Table of Content

15 January 2021, Volume 56 Issue 1

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Research Paper

Application and effect of needlestick injury protection network for nursing staff

LI Jia,HUANG Xuefang,LI Jiarui,WU Jianhui

2021, 56(1):  7-13.  DOI: 10.3761/j.issn.0254-1769.2021.01.001

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Objective To construct a protective network for needlestick,and to evaluate its application effects. Methods Published evidence was reviewed;the availability of evidence was determined,and then comprehensive solutions were constructed to build needlestick protection network for nursing staff（SECRURITY）:Standard of Practice（SOP）;Elearning（videos for prevention of needlestick injury）;Checklist;Unified promotion of needlestick protection;Report;IT（information support）;Yes or no. The number of cases of needlestick before and after the use of protective network,the implementation rate of review indicators,the knowledge,attitude,behavior of nursing staff needlestick protection were compared. Results After the use of the protection network,the number of cases of needlestick for nursing staff decreased from 26 to 16 from June to November in 2019,compared with the same period in 2018,and the incidence rate decreased by 38.5%. Out of 13 review indicators,the implementation rates of 12 indicators were significantly higher（P<0.05）,and the implementation rates of 11 indicators were higher than 80%. The protection knowledge score（8.27±1.21） was significantly higher than before（7.57±1.43,t=-9.622,P<0.001）;the protection attitude score（43.09±2.86）was significantly higher than before（42.45±3.33,t=-3.774,P<0.001）;the protective behavior score（51.22±5.48）was significantly higher than before（50.14±5.82,t=-3.058,P<0.001）. Conclusion The needlestick protection network can reduce the occurrence of needlestick and enhance the knowledge,attitude,and behavior of needlestick prevention for nursing staff.

Construction of a risk prediction model for post-intensive care syndrome-cognitive impairment

WEI Yueqing,LI Hong,LI Yun,WU Jingbing,ZHANG Zhihong,ZHENG Yan

2021, 56(1):  14-20.  DOI: 10.3761/j.issn.0254-1769.2021.01.002

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Objective To explore the risk factors of Post-Intense Care Syndrome-Cognitive Impairment（PICS-CI） in critically ill patients,and to build their risk prediction model. Methods A total of 481 ICU patients from 2 Level A tertiary hospitals in Fujian Province were selected,and divided into a cognitive impairment group（n=215） and a non-cognitive impairment group（n=266） according to their cognitive score of 7 days after being transferred out of ICU. The demography,disease,treatment,physiological and laboratory indicators between the 2 groups were compared;the risk factors of PICS-CI were screened out,and Logistic regression was used to establish a risk prediction model. 118 patients from another 4 hospitals were selected to verify the model prediction. Results Age（OR=1.035）,delirium（OR=10.488）,sepsis（OR=1.925）,propofol dose（OR=1.098）,sleep disorder（OR=0.932） are the independent risk factors of PICS-CI. These 5 factors are used to construct a prediction model,which was internally verified by the modeling group. The calibration curve of the calibration chart is close to the ideal curve;the area under the ROC curve is 0.838;the risk prediction value 0.521 corresponding to the maximum Youden index is the best value;the prediction critical value is 50 points. The external verification shows that the calibration curve of the calibration chart is near the ideal curve,and the area under the ROC curve drawn is 0.797. Conclusion The PICS-CI prediction model constructed in this study shows good prediction efficiency. ICU patients with scores≥50 should receive close attention and early interventions in early stage.

Formulation of early warning assessment scale system for the critical illness changes on gynecologic patients and the test of its predictive effectiveness

QIAO Chengping,ZENG Lihua,ZHAO Lei,FANG Yiyu,QIAO Minmin,YE Min,ZHANG Huiwen,LIU Yaling,TANG Cong,QU Min,XU Huahua

2021, 56(1):  21-27.  DOI: 10.3761/j.issn.0254-1769.2021.01.003

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Objective To construct the gynecological early warning score（GEWS） of critical patients and to test its predicted performance. Methods Using retrospective case analysis,we collected 389 cases of critical illness changes in gynecological patients from January 1,2018 to July 31,2019 in a level A tertiary hospital in Nanjing. The data was analyzed by single factor and multi-factor analysis to determine the relevant factors of gynecological critical illness changes and construct the GEWS table of critical illness to test the predictive effect of the scale. Results GEWS included 12 early warning indicators,including disease type,respiration rate,heart rate,systolic blood pressure,blood oxygen saturation,oxygen inhalation,consciousness,body temperature,lower abdominal pain,hemoglobin content,vaginal bleeding and related symptoms. Oxygen,body temperature,lower abdominal pain and vaginal bleeding are valued of 0 to 2 points,while other indicators were 0 to 3 points,with a total score of 0 to 32 points for 12 indicators;the best cutoff point of ROC curve was 3.5 points,with a sensitivity of 92.32% and a specificity of 88.85%. Conclusion The GEWS table can effectively warn the changes of critical gynecological conditions and predict the risks of changes in critical gynecological conditions,and help to improve the success rate of gynecological critical patients.

