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Table of Content

    15 December 2020, Volume 55 Issue 12
    Research Paper
    Reduction of hospital-acquired pressure ulcers among inpatients:development and implementation of a protocol
    LIU Jie,DING Fu
    2020, 55(12):  1765-1769.  DOI: 10.3761/j.issn.0254-1769.2020.12.001
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    Objective To develop and implement a program to reduce the incidence of Hospital-Acquired Pressure Ulcers(HAPU) among inpatients. Methods In 2015,the nursing department formulated a program to reduce HAPU based on the concept of continuous improvement of Deming’s quality idea through understanding the current situation and analyzing the reasons. The program had been carried out for 5 years and it was dynamically adjusted according to improvement outcomes. The results were standardized and the clinical software was developed to practice the information management of HAPU. The incidence rates of HAPU and the management qualification rates were compared before(2013—2014) and after(2015—2019) the program. Results The incidence rates of HAPU decreased from 0.22% to 0.01% significantly(P<0.001) and the qualification rates were ascended from 62.67% to 98.82% after the implementation of the program.Conclusion The program can reduce the incidence rates and improve the qualification rates of HAPU to promote patients’ safety.

    Construction of nursing of damage control resuscitation for patients with severe abdominal trauma:a Delphi study
    LIU Feng,YE Xianghong,DING Weiwei,HUANG Ping,LIU Baochen,HAN Xiaoqin,WU Cuili,SUN Lin
    2020, 55(12):  1770-1776.  DOI: 10.3761/j.issn.0254-1769.2020.12.002
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    Objective To construct a nursing plan for damage control resuscitation in patients with severe abdominal trauma based on the concept of damage control resuscitation. Methods Based on literature reviews,clinical structure observation and expert meetings,the guidelines and literature related to abdominal trauma were integrated,and the first draft of the nursing plan was formulated. After Delphi expert consultations,the practice plan of damage control resuscitation for patients with severe abdominal trauma was determined. Results In the 2 rounds of expert consultations,the expert positive coefficients were 88.89% and 100%,and the expert authority coefficients were 0.88. The coordination coefficients of items in 2 rounds of inquiry were 0.29 and 0.32,respectively. The final practice plan includes 2 first-level items,15 second-level items,and 50 third-level items. Conclusion The nursing plan constructed in this study is scientific,reliable and practical,and provides guidance for clinical trauma care.

    Evidence-based practice of midwifery care in the second and third stage of labor in normal delivery
    FENG Jialei,YUE Jieya,CHEN Fei,YUAN Yanli,LIU Jun,BAO Airong,CHEN Mei,DENG Jun,LI Jing,DING Yanming
    2020, 55(12):  1777-1783.  DOI: 10.3761/j.issn.0254-1769.2020.12.003
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    Objective To explore the nursing care plan based on the best evidence for the second and third parturition of normal delivery,and to evaluate its application effects. Methods Evidence-based methods are used to systematically retrieve domestic and foreign guidelines for the second and third parturition nursing measures for normal delivery of women,to evaluate and summarize the best evidence,to formulate review indicators,to conduct baseline reviews,and analyze the contributing and obstacle factors based on the review results. A variety of methods were used to train midwives and obstetric nurses,and to compare the delivery outcomes of mothers before and after the application of the evidence,the degree of knowledge and implementation of the evidence by nursing staff. Results After the application of the best evidence,the rates of maternal perineal intact increased from 7.9% to 13.4%;the midwives’ scores of knowledge related to the second and third stages of labor increased from 25~85(54.9±14.3)before training to 50~100(77.1±13.8);except indicatiors 14 and 15,the implementation rate of less than 50% of indicators before the application of evidence have all risen to more than 70%. Conclusion This study is based on the best evidence,combined with the clinical situation of the department,the patient’s willingness. The factors of contributing and obstacle risks were analyzed to formulate the nursing plans of the second and third stage of labor for the normal delivery of the mothers. After the implementation of the evidence,the level of perineal intactness of mothers is improved;the level of knowledge of midwives is improved and their working behavior is regulated.

