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Table of Content

    15 March 2021, Volume 56 Issue 3
    Research Paper
    Construction and evaluation of a model for predicting malnutrition risk in patients with chronic heart failure
    HUI Ning, ZHANG Wenjie
    2021, 56(3):  325-329.  DOI: 10.3761/j.issn.0254-1769.2021.03.001
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    Objective To construct a risk prediction model for malnutrition in patients with chronic heart failure,and verify the prediction effect of the model. Methods From January 2019 to January 2020,109 patients hospitalized in the Department of Cardiovascular Medicine of a tertiary hospital in Zhenjiang were selected as the subjects of model establishment. They were divided into a malnutrition group(40 cases) and a normal nutrition group(69 cases).Logistic regression analysis model was used to establish the influencing factors of the subjects. Hosmer-Lemeshow and receiver operating characteristic curve were used to test the goodness of fit and predictive effect of the model,and 72 patients were included again in the application research of the model. Results The incidence of malnutrition in patients with chronic heart failure was 40.33%. The risk factors for malnutrition were age(OR=3.835),smoking(OR=8.091),total serum protein(OR=9.103),C-reactive protein(OR=5.947),and edema(OR=5.709).Hosmer-Lemeshow test P=0.623;the area under the receiver operating characteristic curve was 0.882;the Youden index was 0.582;the best critical value was 0.604;the sensitivity was 0.625;the specificity was 0.957,and the actual application accuracy rate was 81.94%. Conclusion The risk prediction model constructed in this study has a good effect and can provide references for clinical screening of nutritional risks in patients with chronic heart failure.

    The research of the rehabilitation effects of oscillatory positive expiratory pressure device combined with incentive spirometer for patients with lung cancer after surgery
    ZHANG Xinna, LI Qianqian, WANG Hongyu, XU Ruiyan, LI Chunhong
    2021, 56(3):  330-335.  DOI: 10.3761/j.issn.0254-1769.2021.03.002
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    Objective To evaluate the value of oscillatory positive expiratory pressure device(OPEPD)combined with incentive spirometer(IS)and active cycle of breathing techniques(ACBT) in pulmonary rehabilitation for patients with lung cancer after surgery. Methods 87 patients with lung cancer undergoing single-hole thoracoscopic radical resection of lung cancer from January 2018 to August 2019 in a Level A tertiary hospital were randomly divided into an intervention group and a control group. 43 patients in the control group received ACBT training, while 44 patients in the intervention group received OPEPD combined with IS approach for lung rehabilitation. Both groups were trained for 5 days, and the incidences of complications, 6-minute walk distance(6MWD), vital capacity(VC), Borg dyspnea scores, quality of life(QLQ-LC29) for lung cancer patients, weakness(Frail)scale and satisfaction of rehabilitation nursing were compared between 2 groups. Results There was no significant difference between 2 groups in age, gender, acute physiology and chronic health evaluation(APACHE Ⅱ), lung cancer stage and baseline of complications(P>0.05);6MWD and VC in the intervention group were higher than those in the control group(P<0.05);the complication of respiratory insufficiency, Borg dyspnea scores, QLQ-LC29 and Frail scale in the intervention group were lower than those in the control group(P<0.05);the satisfaction degree of rehabilitation were higher than that in the control group(P=0.034). Conclusion OPEPD combined with IS cannot only reduce weakness and complications, but also improve lung capacity, tolerance for exercises, and nursing satisfaction for patients with lung cancer after surgery.

    Special Planning——Critical Care Nursing
    Construction of a quality evaluation index for intra-hospital transport of emergency critically ill patients
    LIU Ang, MENG Qianqian, ZHANG Honglei, WANG Hongmei, XIAO Hong, MENG Lihong
    2021, 56(3):  336-341.  DOI: 10.3761/j.issn.0254-1769.2021.03.003
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    Objective To construct a quality evaluation index system for intra-hospital transport of emergency critically ill patients,so as to guide clinical practice and scientifically evaluate the quality of intra-hospital transport of emergency critically ill patients. Methods Based on structure-process-outcome theory,the indicator definition and weight were identified and the quality evaluation index was constructed by literature review,semi-structured interviews,Delphi method and Hierarchy analysis. Results The effective recovery rates of questionnaires in the first and second round expert consultation were 90%(18/20) and 100%(18/18),respectively. The expert authority coefficient was 0.903,and the Kendall harmony coefficient was 0.243. The finalized evaluation index included 3 first-level indicators,13 second-level indicators and 60 third-level indicators. Conclusion The constructed evaluation index is scientific,reliable,reasonable,comprehensive,and clinically practical. It can provide continuous scientific evaluation for intra-hospital transport of emergency critically ill patients.