Establishment of a nomogram model for risks of antibiotic associated diarrhea in hospitalized patients with respiratory diseases

ZHAO Dongfang,CHEN Chen,SU Chunyan,ZHANG Huizhi,LIU Ran,HOU Yuemei,SUN Xue

2021, 56(1):  28-32.  DOI: 10.3761/j.issn.0254-1769.2021.01.004

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Objective To determine risk factors of antibiotic associated diarrhea in patients with respiratory diseases,and develop a nomogram model to predict these risks. Methods A total of 291 patients who underwent antibiotics treatment were recruited from January,20l9 and September,2019 at respiratory department in a Level A tertiary hospital in Beijing. Multivariate logistic regression was conducted to identify independent risk factors of antibiotic associated diarrhea in inpatients with respiratory diseases. A nomogram was developed by R software and validated to predict the risk of antibiotic associated diarrhea. Results Multivariate logistic regression analysis revealed that fecal occult blood test[OR=4.517,95%CI（1.440~14.163）],BMI[OR=0.834,95%CI（0.735~0.947）], hemoglobin level[OR=0.970,95%CI（0.946~0.994）],the use of antibiotics before hospitalization[OR=2.957,95%CI（1.076~8.130）] and types of antibiotic[OR=2.148,95%CI（1.146~4.026）] were independent risk factors of antibiotic associated diarrhea in patients with respiratory diseases（P<0.05）. For validation of the nomogram,ROC curve revealed that the model predicting antibiotic associated diarrhea in patients with respiratory diseases was the area under the curve of 0.779,the slope of the calibration plot was close to 1 and the model passed Hosmer-Lemeshow goodness of fit test（ χ²=1.413,P=0.994）,which demonstrated that the model was of good accuracy. Conclusion The nomogram predicting antibiotic associated diarrhea in patients with respiratory diseases was constructed based on fecal occult blood test,BMI,hemoglobin level,the use of antibiotics before hospitalized and types of antibiotic,which has good discrimination and accuracy. It can provide scientific guidance for clinical individualized prevention of antibiotic associated diarrhea.

Special Planning--Clinical Nutrition Nursing

Application of “Internet +”nutrition education on patients with maintenance hemodialysis

SHI Suhua,WANG Peili,ZOU Qiongfang,YOU Liji,LI Yanwa,LIN Qiaohong,WANG Jiwei

2021, 56(1):  33-38.  DOI: 10.3761/j.issn.0254-1769.2021.01.005

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Objective To explore the influence of “Internet +” nutrition education on patients with maintenance hemodialysis. Methods 157 maintenance dialysis patients,from 4 training bases for specialized nurses for blood purification in Fujian Province,were divided into an intervention group and a control group by a random number table method. The patients in the control group received routine nursing care,and the patients in the intervention group received “Internet +” nutrition education on the basis of routine nursing care. After 3 months,the scores of the modified quantitative subjective global assessment,the self-management level scale,and nutrition-related test indexes of 2 groups were compared. Results The total score of the modified quantitative subjective global assessment in the intervention group was lower than that in the control group,and the difference was statistically significant（P<0.05）. The total score of self-management scale in the intervention group was higher than that in the control group,with statistically significant difference（P<0.05）. Compared with the control group,the albumin level increased significantly in the intervention group. The levels of serum potassium,serum creatinine and urea nitrogen decreased significantly,with significant differences（P<0.05）. The levels of hemoglobin,serum Calcium and serum Phosphorus were improved,and the difference was not statistically significant（P>0.05）. Conclusion The “Internet+” nutrition education could improve the self-management level and nutritional status of maintenance hemodialysis patients,in order to improve the quality of life of patients.

Modification and evaluation of a patient-generated subjective global assessment among gastric cancer patients

