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Table of Content

    15 June 2021, Volume 56 Issue 6
    Research Paper
    Effect analysis of the construction and application of the network alliance information platform for cancer specialist nurses
    LIU Qianqian,ZHANG Sulan,TIAN Li,WANG Jiaqi,WANG Panpan,QIN Haixiao,SHAN Chang,YANG Haoyue,CHEN Changying
    2021, 56(6):  805-810.  DOI: 10.3761/j.issn.0254-1769.2021.06.001
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    Objective The informatization platform of network alliance for the cancer specialist nurses(here in after referred to as the platform) was constructed and its application effects were evaluated. Methods 58 nurses specialized in oncology from the supporting hospitals were selected. Before the implementation of the platform(from May to August in 2019),routine supporting interventions were implemented;after the implementation(from September to December in 2019),supporting interventions based on the platform were implemented. The effects of the platform on the management of the specialist nurses,the related indexes of the homogenized nursing quality,the item score,and the satisfaction of the cancer specialist nurses were evaluated. Results ①The implementation of the platform could significantly improve the management effects of specialist nurses,including the number of specialist nursing consultations,oncology specialist technical guidance,specialist nursing rounds,specialist nursing lectures,teaching rounds,and the number of advanced studies(P<0.05). The quality of homogeneous nursing care(including the number of cases of chemical extravasation,occupational exposure,and central venous catheter infection rate)in each hospital was lower than that before the platform application(P<0.05). Moreover,the quality of homogenized care(including the incidence of extravasation of chemotherapeutic agents,the incidence of reported abnormal events and the incidence of central venous catheter infections) in all supporting hospitals was lower than that before the platform application. The out-of-hospital maintenance rate and cancer pain screening rate of central venous catheter were higher than those before the platform application(P<0.05). ②Except for scientific research projects,the scores of 3 aspects(including theoretical knowledge learning,practical guidance and nursing team construction of oncology nurses)and the total score of support effect after the platform application were all improved compared with those before the platform application(P<0.001);③The oncology nurses were satisfied with the application of the platform. Conclusion The platform based on cancer specialist nurses could promote the ability of specialist nurses in the alliance,improve the job satisfaction,and contribute to the continuous improvement of nursing quality.

    Evidence-based practice in prevention of fecal incontinence associated dermatitis in ICU patients
    XU Yuanyuan,SHI Guangling,ZHANG Yanhong,XU Jianzhen,LIU Juan,JIANG Xuejuan,DU Haiyan
    2021, 56(6):  811-817.  DOI: 10.3761/j.issn.0254-1769.2021.06.002
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    Objective To summarize the evidence for the prevention of fecal incontinence associated dermatitis in ICU patients and to evaluate its application effect. Methods To obtain the best evidence,we used the method of evidence-based nursing to search related guidelines,expert consensuses and systematic reviews from domestic and foreign databases from January 2010 to September 2019. The best evidence was evaluated and summarized;review indicators were developed;the baseline review was conducted,and facilitation and obstacles based on the review results were analyzed. From May to September in 2020,the evidence was applied to clinical practice,and the incidence of incontinence associated dermatitis,nurses’ cognitive level of incontinence associated dermatitis knowledge and the implementation rate of review items were compared before and after the application of evidence-based practice. Results Finally,8 articles were included,including 3 clinical practice guidelines,2 expert consensuses and 3 systematic reviews. 11 pieces of best evidence were summarized in terms of risk assessment and prevention strategies. After evidence-based practice,the incidence of incontinence associated dermatitis was 19.10%,which was lower than that before evidence-based practice (40.48%) with statistically significant differences(P<0.05);the score of nurses on incontinence associated dermatitis knowledge questionnaire was(42.35±5.77),which was higher than that before evidence-based practice (35.65±5.07),and the difference was statistically significant (P<0.001). The implementation rates of items 2,4,5,6 increased from 0,0,66.67% and 22.62% to 100%,84.27%,97.75% and 76.40%,and the differences were statistically significant(P<0.001). Conclusion The application of evidence-based practice in the prevention of fecal incontinence related dermatitis in ICU patients can reduce the incidence of incontinence associated dermatitis,improve nurses’ cognitive level and the implementation compliance.

    Investigation and analysis of factors related to refeeding syndrome in ICU patients undergoing enteral nutrition
    LONG Xingxia,YAO Meiqi,YAO Jinlan,WANG Haiyan
    2021, 56(6):  818-823.  DOI: 10.3761/j.issn.0254-1769.2021.06.003
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    Objective To investigate the status of refeeding syndrome during enteral nutrition therapy in ICU patients and to explore the influencing factors. Methods The convenience sampling was adopted,and relevant clinical information of 433 patients who received enteral nutrition from January 2018 to July 2020 in ICU of a tertiary hospital in Zhejiang was retrospectively analyzed. The patients were divided into a refeeding syndrome group and a non-refeeding syndrome group. Results 130 patients developed refeeding syndrome,and the incidence was 30.02%.Logistic regression analysis showed that patients with and without refeeding syndrome were statistically different(P<0.05)in Nutritional Risk Screening 2002(OR=5.504),albumin(OR=2.295),prealbumin(OR=2.957),history of diabetes(OR=2.536),feeding route(OR=2.323),temperature of the nutrition liquid(OR=2.271),protein intake(OR=3.270),calorie intake(OR=3.965)and feeding speed(OR=2.735). Conclusion Nutritional Risk Screening 2002≥3,lower albumin,lower prealbumin,history of diabetes,nasointestinal feeding,higher temperature of the nutrition liquid,higher protein intake,higher calorie intake and faster feeding speed are influencing factors of refeeding syndrome during enteral nutrition therapy in ICU patients. It is necessary for nurses to pay attention to the factors and take a control of them.