    Construction and application of a hierarchical management scheme of physical restraint for ICU patients in neurosurgery
    JI Yuanyuan, WANG Jun, YU Jie, OU Mengxian, ZHAO Pengpeng, LI Yanfei
    2021, 56(3):  342-346.  DOI: 10.3761/j.issn.0254-1769.2021.03.004
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    Objective To construct a hierarchical management scheme for physical restraint in the neurosurgery ICU patients and discuss its application effect. Methods Through the establishment of a project team,literature search and related issues discussion,a hierarchical management scheme for physical restraint in the neurosurgery ICU patients was developed. Using the convenience sampling method,304 patients admitted to the neurosurgery ICU of a tertiary first-class hospital in Beijing from April to September 2019 were selected,and they were divided into an experimental group with 156 cases and a control group with 148 cases according to admission time.The experimental group adopts a physical restraint hierarchical management plan,and the control group adopts the department's routine physical restraint nursing measures. The body restraint rate,average restraint time,restraint intensity,incidence of delirium,unplanned extubation,and the incidence of skin abnormalities at the restraint were compared between the 2 groups. Results After the intervention,the physical restraint rate,average restraint time,restraint intensity,and incidence of delirium in the experimental group were lower than those in the control group(P<0.05);there were no unplanned extubation and skin abnormalities and other restraint-related complications in the 2 groups. Conclusion The graded management scheme for physical restraint in the neurosurgery ICU patients can significantly reduce the rate of physical restraint,shorten restraint time,reduce restraint intensity,and reduce the incidence of delirium,providing a basis for standardizing the use of physical restraint for neurosurgery ICU patients.

    A qualitative research on post-traumatic growth experience of family members of ICU patients in neurosurgery
    LIN Qi, ZENG Li, REN Junhong
    2021, 56(3):  347-352.  DOI: 10.3761/j.issn.0254-1769.2021.03.005
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    Objective To deeply understand the real post-traumatic growth experience of the family members of ICU patients in neurosurgery. Methods The descriptive phenomenological method in qualitative research was used to conduct in-depth interviews with the family members of 12 ICU patients from neurosurgery of a tertiary hospital in Shanghai. Nvivo11 software was used to manage the interview data,and Colaizzi 7-step analysis was used to summarize and extract the topics. Results 4 themes are extracted:the change of philosophy of life,including the appreciation of life,attention to their own health,the establishment of life priorities,the uncertainty of the future;the enhancement of personal strength,including the exploitation of advantage potential,the enhancement of sense of responsibility,the enhancement of sense of self-dependence;improving relationships with others,including "altruistic behavior",and benefiting from interpersonal communication;coping effectively involves setting expectations,comparing downward,and learning to adjust. Conclusion Family members of neurosurgery ICU patients in the fight against adversity can experience the process of posttraumatic growth,present the positive self-change phenomenon;clinical medical personnel should pay attention to patients' family members experience actively,integrating posttraumatic growth and clinical psychological nursing care,clinical intervention to inspire potential and cultivate positive energy,promote growth,as the theme of paradigm shift.

    Construction of a clustering solution to prevent the ventilator associated pneumonia
    XIA Xinhua, ZHANG Zijun, WANG Yuxia, LI Yanan, SUN Yanling, ZHOU Shuling, WANG Jinghua
    2021, 56(3):  353-359.  DOI: 10.3761/j.issn.0254-1769.2021.03.006
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    Objective To construct a clustering solution for preventing the ventilator associated pneumonia(VAP)based on micro-aspiration,and to provide specific procedures for the airway care of mechanically ventilated patients in the intensive care unit. Methods Considering the 2016 version of "clustered nursing package for clinical strategies of preventing ventilator-associated pneumonia" by Tianjin Nursing Quality Control Center as the prototype,we formulated the airway management plans following evidence of domestic and foreign literature,and obtained expert opinions by the Delphi approach. Results 2 rounds of consultations have been taken from 17 experts from October to December 2019,and their positive coefficients were both 100%. The familiarity of the 2 rounds were 0.92 and 0.96,and the authoritative coefficients were 0.82 and 0.89. The coordination coefficients were 0.088~0.485,with variation the coefficients ranged from 0 to 0.239,all of which were statistically significant(P<0.01). Finally,a clustering plan with 10 strategies and 38 specific measures was constructed. Conclusion The clustering solution to prevent the VAP based on micro-aspiration was constructed in this research on the basis of the old package,but the concept of "aspiration" was updated to prevent "micro-aspiration". It was a scientific,reliable and practical program which would be beneficial for the clinical nursing in the intensive care unit.

