Table of Content

10 January 2023, Volume 58 Issue 1

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Special Planning--Stroke Nursing

Nursing guidelines for intravenous thrombolysis in acute ischemic stroke

Internal Medicine Nursing Committee of Chinese Nursing Association , Xuanwu Hospital Capital Medical University , Writing Committee：CHANG Hong, ZHANG Su, FAN Kaiting, ZHAO Jie, TIAN Siying）

2023, 58(1):  10-14.  DOI: 10.3761/j.issn.0254-1769.2023.01.001

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Objective To develop an intravenous thrombolysis nursing guideline for acute ischemic stroke as a guiding tool for the implementation of intravenous thrombolysis for acute ischemic stroke，and to provide a reference for the practice and management of nursing in the standardization of thrombolytic therapy. Methods According to the method of evidence-based nursing practice guidelines，the draft of intravenous thrombolysis nursing guidelines for acute ischemic stroke was constructed. The draft guidelines were reviewed by experts using the catalogue of Clinical Guidelines Research and Evaluation System Ⅱ. According to the results and suggestions of expert review，the guidelines were modified to form the formal guidelines. Results The recommendations included 5 aspects，namely hospital organization management，disease observation，observation and treatment of complications，posture and bed-leaving activities，and quality management. Conclusion The guidelines for intravenous thrombolysis nursing in acute ischemic stroke are evidence-based guidelines based on the best evidence，clinical practice and the judgment of professionals，and can be used as a practical basis for clinical medical staff to make scientific decisions on intravenous thrombolysis therapy in patients with acute ischemic stroke.

Construction of a non-manual airway care program for the prevention of stroke-associated pneumonia

HU Enhui, SHEN Xiaofang, LI Hongyan, XU Yanyan, QIN Xuejuan

2023, 58(1):  15-22.  DOI: 10.3761/j.issn.0254-1769.2023.01.002

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Objective In order to construct a non-artificial airway care scheme for the prevention of stroke-associated pneumonia and to provide references for effectively preventing stroke-associated pneumonia. Methods A group was set up to preliminarily formulate a non-artificial airway management program based on literature research and clinical experience. Through 2 rounds of expert consultations，the items were modified and the final scheme was determined. Results The return rates of questionnaires in 2 rounds were 88.24% and 100%，respectively. The expert authority coefficient is 0.940. After the second round of expert consultation，the variation coefficients of importance and feasibility of each item were 0-0.224 and 0-0.245，and the Kendall harmony coefficients were 0.139 and 0.241，respectively，with statistically significant differences（P<0.001）.The final scheme consists of 4 first-level items with risk assessment，dietary management，respiratory management，and oral health management，16 second-level items and 54 third-level items. Conclusion Experts have a high degree of enthusiasm and authority，and their opinions are well coordinated. The non-artificial airway care scheme constructed in this study for the prevention of stroke-associated pneumonia is reliable，specific and practical.

The decisional conflict and influence factors of proxies of patients with acute ischemic stroke in thrombolysis decision-making

GUO Yuanli, YANG Caixia, GUO Lina, DONG Xiaofang, GAO Huanhuan, LÜ Peihua, MA Keke

2023, 58(1):  23-30.  DOI: 10.3761/j.issn.0254-1769.2023.01.003

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Objective To investigate the status and influencing factors of thrombolysis decisional conflict of proxies decision-makers in patients with acute ischemic stroke. Methods The patients with acute ischemic stroke and their decision-makers were selected from September 2019 to December 2021 in the emergency department of a tertiary A hospital in Zhengzhou，Henan Province. The sociodemographic data and disease-related data of the patients and decision-makers were collected. The decision-makers filled in the Decisional Conflict Scale，the Decision-making Participation Expectation Scale，the Wake Forest Physician Trust Scale，the Perceived Social Support Scale and the State Anxiety Scale，and SPSSAU was used to analyze the data. Pearson and Spearman correlation analysis were used to explore the correlation between variables and decisional conflict，and ridge regression analysis was used to explore the influencing factors. Results A total of 383 decision-making proxies of patients were included in this study. The score of decisional conflict was 35.37±14.57，and 56.4% decision-making proxies had decisional conflict with scores >25. The influence factors of the decisional conflict included sociodemographic factors（patient age，decision-maker gender and education level，medical insurance type，patient economic burden，payer-patient relationship），emotional and psychological factors（decision-maker anxiety level，trust to physician，social support），patients’ disease-related factors（NIHSS，onset period，recurrence times），and characteristics of the decision-making process （number of people involved in the decision-making，whether patients participate in decision-making）. Conclusion Most of the decision-making proxies have decision-making difficulties. The sociodemographic characteristics，psychological characteristics of patients and decision makers and their trust in physicians will affect the decisional conflict. Medical staff should pay attention to the psychological characteristics of decision makers in the process of obtaining thrombolytic informed consent，adopt appropriate communication skills and provide necessary decision-making assistance.