    Neurological Disease Care
    Construction of evidence-based pain management program for patients with intracranial tumor during perioperative period and application effect research
    CHEN Lu,WANG Fang,DI Hengdan,SHENG Lixinbei
    2021, 56(6):  824-830.  DOI: 10.3761/j.issn.0254-1769.2021.06.004
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    Objective To explore the application effects of pain management program in perioperative patients with brain neoplasms. Methods The convenient sampling method was used to select postoperative patients with brain neoplasms who met the inclusion and exclusion criteria in neurosurgery of a tertiary hospital in Nanjing. Among them,51 patients from August to October 2019 were selected as the experimental group. The pain management program was implemented on the basis of routine nursing,and 51 patients from May to July in 2019 were selected as the control group. The pain scores at 24 h and 72 h after operation,self-efficacy scores at 24 h and 1 week after operation,patient satisfaction score and incidence of postoperative complications were compared between the 2 groups. Results In resting state,the score of Numerical Rating Scale(NRS)in experimental group(2.49±0.86)was lower than that in the control group(3.43±0.92),and the difference was statistically significant(t=5.339,P<0.001);one week after operation,the General Self-Efficacy Scale(GSES) score of the experimental group was(21.22±1.71),which was higher than that of the control group(19.51±1.87),and the difference was statistically significant(t=-4.805,P<0.001);the satisfaction score of the experimental group (93.67±2.20) was higher than that of the control group(90.86±2.03),and the difference was statistically significant(t=-6.694,P<0.001). Conclusion The pain management program is helpful to relieve the postoperative resting pain of patients with brain neoplasms,to improve self-efficacy and patient satisfaction,so as to enhance the rehabilitation belief of patients and promote the prognosis of the disease.

    Study on the influencing factors of filter rupture in membrane-based therapeutic plasma exchange for neurological diseases
    GONG Lichao,CHANG Hong,ZHAO Jie,LI Miao,WANG Zhaofeng,WEI Jingxu,ZHANG Yan
    2021, 56(6):  831-835.  DOI: 10.3761/j.issn.0254-1769.2021.06.005
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    Objective To investigate the influencing factors of filter rupture in membrane-based therapeutic plasma exchange(mTPE) for neurological diseases. Methods A retrospective study was conducted to collect the clinical data of 196 cases of mTPE in 42 patients admitted to the department of Neurology in a tertiary hospital from January 2018 to May 2020. Univariate and multivariate Logistic regression analysis was conducted to analyze the risk factors for membrane rupture of the filter. Transmembrane pressure was used as a predictive indicator,and data of 35 plasma exchanges from June 2020 to October 2020 was collected for clinical verification and the best cut-off of transmembrane pressure was analyzed. Results Filter rupture occurred in 19(9.69%) cases of the 196 cases of mTPE. Logistic regression analysis showed that transmembrane pressure(OR=1.192) was an independent risk factor for filter rupture in(mTPE)(P<0.05).The area under ROC curve(AUC) was 0.977 and 95%CI were 0.952~1.000(P<0.01). According to the maximum Youden index value of 0.839,the optimal cut-off value of transmembrane pressure was 50 mmHg;the sensitivity was 89.5%;the specificity was 94.4%. With 50 mmHg as the cut-off value,the verification results showed that the sensitivity was 100%;the specificity was 91.42%;the accuracy was 91.42%. Conclusion The transmembrane pressure has a good predictive effect on filter rupture in mTPE. The clinical transmembrane pressure is maintained below 50 mmHg to prevent the filter rupture.