    Construction and application of a nurse-led diagnostic blood loss management scheme for patients with extremely severe burns
    LIANG Jiangshuyuan, ZENG Fei, FENG Xiuqin
    2021, 56(3):  360-363.  DOI: 10.3761/j.issn.0254-1769.2021.03.007
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    Objective To construct a nurse-led diagnostic blood loss management plan,so as to reduce the diagnostic blood loss in patients with extremely severe burns. Methods A multidisciplinary team was established to form a nurse-led diagnostic blood loss management scheme which was conducted to intervene in a batch of 15 patients with extremely severe burns admitted on June 14,2020,and we evaluated the effect of the intervention.Results The predicted diagnostic blood loss before intervention was(37.45±8.17) ml,and the actual diagnostic blood loss after intervention was(18.16±6.35) ml,with statistical differences(t=102.215,P<0.001). Conclusion The nurse-led diagnostic blood loss management scheme can effectively reduce the amount of diagnostic blood loss in patients with extremely severe burns.

    Nursing care of 6 patients with severe burn treated with extracorporeal membrane pulmonary oxygenation and continuous renal replacement therapy
    ZENG Fei, LIANG Jiangshuyuan, JIN Xiaojuan, FENG Xiuqin
    2021, 56(3):  364-367.  DOI: 10.3761/j.issn.0254-1769.2021.03.008
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    To summarize the nursing experience of 6 severe burn patients with extracorporeal membrane oxygenation(ECMO) and continuous renal replacement therapy(CRRT). Nursing points:the whole process pressure monitoring;the development of individualized liquid management plan to ensure adequate capacity;the precise anticoagulation management to prevent blood clotting in filter and the special attention to wound drainage;the establishment of a full-time team for infection control to strictly prevent infection;under the premise of protecting the burned skin. During the treatment of ECMO combined with CRRT,no one was found with any complications such as tube shedding,tube bleeding,nozzle skin infection,abnormal shutdown of ECMO and CRRT,or bleeding.

    Effects of follow-up services on critically ill patients after ICU:a meta-analysis
    YAO Li, ZENG Lin, WANG Shengjun, YANG Liping, ZHANG Zhigang
    2021, 56(3):  368-375.  DOI: 10.3761/j.issn.0254-1769.2021.03.009
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    Objective To explore the effect of follow-up on critically ill patients. Methods PubMed,Embase,Cochrane Library,Web of Science,CNKI,WanFang Data and Sinomed were searched for randomized controlled trials about follow-up among critical care patients published from inception to May 2020. 2 trained researchers screened the literature,evaluated the quality and extracted data independently,and the meta-analysis was implemented with RevMan 5.3. Results A total of 25 RCTs including 5 134 patients were included in this meta analysis. The results showed that follow up could increase critical care patients' SF 36 MCS scores[WMD=2.03,95%CI(0.27,3.79),P=0.020],cognition scores[SMD=1.13,95%CI(0.91,1.36),P< 0.001],decrease patients' HADS Depression scores[WMD=-0.96, 95%CI(-1.88,-0.04),P=0.040] and reduce the occurrence risk of PTSD[RR=0.79,95%CI(0.66,0.94),P=0.007] and PTSD score[SMD=-0.26,95%CI(-0.46,-0.06),P=0.010]. Conclusion ICU follow up services could reduce the risk of PTSD,alleviate depressive symptoms,and improve patients' mental health and cognitive status.
    Research progress of acute skin failure in critically ill patients
    CHEN Xiangping, LAO Yuewen, ZHANG Yi, GONG Xiaoyan, ZHUANG Yiyu
    2021, 56(3):  376-380.  DOI: 10.3761/j.issn.0254-1769.2021.03.010
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    Patients in the intensive care units are prone to the loss of skin integrity. However,in some cases,the skin breakdown is not caused by pressure but by acute skin failure. In this paper,the definition,diagnostic criteria,risk factors,clinical manifestations,assessment,prevention,and management of acute skin failure are reviewed to provide references for clinical identification,as well as improving skin integrity outcomes in critically ill patients.