Summary of the best evidence of airway nursing management in patients with respiratory infection after stroke

GUO Guihua, XU Xiaoming, WANG Hailiang, LIU Ning

2023, 58(1):  31-38.  DOI: 10.3761/j.issn.0254-1769.2023.01.004

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Objective To retrieve，evaluate and integrate the best evidence of airway nursing management in patients with respiratory infection after stroke，and to provide references for clinical nursing practice. Methods We systematically searched for the best evidence of airway nursing management in patients with respiratory infection after stroke in BMJ best practice，UpToDate，the World Health Organization website，Guidelines International Network，Joanna Briggs Institute，National Institute for Health and Clinical Excellence，Scottish Intercollegiate Guidelines Network，National Guideline Clearinghouse，Registered Nurses’ Association of Ontario，Australian Database of Clinical Practice Guidelines，New Zealand Guidelines Working Group，Yi Maitong Guidelines Network，Embase，the Cochrane Library，PubMed，CNKI，WanFang database，VIP database，SinoMed to collect the literature，including clinical guidelines，evidence summaries，best practice information sheets，expert consensuses，recommended practice，systematic reviews，Meta-analysis and randomized controlled trials. The retrieval period was nearly 5 years. There were 2 researchers evaluating the quality of the literature and extracting the data. Results 20 articles were selected，including 2 top clinical decisions，8 guidelines，3 evidence summaries，4 expert consensuses，1 systematic review，2 randomized controlled trials. 29 pieces of best evidence were formed from 6 aspects，including prevention and management，airway attraction，airway moist，pipeline care，incision nursing，ventilator management. Conclusion This study summarizes the best evidence of airway management in patients with respiratory infection after stroke，and provides evidence-based basis for medical staff. Medical staff should take good nursing measures for airway management according to clinical situation.

Development and psychometric test of the Caregiver Contribution to Self-care of Stroke Patient Scale

WANG Wenna, ZHANG Zhenxiang, ZHANG Dudu, ZHAO Jing, LI Shirui, XUE Menghan

2023, 58(1):  39-45.  DOI: 10.3761/j.issn.0254-1769.2023.01.005

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Objective To develop an instrument for measuring caregiver contribution to self-care of stroke patients，and to test its reliability and validity. Methods Under the guidance of the middle-range theory of self-care of chronic illness，the theoretical dimensions and item pool of the scale and subscale were preliminarily constructed through literature review and semi-structured interview results. Through expert correspondence，pilot study，item analysis and exploratory factor analysis，the items were screened and modified，and the dimensions of the scale and subscale were determined，and then a formal scale was formed. From January to May 2022，224 stroke caregivers were investigated by convenient sampling method to test the reliability and validity of the scale. Results The caregiver contribution to self-care of stroke patient scale included 3 subscales with 25 items. The subscale of caregiver contribution to self-care maintenance contained 3 dimensions，and the cumulative variance contribution rate was 87.533%. The subscale of caregiver contribution to self-care monitoring included 1 dimension，with a cumulative variance contribution rate of 87.683%. The subscale of caregiver contribution to self-care management contained 3 dimensions，and the cumulative variance contribution rate was 87.365%. The content validity of the 3 subscales was 0.973，0.988 and 0.990，respectively，and the criterion-related validity of the 3 subscales was good. The Cronbach’s α of the 3 subscales were 0.893，0.973 and 0.867，respectively. The test-retest reliability after 2 weeks was 0.834，0.829 and 0.887，respectively. Conclusion The caregiver contribution to self-care of stroke patient scale has good reliability and validity，and it can be used as an effective tool to evaluate the self-care contribution of caregivers to stroke survivors.