    Analysis of influencing factors and pathway of post-traumatic growth in family members of neurosurgical intensive care unit patients
    LIN Qi,DONG Fanghui,ZENG Li,YU Qunya,XUE Yiwei
    2021, 56(6):  836-842.  DOI: 10.3761/j.issn.0254-1769.2021.06.006
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    Objective To understand the status quo of post-traumatic growth of family members of patients with severe neurological diseases,and to analyze the influence of hope,gratitude and resilience on post-traumatic growth. Methods From January to December 2019,340 family members of patients in a neurosurgical intensive care unit of a general tertiary hospital in Shanghai were collected by convenience sampling method. Herth Hope Index,Gratitude Questionnaire-Six-Item Form,Connor-Davidson Resilience Scale and Post-traumatic Growth Inventory were used for investigation them. Results The total post-traumatic growth score of 340 family members of patients with severe neurological disease was(73.38±14.02). The post-traumatic growth of patients’ family members was positively correlated with the levels of hope,gratitude and resilience (r=0.319,0.396 and 0.654,all P<0.01). Bootstrap analysis showed that gratitude and resilience had significant mediating effects on the relationship between hope and post-traumatic growth(95%CI:0.743~1.226). It was hoped that gratitude and resilience could positively predict post-traumatic growth(β=0.145,P<0.01;β=0.734,P<0.01),and post-traumatic growth could also be positively predicted through multiple mediators of gratitude sutra resilience (β=0.114,P<0.01). Conclusion Gratitude and resilience play a mediating role in the relationship between hope and post-traumatic growth. Nursing managers can improve the level of mental resilience of patients’ family members and promote post-traumatic growth by constructing gratitude based interventions and education strategies.

    The real experience of stroke patients in young and middle-age adults:a qualitative meta-synthesis
    GONG Shaohua,SUN Chao,YANG Heng,YI Xiaoping,HU Nannan,ZHANG Ao,CHEN Shanshan,LIU Youhua,GUO Hong
    2021, 56(6):  843-851.  DOI: 10.3761/j.issn.0254-1769.2021.06.007
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    Objective To systematically evaluate the disease experience and psychological feeling of young and middle-aged stroke patients,so as to provide theoretical bases for medical staff to meet the needs of patients,improve the quality of nursing services,and further improve the rehabilitation treatment effect and mental health of the population. Methods The computer retrieval was performed in PubMed,Embase,Web of Science,Cochrane Library,ProQuest,CBM,CNKI,WanFang Data,VIP for the qualitative research on real experience,psychological experience and feeling of young and middle-aged patients with cerebral apoplexy,with the retrieval time from inception to July 2020. The literature quality was evaluated using the qualitative research quality evaluation criteria of the Joanna Briggs Institute Evidence-based Health Care Center in Australia,and the research results were summarized and integrated using the pooled integration method. Results A total of 14 articles were included;90 themes were extracted;9 categories were summarized;3 integrated results were formed,namely breaking the normal life,seeking attention and support,getting a positive experience. Conclusion Nurses should pay attention to the negative psychological status of patients,unite family and social support to help patients build confidence and return to family and society. They also need to improve their professionalism,formulate targeted rehabilitation plans for patients,improve continuous nursing services,and provide timely professional support for patients. Special attention should also be given to the positive psychological experience of patients,so as to assist patients to maintain a positive state,and achieve a virtuous circle.

    Nursing care of a patient with amyotrophic lateral sclerosis complicated with esophageal fungal infection
    WANG Minxiu,HUANG Wenxin,LIN Shaoyi
    2021, 56(6):  852-854.  DOI: 10.3761/j.issn.0254-1769.2021.06.008
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    To summarize the nursing experience of a case of amyotrophic lateral sclerosis complicated with esophageal fungal infection. The key point of nursing is the management of dual nasal feeding tubes,including the dual tubes identification,esophageal flushing nursing,prevention of tube blockage,prevention of reflux aspiration. In addition,the anti-fungal drug care,infection control,respiratory management,psychological care are also strengthened. After 62 days of careful treatment and nursing and 4 gastroscopy evaluations,the patient was successfully cured of fungal esophagitis,and percutaneous endoscopic gastrostomy tube was inserted,ensuring the long-term nutrition supply for the patient.

    Reliability and validation study of the Chinese version of M.D. Anderson Symptom Inventory Brain Tumor Module
    PU Shuying,YAO Qianqian,JIANG Wei,LUO Yanfang
    2021, 56(6):  855-860.  DOI: 10.3761/j.issn.0254-1769.2021.06.009
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    Objective To evaluate the reliability and validity of the Chinese version of M.D. Anderson Symptom Inventory Brain Tumor Module(MDASI-BT) as a tool for assessing multiple symptoms in Chinese brain tumor patients. Methods From December 2019 to October 2020,208 patients with primary brain tumor were recruited by convenience sampling method from a tertiary hospital in Yunnan Province for a questionnaire survey,in order to evaluate the reliability and validity of the instrument. Results The Chinese version of MDASI-BT contained 28 items,including 22 symptom assessment items and 6 symptom interference assessment items. Through exploratory factor analysis,6 common factors extracted from 22 symptom assessment items could account for 63.137% of the cumulative variance. One common factor extracted from 6 symptom interference assessment items could explain a cumulative variance of 63.368%. The Cronbach’s α coefficient of the instrument was 0.920,and the split-half reliability was 0.894. Conclusion The Chinese version of MDASI-BT showed high reliability and validity. It can be used as a specific and practical tool for assessing cancer-related symptoms and its disturbance of life in patients with brain tumor.