HUA Hongxia,XU Qin,CHEN Li,LU Jinling,ZHU Hanfei

2021, 56(1):  39-45.  DOI: 10.3761/j.issn.0254-1769.2021.01.006

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Objective To modify the patient-generated subjective global assessment（PG-SGA） scale,and to analyze the reliability,validity and item quality of the modified PG-SGA. Methods Modified items that need to be improved in PG-SGA based on item response analysis were screened out and the revised version of PG-SGA was formed. 281 perioperative gastric cancer patients admitted to a level A tertiary hospital from September 2019 to February 2020 were selected. The weight of each item of the scale was determined by factor analysis;the cut-off values of the modified PG-SGA were divided according to the receiver operator characteristic curve. Finally,reliability and validity were evaluated,and item quality was analyzed again based on item response theory. Results The modified PG-SGA included 11 items,with a total score of 0 to 33. The cutoff value was 11 points. Reliability and validity analysis showed that the accuracy of the modified PG-SGA for nutritional assessment was higher than PG-SGA,and the Youden index was 0.844; the content validity index of the total scale was 0.910; 4 common factors were extracted by exploratory analysis and the cumulative variance contribution rate was 83.494%; the Cronbach’α coefficient of the total scale was 0.707. Analysis results of item response theory showed that the discrimination and difficulty parameters of the modified items were improved. Conclusion The modified PG-SGA is a reliable and valid scale,and the quality of items is improved. This scale can be utilized to conduct clinical nutritional assessment.

Study on the effect of different infusion speeds on the temperature change of enteral nutrient solution

CHEN Peipei,FENG Bo,ZHAO Zhenhua,DONG Dawei

2021, 56(1):  46-49.  DOI: 10.3761/j.issn.0254-1769.2021.01.007

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Objective To investigate the temperature change of enteral nutrition（EN） solution in pharynx and cardia during continuous feeding through a nasogastric tube（NGT） at normal environment temperature. Methods 42 patients with EN support were enrolled by the convenient sampling in the Intensive Care Department of a Level A tertiary hospital in Nanjing. The body temperature of the patients and the EN solution temperature in the NGT（in pharynx and cardia）were measured at different infusion rates（20 ml/h,50 ml/h,70 ml/h,100 ml/h,120 ml/h）. Results The temperature of pharyngeal nutrient solution corresponding to the EN solution infusion rates of 20ml/h,50ml/h,70ml/h,100ml/h,120ml/h were 37.35（36.2,38.2）℃,35.4（34.2,36.7）℃,（33.96±1.80）℃,32.75（30.88,33.63）℃,（31.46±1.55）℃. The corresponding temperature of cardiac nutrient solution were（37.51±0.86）℃,（37.37±0.88）℃,（37.30±0.85）℃,（37.13±0.86）℃,36.8（36.28,37.6）℃. When the infusion rate of the EN solution was less or equal to 100 ml/h,there was no significant difference between the EN solution temperature in the cardia and the body temperature of patients（P>0.05）.But when the infusion solution rate was≥50 ml/h,there were significant differences between the temperature of pharyngeal camp solution and the patient’s body temperature（P<0.05）. There was no significant difference among the EN solution temperature in the cardia and the temperature variation in different body temperature groups（36.0~37.0 ℃,37.1~38.0 ℃,38.1~39.0 ℃）（P>0.05）. Conclusion When the EN solution infusion rate was less or equal to 100ml/h and the body temperature ranges between 36.0~39.0 ℃,the EN solution temperature in cardia is close to the body temperature of the patient.

Variation trend of gastric residual volume and influencing factors of full feeding in patients receiving continuous enteral nutrition

YU Kunrong,XIA Ying,ZHAO Shuya,LI Zheng,WENG Li

2021, 56(1):  50-55.  DOI: 10.3761/j.issn.0254-1769.2021.01.008

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Objective To explore the variation trend of gastric residual volume and influencing factors of full feeding in ICU patients receiving continuous enteral nutrition. Methods Patients admitted in medical ICU of Peking Union Medical College Hospital from January 2014 to August 2019 were enrolled,and a retrospective analysis of patients receiving continuous enteral feeding via nasogastric tube was performed. The variation trend of gastric residual volume during the first 7 ICU days was analyzed;the full feeding rates of the 7th day between different groups with gastric residual volume more or less than 200 ml were compared;influencing factors of full feeding were evaluated by univariate analysis and multivariate logistic regression analysis. Results 1 057 ICU patients were enrolled,and the peak of gastric residual volume during the first 7 ICU days occurred at the 8th to 12th hour after the beginning of continuous enteral feeding. 715 patients who stayed in ICU over 7 days were analyzed for full feeding;23.1% of patients reached full feeding target on the 7th day;the full feeding rates of patients with gastric residual volume larger than 200ml（14.1%） were significantly lower than those of patients with less gastric residual volume（24.3%, χ²=4.023,P=0.045）. Overweight（OR=0.490,P=0.003）,obesity（OR=0.347,P=0.022）,and SOFA score（OR=0.930,P=0.024）were independent risk factors of full feeding,while underweight（OR=2.464,P=0.007,） and mechanical ventilation（OR=2.116,P=0.004）were protective factors. Conclusion The gastric residual volume of ICU patients receiving continuous enteral feeding varies regularly,and many patients have not been fully fed,while large gastric residual volume is not an independent risk factor of full feeding. Therefore,patients who are overweight,obese or have greater SOFA score should receive much attention on their enteral feeding.