A scoping review of assessment tools for post-stroke fatigue

ZANG Shuang, CUI Ying, NI Cuiping, MU Jiaxin, ZHANG Lu, SONG Bing, LIU Yu

2023, 58(1):  46-54.  DOI: 10.3761/j.issn.0254-1769.2023.01.006

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Objective To collect assessment tools for post-stroke fatigue at home and abroad，to summarize and analyze their development process，characteristics and applications，so as to provide references for clinical medical staff to select the suitable assessment tools for post-stroke fatigue screening. Methods Focusing on assessment tools for post-stroke fatigue，we systematically searched 7 Chinese and English databases from the inception to March 13，2022. Relevant information was extracted for systematic analysis，and results were standardizedly reported using a scope review method. Results 48 studies were involved in the final review，including 36 studies on the development and validation of assessment tools，and 12 studies on the localization and application of assessment tools，involving 20 post-stroke fatigue assessment tools. Conclusion It is recommended to use the multi-dimensional fatigue assessment tools for post-stroke fatigue. In the future，the reliability and validity of existing post-stroke fatigue assessment tools still need to be further verified and improved，and comprehensive and effective post-stroke fatigue specific assessment tools should be continuously introduced or developed.

Specialist Practice and Research

Construction and application of a physical restraint management system for ICU patients

ZHANG Shuai, CHEN Juanhong, QUAN Yinyin, YAO Huiping

2023, 58(1):  55-59.  DOI: 10.3761/j.issn.0254-1769.2023.01.007

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Objective To develop a physical restraint management system for ICU patients and explore its application effect. Methods A research and development team was established to build a physical restraint management system for ICU patients based on the ICU patient physical restraint assessment scale. The system collects relevant data in real time to realize the functions of dynamic reminder and quality control of patients’ physical restraint decision-making. A total of 216 patients admitted to the ICU of a tertiary A hospital in Zhejiang Province from January 2022 to June 2022 were selected as the research subjects. The patient’s physical restraint rate，length of physical restraint and the incidence of unplanned extubation of the system were compared after application（April to June 2022） and before application（January to March 2022）. The nurses’ satisfaction with the management system was collected. Results After the application of the physical restraint management system for ICU patients，the physical restraint rate was 35.19%，which was significantly lower than 49.07% before application. After the application，the physical restraint time of the patients was 45.71（16.41，121.31） h，which was significantly shorter than 126.00（28.05，317.00） h of the control group. There was no significant difference in the incidence of unplanned extubation between 2 groups. The total average score of ICU nurses’ satisfaction with the system was （4.56±0.48） points. Conclusion The use of the physical restraint management system for ICU patients can help reduce the use rate and duration of physical restraint in patients，and nurses are more satisfied with the system.

The illness experience of adolescent patients with systemic lupus erythematosus：a qualitative study

YANG Ying, LI Ji, LIAN Dongmei, CHEN Yingxiang, LI Yang

2023, 58(1):  60-67.  DOI: 10.3761/j.issn.0254-1769.2023.01.008

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Objective To understand the illness experience of adolescent patients with systemic lupus erythematosus，so as to provide references for clinical medical staff to formulate targeted intervention strategies. Methods Semi-structured interviews were carried out from January to April 2022 by phenomenology. 11 adolescent patients with systemic lupus erythematosus from the pediatric clinic or ward of a tertiary A hospital in Beijing were recruited，and Colaizzi’s 7-step analysis method was applied to analyze and refine themes of interview data. Results 4 themes were extracted. Theme 1：bad physiological experience（pain and fatigue）； theme 2：negative psychological experience（suffer harm from others，prejudice against oneself，fear of disease，and worries about the future）； theme 3：disease coping style（conflict and resistance，compromise and concession，acceptance and adjustment）； theme 4：po-sitive psychological experience（feel the support of others and gain self-growth）. Conclusion Pediatric medical staff should pay attention to the physical and mental feelings of adolescent patients with systemic lupus erythematosus in the course of illness，and give scientific and effective interventions to promote their physical and mental comfort.