    Specialist Practice and Research
    Investigation on the current situation of peripheral arterial catheter indwelling and maintenance in ICU of Beijing tertiary hospitals
    YUAN Cui,XIAO Yanyan,WANG Yi,WANG Fang,DING Yanming
    2021, 56(6):  861-866.  DOI: 10.3761/j.issn.0254-1769.2021.06.010
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    Objective To investigate the situation of insertion and maintenance of peripheral arterial catheter in adult ICU patients of Beijing tertiary hospitals. Methods The questionnaire was developed using Delphi consensus process. ICU nurses were recruited form 20 tertiary general hospitals in Beijing by stratified sampling method from May to June 2020. Results 992 questionnaires were sent out and 981 were received with an effective recovery rate of 98.9%. ICU physicians(41.1%)and nurses(45.2%) were mainly responsible for catheterization. 24.1% of ICU nurses only occasionally or never performed Allen tests before catheterization. 58.6% of nurses used heparin saline as rinse solution. However,42.2% of nurses occasionally or never adjusted the type of rinse solution according to patient conditions,and 54.4% occasionally or never performed square wave test. Only 45.2% of nurses reported that the volume of discarded blood was 3 times the volume in the front of the catheter;56.4% used a syringe to suck blood at the junction;42.9% rinsed blood into a container. Conclusion The cognition and practice of nursing staff in Beijing in terms of catheter insertion,maintenance and blood sampling are still insufficient,which needs to be further improved. Uniform standards and specifications are recommended to be developed both by doctors and nurses. The training on catheter insertion and maintenance should be strengthened in order to enhance nursing quality in the future.

    Research on the changing trajectory and influencing factors of quality of life in patients with allogeneic hematopoietic stem cell transplantation
    SONG Yaya,ZHU Xiaming,LU Yin,GE Yongqin,JING Xiuchen,CHEN Ying,LI Qin,TANG Fang,YANG Miaohua,LI Yaohong
    2021, 56(6):  867-872.  DOI: 10.3761/j.issn.0254-1769.2021.06.011
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    Objective To investigate the changing trajectory of quality of life and its influencing factors in allogeneic hematopoietic stem cell transplantation(allo-HSCT)patients within 3 years. Methods The convenience sampling method was used to select patients who received allo-HSCT from July 2016 to October 2017 in a tertiary hospital of Suzhou City as the research subjects. The general data table and Functional Assessment of Cancer Treatment-Bone Marrow Transplant(FACT-BMT) were adopted to investigate the quality of life of patients at different time points(1~2 days before transplantation,1 month,3 months,6 months,1 year,1.5 years and 3 years after transplantation). Results The quality of life of patients with allo-HSCT was the worst at 1 month after transplantation,and then gradually increased and basically returned to pre-transplant level at 6 months after transplantation. The quality of life of patients 3 years after transplantation was significantly higher than pre-transplant patients,with statistically significant differences(P<0.05). The trajectories of physiological health,functional integrity and stem cell transplantation were consistent with the trajectory of the total score of quality of life,showing a fluctuating upward pattern. The score of emotional stability dimension was the lowest before transplantation and gradually increased over the transplantation time. There was no significant differences between the scores of social/family stability before transplantation and the scores of each time point(P>0.05). Multiple linear regression analysis showed that the major factors affecting the quality of life of allo-HSCT patients at 3 years were residence(t=3.175,P=0.002),average monthly household income(t=3.320,P=0.001),transplanted complications(t=-6.955,P<0.001) and whether the patient returns to work/school(t=2.706,P=0.008). Conclusion The overall quality of life of allo-HSCT patients showed a fluctuating upward trend. There were differences in the recovery time and the changing trajectory among the 5 dimensions affecting quality of life. Nurses can dynamically adjust the focus of nursing interventions according to the changing trajectory of quality of life,so as to provide patients with more precise continuous nursing support.

    Construction of a perioperative nursing scheme for transoral endoscopic thyroidectomy vestibular approach
    QIN Fawei,LIU Meifeng,CHEN Hongyuan
    2021, 56(6):  873-879.  DOI: 10.3761/j.issn.0254-1769.2021.06.012
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    Objective In order to construct a perioperative nursing scheme for transoral endoscopic thyroidectomy vestibular approach(TOETVA). Methods We combined the literature and clinical experience to construct a perioperative nursing scheme. 15 thyroid surgeons,thyroid surgical care specialists,surgical care teachers,etc. from Shandong Province,Beijing,Tianjin,Hebei Province,and Guangdong Province were invited to conduct Delphi expert consultation from March to May 2020. Results 2 rounds of expert consultations were carried out,and the effective recovery rate of the questionnaire is 100%.Expert authority coefficients of 2 rounds are 0.81,0.87.The Kendall harmony coefficients of the first,second,and third-level indicators in the first round were 0.156~0.360,which were statistically significant(all P<0.001);the Kendall harmony coefficients of the first,second and third levels in the second round were 0.501~0.646 with statistically significant(all P<0.001);the coefficient of variation of each item in the second round is 0.05~0.11,and the full score is 26.7%~93.3%.The ultimately determined TOETVA perioperative nursing scheme includes 5 first-level indicators(general care,psychological counseling,maintaining a smooth respiratory tract,comfortable management,complications,processing),19 secondary indicators and 59 third-level indicators.Conclusion The TOETVA perioperative nursing scheme constructed in this study is scientific,specific,practical and feasible.