Influencing factors of dietary adherence among patients following bariatric surgery:a qualitative study

ZHU Hanfei,YANG Ningli,REN Ziqi,ZHAO Kang,JIANG Xiaoman,XU Qin

2021, 56(1):  56-61.  DOI: 10.3761/j.issn.0254-1769.2021.01.009

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Objective To provide an in-depth description of factors that influence postoperative patients’ dietary adherence who underwent bariatric surgery. Methods A qualitative description was conducted based on Attitude—Social influence—Self-efficacy model. 20 postoperative patients in a level A tertiary hospital in Jiangsu were selected by the purposive sampling and were interviewed in a semi-structured way from November to December 2019. The data was categorized and analyzed by directed content analysis. Results The final analysis yielded a total of 7 generic categories belonging to 3 categories. These were attitude（positive attitude that benefits to physical and mental health;uncomfortable negative attitude and experience）,social influence（subjective norms,injunctive norms and descriptive norms of important people）,self-efficacy（low self-efficacy in dealing with subjective situations and low self-efficacy in dealing with objective situations）. Conclusion The facilitators of postoperative patients’ dietary adherence included positive attitude and positive effect of important people. The barriers included negative attitude,negative effect of important people and low self-efficacy. Health workers should make evaluation and interventions based on these factors,which can improve patients’ dietary adherence and clinical outcomes.

Summary of the best evidence for early enteral nutrition in patients after pancreatoduodenectomy

YU Mengying,LU Fangyan,YING Huajie

2021, 56(1):  62-68.  DOI: 10.3761/j.issn.0254-1769.2021.01.010

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Objective To retrieve the best evidence on early enteral nutrition in patients after pancreaticoduodenectomy（PD）and to summarize the best available evidence for clinical nurses to provide evidence-based guidance for the management. Methods All evidence on early enteral nutrition in patients after PD was retrieved from databases and websites including UpToDate,BMJ Best Practice,JBI Library,Cochrane Library,NICE,ASPEN,ESPEN,PubMed,CBM,VIP,CNKI and Wanfang. The retrieved evidence included guidelines,expert consensuses,evidence summaries,systematic reviews,meta-analysis and related original studies. The retrieval period was from the inception of databases to June 15,2020. 2 researchers with evidence-based nursing background assessed the quality of the literature independently,combined with the opinions of professionals,extracted and summarized the evidence of the literature that met the quality standards. Results A total of 281 references were obtained from the initial search,and 12 pieces of literature were included,including 4 guidelines,1 expert consensus,2 systematic evaluations and 5 meta-analysis. Finally,totally 11 pieces of best evidence were summarized from 4 aspects on indications and safety assessment of early enteral nutrition,timing of early enteral nutrition,route selection and target nutrient requirement management. Conclusion Early enteral nutrition after PD is safe and feasible. Evidence users should select best evidence based on the clinical context,the promoting factors and the obstacles and willingness of patients,so as to form a scientific and evidence-based practice plan for early enteral nutrition after PD management,and to accelerate patients’ recovery and improve nursing quality.

Specialist Practice and Research

Application of pulmonary rehabilitation technique combined with manual hyperinflation in patients with cervical spinal cord injury after tracheotomy

DENG Shuijuan,ZHOU Chunlan,ZHOU Jungui,LIU Yu,ZHOU Zhou,QIAN Dadi

2021, 56(1):  69-72.  DOI: 10.3761/j.issn.0254-1769.2021.01.011

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Objective To explore the effects of pulmonary rehabilitation technique combined with manual hyperinflation on patients with cervical spinal cord injury after tracheotomy. Methods From January 2017 to September 2019,66 patients with cervical spinal cord injury after tracheotomy were enrolled in this study. They were randomly allocated to an experimental group with 33 cases and a control group with 33 cases according to the block random number table generated by SPSS. In the experimental group,manual hyperinflation technique was added on the basis of routine lung rehabilitation nursing care,such as aerosol inhalation,vibration sputum expectoration,and sputum suction after abdominal compression. In the control group,routine lung rehabilitation nursing care was adopted. Before and after the intervention for 4 weeks,vital capacity（FVC）,forced expiratory volume in a second（FEV1）,maximum expiratory volume（PEF） were examined using spirometer and the incidence of atelectasis was calculated in both groups. Results After 4 weeks of interventions,FVC（4.17±0.70） L,FEV₁（3.86±0.94） L,PEF（266.67±36.70） L in the experimental group were significantly higher than these in the control group with FVC（3.06±0.73） L,FEV₁（2.91±0.72） L,PEF（221.73±19.53） L（P<0.05）,and the incidence of pulmonary atelectasis in the experimental group（3.03%）was lower than that in the control group（24.24%）（P<0.05）. Conclusion In patients with cervical spinal cord injury after tracheotomy,the application of manual hyperinflation technique can effectively improve the pulmonary function,increase the lung compliance of patients,reduce the occurrence of atelectasis and pulmonary collapse,and significantly improve the effects of pulmonary rehabilitation.