    Standards
    An expert consensus on high-risk nursing procedures and protection from aerosol-generated respiratory infectious diseases
    Nursing Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Nursing Department of Peking Union Medical College Hospital, Surgery Nursing Committee of Chinese Nursing Association(Writing Committee:WANG Hui, WU Xinjuan, MA Yufen, HU Luhong)
    2020, 55(12):  1784-1784.  DOI: 10.3761/j.issn.0254-1769.2020.12.004
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    Objective To establish a consensus on the protection of high-risk nursing procedures of aerosol transmission in respiratory infectious diseases. Methods The consensus was preliminarily formed through combining relevant literature and the work experience of clinical nursing experts,and it was eventually confirmed by 2 rounds of Delphi expert consultations and expert meetings. Results The consensus included basic requirements for protec-tion and highlights of protection on 6 nursing procedures of high risk of aerosol transmission in respiratory infec-tious diseases. The basic requirements contained 3 aspects,including environmental control,personal protection,mana-gement and control. 6 nursing procedures were listed as following:oxygen inhalation,mechanical ventilation,sputum suction,atomization inhalation,throat swab collection,and cardiopulmonary resuscitation. Conclusion This scientific consensus was conducive to provide clinical guidance for the protection of aerosol-generating nursing procedures.

    Specialist Practice and Research
    A qualitative study on the experience of related donors of allogeneic hematopoietic stem cell transplantation
    WANG Ting,YAN Xia,LI Canying,SUN Hui,JIANG Hua
    2020, 55(12):  1785-1790.  DOI: 10.3761/j.issn.0254-1769.2020.12.005
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    Objective To explore the experience of related donors in the process of allogeneic Hematopoietic Stem Cell Transplantation(HSCT),so as to take precision nursing and to guide clinical practice. Methods A purposive sampling and a semi-structured interview method were used in our center. 2 trained nurses interviewed the related donors of allogeneic HSCT. The content of interviews was recorded by a voice recorder. When the information was saturated,the interview was terminated. In this study,18 related donors were included. Finally,the data was analyzed by 7 steps of Colaizzi of phenomenology. Results The interview contents were summarized into 5 themes,namely the diversity of determinants of donation,physical and mental stress of donors,the heavy burden of responsibility,the feeling of neglect,the positive impact of donation. Conclusion In the process of donation,related donors suffered from pressure of physiology,psychology,life and so on. Medical staff should strengthen the communication with donors and provide more comprehensive professional guidance,so as to create a positive atmosphere for donors and patients.

    Development and clinical application of standardized management of inter-hospital referral in critically ill patients
    CHENG Junya,JU Qiaoyan,LIU Xueying,CAO Weizhong,CHEN Zihong,ZHU Lingya
    2020, 55(12):  1791-1795.  DOI: 10.3761/j.issn.0254-1769.2020.12.006
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    Objective To evaluate clinical application effects of standardized management of inter-hospital referral process. Methods The process of inter-hospital referral and the checklist of handover were formulated through literature reviews,expert discussions and consultations. The process and the checklist were adjusted by modified Delphi method,and were applied into the clinical practice for 2 months. The impact on the duration of inter-hospital referral and the incidence of adverse events was observed. Results After the clinical application,the rate of the communication between referral hospitals before the transferring has reached 100%;the completion rate of checklists was 96.15%;the length of time on handover fell from(14.44±3.52)mins to(9.33±1.83)mins;the incidence of adverse events decreased from 21.05% to 3.84%;the differences were statistically significant(P<0.01,P<0.05). Conclusion The process and the checklist of inter-hospital referral are scientific and practical. They standardized the process,improved the work efficiency and reduced the incidence of adverse events,which can be applied to clinical practice and improve patient safety.

    Analysis of the puerperae's expectations and perceived status of puerperal health management services
    TIAN Ce,JIANG Yue,YANG Fang,XU Ying,LEE Soowon,ZHAO Hong,ZHU Qin
    2020, 55(12):  1796-1801.  DOI: 10.3761/j.issn.0254-1769.2020.12.007
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    Objective To explore and analyze expectations and perceptions of puerperal health management(PHM),so as to provide references for optimizing PHM services. Methods A questionnaire survey was conducted in an obstetrics clinic of a hospital in Beijing from April to June 2019,using a self-designed questionnaire on the puerperae’s expectations and perceived status of PHM services. The questionnaire included 4 dimensions,namely maternal physical and mental recovery,infant care,social support and approaches of PHM. The Cronbach’s α value of the questionnaire is 0.937,and the KMO is 0.730. 6 common factors were extracted,and the cumulative interpretation of variation was 76.9%. Results A total of 699 valid questionnaires were collected. Among the 19 PHM services,except blood glucose and blood pressure monitoring for mothers and breastfeeding guidance for mothers with diseases,the differences between expectations and perceived status of other services had statistical significance(all P<0.001). There was a significant gap between expectations and perceived status of PHM in 6 services,namely knowledge of common diseases in infants,infant touch guidance,breastfeeding guidance,postpartum weight management,guidance of infant rearing skills,postpartum medication guidance. Conclusion There was a significant gap between PHM expectations and perceived status. It is suggested that relevant departments should increase investment in PHM and strengthen supervision of its quality. Community health workers should also continuously improve their ability,understand the high expectations of PHM,and help to improve the quality of PHM services.