    Specialist Practice and Research
    Construction of nursing intervention system for patients with type 2 diabetes and osteoporosis
    GUO Shanping, DUAN Gongxiang, CHEN Changrong, LIU Chunxiang, YAN Miaomiao, HUANG Zhuying
    2021, 56(3):  381-386.  DOI: 10.3761/j.issn.0254-1769.2021.03.011
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    Objective To construct a feasible,systematic and standardized nursing intervention system for patients with type 2 diabetes and osteoporosis,and to provide relevant evidence. Methods The preliminary intervention system was drafted by searching literature on the basis of relevant guidelines and case reviews,and the Delphi method was adopted to finalize the system in accordance with expert advice and clinical experience. Results Totally 15 experts were enrolled,and the opinions of all experts tended to be consistent after 2 rounds of consultation. The expert authority coefficient was 0.862,and the importance and feasibility of Kendall's coordination coefficients were 0.369,0.396 and 0.428,0.415 in the 2 rounds respectively(P<0.001). The content included 6 sections for first-level indicator,namely nutrition intervention,exercise intervention,disease-related knowledge education,medication guidance,pain nursing intervention,and psychosocial intervention;it also contained 19 second-level indicators,and 59 third-level indicators. Conclusion The content of nursing intervention system is scientific,reliable,practical and pertinent,and is of great significance for clinical nursing practice.

    Construction of core competency evaluation index system for breast cancer case managers
    WANG Yingxin, LIU Fei, ZHANG Shuqi, WANG Yue, GU Hongtao, HUANG Lihong
    2021, 56(3):  387-392.  DOI: 10.3761/j.issn.0254-1769.2021.03.012
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    Objective To establish an index system for evaluating the core competence of breast cancer case managers in China. Methods The items were constructed based on literature review and panel discussion. 19 medical and nursing specialists of breast cancer in Beijing,Guangdong,Guangxi,Zhejiang and Taiwan were consulted twice during October to December 2019,and then the weight of each index was calculated. Results The evaluation index system of core competence of breast cancer case managers was finally established,including 5 first-level indicators,12 second-level indicators and 43 third-level indicators. The authority coefficient of expert consultation was 0.93;the familiarity coefficient was 0.92 and 0.91;the judgment basis coefficient was 0.95. The coordination coefficient of the indicators in the first round of expert consultation was 0.121~0.208,and it was 0.191~0.341 in the second round. Conclusion The expert consultation on the core competence of breast cancer case managers at all levels tends to be consistent and reliable,which can provide quantifiable references for the training,assessment and evaluation of breast cancer case managers.

    Midwives' experience of providing bereavement care for women after perinatal death:a qualitative study
    SHEN Qiaoqiao, ZHANG Zhengmin, LIANG Yunyi, ZUO Qianqian, TONG Pei, ZHENG Yajing, GAO Yulin
    2021, 56(3):  393-398.  DOI: 10.3761/j.issn.0254-1769.2021.03.013
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    Objective To explore midwives' inner feelings and experience of providing bereavement care for women experiencing perinatal death. Methods Study participants were recruited through purposive sampling. Semi-structured interviews were conducted between October and December 2019 in 18 midwives from 11 tertiary hospitals in Guangdong,China. Transcripts of interviews were analyzed using Colaizzi 7-step analysis method. Results 3 themes were extracted,including the suffering from negative emotions of midwives,the co-existence of positive and negative coping,and the expectation to receive organizational support. Conclusion When caring for bereaved women,midwives had negative emotional reactions and adopted negative coping styles,which could not ensure the quality of maternal care. It is suggested that hospitals and relevant departments can provide emotional support and training for midwives,and encourage midwives to respond positively. At the same time,formulation of evidence-based nursing pathway and establishment of multi-disciplinary professional teams are necessary,so as to promote the development of perinatal bereavement care services.