Construction of an evaluation index system for hospital-community linkage continued nursing quality after percutaneous coronary intervention

LU Xueping,HUANG Xia,JIA Peipei,WANG Bin,WU Yingyu,LANG Hanxu,GAO Dong

2021, 56(1):  73-79.  DOI: 10.3761/j.issn.0254-1769.2021.01.012

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Objective To build a scientific and systematic evaluation index system of hospital-community continuous nursing quality after percutaneous coronary intervention（PCI） to provide a reference for nursing managers and clinical nurses to objectively evaluate the quality of hospital-community continuous nursing after PCI. Methods This study was conducted from November 2019 to April 2020 based on the three-dimensional quality structure model of“structure-process-result”,using literature review,semi-structured interviews,expert consultations and analytic hierarchy process to determine the content of the hospital-community linkage continuous nursing quality after PCI evaluation index system and the weight of each index. Results The effective recovery rates of the 2 rounds of expert consultations were 95% and 100% respectively;the expert authority coefficients were 0.933 and 0.937 res-pectively;the Kendall harmony coefficients were 0.201 and 0.226 respectively（P<0.001）. The final evaluation index system includes 3 first-level indicators,14 second-level indicators and 62 third-level indicators,among which the structural quality includes 4 second-level indicators and 16 third-level indicators;the process quality includes 3 second-level indicators and 18 third-level indicators;the result quality includes 7 second-level indicators and 28 third-level indicators. Conclusion The hospital-community continuous nursing quality evaluation index system constructed after PCI is scientific and reliable,which can provide a basis for continuous nursing quality evaluation and continuous improvement.

A qualitative study on disease experience and recurrence risk perception of stroke survivors

LIN Beilei,GUO Yunfei,ZHANG Zhenxiang,MEI Yongxia,SONG Junli,XUE Lihong,PENG Rui,ZHAI Qinghua

2021, 56(1):  80-85.  DOI: 10.3761/j.issn.0254-1769.2021.01.013

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Objective To gain insights into the perception of the disease experience and recurrence risk from the perspective of patients who experienced first-ever and recurrent stroke. Methods A phenomenological approach was conducted and a total of 19 stroke survivors were enrolled for semi-structural in-depth interviews. Colaizzi method was used to analyze the data. Results The abstraction process generated 3 categories according to the number of recurrences,which showed different characteristics. First-ever stroke survivors could identify anomalies but lacked of professional information resources;they could actively seek treatment with awareness of benefits of timely hospitalization;they were overoptimistic towards prognosis and easily overlooked the risk of recurrence. For the patients with a second stroke,adequate information about warning signs was still needed;they perceived the severity of recurrent stroke and aroused self-reproach and self-examination;susceptibility of recurrence,sense of powerlessness and the loss of control were experienced. Regarding to patients with multiple recurrences,their social participation ability significantly decreased;they perceived no visible benefits of behavioral changes;they started to focus on life and death with positive or negative acceptance of recurrence. Conclusion Despite differences of patients,inadequate awareness of recurrence risks is a common phenomenon. It is recommended to develop a classified health guidance according to patients’ recurrence times,to implement risk communication education to promote disease awareness and recurrent risk perception of stroke survivors.

A qualitative research on perceptions and experience of adolescents with epilepsy

CAI Libai,LIU Yanjin,SUN Xiaoyin,DU Ruofei,GUO Yuanli,WANG Aixia,CUI Miaoran

2021, 56(1):  86-90.  DOI: 10.3761/j.issn.0254-1769.2021.01.014

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Objective To explore the perceptions and experience of adolescents with epilepsy,in order to provide references for the development of nursing intervention strategies. Methods Semi-structured interviews were carried out from October to December 2019 by phenomenology. 13 adolescents with epilepsy from a level A tertiary hospital in Zhengzhou were recruited,and Colaizzi’s 7-step analysis method was applied to analyze,induce,and refine themes of interview data. Results 4 themes were extracted,namely theme 1:inadequate self-management of epilepsy;theme 2:decline in quality of life;theme 3:obviously self-perceived burden;theme 4:eager for understanding and social support. Conclusion Adolescents with epilepsy have multiple burdens and requirements in physical,psychological and social aspects.Nurses were advised to pay much more attention to the emotional and psychological response of them. Sufficient psychological guidance and multi-dimensional social support were also needed.

