Table of Content

20 June 2023, Volume 58 Issue 12

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Research Paper

Construction and application of enteral nutrition protocol for patients with intra-abdominal hypertension oriented by intra-abdominal pressure

YUAN Mengmei, HUANG Xiaoxia, TANG Jiaying, FENG Xiuqin

2023, 58(12):  1413-1421.  DOI: 10.3761/j.issn.0254-1769.2023.12.001

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Objective To construct and apply an enteral nutrition protocol for patients with intra-abdominal hypertension oriented by intra-abdominal pressure，and provide systematic and standardized interventions for the implementation of enteral nutrition for patients with intra-abdominal hypertension，to reduce the incidence of feeding intolerance and improve the feeding compliance rate. Methods Through literature review and the Delphi method，the enteral nutrition protocol for patients with intra-abdominal hypertension was constructed，and 218 patients with intra-abdominal hypertension admitted to the emergency ICU of a tertiary hospital in Zhejiang Province from January to October 2022 were selected by convenient sampling method. The experimental group used the enteral nutrition protocol for patients with intra-abdominal hypertension oriented by intra-abdominal pressure for enteral nutrition treatment，and the control group used the conventional enteral nutrition treatment in ICU. The incidence of feeding intolerance symptoms，the feeding compliance rate on the 3rd and 7th day of enteral nutrition，the duration of enteral nutrition，and the number of days in ICU were compared between the 2 groups. Results The incidence of feeding intolerance symptoms in the experimental group（58.70%） was lower than that in the control group（74.31%）；the feeding compliance rate on the 3rd day of enteral nutrition（31.19%） was higher than that in the control group （16.51%）；the rate of feeding on the 7th day of enteral nutrition（28.44%） was higher than that in the control group（13.76%），and the differences were statistically significant（all P<0.05）. There was no significant difference in the duration of enteral nutrition and ICU stay between the 2 groups（all P>0.05）. Conclusion The enteral nutrition protocol for patients with intra-abdominal hypertension oriented by intra-abdominal pressure has clinical guiding significance，which can reduce the incidence of feeding intolerance and improve the feeding compliance rate in patients with intra-abdominal hypertension.

Special Planning—Premature Infant Care

Effects of non-nutritive breast sucking on the oral feeding ability of very low birth weight preterm infants

LI Liling, WANG Li, YU Ling, WU Xi, YAN Weili, CAO Yun, DOU Yalan, WANG Yin, HU Xiaojing

2023, 58(12):  1422-1426.  DOI: 10.3761/j.issn.0254-1769.2023.12.002

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Objective To investigate the effect of non-nutritive breast sucking on oral feeding ability in very low birth weight preterm infants. Methods From July 2020 to June 2021，148 very low birth weight preterm infants admitted to the NICU of a tertiary children’s hospital in Shanghai were consecutively included，and they were divided into an experimental group and a control group with 74 cases in each group by block randomization. After the mechanical ventilation weaned，infants in the experimental group received non-nutritive breast sucking once a day for 5 minutes each time，and sucked the pacifier for 5 minutes before each tube feeding. The infants in the control group only sucked the pacifier for 5 minutes before each tube feeding. The time to achieve full oral feeding，the corrected gestational age at full oral feeding，the score of the Breastfeeding Behaviour Scale for premature infants，the days of breast feeding，and the breast feeding rate on the day of discharge were compared between 2 groups. Results There were 2 cases dropped in the experimental group and no cases dropped in the control group. The time to achieve full oral feeding was（12.29±4.12） d in the experimental group and（16.87±7.42） d in the control group. The difference between 2 groups was statistically significant（P<0.001）. The corrected gestational age at the time of full oral feeding was（36.45±1.54） weeks in the experimental group and（36.13±4.59） weeks in the control group，and there was no significant difference between 2 groups（P=0.574）. At the time of discharge，the Breastfeeding Behavior Scale score was[12.0（10.0，13.0）] in the experimental group and[6.0（1.5，8.5）] in the control group. The difference between 2 groups was statistically significant（P<0.001）. During hospitalization，the days of breastfeeding in the experimental group were[47.0（33.8，62.8）] d，while those in the control group were[37.5（19.0，56.3）] d. The difference between 2 groups was statistically significant（P=0.021）. The breastfeeding rate on the day of discharge was 84.7% in the experimental group and 66.2% in the control group，and the difference between 2 groups was statistically significant（P=0.012）. Conclusion The implementation of non-nutritive breast sucking can shorten the time to achieve full oral feeding in very low birth weight preterm infants，promote their breastfeeding behaviour，increase the days of breast feeding with their own mother’s milk during hospital stay，and improve breast feeding rate.