    AIDS patients using internal and external strength resources to cope with the disease:a qualitative research
    YU Jing, XIE Xinger, QIAN Xiangyun, QI Longju, HE Jiafeng, ZHUANG Xun
    2021, 56(3):  399-403.  DOI: 10.3761/j.issn.0254-1769.2021.03.014
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    Objective To explore the real experience of AIDS patients using internal and external strength resources to cope with the disease,in order to provide references for the construction of AIDS patients case management plan based on internal and external strength resources model. Methods Semi-structured interviews were conducted with 30 AIDS outpatients and inpatients in a designated AIDS treatment institution of a Level A tertiary hospital from November to December 2019,and the data was analyzed by Colaizzi's seven-step method. Results 2 themes were extracted:Theme 1 is internal strength resources,including accepting the patient role,disease coping ability and self-growth;Theme 2 is the external strength resources,including family support,peer support,national policy support. Conclusion AIDS patients can fully utilize internal strength resources to improve disease coping ability and the treatment compliance with the help of external strength resources. We should build a good support mechanism for AIDS patients with the guidance of internal and external strength resources,so as to help them stimulate patients' self-efficacy,overcome stigma and self-discrimination,adapt to the role of patients,and promote the establishment of healthy behaviors.

    TCM Nursing
    Analysis of dialectical acupoint selection rules of acupoint massage in treatment of insomnia
    HUANG Ruiying, MA Xiaoqin, YAN Xinling
    2021, 56(3):  404-408.  DOI: 10.3761/j.issn.0254-1769.2021.03.015
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    Objective To explore the dialectical classification of insomnia and the potential laws of points selection in the treatment of insomnia by using data mining.Methods The literature on acupoint massage therapy for insomnia in PubMed,Web of science,CNKI,Wan Fang Data,CBM were searched by computer,and it was ranged from the time of the estabilishment of databases to November 15,2020. Excel was used to establish acupoint database of acupoint massage for insomnia;the Apriori section provided by SPSS Modeler18.0 is used to analyze and describe the association rules among various acupoints. Results Totally 137 documents,involving 97 acupuncture points,were included;most points are distributed on the head and face. The most common points were Point Baihui,Point Taiyang,Point Shenmen,Point Yintang. Most of the points are distributed in the urinary bladder channel of Foot-Taiyang(18.5%) and Governor Vessel(14.8%). In the dialectical classification of insomnia treated by acupoint massage,deficiency syndrome is the main syndrome;heart-spleen deficiency is the main syndrome type,followed by heart-kidney imbalance. In the treatment of insomnia,the most common combination of acupoints is Point Taiyang - Point Yintang and Point Taiyang - Point Yintang - Point Baihui. Conclusion Data mining can effectively explore the common acupoints,main syndrome types and compatibility rules of acupoints in acupoint massage treatment of insomnia,and provide reliable bases for clinical nurses to select acupoints.Compatibility of acupoints conforms to the law of acupoints matching of traditional Chinese medicine,which is mainly based on meridian circulation and combined with syndrome samples,and has a better effect in treating insomnia.

    Nursing Management
    Associations between circadian activity rhythms and perceived fatigue before and after shift work among female nurses in intensive care units
    ZHANG Xin, DONG Jingqi, XU Shuhui, LI Shiyu
    2021, 56(3):  409-414.  DOI: 10.3761/j.issn.0254-1769.2021.03.016
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    Objective To compare the differences of circadian activity rhythms indexes and fatigue severity among female nurses(8-and 12-hour shift)in intensive care units(ICU)before and after their shift work;further more,to explore the influencing factors of fatigue. Methods A convenience sample of 228 female nurses from ICU of 3 hospitals in Beijing was involved. A demographic form and Lee's Fatigue Scale were included as measurements,and objective data was collected from motion sensor monitor(wrist actigraph). Results The circadian rhythms indexes(r24 and circadian activity rhythms)among nurses in ICU were generally low. The total sleep time(TST) of the 8-hour shift nurse was significantly lower than that of the 12-hour shift nurse(P<0.001). The 8-hour shift nurses had significantly higher fatigue severity before night shift,and 12-hour shift nurses had significantly higher fatigue after night shift(P<0.001),with statistically significant differences. The circadian rhythms indexes of working activity level,TST and rest-activity cycles(r24) were significant predictors for fatigue severity after night shift work(P<0.05),especially for 12-hours shift nurses in ICU. Conclusion By exploring the associations between circadian activity rhythms indexes and fatigue severity before and after work,it helps nursing managers understand the working status of nurses in ICU. It can also provide a basis for scheduling shift-work and quantifying workload.