Study on the status of cognitive behaviour for delayed diagnosis and treatment in diabetes patients in rural areas

JIA Honghong,HUO Guixia,WANG Haili,LIU Yang,LUO Xiaoxi,YANG Shuang

2021, 56(1):  91-96.  DOI: 10.3761/j.ssn.0254-1769.2021.01.015

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Objective To describe the status of cognitive behaviour in diabetes patients with delayed diagnosis and treatment in rural areas,and to analyze the influencing factors. Methods From June 2018 to December 2019,a convenience sampling method was used to select 832 cases of diabetes patients with delayed diagnosis and treatment in rural areas of Daqing city in Heilongjiang province and Tangshan city in Hebei province. By general data questionnaire and the scale for cognitive behaviour with delayed diagnosis and treatment of diabetes patients in rural areas,we investigated and analyzed its influence factors. Results The total score of cognitive behavioral for delayed diagnosis and treatment of diabetes patients in rural areas was（47.98±11.27）,with the highest score in disease control dimension and the lowest score in symptom alert dimension. The results of linear regression analysis showed that age,gender and per capita monthly family income were independent factors influencing the level of cognitive behaviour for delayed diagnosis and treatment of diabetes patients in rural areas. Conclusion The level of cognitive behaviour of diabetes patients with delayed diagnosis and treatment in rural areas was lower.Medical personnel should pay more attention to the diabetes patients with delayed diagnosis and treatment in rural areas,and help them to improve the diagnosis and treatment rate and control blood glucose level through health education,warning education,dynamic tracking and other interventions.

Nursing Management

Construction of a nursing quality index system for cognitive training nursing clinics

CHANG Hong,QIAO Yuchen,ZHAO Jie,WANG Rui,WANG Jiamei,SUN Jing

2021, 56(1):  97-102.  DOI: 10.3761/j.issn.0254-1769.2021.01.016

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Objective To construct a quality index system for cognitive training nursing clinics in line with China’s national conditions,and to provide references for related practitioners. Methods Based on the literature research,theoretical analysis,and clinical investigation,a draft on indexes was constructed. Using Delphi’s expert consultation method,16 experts were selected and 2 rounds of consultations were conducted to establish a nursing quality index system for cognitive training nursing clinics. Results The recovery and effective rates of 2 rounds of consultation documents were 100%,and the authority coefficient of the second round of consulting experts was 0.836. Expert opinion coordination coefficients of the 3-level indexes were 0.755,0.813,0.929 respectively（P<0.05）. The final quality index system includes 3 first-level indicators（structure quality,process quality and outcome quality）,10 second-level indicators,and 34 third-level indicators. Conclusion The quality index system of cognitive training nursing clinics constructed in this study is scientific and practical,and it can provide references for comprehensive evaluation and standardized management of cognitive training nursing clinics.

Community Care

Study on the adaptability of personalized drinking water nomogram to the disabled elderly in nursing homes

ZHANG Hong,SHEN Jun,XIAO Lily Dongxia,YU Xiuli,TONG Lifang,LIU Yue,CHEN Qiu,WANG Xinxia,ZHANG Dandan,HUO Dan

2021, 56(1):  103-108.  DOI: 10.3761/j.issn.0254-1769.2021.01.017

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Objective To explore the adaptability and application effect of personalized drinking water recommendation nomogram in the elderly with disability in nursing homes,and to provide references for the prevention of dehydration of the elderly with disability in the nursing homes. Methods In October 2018,95 disabled elderly people with normal plasma osmolality（280~<295mmol/L） were selected from a nursing home to investigate the 7-day drinking water consumption,and the differences between the recommended drinking water consumption of personalized drinking water consumption recommendation nomogram and the average 7-day drinking water consumption of the elderly were analyzed. From March to August 2019,150 cases of the disabled elderly in the nursing homes were randomly divided into a test group,control group 1 and control group 2. The test group received the recommended drinking water quantity of personalized drinking water quantity recommendation nomogram;there was no intervention in control group 1,and the disabled elderly drank according to the original amount of drinking water and habits;control group 2 received 1 200 ml/day. The plasma osmolality,constipation and urinary tract infection of 3 groups were compared before and 6 months after the interventions. Results There was no significant difference between the recommended drinking water quantity of the personalized drinking water quantity recommendation nomogram and the 7-day drinking water quantity mean value of the normal plasma osmotic pressure elderly（P>0.05）;6 months after the implementation of different drinking water targets and drinking water interventions,the differences of plasma osmolality between 3 groups were statistically significant（P<0.001）. The comparison between 2 groups showed that the intervention effect of the test group and the control group 2 was better than that of the control group 1,and the intervention effect of the test group was better than that of the control group 2. Conclusion Considering the individual differences of the disabled elderly,personalized recommended drinking water nomogram is suitable for the disabled elderly in nursing homes and it can improve plasma osmotic pressure.