Effect of health education based on information-motivation-behavior model on paternal self-efficacy of support breastfeeding of late prematurity

ZHENG Jiaying, ZHANG Jing, LI Peng, LI Ying

2023, 58(12):  1427-1434.  DOI: 10.3761/j.issn.0254-1769.2023.12.003

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Objective To explore the effect of information-motivation-behavioral（IMB） model on self-efficacy of fathers of late preterm infants in support of breastfeeding. Methods A total of 86 fathers of late preterm infants who were transferred to the neonatology department immediately after delivery in a tertiary A hospital in Taiyuan City from October 2021 to February 2022 were conveniently selected as the research objects. According to the length of hospitalization，43 fathers from December 2021 to February 2022 were selected as the experimental group. 43 fathers from October to November 2021 were used as a control group. The experimental group received IMB model based on routine nursing，and the control group received routine nursing. The scores of self-efficacy of paternal breastfeeding support and exclusive breastfeeding rate were compared between the 2 groups at different time points. The scores of breastfeeding knowledge，behavior and attitude of the 2 groups were compared，as well as the incidence of insufficient lactation. Results The self-efficacy scores of fathers supporting breastfeeding in the experimental group were higher than those in the control group at discharge and 1 month after discharge，and the difference was statistically significant（P<0.001）. With the extension of time，the self-efficacy scores of each group increased gradually. The scores of fathers’ breastfeeding knowledge and behavior at discharge in the experimental group were higher than those in the control group；the incidence of maternal insufficient lactation in the experimental group was lower than that in the control group；the exclusive breastfeeding rate of preterm infants at 40 weeks，3 months and 6 months of adjusted gestational age was higher than that in the control group；the difference was statistically significant（P<0.05）. Conclusion Nursing intervention based on IMB model can effectively improve the self-efficacy and scores of breastfeeding knowledge，behavior and attitude of fathers of late preterm infants to support breastfeeding，reduce the pressure of fathers to take care of mothers and preterm infants，so as to increase the rate of exclusive breastfeeding of premature infants.

Application of an intervention based on co-parenting theory on hospital-home transitional breastfeeding of NICU preterm infants

HANG Lin, ZHANG Jieping, XIANG Danyu, CHEN Yuying

2023, 58(12):  1435-1441.  DOI: 10.3761/j.issn.0254-1769.2023.12.004

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Objective To explore effect of an intervention program based on co-parenting theory. Methods By judgment sampling method，90 parents of premature infants and their parents admitted to neonatal intensive care unit in a tertiary A hospital in Yangzhou，Jiangsu Province from June to December 2021 were selected as the research subjects. They were divided into a control group and an experimental group with 45 pairs in each group. In addition to routine nursing，the experimental group received co-parenting breastfeeding support based on co-parenting theory. The control group only adopted routine nursing. The 2 groups of premature infants were measured by mothers’ perception of co-parenting，family support for breastfeeding，breastfeeding attitudes，breastfeeding rate and duration of exclusive breastfeeding before discharge，2 weeks，4 weeks and 6 weeks after discharge. Results 12 pairs of preterm infants dropped，and 38 pairs were included in the experimental group and 40 pairs in the control group at last. Scores of mothers’ perception of co-parenting，family support for breastfeeding，breastfeeding attitudes in the experimental group were higher than those in the control group 2 weeks，4 weeks and 6 weeks after discharge，and the difference was statistically significant（P<0.05）. The exclusive breastfeeding rate of the experimental group was higher than that of the control group 4 weeks and 6 weeks after discharge（P<0.05）. The duration of exclusive breastfeeding after discharge in the experimental group was higher than that in the control group，and the difference was statistically significant（P=0.003）. Conclusion The breastfeeding support program based on co-parenting theory implemented in NICU hospital-family transitional period of preterm infants can improve mothers’ perceptions of co-parenting，perceptions of breastfeeding family support and attitudes towards breastfeeding，increase exclusive breastfeeding rates and extend the duration of exclusive breastfeeding.