    Construction and preliminary application of a symptom assessment scale for breast cancer patients with endocrine therapy
    LI Qingqing,NI Jianfen,FANG Qunying,WU Wanying
    2021, 56(6):  880-886.  DOI: 10.3761/j.issn.0254-1769.2021.06.013
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    Objective According to the symptom characteristics of breast cancer patients with endocrine therapy,a symptom assessment scale was developed for breast cancer patients with endocrine therapy in China,and its reliability and validity were tested. Methods Based on the literature reviews and references to the existing symptom assessment scales,the initial item pool of the scale was developed. The initial scale was formed through 2 rounds of Delphi consultations. Through the cognitive interviews of 11 patients,the scale items were further revised to form the clinical test scale. A questionnaire survey was conducted on 325 breast cancer patients with endocrine therapy in a tertiary cancer hospital in Zhejiang Province from July to September 2020 to test the reliability and validity of the scale. Results The final version of the symptom assessment scale for breast cancer patients with endocrine therapy included 33 items,and exploratory factor analysis extracted 7 common factors,and the cumulative variance contribution rate was 68.76%. The content validity index of each item was 0.78~1.00,and the content validity index of the scale was 0.91. Correlation analysis results showed that the correlation coefficient between the scale dimension and the total score was 0.58~0.79(P<0.05). The correlation coefficients between dimensions were 0.26~0.52(P<0.05). Cronbach’s α coefficient,retest reliability and half reliability were 0.94,0.95 and 0.84 respectively. Conclusion The symptom assessment scale for breast cancer patients with endocrine therapy developed in this study has good reliability and validity and it is suitable for symptom assessment of related population.

    Nursing Management
    Analysis of nurses work status and differences between secondary and tertiary hospitals in Guangdong Province
    XIANG Yang,LIU Jiali,LIU Xu,WANG Yun,YOU Liming
    2021, 56(6):  887-892.  DOI: 10.3761/j.issn.0254-1769.2021.06.014
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    Objective To describe the work status of nurses in secondary and tertiary hospitals in Guangdong province in China,and to analyze the differences between secondary and tertiary hospitals. Methods A total of 4,163 nurses from 36 secondary and tertiary hospitals were investigated with questionnaires on the demographic characteristics,nursing work environments,care left undone,burnout,job satisfaction and intention to stay. Results The overall score of nursing work environments was 3.03(2.74,3.61);the score:for the subscale of staffing and resources adequacy and nurse participating in hospital affairs were the lowest,which were 3.00(2.50,3.50) and 3.00(2.56,3.56),respectively. Perception of nurses in tertiary hospitals on nursing work environments was significantly worse than that of nurses in secondary hospitals for both overall scale and 5 subscales(all P<0.001). The average number of care left undone reported by nurses was 6.0(1.0,11.0),with a significantly higher number of those reported by nurses in tertiary hospitals than those in secondary hospitals (P=0.036). Nurses in the secondary and tertiary hospitals experienced a moderate level of emotional exhaustion and depersonalization,and a high level of reduced personal accomplishment. Furthermore,61.42% of nurses were satisfied with their work and 79.87% had the intention to stay. Compared to nurses in secondary hospitals,the level of burnout among nurses in tertiary hospitals was at a higher level(P<0.001 both for emotional exhaustion and depersonalization),and the proportion of nurses who were satisfied with their work and willing to stay was lower(all P<0.050). Conclusion In Guangdong province,attention should be paid to further improvement of the work environment. Due to heavy workload and low job satisfaction of nurses,this situation was more prominent in tertiary hospitals than it in secondary hospitals.

    Development of post competency index system for nurses in Central Sterile Service Department
    KANG Jie,ZHANG Qing,YANG Hong,DU Heying,WU Keping,XU Mingze
    2021, 56(6):  893-898.  DOI: 10.3761/j.issn.0254-1769.2021.06.015
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    Objective To develop the post competency index system for nurses in Central Sterile Service Department,so as to provide scientific bases for the homogenized,standardized training strategy and evaluation of the competence level of the nurses in Central Sterile Service Department. Methods According to the Iceberg Competency Model,the paper drew up an evaluation index framework for the competency of nurses and prepared the inquiry paper of expert letters based on methods as document analysis. 3 rounds of Delphi consultation questionnaires were sent to 20 experts from 11 provinces and cities in May 2020. They were experienced in areas of management of central sterile supply,and helped to define the post competency index system for nurses in Central Sterile Service and its weight assignment. Results The established post competency index system for nurses in Central Sterile Service consisted of 4 first-level indexes,including theoretical knowledge,operational skills,comprehensive ability and personal characteristics,58 second-level indexes after 3 rounds of Delphi consultations. The effective response rate was 100%. The three-round authority coefficient values were 0.88,0.88,and 0.89 respectively. The Kendall harmony coefficients of expert opinions of the 3 rounds of first and second-level indexes were 0.301,0.343,0.413 and 0.322,0.256,0.292,respectively,and P<0.001 after the consistency test. Conclusion The post competency model for nurses in Central Sterile Service Department constructed in the study is reliable,scientific and practical,which will pro-vide objective quantitative bases for post training and evaluation for nurses in Central Sterile Service Department.