    A survey of the application of midwifery technology in 1213 medical institutions
    YANG Wenqian,LUO Biru,XU Xinfen,JIANG Mei
    2020, 55(12):  1802-1807.  DOI: 10.3761/j.issn.0254-1769.2020.12.008
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    Objective To investigate the present application situation of the appropriate technologies of midwifery in Chinese mainland,so as to provide references for future midwifery education,training and policy-making. Methods From December 2017 to November 2018,a self-designed questionnaire was conducted to investigate the current situation of appropriate technical application in 1 213 secondary and above midwifery medical institutions in 22 provinces,municipalities or autonomous regions by purposive sampling. Results A total of 672(55.4%) tertiary hospitals and 541(44.6%) secondary hospitals were investigated. The application rates of free position,mental health care,comprehensive support,non-drug analgesia and guided music in tertiary midwifery medical institutions were all higher than those in secondary hospitals,and the differences were statistically significant(P<0.05). The application rates of shaving pubic hair,anal evaluation,forced position,conventional artificial rupture of membrane and abdominal pressure in secondary hospitals were higher than those in tertiary midwifery medical institutions,and the differences were statistically significant(P<0.05). According to the type of hospitals,the outpatient service rates of free position,guided delivery and midwife in general hospitals were all lower than those in specialized hospitals and maternal and child care hospitals,and the differences were statistically significant(P<0.05). In general hospitals,the application rates of midwifery technology such as shaving pubic hair,dilating vagina with hand in the second stage of labor and forced position were higher than those in specialized hospitals and maternal and child health care hospitals,and the differences were statistically significant(P<0.05). Conclusion The use of beneficial midwifery techniques in delivery rooms of Chinese hospitals is good,however,the use of other midwifery techniques is jagged and the application in different levels of hospitals is unbalanced. The implementation standards and norms of appropriate midwifery technology must be formulated and the quality of midwifery services should be enhanced to improve the present situation of appropriate technical application and ensure the safety of mothers and infants in China.

    Construction of nursing procedures knowledge base for pediatric hyperthermia based on clinical care classification
    ZHAO Yongxin,GU Ying,ZHANG Xiaobo,LIU Fang,WU Ying,YE Lan,WANG Huimei,WAN Yanmin,LU Chunmei,XIA Aimei
    2020, 55(12):  1808-1812.  DOI: 10.3761/j.issn.0254-1769.2020.12.009
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    Objective To build a knowledge base of nursing procedures in pediatric hyperthermia based on Clinical Care Classification(CCC) 2.5 version. Methods With the common symptoms of pediatrics “axillary temperature≥37.5 ℃” as the research content,the research team summarized all the specific nursing measures related to "axillary temperature≥37.5 ℃" combined with clinical nursing routine and hospital management system based on CCC 2.5 version by evidence-based nursing method. Based on the definition of "axillary temperature≥37.5℃" related nursing diagnosis,core nursing interventions,modifiers of nursing activity types and modifiers of nursing outcomes in CCC 2.5,the first draft of knowledge base of "pediatric hyperthermia" nursing procedures was constructed.According to the coding rules of "code of specific nursing measures=code of core nursing interventions +code of modifiers of nursing activity type" and "code of nursing outcomes=code of nursing diagnosis+code of nursing outcome modifiers" in CCC 2.5,the first draft of the knowledge base was coded. After that,the expert consultation meeting was held to evaluate,discuss and revise the draft content and code of the knowledge base,and the final draft of the knowledge base was determined. Results The final draft of the knowledge base of pediatric "hyperthermia" nursing procedures includes 1 nursing diagnosis,19 specific nursing measures and 4 nursing outcomes. Conclusion The knowledge base of pediatric "hyperthermia" nursing procedures is professional,scientific and practical,which standardizes nursing language and facilitates information sharing.