    Nursing Education
    An investigation of knowledge,attitude and practice on simulation teaching among nursing teachers from colleges and universities of China
    JIN Sanli, PANG Dong, YEMING Lezi, LI Ting, YANG Ping, LU Qian
    2021, 56(3):  415-420.  DOI: 10.3761/j.issn.0254-1769.2021.03.017
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    Objective To investigate the knowledge,attitude and practice(KAP) on simulation teaching among nursing teachers from colleges and universities of China. Methods Self-designed E-questionnaires of KAP about simulation teaching were delivered to 201 nursing teachers from 38 colleges and universities all over the country by conventional sampling. Results The mean scores on knowledge and attitude of all teachers were(60.85±12.78) and(74.61±10.82)respectively. 146(72.6%) teachers have carried out simulation teaching and their mean scores of behavior was(65.36±17.56). Factor analysis showed that education was the influencing factor of nursing teachers' knowledge score,and institution classification was the influencing factor of nursing teachers' attitude and behavior scores. --Conclusions-- Nursing teachers had a low level of knowledge on simulation teaching. Their attitudes towards it were positive,while their behaviors were still insufficient. It is suggested that the standardized training of nursing teachers' knowledge about simulation teaching scores on should be strengthened,and the training of attitude should not be ignored,so as to improve the quality of simulation teaching.

    Community Care
    Establishment and practice of smart aged care platform based on hybrid aware model
    HUANG Huanhuan, ZHOU Kejia, CAO Songmei, CHEN Xuejun, XIAO Mingzhao, WANG Rongrong, ZHAO Qinghua
    2021, 56(3):  421-426.  DOI: 10.3761/j.issn.0254-1769.2021.03.018
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    Objective To design,establish and practice the smart aged care platform,to ensure the safety of community-home-based older adults,to improve the quality and comfort of aged care. Methods The hybrid aware model was used to build the concept framework of smart aged care platform,and the smart aged care platform was practiced in Chongqing community-home-based elderly health service technology promotion base. Results The smart aged care platform consists 5 subsystems,namely physiological data sensing system,environment data sensing system,location data sensing system,activities data sensing system and decision support system,respectively. It was divided into 4 system architectures,namely data acquisition layer,data interaction layer,business performance layer and application management layer. Until June 2020,the platform has been in use for 7 months,and there are 180 signed old people. The incidence of adverse events is 0,and the satisfaction rate of users and their families is 96%. Elderly users believe that smart aged care platform can enhance psychological security,meet the needs of medical care,and maintain the autonomy of life,but also report the personal privacy concerns and technical discomfort. Conclusion Although there is still space for improvement,the smart aged care platform based on hybrid aware model runs well with positive user evaluation,which is expected to provide references for the intelligent transformation and upgrading of the elderly health service industry.

    Clinical Practice
    Infusion management of emergency treatment for 15 infants with severe diabetic ketoacidosis
    CHEN Xiaochun, ZHENG Yan, YUAN Ting, ZHU Jihua, ZHANG Wenwen
    2021, 56(3):  427-430.  DOI: 10.3761/j.issn.0254-1769.2021.03.019
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    To summarize the infusion management of 15 infants with severe diabetic ketoacidosis for 48 hours. The main measures include:rapid assessment and rapid establishment of venous access,standardized and reasonable rehydration and the application of low-dose insulin, good assessment and monitoring in the process of rehydration,early detection and early intervention of various potential transfusion complications. The ketoacidosis was corrected within 48 hours, and the blood glucose was stable after follow-up treatment.

    Postoperative nursing care of a child with right ventricular double outlet and Dandy-Walker syndrome
    LIU Wei, HAN Dong, BU Huidi
    2021, 56(3):  431-434.  DOI: 10.3761/j.issn.0254-1769.2021.03.020
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    A child with right ventricular double outlet complicated with Dandy-walker syndrome after primary nursing experience was summarized. The main points of nursing include cardiac function maintenance,nervous system observation and protection,prevention of complications,control of infection and nutritional support,among which left ventricular function maintenance,nervous system symptom observation and prevention are the keys. Through individualized and meticulous treatment and nursing care,the child recovered well and was transferred to neurosurgery for the second stage Dandy-walker syndrome correction 14 d after the operation.

    Nursing care of a child with intestinal Behcet's disease complicated with gastrointestinal bleeding and perforation
    DING Yaping, ZHOU Hongqin, XIA Shanshan, WU Haiyan, TONG Xiangfei
    2021, 56(3):  435-438.  DOI: 10.3761/j.issn.0254-1769.2021.03.021
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    To summarize the nursing experience of a case of intestinal Behcet's disease with gastrointestinal bleeding and perforation. Nursing points include nursing of gastrointestinal bleeding,drainage tube nursing,nutritional support,drug nursing,peripheral central venous catheterization,psychological nursing of children and parents,etc. After active treatment and meticulous care,the child's condition was under control and this child was transferred to the gastroenterology department for continued treatment.