    Nursing Education
    Investigation on the quality of online teaching of nursing teachers in undergraduate education
    CHEN Hua,LI Xiaohua,WANG Panpan,SUN Hongyu
    2021, 56(6):  899-903.  DOI: 10.3761/j.issn.0254-1769.2021.06.016
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    Objective To investigte the work status of nursing teachers in colleges and universities under the background of online education,including problems and difficulties. Methods A self-designed questionnaire “national survey on online teaching quality of undergraduate nursing education(teacher version)” was used to conduct among 1 223 nursing teachers and clinical teachers from June 10 to June 30,2020. Results Among the investigated teachers,783 teachers(64.0%) had no experience of online teaching before February 2020,but 1 114 teachers(83.8%) accepted online teaching. From February to June 2020,teachers could provide students with all-round learning support and rich teaching activities. Compared with the theory teaching,259(57.9%) and 109(44.7%) teachers thought that the effect of experimental teaching and clinical practice teaching was worse. Network failure (72.4%),uncontrollable online classroom state(60.8%) and inactive interaction of students(56.6%)were the main difficulties of online teaching. The overall level of teachers’ self-evaluation of online teaching quality was satisfied,and the score of teaching preparation was the highest,with an average score of 4.1±0.7. Conclusion Most teachers lack online teaching experience,but they had a positive attitude towards online education. The effects of online experiment teaching and practice teaching were not ideal. The quality of self-evaluation teaching was satisfactory. It is suggested that nursing teachers should provide better nursing education through the combination of online and offline education in the future.

    Clinical Practice
    Nursing care of 44 cases of PICC patients with initial catheter malposition in superior vena cava
    FENG Feng,XU Hongxia,WANG Ling,XU Zhe,WU Xiaoli,JIANG Li,JIN Aiyun
    2021, 56(6):  904-906.  DOI: 10.3761/j.issn.0254-1769.2021.06.017
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    This article summarizes the experience in the identification and treatment of 44 cases of patients with initial superior vena cava malposition occurred during peripherally inserted central catheter (PICC) line catheteriza-tion. The 1 370 patients with PICC catheterization in a tertiary hospital in Hangzhou from January to May 2020,among which 44 cases developed initial superior vena cava malposition with the occurrence rate of 3.2%. We were able to reposition in 43 cases through treatment guided by the B-scan ultrasonography and comprehensive analysis of the shape and amplitude of the P wave in intracavitary electrocardiogram. We observed in 1 case that the catheter was mistakenly delivered malposition to Azygos vein. The success rate is 97.7%.

    Post-operative care of 12 patients implanted left ventricular assist system
    ZHANG Qian,LI Yonggang,LAN Jun,LI Qingyin,HUANG Yujia,SHI Li
    2021, 56(6):  907-911.  DOI: 10.3761/j.issn.0254-1769.2021.06.018
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    This article summarized key nursing points of 12 patients implanted left ventricular assist system EVAHEART I. Key points of nursing care included the monitoring of blood pump flow rate and cardiac function,the monitoring of organ and tissue perfusion,surveillance of complications such as coagulopathy,infection,stroke and arrhythmia,early rehabilitation training and discharge follow-up care. After careful treatment and care,all 12 patients were discharged from the hospital with the ventricular assist system EVAHEART I.

    Nursing care of lung rehabilitation for a case of Eisenmenger syndrome parturient woman after double lung transplantation and ventricular septal defect repair
    LU Shan,SU Yunyan,SUN Xiaoling,WANG Zheyun
    2021, 56(6):  912-916.  DOI: 10.3761/j.issn.0254-1769.2021.06.019
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    To summarize the lung rehabilitation nursing experience of a case of Eisenmenger syndrome after double lung transplantation and ventricular septal defect repair. The key points of nursing include:establishing multi-disciplinary pulmonary rehabilitation team,carrying out sequential respiratory support treatment and nursing,using respiratory function training apparatus correctly,carrying out motor function rehabilitation exercise step by step,and strengthening nutritional support and psychological rehabilitation. After multidisciplinary team cooperation,the patient was extubated on the first day after surgery and got out of bed,and discharged smoothly on the 46th day after operation.