    Development of an assessment scale of hypothermia risks for trauma patients and its test of validity and reliability
    TU Jiayuan,LIU Yun,SUN Lin,CHEN Xueshun,NIE Shinan,HAN Xiaoqin,JING Wenhua,YU Haitao
    2020, 55(12):  1813-1818.  DOI: 10.3761/j.issn.0254-1769.2020.12.010
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    Objective To develop an assessment scale of hypothermia risks in trauma patients pre-hospital and in 3 hours after admission,and to test its reliability and validity. Methods The draft assessment scale of hypothermia risks was constructed by the literature analysis method and 2 rounds of Delphi consultations. The data of 91 patients with trauma was collected,and the items screening and the test of reliability and validity were carried out. Results The scale had 2 dimensions,11 first-level items and 25 second-level items. The exploratory factor analysis identified 2 principal factors,and the accumulative contribution of variance was 58.171%. The load value of common factors of each item was between 0.535~0.877. The correlation coefficient of the effective standard was 0.804;the area under the ROC curve was 0.924;the confidence interval of 95% was 0.866~0.982(P<0.001);the Cronbach’s α coefficient of the scale was 0.875. Conclusion The assessment scale of hypothermia in trauma patients has good reliability and validity,and can be used in clinical practice to assist in the identification and prediction of hypothermia.

    Construction and preliminary application of Symptom Cluster Scale for inflammatory bowel disease
    GU Fangchen,LIN Zheng,SHANG Xingchen,BIAN Qiugui,LIN Lin,ZHANG Hongjie
    2020, 55(12):  1819-1824.  DOI: 10.3761/j.issn.0254-1769.2020.12.011
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    Objective We developed a scientific and standardized symptom clusters assessment scale for patients with inflammatory bowel disease and performed a reliability and validity test. Methods Guided by the Symptoms Experience Model,our research group developed the first draft of the scale through literature review and Delphi expert consultation. After descriptive defining of the items,we conducted pilot experiment with a small sample size and refined the scale based on patient feedback. 150 patients with inflammatory bowel disease admitted to the Department of Gastroenterology in 4 tertiary hospitals in Jiangsu Province from June to September 2019 were conveniently selected and investigated. The data was analyzed by SPSS 20.0 to determine the reliability and validity of the scale. Results The final Symptom Cluster Scale for Inflammatory Bowel Disease consisted of 18 items. The content validity index of the scale was 0.850,and the content validity index of each item was 0.941~1.000. Exploratory factor analysis extracted 5 common factors,and the cumulative variance contribution rate was 77.390%. There was a positive correlation between each factor and the total scale,the correlation coefficient was 0.580~0.857;the correlation coefficient between the total scale and the Inflammatory Bowel Disease Questionnaire was 0.925. The Cronbach’s alpha coefficient of the total scale was 0.900,and the test-retest reliability was 0.856. Conclusion The Symptom Cluster Scale for Inflammatory Bowel Disease has good reliability and validity,which can guide medical staff to comprehensively and accurately evaluate patients and provide evidence to develop individualized symptom management measures for patients with inflammatory bowel disease.

    Nursing Management
    Investigation and analysis on willingness of nurse to use Internet + Nursing Services in non-pilot provinces
    LI Jingjian,GOU Juxiang,ZHOU Qian,HU Ziyi,ZHENG Xun
    2020, 55(12):  1825-1830.  DOI: 10.3761/j.issn.0254-1769.2020.12.012
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    Objective To analyze the understanding level,service willingness and influencing factors of using Internet + Nursing Services(hereinafter referred to as the service) by nurses in non-pilot provinces and cities,so as to provide references for the development of the service. Methods A convenience sampling method was adopted to conduct a questionnaire survey to investigate registered nurses in hospitals of different grades in non-pilot provinces and cities. Results Among 3 242 nurses from 127 hospitals in South China,North China,Central China,East China,Northeast China,Northwest China and Southwest China,641(19.8%) nurses knew the service and 1 541(47.5%) were willing to participate in the service. 390(60.8%) nurses got the information about the service through social networks. The benefits of nurses participating in the service are as following. 2 690(82.9%) nurses choose the option of reflecting the value of nursing;2 557(78.8%) nurses choose increasing their income. 2 442(75.3%) nurses choose broadening their practice path and promoting the development of nursing discipline. 2 706(83.4%) nurses believed that medical risks and disputes were increased,and they were worried that the safety of practice would not be guaranteed. 3 045(93.9%) nurses hoped that the legislation could be clearly defined at national level to ensure the safety of practice. Logistic regression analysis showed that male nurse, being married, high education level, high vocational title, mortgage pressure, and understanding of the service were influencing factors for nurse willingness to participate(P<0.05). Conclusion Nurses had a lower level of understanding of the service,and different under-standing levels of the service affected their willingness to participate. Improving the relevant legal system,popu-larizing relevant policies and publicity were essential to promote the willingness of nurses to participate in the service.