Study on the status of cognitive function in community elderly adults with chronic diseases

PAN Jingxue,CHEN Liqun,WANG Jingli,XU Huiqin,XIE Boqin

2021, 56(1):  109-115.  DOI: 10.3761/j.issn.0254-1769.202 1.01.018

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Objective To investigate the current states of cognitive impairment and to identify the influencing factors associated with cognitive impairment in community-dwelling older adults with chronic diseases. Methods A total of 734 patients aged 60 years or older with chronic diseases were recruited from a community health service center in Shanghai by convenient sampling method. Data on demographics,clinical information and lifestyle were collected. Montreal cognitive assessment basic scale（MoCA-B） was used to measure cognitive function. Results In the sample of 734 elderly patients with chronic diseases,373（50.8%） had cognitive impairment,including 326（44.4%） with mild cognitive impairment and 47（6.4%） with Alzheimer disease. The results of multivariate Logistic regression analysis showed that age,light physical household chores,physical exercise,frequency of playing wechat or computer,hobbies,hearing loss,and history of diabetes are all common influencing factors for mild cognitive impairment patients and Alzheimer disease patients. Low education and family history of dementia（P<0.05） are factors specially associated with mild cognitive impairment. The Kruskal-Wallis analysis showed that the types of chronic diseases had statistically significant differences in the average score of MoCA-B rank（P<0.05）. Conclusion Elderly adults with 4 chronic diseases in the community have a higher prevalence of cognitive impairment than those with single one chronic disease. Health clinicians should screen cognitive function for older adults to identify these vulnerable population as early as possible.

Clinical Practice

Nursing care of a premature infant with acute renal failure undergoing modified continuous drainage of peritoneal dialysis

WEI Yanfei,WEI Ba,WEI Yijun,FU Chan,LIANG Jing,GAN Yuan,TANG Haihong,JIANG Yongjiang

2021, 56(1):  116-119.  DOI: 10.3761/j.issn.0254-1769.2021.01.019

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The nursing key points of a premature infant with acute renal failure undergoing modified continuous drainage and peritoneal dialysis were summarized. Key points:the central venous（double cavity）catheter was selected for continuous drainage;plugging and serious complications were prevented by squeezing drainage tube at fixed time and observing aseptic technique. Lactate peritoneal dialysate heated by infusion thermostats and the controlled infusion speed and body temperature were chose to prevent hypothermia. Abdominal symptoms,input and output of dialysate and urine,and other aspects were closely observed and recorded on a tabular nursing record sheet. Feeding care and the prevention of serious complications were intensified and managed. The infant,underwent 7 days peritoneal dialysis of 20 days in the hospital,recovered smoothly with satisfaction by telephone follow-up.

Nursing cooperation in a case of extracorporeal membrane oxygenation assisted off-pump coronary unroofing surgery in children

ZOU Chen,ZHANG Zewei,YANG Lijun,ZHAO Hangyan

2021, 56(1):  120-123.  DOI: 10.3761/j.issn.0254-1769.2021.01.020

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To summarize nursing cooperation in a case of extracorporeal membrane oxygenation（ECMO） assisted off-pump coronary unroofing surgery in children. The nursing points are as follows:preoperative condition discussion,intraoperative preparation,ECMO hospital transportation,surgical nursing cooperation,emergency plan formulation and postoperative management. In this case,cardiac surgery was successfully completed. ECMO support was continued after the operation and weaned 14 days later. The patient was discharged 27 days after surgery.

Evidence Synthesis Research

A systematic review of risk prediction models for diabetic foot

XIE Xiaoran,XU Rong

2021, 56(1):  124-131.  DOI: 10.3761/j.issn.0254-1769.2021.01.021

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Objective We systematically analyzed and compared the relevant studies on risk prediction models for diabetic foot,so as to provide references for nursing practice. Methods We searched PubMed,Embase,Web of Science,Cochrane Library,CBM,CNKI,Wanfang Data from the inception to March 1,2020,in order to collect studies on risk prediction models for diabetic foot. 2 researchers independently screened the literature,extracted information,and assessed the risk of bias and applicability concerns of the included literature by the prediction model risk of bias assessment tool. Results The search identified 7 relevant studies,including 6 development studies and 1 verification study. The area under the curve of 7 models was 0.65~0.88. The presence of monofilament insensitivity was the most commonly reported predictive factor of diabetic foot among all included models. All included studies have low concerns regarding applicability,but with a certain bias,which mostly due to the absence or non-reported of the blind method,the insufficient number of events per variable,omitting samples with missing data,the lack of model performance assessment and overfitting. Conclusion The research on risk prediction models for diabetic foot is still in the development stage. In the future,prediction models with good performance and low risk of bias should be developed and verified internally or externally.