Effects of mindfulness intervention combined with information support on the mental health status of fathers of premature infants

NING Shian, JIANG Mei, LIU Xuehua, LI Zhen, CHEN Jingli

2023, 58(12):  1442-1448.  DOI: 10.3761/j.issn.0254-1769.2023.12.005

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Objective To explore the effects of mindfulness intervention combined with information support on the mental health status of fathers of premature infants. Methods This study was a non-synchronous controlled trial. Convenience sampling method was used to select 70 fathers of preterm infants admitted to NICU of a tertiary A hospital in Beijing from July to October 2021 as research subjects. Fathers of preterm infants enrolled from July to August 2021 were selected as an experimental group，and those enrolled from September to October 2021 as a control group. During the hospitalization，the experimental group received mindfulness intervention and information support，and the control group received routine health education. The Edinburgh Postpartum Depression Scale，Self-rating Anxiety Scale，Perceived Stress Scale and Five-factor Mindfulness Scale were used to evaluate the incidence of depression，anxiety，stress and mindfulness of fathers before，at the end of intervention and a month after inter-vention. Results A total of 9 cases were dropped，including 4 cases in the experimental group and 5 cases in the control group. The results of generalized estimation equation or repeated measure analysis of variance showed that the incidence rate of depression，anxiety level，stress level and mindfulness level of the 2 groups at different time points were statistically significant （P<0.05）. Simple effect analysis showed that there were no significant differences in depression incidence，anxiety level，stress level and mindfulness level between the 2 groups before intervention （P>0.05）. At the end of intervention，the incidence of depression and stress level of experimental group were lower than that of the control group，and the level of mindfulness was higher than that of the control group，and the difference was statistically significant（P<0.05）. A month after intervention，the incidence of depression，anxiety level and stress level of experimental group were lower than that of the control group，while the level of mindfulness was higher than that of the control group，with statistical significance（P<0.05）. Conclusion The implementation of mindfulness intervention combined with information support can reduce the incidence of depression，improve the symptoms of anxiety and stress，and increase the level of mindfulness in fathers of premature infants，which has a positive impact on the mental health status of fathers of premature infants.

Summary of best evidence of sleep protection for premature infants in NICU

NIE Ling, SUN Xiaoling, JIANG Ling, MA Yuelan, LIU Yongshu, SHEN Ting, YU Ting, CAI Huiwen

2023, 58(12):  1449-1455.  DOI: 10.3761/j.issn.0254-1769.2023.12.006

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Objective To retrieve，evaluate and integrate relevant evidence of the sleep protection for premature infants in NICU to provide clinical references. Methods According to the “6S” model of evidence resources，we searched computer decision support systems，guideline websites，association websites and databases for all evidence of sleep protection for preterm infants in NICU，including relevant clinical decision support，clinical practice guidelines，systematic reviews，technical reports，evidence summaries，expert consensuses，and the search time limit is from January 2012 to July 2022. Results A total of 12 pieces of the literature were included，including 1 clinical decision support，2 guidelines，1 technical report，1 evidence summary，6 systematic reviews，1 expert consensus. After sorted out，24 pieces of best evidence were summarized from 6 aspects，including sleep assessment，process optimization，environmental support，postural support，sensory stimulation and training education. Conclusion This study summarized the current best evidence of sleep protection for premature infants in NICU. Medical staff should consider the clinical situation when applying the evidence，formulate and implement scientific sleep protection programs to improve the nursing quality for premature infants.

Research progress on the effect of sensory stimulation on neural development of premature infants

HUANG Ting, ZHENG Jianhuang, LIN Chunyan

2023, 58(12):  1456-1461.  DOI: 10.3761/j.issn.0254-1769.2023.12.007

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The nervous system of premature infants is immature. Sensory stimulation is one of the ways to support the early development of premature infants including visual，tactile，olfactory，auditory and vestibular stimulation. This article summarizes the characteristics of neural development of premature infants，the factors affecting neural development of premature infants，the methods of sensory stimulation and the effects on neural development of premature infants，and puts forward practical suggestions，aiming to provide references for medical staff to carry out sensory stimulation and improve neural development of premature infants.