    Nursing Education
    Research on the construction of training knowledge system to prevent inpatient suicide
    CHEN Ying,HU Deying,DING Fang,PENG Xiao,MAO Shiqing,LIU Yue
    2020, 55(12):  1831-1835.  DOI: 10.3761/j.issn.0254-1769.2020.12.013
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    Objective To construct the knowledge system of inpatient suicide prevention training and provide bases for clinical nurses to carry out suicide training in inpatients. Methods Based on literature review,the training knowledge demand status of nurses for patients to prevent suicide was surveyed,and the expert consultation draft was preliminarily constructed. Delphi method was used to organize the recommendations from 25 experts that specialized in suicide prevention,nursing safety management,nursing humanistic care and psychological nursing. In accordance with 2 rounds of expert consultations,some items were revised. Results The response rates of 2 rounds are respectively 96.0% and 91.7%. The authority coefficient of experts is 0.88 and 0.83 respectively. The Kendall harmony coefficient was 0.29 and 0.17 respectively(P<0.001).The final knowledge system of patient suicide prevention training consists of 4 first-level items and 26 second-level items. Conclusion The knowledge system of inpatient suicide prevention training has high reliability and practicability,which can provide bases for clinical patient suicide prevention training.

    Community Care
    Analysis of health status and its influencing factors of community residents based on the intelligent health monitoring system
    SUN Hongyu,SUN Yumei,SUN Jingyi,DONG Chaoqun,CHEN Hua,SHI Jingdong
    2020, 55(12):  1836-1843.  DOI: 10.3761/j.issn.0254-1769.2020.12.014
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    Objective To investigate the health status of community residents and to analyze related influencing factors. Methods A descriptive cross-sectional study was conducted to obtain data of 4 311 community residents in China from April to May,2019. Intelligent health monitoring system,including their general characteristics,health behavior,health status,results of generalized anxiety disorder scale-7(GAD-7) and patient health questionnair-9(PHQ-9),was used as the suvery tool. Descriptive statistics,chi square test and logistic regression were used for data analysis. Results The average age of the participants was(29.25±11.88) years old,and the prevalence of chronic diseases was 13.8%. There were 1 480(34.3%) patients with anxiety and 1 620(37.6%) with depression. The smoking rate and drinking rate were 12.2% and 32.3% respectively. Age,education level,being married,meal regularity,additional meal in the morning,eating dinner,meat-based diet,salty diet,other special diet,drinking alcohol,taking vigorous exercise,anxiety and depression were the influencing factors of chronic diseases. Conclusion The health condition of community residents was generally good,while the symptoms of anxiety and depression were common,which implies that much attention should be paid on the emotional health. The risk factors of chronic diseases were old age,being married,irregular meal,meat-based diet,salty diet,other special diet,drinking alcohol,no vigorious exercise,depression and anxiety. These findings can provide suggestions for the community to develop interventions to promote residents’ health.

    Vascular Access Nursing
    The influence of PICC catheterization history on PICC insertion process and catheter indwelling effect
    CAO Xiuzhu,ZHAO Linfang,ZENG Xufen,WANG Yaping,JIN Xianghong,CHEN Xianghua
    2020, 55(12):  1844-1849.  DOI: 10.3761/j.issn.0254-1769.2020.12.015
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    Objective To explore the influence of PICC catheterization history on the reinsertion process and the indwelling effect. Methods The data of the operation and indwelling process of PICC patients in a tertiary hospital in Hangzhou from January to December 2019 were reviewed and analyzed. A total of 2 877 effective cases were collected to compare the puncture and delivery process,the occurrence of complications and the indwelling time between patients with different catheterization history. Results There were statistical differences in the total success rate of catheterization,vein selection,arm selection,adjustment ratio during catheterization,and the incidence of primary malposition between 2 groups without catheterization history and those with catheterization history. There was a statistically significant difference in the total incidence of complications between 2 groups without a history of catheterization and that with a history of catheterization. There was a statistically significant difference in the total incidence of complications and the incidence of catheter-related thrombosis between the ipsilateral catheterization history and the non-ipsilateral catheterization history. Conclusion Patients with a history of PICC catheterization are limited in the veins available for puncture,while brachial veins are often used for puncture. The difficulty of catheterization was increased. The incidence of primary malposition is higher,and the incidence of complications during indwelling is higher. Particularly,for patients with a history of ipsilateral catheterization,the incidence of catheter-related thrombosis is higher,which affects the safe use and long-term indwelling of PICC.