    Nursing care of a severe pemphigus complicated patient with subcutaneous hematoma treated with Rituximab
    HE Xueyu,ZENG Xiaofang
    2021, 56(6):  917-920.  DOI: 10.3761/j.issn.0254-1769.2021.06.020
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    This article aims to summarize the nursing experiences of a severe pemphigus patient complicated with multiple subcutaneous hematomas treated with rituximab. The nursing points:to control skin infection and promote skin wound healing according to the principle of wound TIME management;to create opportunities to apply rituximab in time;to take care of the whole process of rituximab infusing to ensure safety;multidisciplinary consultation evaluates and analyzes reasons of huge subcutaneous hematoma forming,and comprehensive nursing promotes hematoma regression. After 33 days of hospitalization,the patient’s skin wound healed completely;the hematoma shrank;the patient got better and was discharged. After 30 days follow-up,subcutaneous hematoma vanished and pemphigus did not recur.

    Evidence Synthesis Research
    Evidence summary of patient identification
    XU Rong,WANG Hui,YANG Weimei,WANG Lan,YANG Xueke,XIAO Yaru,CHEN Yushuang,QU Xi,DAI Ling,QU Jia
    2021, 56(6):  921-928.  DOI: 10.3761/j.issn.0254-1769.2021.06.021
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    Objective We searched,evaluated and integrated the best evidence of patients’ identification,so as to provide bases for formulating the management standards of patients’ identification. Methods According to the "6S" model,we used the evidence-based nursing method to search the relevant literature. Johns Hopkins evidence classification system was used to grade the evidence,and we also used AGREEⅡ(2017 version) and JBI evidence-based health care center’s document quality evaluation standard and evidence recommendation system(2014 version) to evaluate the quality of various studies and the level of evidence recommendations. Results A total of 23 articles were included,including 3 guidelines,1 clinical decision-making,8 expert consensuses,4 recommended practices,3 evidence summaries,1 systematic evaluation,2 government reports and 1 hospital standard. Finally,42 pieces of best evidence are summarized. Conclusion The leaderships of medical institutions should manage the patients’ identification scientifically according to the actual conditions of different places and hospitals. They should focus on controlling the timing of identification,strengthening the management of special groups and strengthening the quality control. Meantime,the application personnel also need to continuously update the evidence to improve the hospital safety management by applying the best evidence.

    The effectiveness of compression therapy with pneumatic compression devices on wound healing in patients with venous ulcers:a meta analysis
    LI Fei,NAN Fang,DANG Yun,GAI Tiantian,LI Yue,WANG Zhiwen
    2021, 56(6):  929-933.  DOI: 10.3761/j.issn.0254-1769.2021.06.022
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    Objective To evaluate the effect of pneumatic compression devices and short stretch bandages compression therapy on wound healing in patients with leg venous ulcer. Methods Databases such as the Cochrane Library,PubMed,CINAHL,Web of Science,CNKI,Wanfang,VIP and CBM database were searched up to January 20,2021 for randomized controlled trials(RCTs) on the effectiveness of pneumatic compression devices and short stretch bandages compression therapy on wound healing in patients with venous ulcers. According to the inclusion and exclusion criteria,2 researches independently screened each database,extracted data,and assessed the methodological quality of included studies. RevMan 5.3 software was used for meta analysis. Results 6 RCT studies involving 350 patients were included. The meta analysis showed that there was no significant difference of the pneumatic compression devices compared with the short stretch bandage for compression therapy in wound healing rate [RR=0.88,95%CI(0.71,1.09),P=0.25],change of ulcer size[MD=-3.22,95%CI(-6.73,0.28),P=0.07],rate of healing[SMD=1.45,95%CI(-0.31,3.21),P=0.11],and adverse event[RR=0.55,95%CI(0.08,3.75),P=0.54]. Conclusion Compression therapy for leg venous ulcer patients with pneumatic compression devices can achieve similar effects with short stretch bandage on wound healing rate,change of ulcer size,rate of healing,and adverse event. As all the studies included in this meta-analysis are foreign literature,pilot trials with small samples can be carried out in the future to further evaluate the applicability and feasibility of pneumatic compression therapy in leg venous ulcer patient in China.

    Evidence summary for prevention and management of pregnancy-related low back pain
    SHI Zhiyi,LU Ying,XING Liyuan,LIU Weihua,WANG Shujing,WANG Zhenzhen,ZHANG Hongmei
    2021, 56(6):  934-941.  DOI: 10.3761/j.issn.0254-1769.2021.06.023
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    Objective To select and obtain the best evidence for pregnancy-related low back pain,so as to provide references for clinical practice to decrease the incidence and degree of pregnancy-related low back pain. Methods We systematically searched related websites,databases for all evidence on prevention and management of pregnancy-related low back pain,including guidelines,best practice information booklets,evidence summaries,system reviews,expert consensuses research from the inception of databases to September,2020. Literature was evaluated and rated for quality by 2 researchers independently. Results Totally,20 articles were enrolled,including 1 clinical decision,2 guidelines,12 systematic reviews and 5 randomized controlled trials. A total of 27 pieces of evidence were summarized,including pregnancy-related low back pain assessment and diagnosis,daily life management,multidisciplinary management,drug management and non-drug management. Conclusion A multidisciplinary cooperation plan for the prevention and management of pregnancy-related low back pain was formed. The best evidence should be selected in accordance with the clinical environment and pregnant women’s preferences,so as to reduce the incidence and degree of pregnancy-related low back pain.