Review

The application and enlightenment of Clinical Care Classification System in nursing practice

MA Yuxia,ZHANG Yuanyuan,WANG Yutan,LI Sijun,YAN Fanghong,HAN Lin

2021, 56(1):  132-136.  DOI: 10.3761/j.issn.0254-1769.2021.01.022

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Clinical Care Classification System is one of 12 standardized languages recognized by the American Nurses Association. This paper summarizes the development,structural framework,coding rules of Clinical Care Classification System and its similarities and differences between other nursing terms. The paper discusses the appli-cation status of Clinical Care Classification System in clinical nursing practice abroad from 3 aspects of applicability,mapping and compatibility,analyzes the application value of the system in clinical nursing practice,and provides thinking for its popularization and application in clinical nursing in China.

Research progress on intervention management of emotional labor in nurses

LU Shan,SUN Xiaoling

2021, 56(1):  137-142.  DOI: 10.3761/j.issn.0254-1769.2021.01.023

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In the context of the Healthy China strategy,the social demands for nursing care continue to increase,and people’s requirements for nursing care continue to improve. As the main force to build a healthy China,nurses must integrate professional technology and humanistic care. In clinical work,nurses do a lot of physical and mental work,but also pay more emotional work. In recent years,more and more scholars have realized the importance of nurses’ physical and mental health to guarantee clinical nursing quality and stabilize nursing teams.Based on the summary and analysis of the concept,assessment tools and influencing factors of emotional labor of nurses,this paper introduces the progress on intervention management of emotional labor in nurses from 3 aspects,including nurses themselves,nursing managers and hospital organization management,aiming to provide theoretical bases for further research on the intervention of emotional labor in nurses and promote the management level of emotional labor in nurses.

Research progress on health information needs and interventions for patients receiving assisted reproductive technology for pregnancy

YANG Mengye,ZHANG Yan,NIU Fangfang

2021, 56(1):  143-147.  DOI: 10.3761/j.issn.0254-1769.2021.01.024

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The information needs of patients with assisted reproductive therapy mainly include 6 aspects,namely disease treatment,treatment guidance,treatment progress,physical adaptation,medical support and social psychology. We summarize the information needs of patients with assisted reproductive technology（ART）. Moreover,we review the application of health education given by specialist nurses,the information supported by peers and other patients,as well as the interactive health information communication model. We expect that it could provide some references to develop the multiform ways of information support for patients with ART.

Research progress on health related quality of life in adult ICU discharged patients

HE Manman,JIANG Zhixia,WANG Ying,HU Rujun,LI Xiaojuan,HE Min,WANG Yu,CHEN Minzhu

2021, 56(1):  148-154.  DOI: 10.3761/j.issn.0254-1769.2021.01.025

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This article reviews the latest studies on health related quality of life（HRQOL） in adult ICU discharged patients,including the short- and long-term status quo of HRQOL,influencing factors,and interventions. At present,the short- and long-term HRQOL in adult ICU discharged patients still remains unsatisfactory,as there are many influencing factors of HRQOL and the great individual differences of ICU discharged patients. It is suggested that personalized nursing interventions should be carried out in clinical practice aiming at the influencing factors,and effective interventions should be further explored to improve HRQOL of adult ICU discharged patients,so as to provide bases for the construction of systematic intervention plans.

Overseas Knowledge

Psychometric testing of the Chinese version of Psychological Adaptation Scale for caregivers of children with cancer

WANG Mengjia,ZHANG Ruixing,CHANG Mingyu,CHENG Mengyin

2021, 56(1):  155-160.  DOI: 10.3761/j.issn.0254-1769.2021.01.026

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Objective This study aimed to translate the Psychological Adaptation Scale（PAS） into Chinese and explore the psychometric qualities of the Chinese translation of the Psychological Adaptation Scale（C-PAS）. Methods The PAS was translated and culturally adjusted into Chinese in strict accordance with the Brislin translation model. The reliability and validity of the C-PAS were tested through a survey of 221 caregivers of children with cancer by convenience sampling from October 2019 to December 2019. Results There were 20 items in C-PAS,including 4 dimensions of coping efficacy（4 items）,self-esteem（6 items）,social integration（5 items）,and spiritual well-being（5 items）. In exploratory factor analysis,the cumulative variance contribution rate of 4 common factors was 55.996%. Cronbach’s alpha coefficient for the overall scale was 0.900;the split half reliability coefficient was 0.792;the test-retest reliability coefficient was 0.876. Conclusion The Chinese version of PAS has been proved to be reliable and valid which can be used to evaluate the psychological adaptation level of caregivers of children with cancer in China.