    Basic Nursing
    Application of modified citrate infusion method for patients under continuous renal replacement therapy
    LU Liang,ZHOU Na,XU Yu,WANG Fengtao,LI Xiaozhi,SHEN Yanling
    2020, 55(12):  1850-1854.  DOI: 10.3761/j.issn.0254-1769.2020.12.016
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    Objective The aim of this study is to compare the anticoagulant effects of different citrate infusion methods in treatment with continuous blood purification(CBP). Methods From January to December 2018,40 patients with CBP were recruited randomly from Intensive Care Unit of the Affiliated Hospital of Qingdao University. These patients were randomly allocated into 2 groups according to the different infusion methods of citrate. In the control group,patients(n=20) were treated with a simplified infusion method,and all 4% citrate solution was infused into the artery of the single needle double lumen tube. In the observation group,patients(n=20) were treated with the improved citrate infusion method. Briefly,4% sodium citrate solution was infused into the artery and venous chamber,respectively. The sum of 2 pumping speeds was the same as that in the control group. The coagulation levels of filters and venous chambers in 2 groups after 48 hour were compared respectively. The monitoring was terminated when the level Ⅲ coagulation presented in venous chambers. The peripheral calcium,filtered calcium,bicarbonate value and the service life of cardiopulmonary bypass were measured. Results After 48 hours,40% of venous chambers in the control group presented level Ⅱ coagulation,which was significantly higher than 10% in the observation group(P=0.031) with none of tube presenting level Ⅲ coagulation. The average service time of cardiopulmonary bypass in the observation group was(96.78±17.49) h,which was significantly higher than(65.50±13.63) h in the control group,and the differences were statistically significant(t=12.204,P=0.001). There was no statistically significant difference in coagulation status and blood calcium value between 2 groups(P>0.05). Conclusion The modified regional citrate infusion is a safe,feasible,and effective method for the treatment of CBP.

    Clinical Practice
    Nursing care of a patient with portal vein thrombosis secondary liver failure after liver transplantation
    SHEN Mingyan,LU Jianfang,JIN Yaxian,ZHANG Yuanyuan,CHEN Xiang,FENG Zhixian
    2020, 55(12):  1855-1858.  DOI: 10.3761/j.issn.0254-1769.2020.12.017
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    To summarize the nursing process of a patient with portal vein thrombosis secondary liver failure after liver transplantation who underwent a liver re-transplantation. Nursing points:Based on collaboration of multi-disciplinary teams,during the process of artificial liver support treatment,the accuracy of the dosage of anticoagulant drugs was ensured;coagulation indicators were observed closely,and bleeding prevention measures were implemented. The measures to prevent thrombosis during the perioperative period of re-transplantation were taken and liver blood flow changes were dynamically monitored. During the implementation of minimal immunosuppressive therapy,acute rejection and infection were strictly prevented;during the concurrent chylofistula,a low-fat diet and drainage tube care were carried out. The patient was discharged on foot on the 63rd day after admission.

    Evidence Synthesis Research
    Evidence summary of pelvic floor muscle training applied in prevention and treatment of post-prostatectomy incontinence
    SI Longmei,ZHANG Peiying,ZHANG Meng,LIU Yue,WANG Cai,SHANG Yanhua,WANG Huimei,XU Yunhong,HUANG Yanbo,DING Yanming
    2020, 55(12):  1859-1863.  DOI: 10.3761/j.issn.0254-1769.2020.12.018
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    Objective To retrieve,evaluate and summarize the best evidence of pelvic floor muscle training applied in prevention and treatment of post-prostatectomy incontinence,so as to provide references for clinical practice. Methods We searched the guideline websites,association official websites and databases to collect literature including guidelines,evidence summaries,best practice information sheets,recommend practice and system reviews. 2 researchers independently evaluated quality of literature and extracted data. Results Totally 11 articles were enrolled,including 3 guidelines,1 evidence summary and 7 systematic reviews. Finally 11 pieces of best evidence on training aims,assessment of urinary incontinence,application timing,effects and methods,factors influencing effects of interventions were summarized. Conclusion This study summarized the best evidence of pelvic floor muscle training applied in prevention and treatment of post-prostatectomy incontinence to provide more targeted and scientific guidance for clinical medical staff in the assessment of urinary incontinence,pelvic floor muscle training,health education and instructions for patients undergoing radical prostatectomy.