    Evidence Synthesis Research
    Evidence summary for recognition and nursing of post-stroke aphasia
    YE Mingming, WENG Yingli, ZHAO Bolun, ZHANG Wei, CAO Ding, ZHOU Lanshu
    2021, 56(3):  439-444.  DOI: 10.3761/j.issn.0254-1769.2021.03.022
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    Objective To retrieve,appraise and integrate the available evidence on aphasia in patients with stroke,so as to promote the accuracy of recognition and the efficiency of management. Methods Based on the model of evidence pyramid,relevant literature published in the past 10 years were searched and retrieved. JBI evidence appraisal and recommendation system were used to evaluate quality of studies and the level of evidence.Results A total of 12 papers were included,including 4 guidelines,2 best practices,l clinical decision and 5 systematic reviews. Totally 24 pieces of best evidence were summarized from 5 aspects of assessment,diagnosis,planning,implementation,and evaluation. Conclusion The screening of post-stroke aphasia facilitates early recognition,and the evidence of post-stroke aphasia management provides evidence-based references for the rehabilitation of patients with post-stroke aphasia. It is recommended that cultural characteristics,medical resources and the patient's own condition should be taken into consideration while applying the evidence.

    Evidence summary for management of bedside electrocardiogram monitor alarms
    ZHANG Yi, CHEN Xiangping, SHAO Sang, ZHUANG Yiyu, LAO Yuewen, DING Zhuyu, WANG Ping, XIAO Yanping
    2021, 56(3):  445-451.  DOI: 10.3761/j.issn.0254-1769.2021.03.023
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    Objective To retrieve,appraise and synthesize the best available evidence on the management of bedside electrocardiogram monitor alarms. Methods We searched the literature from BMJ Best Practice,UpToDate,Cochrane Library,Joanna Briggs Institute(JBI),PubMed,Embase,Registered Nurses' Association of Ontario(RNAO),Guidelines International Network(GIN),CNKI,Wanfang to collect relevant guidelines,systematic reviews,best practice information sheets,evidence summaries and expert consensuses. The retrieval period was from the inception of databases to January 2020. 2 researchers independently appraised articles,and extracted data from eligible studies according to the judgment of professionals. Results A total of 14 related articles were enrolled,including 5 clinical practice guidelines,1 national standard,1 national health industry standard,2 expert consensuses,1 evidence summary,4 systematic reviews. Totally 20 pieces of best evidence were summarized from 7 aspects,namely multidisciplinary cooperation,monitoring operation,alarm evaluation,alarm setting,alarm processing,training and education,and monitor maintenance. Conclusion This study summarized the best evidence on management of bedside monitor alarms. It is recommended to implement a multidisciplinary alarm management model,standardize the clinical practice of alarms,and strengthen training and equipment maintenance to achieve safety management goals.
    Evidence summary of perioperative health education for patients undergoing ostomy surgery
    SI Longmei, LIU Fei, ZHANG Peiying, ZHANG Meng, HUANG Yanbo, CHEN Xu, HU Shasha, LIU Yue, DING Yanming
    2021, 56(3):  452-457.  DOI: 10.3761/j.issn.0254-1769.2021.03.024
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    Objective To retrieve,evaluate and summarize the best evidence of perioperative health education for patients undergoing ostomy surgery.Methods We searched Registered Nurses' Association of Ontario,Scottish Intercollegiate Guidelines Network,New Zealand Guidelines Group,Australian Government National Health and Medical Research Council,Guidelines International Network,BMJ Best Practice,UpToDate,Joanna Briggs Institute library,Cochrane library,and special websites,such as World Council of Enterostomal Therapists,Wound,Ostomy and Continence Society,American Society of Colon and Rectal Surgeons,Nurses Specialized in Wound,Ostomy and Continence Canada,United Ostomy Associations of America,American Urological Association and European Associations of Urology,to collect relevant guidelines,evidence summaries,recommended practices and systematic reviews and expert consensuses published from database construction to January 7st of 2020. 2 researchers evaluated the quality of the literature,and extracted recommendations and research conclusions from the included literature. Results Totally 11 articles were involved,including 5 guidelines,3 evidence summaries,1 recommended practice and 2 systematic reviews. Finally,18 pieces of best evidence about educator qualification,education targets,education timing,assessment,preoperative education,postoperative education,education strategy and evaluation were summarized.Conclusion This study summarized the best evidence of perioperative health education for patients undergoing ostomy surgery. With reasonable planning,it can reduce the incidence of stomal and peristomal complications,promote patients to return to society as soon as possible,and thus improve the quality of life of patients.