Investigestion and character analysis of function of 12 141 older people in 9 provinces

HU Huixiu, SUN Chao, ZHAO Yajie, LI Lei, LI Jingnan

2023, 58(1):  68-73.  DOI: 10.3761/j.issn.0254-1769.2023.01.009

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Objective To investigate the current situation of function in the older people and explore the diversities among different settings，age，gender and residence area，so as to provide empirical support for meeting the differentiated and diversified service needs of the older people. Methods The physical and cognitive function of 12 141 older people in 9 provinces from the east，south，central，north，and southwest region of China were investigated by WeChat Mini Program. The physical function includes activity of daily living，balance，pace，strength，risk for fall，vision and hearing function. The missing value data was interpolated by multiple interpolation method. Results The results of our study showed that the incidence of basic and instrumental activities of daily living were 45.9% and 80.5% respectively，39.5% for balance impairment，68.1% for low walking speed，64.5% for low strength，32.7% for falling risk，41.0% for visual impairment，17.6% for hearing impairment，and 30.0% for cognitive impairment. The setting，age，gender，and residence can affect the physical and cognitive functions of the elderly. Conclusion The function of the older people need to be improved. Attention should be paid to physical and cognitive functions of older people who are elderly，female，living in nursing home or rural area，and the early monitoring and intervention of high-risk groups should be carried out. Eventually treatment procedure for the older people with different degrees and different dimensions of dysfunction can be developed，so as to meet the differentiated and diversified long-term care service needs.

Nursing Management

Development and reliability and validity of a Psychological Capital Scale for Nurses

YUAN Zhongqing, WANG Jialin, JIN Man, TENG Mei, HE Hong

2023, 58(1):  74-79.  DOI: 10.3761/j.issn.0254-1769.2023.01.010

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Objective To develop a Psychological Capital Scale for Nurses and to test its reliability and validity. Methods Guided by the positive organizational behavior theory，an initial scale was developed through literature review，Delphi and pre-survey. From November to December 2021，255 nurses from 5 tertiary A general hospitals in Chengdu were selected for questionnaire survey，and the reliability and validity of the scale were analyzed. From January 2022 to March，350 nurses from above 5 hospitals were selected to conduct a questionnaire survey for confirmatory factor analysis. Results Psychological Capital Scale for Nurses contains 6 dimensions and 30 items. Cronbach’s α coefficient，split-half reliability，test-retest reliability and the scale level content validity index was 0.981，0.996，0.918，and 0.956，respectively. The correlation coefficient between the dimension and total score of the scale and Utrecht Work Engagement Scale was 0.680~0.750，and the Compassion Fatigue-short Scale was -0.600~ -0.569（all P<0.05）. Exploratory factor analysis extracted 6 factors，and the cumulative variance contribution rate was 77.587%. The confirmatory factor analysis revealed that the factor structure of the scale was stable. Conclusion The Psychological Capital Scale for Nurses has ideal reliability and validity，which can be used to measure nurses’ psychological capital.

Clinical Practice

Successful pregnancy and delivery after heart and lung transplantation：a case report

LI Jiuhong, DONG Alan, LI Yamin, LIU Yiting, ZHANG Xia, XIE Juanyu, YU Mei, REN Min

2023, 58(1):  80-84.  DOI: 10.3761/j.issn.0254-1769.2023.01.011

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To summarize the nursing experience of a patient with successful pregnancy and delivery after heart-lung transplantation. Nursing points include：establishing a multidisciplinary team of perinatal maternal-fetal cardiovascular disease to escort patients for successful delivery； individualized pre-pregnancy counseling to choose the best timing for pregnancy； adjustment of the immunosuppressive regimen during pregnancy and close monitoring of blood drug concentrations； refined pregnancy management，prevention of serious complications； rational selection of the mode of delivery and strict monitoring during labor；postpartum care and feeding guidance； psychological counseling to enhance patient confidence. After careful nursing and guidance，the patient successfully conceived and gave birth to a healthy baby. The mother and baby were discharged safely 5 days after the operation，and they were in good condition after 3 months of follow-up.