    The experience of cancer patients and their relatives in advance care planning:a meta-synthesis of qualitative research
    DENG Zhijian,CHEN Xiangying,YANG Liu,ZHANG Jianghui,DENG Renli
    2020, 55(12):  1864-1870.  DOI: 10.3761/j.issn.0254-1769.2020.12.019
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    Objective To conduct a meta-synthesis of the experience of cancer patients and their relatives in advance care planning ( ACP ) and provide evidence-baced guidance for the development and implementation of ACP in cancer patients. Methods The research question,inclusion and exclusion criteria were constructed by PICo model. 6 databases( Embase, MEDLINE, PsycINFO, CINAHL, Cochrane library CNKI, CMB ) were included to retrieve literature on the experience of cancer patients and their relatives about ACP intervention from inception until Feb 2020. The JBI Critical Appraisal Tool for qualitative studies from Australia was used to evaluate the methodology quality of included research. Meta-aggregation was used to conduct the synthesis. Results 47 findings were extracted from 8 qualified studies and integrated into 5 categories. 2 synthesis results were summarized from the 5 categories. Synthesis result 1:Patients benefit from individual and flexible ACP strategy;Synthesis result 2:Barriers to ACP come from patients themselves,their family members and the cultural background of their society. Conclusion ACP is a complex social process and influenced by many factors. It requires joint efforts of different stakeholders to achieve high-quality and successful ACP.

    Review
    The identification and clinical nursing care of pancreatic exocrine insufficiency in patients with acute pancreatitis
    WANG Xinran,ZHONG Lixia,ZHANG Xiaoxue
    2020, 55(12):  1871-1875.  DOI: 10.3761/j.issn.0254-1769.2020.12.020
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    The incidence of acute pancreatitis is increasing year by year. Nearly one-third of patients develop exocrine pancreatic insufficiency after acute pancreatitis,which leads to the symptoms such as digestion disorders,absorption disorders and malnutrition. This article reviewed domestic and international literature on the importance of nursing staff’s attention to pancreatic exocrine insufficiency,and the recognition,monitoring and nursing measures of pancreatic exocrine insufficiency. It provided scientific bases for relevant clinical work of nursing staff.

    A scoping review of discharge planning practice tools in hospitalized patients
    KE Jian,WANG Hui,WANG Ying,LIU Yu,YUE Xiao,WANG Binghua,HU Kaili,YANG Chunzi,HUANG Haishan
    2020, 55(12):  1876-1883.  DOI: 10.3761/j.issn.0254-1769.2020.12.021
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    Objective To integrate the relevant research,guidelines and government documents on the practice tools of discharge planning in inpatients by taking scoping reviews. Methods Focusing on the practical tools of discharge planning,we systematically searched the relevant databases,guidelines and government websites,extracted the information including author,year,country,name,applicable object,content introduction,using time and the purpose of the tools. Results Along the time line from admission to discharge of a patient,the discharge planning practice tools were divided into 5 categories:admission - evaluation,hospitalization - implementation,24 hours before discharge - verification,on discharge - referral,and after discharge - follow-up,with a total of 29 tools to promote the smooth implementation of the discharge plan. Conclusion Health care personnel should formulate and develop suitable practice tools of discharge planning based on national conditions and medical environment,so as to effectively promote the implementation of discharge plans with standardized tools,optimize the outcomes of patients,and promote the continuity of medical care services for patients.

    The application of sleep disorder assessment tools in patients with cognitive impairment:a system review
    YANG Xuan,QIAO Yuchen,ZHAO Jie,CHANG Hong
    2020, 55(12):  1884-1889.  DOI: 10.3761/j.issn.0254-1769.2020.12.022
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    The occurrence of sleep disorders can aggravate the cognitive function of patients with cognitive impairment,increase mental and behavioral abnormalities,reduce the quality of life,bring greater burden to caregivers,and increase social and economic costs. This article reviews,compares and analyzes the content,characteristics,application,and limitations of sleep impairment assessment tools in patients with cognitive impairment development status of assessment tools at home and abroad,and also proposes future research direction. It aims to provide a reference for the localization of the development of sleep assessment tools for patients with cognitive impairment,and to provide some useful information about the accurate assessment and personalized care of patients with cognitive impairment.

