients with diet in hemodialysis,and guide their dietary behaviors during dialysis,so as to reduce the occurrence of adverse dietary reactions.

The effects of oral droplet colostrum during early mechanical ventilation in premature infants with extremely low birth weight

LI Yumei, PAN Yingjie, CHEN Yingying, CHEN Xiaochun

2020, 55(6):  884-888.  DOI: 10.3761/j.issn.0254-1769.2020.06.017

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Objective To investigate the effects of oral droplet colostrum during early mechanical ventilation in premature infants with extremely low birth weight. Methods 130 cases of extremely low birth weight infants with invasive or non-invasive mechanical ventilation were selected and randomly allocated into an experimental group and a control group with 65 cases in each group. In the experimental group, oropharyngeal colostrum started within 24 hours after birth for 5d. Colostrum in control group was only usedfor gastrointestinal nutrition. Airway secretions and urine samples of 2 groups were collected on the 1st and 6th day after birth,and sIgA and lactoferrin concentrations were detected. The incidence of complications was observed in both groups. Mechanical ventilation time and hospital stay of 2 groups were recorded. Results On the 6th day after birth, the concentrations of sIgA and lactoferrin in airway secretions and urine samples in the experimental group were higher than those in the control group, with statistically significant differences（P<0.05）. The incidences of sepsis, neonatal necrotizing enterocolitis and ventilator-associated pneumonia were significantly lower in the experimental group than those in the control group, with statistically significant differences（P<0.05）. The duration of mechanical ventilation and average length of hospital stay in the experimental group were shorter than those in the control group （P<0.05）. Conclusion Early oral droplet colostrum can improve the immune function of infants with extremely low birth weight, reduce the incidence of recent complications, shorten the duration of mechanical ventilation and hospital stay, and reduce medical costs. Therefore, more supporting strategies should be provided to start oral droplet colostrum as early as possible.

Investigation on the current situation of case management for children with diabetes in 31 provinces regions

WANG Yan, WU Liping, LIN Qin, SHENG Wei, WU Yujie

2020, 55(6):  889-893.  DOI: 10.3761/j.issn.0254-1769.2020.06.018

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Objective To investigate the current status of case management for children with diabetes in 31 provinces regions,and to provide references for the construction of case management model for children with diabetes. Methods Using convenient sampling,a self-designed electronic questionnaire was adopted to conduct across-sectional survey of nursing managers and diabetes nurses from 89 hospitals in 31 provinces of China from May 16 to May 31,2019. Results A total of 28 children’s hospitals,49 general hospitals and 12 maternal and child health care institutions were investigated. Among them,23 hospitals（25.84%） carried out case management for children with diabetes. However,among the 178 respondents,only 124（69.66%） were aware of case management. The implementation rales of pediatric diabetes case management in children’s hospitals and tertiary hospitals were better than those in non-children-specialized hospitals and secondary hospitals. The top 3 reasons why hospitals did not develop case management for diabetic children included the little knowing about case management among relevant professional personnel,imperfection of operation system and the shortage of staff. Conclusion Case management for diabetic children is far beyond fully covered in domestic hospitals. Taking full advantage of children’s hospitals and tertiary hospitals will facilitate the establishment of standardized work procedures and effective evaluation system,in order to provide high-quality services for diabetic children.

Nursing Management

Experience and support of nurses as the second victims in patient safety incidents

CHEN Jiaojiao, YANG Qiao, ZHAO Qinghua, ZHENG Shuangjiang, XIAO Mingzhao

2020, 55(6):  894-899.  DOI: 10.3761/j.issn.0254-1769.2020.06.019

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Objective To investigate the status of experience and support of nurses as the second victims in patient safety incidents in Chongqing,and to analyze its relevant factors. Methods In January 2019,nurses from 7 hospitals in Chongqing were conveniently selected as respondents for an online survey by the second victim experience and support questionnaire,and univariate analysis and multiple linear regression analysis were adopted to investigate the level of the second victim experience and support. Results A total of 1 422 valid questionnaires were collected,and mean scores of distress and support dimension items were （3.55±0.68） and （2.43±0.61）,respectively. Mean score of “psychological distress” was the highest in distress dimension,while mean score of “colleague support” was the lowest in support dimension. The experience and support level of second victims were affected by income,professional title,age and marital status. Conclusion Nurses,as the second victims of patient safety incidents,mainly suffered from “psychological distress” and relied on “colleague support”. Managers should pay attention to nurses as the second victims in patient safety incidents,and provide corresponding support for them according to different influencing factors.