Evidence Synthesis Research

Evidence summary for strategies to promote swallowing function in patients with head and neck tumors

LEI Beimei, LI Zhen, XIE Changning, YUE Liqing, DAI Meiling, HUANG Ruirui, LUO Aihong, PENG Huan

2023, 58(1):  85-90.  DOI: 10.3761/j.issn.0254-1769.2023.01.012

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Objective To retrieve，evaluate and summarize the best evidence of strategies to promote swallowing function in patients with head and neck tumors，providing evidence-based evidence for clinical practice. Methods Following the “6S” evidence model，we searched the UpToDate，BMJ Best Practice，GIN，NGC，RANO，JBI，Cochrane Library，PubMed，Embase，CINAHL，Web of Science，CNKI，Wanfang and the International Otolaryngology Head and Neck Surgery and Dysphagia Association to collect the literature，including guidelines，systematic reviews，expert consensuses，clinical decisions，evidence summaries and recommended practices. The retrieval time was from inception to December 1st，2021. Results 15 articles were enrolled，including 7 guidelines，4 systematic reviews，2 expert consensuses and 2 evidence summaries. Finally，18 pieces of best evidence were summarized about multidisciplinary collaboration，swallowing assessment，interventions on dysphagia and follow-up. Conclusion The swallowing function promotion strategies can effectively improve the swallowing function of patients with head and neck tumors. When translating nursing evidence，healthcare professionals should formulate a personalized swallowing function promotion plan for patients based on the actual clinical situation and individual willingness.

Evidence summary of yoga management for patients with cancer-related fatigue

YUAN Shuqi, WANG Yuanyuan, JIA Lingying, HU Yan

2023, 58(1):  91-97.  DOI: 10.3761/j.issn.0254-1769.2023.01.013

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Objective To provide solid evidence for clinical development and implementation of yoga exercise for patients with cancer-related fatigue，we systematically retrieve，extract，summarize and analyze both the latest and the best evidence of yoga exercise for patients with cancer-related fatigue. Methods We searched BMJ Best Practice，UpToDate，NICE，RNAO，SIGN，NCCN，GIN，Yimaitong Guideline，JBI Library，Cochrane Library，PubMed，Web of Science，CINAHL，Wanfang Database，CNKI，CBM，AACR and ONS website to collect all relevant evidence，including guidelines，evidence summaries，best practice，expert consensuses，systematic reviews and et al. published from establishment of the database to December，2021. There were 2 researchers who independently screened articles and evaluated methodological quality. Evidence was extracted and summarized according to the theme. Results A total of 7 articles were finally included，containing 1 guideline and 6 systematic reviews. 22 pieces of evidence related to yoga exercise for patients with cancer-related fatigue were extracted and summarized into 9 themes，including exercise cognition，effects，yoga type，assessment，guidance and supervision，target population，principles formulation，exercise parameters and measurements. Conclusion Health care providers should carry out the best evidence practice of personalized yoga exercise prescription for cancer patients according to the characteristics of different cancer population，in order to reduce their fatigue and improve their quality of life.

Evidence summary for the nursing of gastrointestinal symptom clusters in colorectal cancer patients with chemoradiotherapy

YANG Junlin, YANG Jian, ZHAO Lili, TIAN Yumei, NING Yanhua, TANG Yuanyuan

2023, 58(1):  98-104.  DOI: 10.3761/j.issn.0254-1769.2023.01.014

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Objective To retrieve，evaluate and summarize the best evidence related to the care of gastrointestinal symptom clusters，such as nausea，vomiting，diarrhea and constipation，in colorectal cancer patients undergoing chemoradiotherapy at home and abroad，and to provide an evidence-based basis for clinical nursing care practice. Methods According to the “6S” model system，the literature related to gastrointestinal symptom clusters nursing of colorectal cancer patients with chemoradiotherapy was retrieved from relevant databases and websites at home and abroad，including clinical decisions，guidelines，systematic reviews，evidence summaries and expert consensuses. The retrieval period was from January 2017 to April 2022. There were 2 researchers who independently evaluated the included literature and integrated the evidence. Results A total of 16 articles were included，including 5 clinical decisions，6 guidelines，3 systematic reviews and 2 evidence summaries. 28 pieces of evidence were summarized from 4 aspects，namely organization management，constipation nursing，diarrhea nursing，malignant and vomiting nursing. Conclusion This study summarizes the best evidence of gastrointestinal symptom clusters nursing in colorectal cancer patients undergoing chemoradiotherapy，which can provide references for clinical practice. Nursing staff should combine the patient’s specific symptoms with actual needs for individualized nursing.