    Progress on integrated care with quaternary linkage in senile dementia
    YIN Xiaotong,ZHU Lanyu,LI Chunying
    2020, 55(12):  1890-1895.  DOI: 10.3761/j.issn.0254-1769.2020.12.023
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    With the acceleration of the aging process,the care of senile dementia has become the focus of atten-tion. This paper analyzes the concept of the Alzheimer’s disease,introduces the classification and diagnosis of Alzheimer’s disease,and summarizes the meaning of the integrated care with quaternary linkage. The development of integrated care were reviewed from the perspective of both at home and abroad,and its main framework and function were summarized. Recommendations on the network technology application,linkage referral,cultivating double levels of nursing talents,the foundation of Alzheimer community were put forward,in order to provide references for dementia care problems of elderly patients in China.

    The research advances on the adaptability of the elderly in institutional care facilities
    ZHANG Fengjian,XIONG Han,LIU Yilan,WANG Rong,WANG Jieyu
    2020, 55(12):  1896-1902.  DOI: 10.3761/j.issn.0254-1769.2020.12.024
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    With the accelerating of aging in the world,living in institutional care facilities is one of the main options for the elderly. However,adaptability problems were commonly reported in the elderly as their relocating to institutional care facilities with the environment changes. Previous studies have shown that the elderly with adaptability problems may result in physical and psychosocial changes,which significantly influenced their quality of life. In previous studies,several evaluation tools were developed to measure the adaptability of the elderly,and the influential factors were explored,such as personal willingness,care quality of long-term care institutions,family support,and social support. This article focuses on the adaptability of the elderly in institutional care facilities,reviews the relevant research on it,and analyzes its concepts,current situation,evaluation tools and influencing factors. It also proposes the corresponding intervention strategies through the following 4 systems:social support system,institution system,family system,and personal system,providing references for improving the adaptability of the elderly in institutional care facilities and improving the quality of life of the elderly in institutions.

    Nursing Instruments Innovation
    Design of automatic vaginal retractor with suction function and its application
    WANG Shanshan,XU Hongyan,LIU Yuhui,FENG Suwen
    2020, 55(12):  1903-1905.  DOI: 10.3761/j.issn.0254-1769.2020.12.025
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    Objective To design an automatic vaginal retractor with suction and to evaluate its effects of clinical application. Methods An automatic vaginal retractor with suction was designed and manufactured. 100 patients diagnosed with high-grade cervical squamous intraepithelial carcinoma(HSIL) and admitted for cervix cold knife conization were enrolled between March and November 2019 in a tertiary obstetrics and gynecology hospital in Zhejiang Province. 50 patients were designated randomly into an experimental group applied with the automatic vaginal retractor with suction during the surgery;L shaped vaginal retractor was used in other 50 patients designated into the control group. Medical staff number (surgeons and nurses) needed for conization,operation time,intraoperative blood loss,incidence of perioperative complication and medical staff satisfaction were evaluated. Results Staff(surgeons and nurses) number in conization during the use of the vaginal automatic retractor with suction was 1-2 instead of 3 in the control group during the use of L shaped vaginal retractor(t=-23.19,P<0.001). The experimental group applied with automatic vaginal retractor with suction had significantly shorter total operation time(26.20±7.75 min vs 36.28±9.66 min)(t=-5.75,P<0.001),lower intraoperative blood loss(31.20±19.75 ml vs 48.50±32.12 ml)(t=-3.244,P=0.002)in comparison with those in the control group with the L shaped vaginal retractor,no perioperative complication was observed in either group. Conclusion The automatic vaginal retractor with suction can save medical human resources,reduce operation time and intraoperative blood loss in the cervix cold knife conization,and offer protection for medical staff and patients by automatic suction of blood in operation area and surgical smoker.

    Overseas Knowledge
    Development of learning disability nursing and its enlightenment
    GUO Lina, LIU Yanjin, GUO Yuru, WANG Kankan, ZHU Yiru, WEI Miao, WANG Qi, HE Yu
    2020, 55(12):  1906-1910.  DOI: 10.3761/j.issn.0254-1769.2020.12.026
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    Learning disability nursing in the UK has a history of more than 100 years. It has experienced many difficulties and innovations in its development process,and has accumulated rich experience. This article mainly introduces the development of learning disabilities nursing in the UK,nurses’ responsibilities and work content,talent training and management system,challenges and coping strategies. It proposes recommendations for the development of learning disabilities nursing in China,aiming to provide new perspectives for the innovation of nursing service mode and the improvement of nursing service system,and to provide references for nurses to lead health services.