Specialist Practice and Research

Effect of early bed resistance exercise on postoperative rehabilitation in patients with gastrointestinal tumors

GU Yifan, WU Qian, WANG Xiayun, ZHOU Jie

2023, 58(12):  1462-1468.  DOI: 10.3761/j.issn.0254-1769.2023.12.008

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Objective To investigate the effect of early bed resistance exercise on postoperative rehabilitation in patients with gastrointestinal tumors. Methods By random sampling of experimental study design，150 patients who received gastrointestinal tumor surgery were selected from a tertiary A hospital in Shanghai during January to December 2021. The random number table method was employed to divide them into a test group with 74 cases and a control group with 76 cases. The test group received the postoperative early bed resistance exercise. The control group was given the early postoperative ambulation protocol. The differences in pain score，dominant hand grip strength，time to recovery of digestive tract function，catheter retention time，postoperative hospitalization time after the intervention were compared，and the safety of resistance exercise was evaluated. Results In the postoperative rehabilitation index of the 2 groups，the increase in dominant hand grip strength after the intervention was greater than that before the intervention（P=0.017）；the first exhaust time in the control group was earlier than that in the test group（P=0.032）；the remaining indicators included postoperative pain scores，catheter indwelling time，hospital days，hospitalization costs in both groups，and the differences were not statistically significant（P>0.05）. The number of patients with heart rate fluctuation after exercise and those with physical exhaustion was less than that of the control group，and all the differences were statistically significant（P<0.05），and no serious personal injury or serious adverse events occurred during the activities. Conclusion Early bed resistance exercise can increase muscle strength after gastrointestinal tumors，reduce heart rate fluctuation and fatigue after early activity and pro-mote postoperative recovery of gastrointestinal tumors.

Design and application of a self-management tool in patients with chronic heart failure

ZHU Haixiang, ZHUANG Yiyu, HAN Xiaoxue, YANG Fan, WU Yuan, XU Qijin

2023, 58(12):  1469-1475.  DOI: 10.3761/j.issn.0254-1769.2023.12.009

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Objective To develop and explore the application effect of the self-management decision wheel in patients with chronic heart failure（CHF）. Methods Based on literature review and patient interviews，a self-management decision wheel for CHF patients at all levels of knowledge was developed. Patients with CHF who were admitted to a tertiary A hospital in Zhejiang province from July 2021 to June 2022 were selected as the research subjects，among which 80 patients from January to June 2022 were taken as the intervention group，and 85 patients from July to December 2021 were selected as the control group. The intervention group used the decision wheel for self-management on the basis of the traditional management，and the control group was managed according to the traditional method. Self-care ability，carbon dioxide ventilation equivalent slope（VE/VCO₂ slope），major adverse cardiac events，and re-hospitalization rates were compared at 1th and 3th after intervention between the 2 groups. Results A total of 3 cases were dropped，and 78 cases in the final experimental group and 84 cases in the control group. The results of repeated measurement analysis of variance showed that at different time points the self-care ability， time effect of VE/VCO₂ slope，inter group effect，and interaction effect of the two groups were statistically significant（P<0.05），and the experimental group was superior to the control group. The incidence of cardiovascular adverse events and the re-hospitalization rate in the experimental group were lower than those in the control group at 3 months（P<0.001）. Conclusion The self-management decision tool constructed in this study is more scientific and practical，and it can effectively improve the self-care ability of patients with CHF，improve the patient prognosis，and reduce the rate of re-hospitalization.

Construction of a medication management program of elderly patients with polypharmacy after percutaneous coronary intervention

CHENG Ting, TU Hui, XIONG Xiaoyun, GUO Ting, ZHANG Weifang, PENG Ying

2023, 58(12):  1476-1482.  DOI: 10.3761/j.issn.0254-1769.2023.12.010

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Objective To construct a program for elderly patients with polypharmacy after percutaneous coronary intervention，and to ensure the safety of patients’ polypharmacy throughout the process. Methods Based on evidence-based methods to retrieve domestic and foreign literature，and guided by the 4R crisis management theory，the first draft of the medication management program was formulated by the research group，and the final program was revised and established according to the experts’ opinions by Delphi method from January to July 2022. Results 15 experts participated in 2 rounds of consultations，and the effective recovery rate of questionnaire was 100%. The expert authority scores of 2 rounds were 0.90，and the importance and operability of the second round of expert opinions Kendall harmony were 0.216 and 0.289. The final program contained 4 primary indicators，7 secondary indicators and 23 tertiary indicators. Conclusion The constructed medication management program for elderly patients with polypharmacy after percutaneous coronary intervention is scientific and comprehensive，which can provide a theoretical basis and practical direction for the management of patients.