Study on knowledge,attitude and practice status of rehabilitation nursing among nurses in 31 provinces and autonomous regions

XIE Jiaxing, WEI Liwei, HU Yanli, BAI Xiaoli

2020, 55(6):  900-905.  DOI: 10.3761/j.issn.0254-1769.2020.06.020

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Objective To investigate knowledge,attitude and practice（KAP） status of rehabilitation nursing among nurses in 31 provinces and autonomous regions of China and to provide references for the specialty training of rehabilitation nursing. Methods A self-designed questionnaire was used to survey 17,088 nurses from 155 different levels of hospitals in 31 provinces and autonomous regions of China. Results The total score of rehabilitation nursing KAP among nurses is 160.57±23.44,which is at a moderate level. 2.37% of participants score well in knowledge;85.9% score well in attitude. Nurses with longer working years and higher professional titles have higher level of KAP（P<0.01）. The result of clustering analysis and multiple comparisons shows that the scores of knowledge and attitude of nurses from the first category of high-score areas（Jiangsu Province,Zhejiang Province and etc.） were significantly higher than those in the second category（Henan Province,Beijing and etc.） and the third category（Xinjiang,Tibet and etc.） of low-score areas（P<0.01）. The result of knowledge clustering analysis in 16 departments showed that the scores of KAP in community service centers and most of internal medicine departments were significantly lower than those in other departments（P<0.01）. The correlation coefficients between knowledge and attitude（r=0.665,P<0.01）,knowledge and practice（r=0.590,P<0.01）,attitude and practice（r=0.320,P<0.01）,indicated a significant correlation. Conclusion Nurses have a positive attitude towards rehabilitation nursing. However,the level of knowledge should be improved.

Nursing Education

The evaluation of training effect of disaster preparation on nurses in department of emergency

MA Jing, DUAN Meihua, MA Yulong, LIANG Peifeng

2020, 55(6):  906-910.  DOI: 10.3761/j.issn.0254-1769.2020.06.021

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Objective To evaluate and analyze the effect of disaster preparedness training for nurses in emergency departments. Methods 265 emergency nurses were selected by convenient sampling. 20 qualified emergency specialists were recruited to carry out the training according to the primary trauma care（PTC） model. Guided by the Kirkpatrick model,a questionnaire survey,written test,scenario simulation,workshops and other methods were used to evaluate based on 4 levels,namely response level,learning level,behavior level and result level. Results The overall satisfaction score of nurses in emergency department was（8.68±0.83）. The theoretical score of nurses in emergency departments after training （72.51±8.24） was higher than it before training （62.14±7.31） with statistical significance（P<0.05）; the practical skill score after training （74.08±6.87） was higher than it before training （68.23±6.4）,and the difference was statistically significant（P<0.05）. The average score of disaster readiness was（4.47±1.09）. 116 people （49.06%） had high disaster readiness; 101 people （43.02%） had high coping readiness; 109 people （52.08%） had high disaster recovery readiness. Conclusion PTC model and covariant model are helpful to improve the training effect of emergency nurses’ disaster preparedness. After training,emergency nurses’ disaster emergency knowledge,special operation performance and assessment score of scenario model are significantly higher than those before training.

Establishment and practice of advanced nursing practice workshop

MO Yuanyuan, LI Huiling, TIAN Li, SUI Wenjie, MENG Hongyan, LI Chunhui, JING Xiuchen

2020, 55(6):  911-914.  DOI: 10.3761/j.issn.0254-1769.2020.06.022

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Objective To explore the establishment and effect of advanced nursing practice workshop in teaching. Methods 88 postgraduate students of nursing master’s degree from 2016 to 2018 in a university were recruited to join the advanced nursing practice courses in the teaching workshop,and the assessment results of the advanced nursing practice workshop,students’ reflection diary and qualitative interview results of 18 nursing master students were adopted to evaluate the effect. Result The total score of the comprehensive ability examination of the postgraduates of nursing master’s degree is（87.19±4.61）. Based on the analysis of students’ reflection diary and interview results,3 themes of “workshop characteristics”,“workshop reflection” and “workshop exploration” are extracted. Conclusion The workshop has its specific advantages,and the students generally have good feedback. It not only improves the comprehensive ability of nursing master students,but also benefits their career growth and practice in the future.