    Review
    Research progress of fall-related psychological concerns among older adults
    ZHANG Huaguo,SONG Mi,XU Yue,PI Hongying
    2021, 56(3):  458-463.  DOI: 10.3761/j.issn.0254-1769.2020.03.025
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    Fall-related psychological concerns commonly exist among older adults,which poses a serious public health problems. 4 main concepts make up fall-related psychological concerns,including fear of falling,falls-related self-efficacy,balance confidence,and outcome expectancy. There are some confusions regarding the concept and measurement of fall-related psychological concerns in the literature. Consequently,greater attention should be devoted to investigating fall-related psychological concerns. Therefore,the purpose of this study was to clarify these confusions with a review,which may help medical staff better understand fall-related psychological concerns among older adults,and optimize intervention measures,so as to reduce the risk and occurrence of falls.

    Research progress of self-care in patients with breast cancer-related lymphedema
    YOU Miaoning, WAN Qiaoqin
    2021, 56(3):  464-467.  DOI: 10.3761/j.issn.0254-1769.2021.03.026
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    Self-care is the key to achieve successful treatment for patients with breast cancer-related lymphedema(BCRL),but the self-care process is long and affected by many factors. This article reviewed the status of self-care adherence in patients with BCRL. It analyzed the factors that affect the self-care adherence of patients with BCRL,in order to provide references for the follow-up research.

    Research progress of anosognosia in dementia patients
    LI Shuya, LI Zheng
    2021, 56(3):  468-472.  DOI: 10.3761/j.issn.0254-1769.2021.03.027
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    Anosognosia is one of symptoms in dementia,which has harmful effects on the treatment compliance,patient safety and caregivers' burden. Severe anosognosia promotes the transformation of mild cognitive impairment to dementia. This paper reviews the concept,occurrence and related mechanism of anosognosia,reviews the relationship between anosognosia and cognitive function,mental behavior in dementia,and summarizes the intervention measures,aiming to provide references for further research.
    Research progress of fluid management strategies in patients with heart failure
    LUO Zhenlan, GONG Jinghuan, ZHU Lingyan
    2021, 56(3):  473-477.  DOI: 10.3761/j.issn.0254-1769.2021.03.028
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    Fluid management is a prevention and management strategy of heart disease. The aim of this strategy is to prevent and control fluid retention in patients with heart failure,thereby reducing the re-hospitalization rate and mortality,and improving their quality of life. This paper summarizes the specific content and development form of liquid management,and points out the defects and improvement direction of current liquid management research,aiming to arouse the attention of nurses on fluid management of patients with heart failure,and to explore a suitable fluid management model for them.

    Nursing Instruments Innovation
    Design and application of a birdnest-shaped bath mat
    PING Ling, WANG Zhulin, CHEN Juhong
    2021, 56(3):  478-480.  DOI: 10.3761/j.issn.0254-1769.2021.03.029
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    Objective The birdnest bath mat was an original design,and its application effects in neonatal bath were discussed. Methods The birdnest bath mat consists of head,middle and tail. A total of 100 newborns from October 2018 to January 2019 were selected into an experimental group. From June to September 2018,100 newborns were allocated into a control group. The experimental group used the self-designed birdnest bath mat for newborn bath,and the control group used the traditional bath method for newborns. The time of crying during the first bath,the soreness of the nurse's arms and lower back,and the satisfaction of the parents of the 2 groups were observed. Results The crying time during the bath was(2.06±0.37) min in the experimental group and(2.56±0.49) min in the control group. The difference was statistically significant(t=5.625,P<0.001). The parental satisfaction rate was 98% in the experimental group and 93% in the control group. The difference was statistically significant ( χ 2=5.817,P=0.016). The pain score of arms and back pain during bathing was(3.66±1.78) in the experimental group and(5.43±1.81) in the control group. The difference between the 2 groups was statistically significant(t=6.672,P=0.003). Conclusion The bird nest type bath mat is easy to use,improves the comfort and security of newborns,increases the satisfaction of parents,and alleviates the pain of nurse arms and lower back.