    Review
    Research progress of mobile health application in family care of patients with dementia
    LI Xue,LI Dongmei,HU Ziyan,ZHOU Yao,PING Yanru,XU Hong
    2021, 56(6):  942-947.  DOI: 10.3761/j.issn.0254-1769.2021.06.024
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    As the focus of global public health,dementia has aroused great public concerns. This paper introduces the definition,development background and application types of mobile health applications in nursing care of patients with dementia,including early screening,cognitive training,daily assistance,activity monitoring,social activities and caregivers support. It sums up advantages and disadvantages of the various types of application effects. According to the domestic current situation of the application,it is proposed to use multidisciplinary teams to develop mobile health applications in line with Chinese culture and implement interventions,so as to provide references and bases for the research on mobile health care of patients with dementia in China.

    Research progress on an assessment tool of patient-reported outcomes for breast cancer patients
    ZHANG Chenglin,LI Qinghe,WU Cuigan,ZHANG Jing
    2021, 56(6):  948-951.  DOI: 10.3761/j.issn.0254-1769.2021.06.025
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    This paper reviewed the patient-reported outcomes and assessment tools for patients with breast cancer,and summarized the major contents,application and limitations of generic and specific patient-reported outcome measures. We also analyzed the characteristics and existing problems of the assessment tools,so as to provide references for the development of patient-reported outcome measures and implementing management of symptoms and clinical decisions in patients with breast cancer.

    Nursing Instruments Innovation
    The design and application of a modular embedded storage device in clinical practice
    FENG Jia,YU Shenmei,ZHANG Qiuxia,MAO Yue,ZHAO Fei
    2021, 56(6):  952-957.  DOI: 10.3761/j.issn.0254-1769.2021.06.026
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    Objective To design a modular embedded storage device and explore its effect. Methods Quasi-experimental design was used in this study. Nurses from a cardiology department of our hospital used the modular embedded storage device to prepare supplies for nursing operation items(in an experimental group),while nurses from a neurology department used general storage cabinets to prepare nursing products(in a control group). Researchers tracked time spent on preparing 5 high-frequency nursing operation items in the 2 groups for 3 months. The preparation time of nursing supplies,the quantity and cost of out-of-date stock,and the satisfaction of nurses were compared between the 2 groups. Results Compared with it in the control group,the material preparation time in the experimental group was significantly shortened,and the difference was statistically significant(P<0.001). The total satisfaction score of the experimental group was higher than that of the control group,and there were statistical differences in time-saving,comfort,convenience,safety and accuracy of picking goods(P<0.05). There were 13 539 nursing materials expired in the control group in a year while only 3 invalid items in the experimental group,which were equivalent to 13,089 RMB and 45 RMB respectively. Conclusion The modular embedded storage device is useful to facilitate cost efficiency of the nursing supply chain,improve quality and safety of the working system,and improve nurses’ satisfaction. It is worth promoting.

    Application and evaluation of a modified chest strap in robotic thyroidectomy
    HU Mei,ZHENG Lei,WANG Fang,JING Xiujuan,YAN Jiqi,CHEN Mengjiao,LÜ Yanwen,WANG Jun
    2021, 56(6):  958-960.  DOI: 10.3761/j.issn.0254-1769.2021.06.027
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    Objective To explore the effect of a modified chest strap after minimally invasive thyroid surgery. Methods A improved chest strap was developed,which can be adjusted and fixed according to the patient’s body and needs. At the same time,the ice pack device can be placed on the chest as needed. The chest strap and cold compress are maintained simultaneously during the use. From July 2019 to August 2020,82 patients underwent elective minimally invasive thyroid surgery. The patients were divided into a control group with 42 cases and an experimental group with 40 cases according to the time. The control group selected from July to December 2019 used traditional medical chest straps. The experimental group selected from January to August 2020 used improved vest-style chest straps. The pain scores,comfort,subcutaneous congestion,and satisfaction with the chest straps were compared between the 2 groups after using the chest straps. The patient’s pain score was evaluated by Numerical Rating Scale;the patient’s comfort score was evaluated by Kolcaba Comfort Scale;patients satisfaction was evaluated by a satisfaction questionnaire. Results The pain score in the experimental group was 2.1±0.2,which was lower than 2.9±0.2 in the control group(t=2.776,P=0.007). The comfort score in the experimental group was 84.9±1.4,which was better than 79.7±1.1 in the control group(t=2.871,P=0.005). 20% of patients in the experimental group had symptoms of subcutaneous congestion,while 31% of patients in the control group had subcutaneous congestion(χ2=1.290,P=0.256). Patients’ overall satisfaction in the experimental group was 95%,which was significantly higher than 59.5% in the control group(Z=14.642,P=0.001). Conclusion The use of the new and improved vest-style chest strap can reduce the patient’s pain and improve the patient’s comfort and satisfaction.