Review

Video education for advance care planning：a scoping review

DING Min, WANG Qian, YAN Rong, LIN Yuting, MENG Xiangmin

2023, 58(1):  105-111.  DOI: 10.3761/j.issn.0254-1769.2023.01.015

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Objective To review the application of video education in Advance Care Planning（ACP），and identify the elements of video education for ACP，so as to provide the guidance for future research. Methods A literature search was performed in the PubMed，Embase，CINAHL，Web of Science，PsycINFO，Cochrane Library，CNKI，Wanfang，VIP and CBMdisc. The retrieval time was from the establishment of the database to April 30，2022. The included studies were summarized and analyzed. Results A total of 27 articles were included. Forms of video educational include mobile terminal devices，telemedicine. The core content includes providing ACP related knowledge，providing disease-related knowledge and information on the advantages and disadvantages of treatment measures，clarifying values，goals and medical care preferences. The outcome indicators were mainly the process indicators，action indicators，care outcome indicators，feasibility evaluation. Conclusion Video education in the field of ACP presents preliminary effects and feasibility. It is suggested that researchers could draw on and refer to foreign ACP video education tools，develop and update scientific and feasible ACP video education tools for our country，explore appropriate ACP video education strategies，improve the effectiveness evaluation index，and improve the quality of ACP video education.

Research progress on fear of falling related activity restriction of the elderly

ZHANG Yuxin, ZHANG Kaili

2023, 58(1):  112-116.  DOI: 10.3761/j.issn.0254-1769.2023.01.016

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Fear of falling related activity restriction（FFAR） commonly exists among the elderly，and activity restriction will bring serious harmful consequences to the elderly. Existing studies have focused on falling and fear of falling，while FFAR has received little attention. This paper reviews the definition，incidence，assessment tools，adverse consequences，influencing factors，intervention methods and effects of elderly FFAR，aiming to attract clinical staff with much attention on FFAR and provide further research references.

A literature review on the application of acute care for the elderly unit in hospitalized patients

LU Wenyan, LIU Xiaoling, XIA Jiangliu, ZHANG Dan, ZHANG Xuemeng, ZHU Lingling, ZHAO Hua

2023, 58(1):  117-120.  DOI: 10.3761/j.issn.0254-1769.2023.01.017

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As a special care unit，the unit of acute care for the elderly（ACE） focused on functional maintaining of elderly patients during hospitalization to recover rapidly and return to the family as soon as possible. This paper summarized the origin，development，key elements，working procedures and application effects of the ACE unit，and suggested the development direction of ACE unit according to Chinese national conditions，which can be used as a reference for nursing clinical practice.

Overseas Knowledge

The translation of the Hematology Information Needs Questionnaire and its reliability and validity test

MA Longting, WEI Zhiqiong, WANG Linan, HAO Rui, ZHOU Xueying, ZHU Xinran, LIU Jingjing, LIU Lijuan, ZHUANG Shumei

2023, 58(1):  121-128.  DOI: 10.3761/j.issn.0254-1769.2023.01.018

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Objective The purpose is to translate the Hematology Information Needs Questionnaire（HINQ） into Chinese，and to test its reliability and validity. Methods The cross-cultural adaption guide of Beaton was used to translate the scale. The reliability and validity of the HINQ were tested through a survey of 362 patients with hematologic neoplasms in a tertiary specialized hospital in Tianjin by convenience sampling from October to December 2021. Results 345 valid questionnaires were collected. The Chinese version of the scale included 7 dimensions of disease（with 10 items），treatment（with 19 items），etiology（with 3 items），sleep and physical changes（with 6 items），self-care（with 7 items），medical tests and prognosis（with 11 items），psycho-social aspect（with 6 items），with a total of 62 items. In exploratory factor analysis，the cumulative variance contribution of 7 common factors was 73.963%. The item-level content validity index of the Chinese HINQ is 0.830~1.000，the scale-level content validity index is 0.949；Cronbach’s α coefficient for the overall scale was 0.986，and the Cronbach’s α coefficients of each dimension ranged from 0.903~0.976； the test-retest reliability of the total scale was 0.896，and the split half reliability coefficient was 0.917. Conclusion The scale has good reliability and validity，and it can be used as an assessment tool for the information needs of patients with hematologic neoplasms.