Community Care

Qualitative study on narrative nursing experience of community contracted nurses

XU Lijie, YUE Peng

2020, 55(6):  915-919.  DOI: 10.3761/j.issn.0254-1769.2020.06.023

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Objective To understand the nursing experience,personal gain and career development needs of community contracted nurses in the process of implementing health management for patients with narrative nursing method,in order to provide the basis for the development of community narrative nursing and talent training. Methods Using phenomenological research methods,13 nurses from 2 community health service centers（stations）in Beijing who have carried out narrative nursing were interviewed with semi-structured interviews. Colaizzi method was used to analyze the data. Results After the development of narrative nursing,4 themes were extracted in work experience and feelings,namely increased sense of job satisfaction,highlighted sense of professional existence,enhanced sense of identity of nursing model,and increased sense of work pleasure. 4 themes were extracted in personal growth and harvest,namely learning to respect,understanding,caring for each other,and enabling the self. 3 themes were extracted in future career development needs,namely hoping for reasonable staffing,expecting more professional training opportunities,and expecting to have a bigger nursing development platform. Conclusion Through the narrative nursing,the professional identity and self-value of community nurses were significantly improved. Relevant institutions should also provide more opportunities of learning,training and communicating for nurses,in order to enhance the professional ability and to guarantee the development of community nursing.

Basic Nursing

Investigation on the current situation of airway secretion aspiration of invasive mechanical ventilation in adults

GUAN Xin, YANG Hui, LI Xuting, DONG Liang, LI Zhen, WANG Dou, YING Xiao, SUN Hong

2020, 55(6):  922-927.  DOI: 10.3761/j.issn.0254-1769.2020.06.025

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Objective To investigate the current situation of airway secretion aspiration performed by nurses in adults with invasive mechanical ventilation. Methods A questionnaire was designed by the drafting group of the Chinese Nursing Association “Practices Standard for Endotracheal Suctioning in Adult Receiving Invasive Mechanical Ventilation”. An online questionnaire platform was used to make electronic questionnaires. From March to April 2019,21,279 nurses were investigated by the Critical Care and Respiratory Committee of the Chinese Nursing Association. Results 10,679（50.19%） nurses chose to perform aspiration on time and on demand. 17,554（82.49%） nurses preferred airway sputum aspiration. 16,167（75.98%） nurses’ choice of ‘the length of time to give high concentration of oxygen before and after sputum aspiration’ was incorrect. 3,715（17.46%） nurses always or often dropped saline into the airway during sputum aspiration. 4,857（22.83%） nurses did not know the frequency of replacing closed suction tubes. Conclusion The theory and practice of Chinese nurses in the suction of airway secretions from invasive mechanical ventilation in adults need to be unified and standardized.

Evidence Synthesis Research

The illness experience of patients with post-stroke urinary incontinence：a qualitative meta-synthesis

WANG Yongli, ZHANG Zhenxiang, MEI Yongxia, LIN Beilei, GUO Yawen

2020, 55(6):  932-936.  DOI: 10.3761/j.issn.0254-1769.2020.06.027

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Objective To systematically review the illness experience of patients with post-stroke urinary incontinence（PSUI） and provide references for healthcare workers to carry out precision nursing intervention. Methods We searched databases including the Cochrane Library,PubMed,EMbase,CINAHL,Web of Science,PsyINFO,CBM,CNKI and Wanfang from inception to May 2019 to collect qualitative studies on the illness experience of PSUI patients. The quality of included studies was evaluated by JBI Critical Appraisal Tool for qualitative studies. Results A total of 5 studies were included,with 34 complete research findings grouped into 7 categories by their similarities. Two integrated findings were synthesized：patients with PSUI can have severe negative emotion and interpersonal tension with limited daily activities;patients with PSUI have poor self-management due to communication barriers and lack of information,therefore,they are longing for family and social support. Conclusion Healthcare professionals should pay more attention to the illness experience and information needs of patients with PSUI,and provide psychological counseling,medical support and humanistic care,in order to help patients to improve their confidence in coping with the disease and improve theirquality of life.