A qualitative study on the psychological experience of HIV/AIDS patients for the disclosing of HIV to non-AIDS professionals

HUANG Ying, WANG Huafen, SHAO Lifang, LOU Fangyuan, SUN Danping, ZHAN Xiaoqin

2023, 58(12):  1483-1488.  DOI: 10.3761/j.issn.0254-1769.2023.12.011

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Objective To understand the psychological experience of HIV/AIDS patients for the disclosing of HIV to non-AIDS professionals，so as to provide references for promoting patients’ willingness to disclose HIV，and effectiveness and safety of diagnosis and treatment by both medical staff and patients. Methods From February 2021 to March 2022，by using purposive sampling method，semi-structured in-depth interviews were conducted with 12 HIV/AIDS patients in a tertiary hospital in Zhejiang，China. The data was transcribed，analyzed，and refined by the Colaizzi’s method. Results The experience of HIV/AIDS patients to disclose HIV to non-AIDS professionals can be summarized into 3 themes. HIV/AIDS patients worried that the HIV disclosure would make them suffer from double stigma by medical staff，and there was self-stigma existing in the patient’s subconsciousness. They also feared that the HIV disclosure would damage the interests of individual to receive medical treatment. They hoped that the HIV disclosure reflect patients’ personal integrity. Conclusion HIV/AIDS patients generally have stigma when disclosing HIV to other specialized medical personnel. Cautious and concealed disclosure can avert discrimination or insult caused by improper disclosure. It is recommended to implement integrated palliative care intervention to reduce the stigmatization experience of patients，strengthen the training of HIV stigma awareness and coping skills，and call on the relevant functional departments of government and hospital to strengthen law enforcement supervision，guarantee the rights of doctors and patients，and create a comfortable medical environment for patients，so as to reduce the disclosure burden of HIV/AIDS patients and enhance the willingness of patients to disclose HIV.

Evidence Synthesis Research

Summary of best evidence for the management of insulin intravenous infusion in ICU patients

XU Huajiao, WU Lingling, ZHANG Qi

2023, 58(12):  1489-1495.  DOI: 10.3761/j.issn.0254-1769.2023.12.012

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Objective To search，evaluate，and synthesize the relevant evidence for the management of insulin intravenous infusion in ICU patients and summarize the best evidence. Methods We searched Guidelines International Network（GIN），National Institute for Health and Care Excellence（NICE），National Guideline Clearinghouse（NGC），Registered Nurse Association of Ontario（RNAO），Scottish Intercollegiate Guidelines Network（SIGN），BMJ Best Practice，JBI，Cochrane Library，PubMed，Embase，CINAHL，UpToDate，SinoMed，CNKI，Wangfang Database and clinical guidelines APP to collect clinical decisions，guidelines，evidence summaries，expert consensuses related to insulin intravenous infusion management of adult patients in ICU. Through literature quality evaluation，the evidence was extracted from the literature that met the quality standards. The search period is from the inception to August 31，2022. Literature screening and quality evaluation were conducted independently by 2 researchers，and the evidence was extracted and summarized according to the subject. Results A total of 8 articles were selected，including 2 guidelines，1 systematic review，4 evidence summaries and 1 expert consensus. Finally，19 pieces of best evidence were formed in 4 aspects，including blood glucose control target，blood glucose monitoring，insulin infusion and hypoglycemia disposal. Conclusion The study summarizes the best evidence for blood glucose monitoring，insulin infusion，and hypoglycemia management during intravenous insulin infusion in critically ill patients，which provides a basis for clinical nursing practice. Nursing staff can reasonably select the best evidence for localization application according to clinical situation to promote the management of ICU patients with intravenous insulin infusion.

A systematic review of risk prediction models for liver failure after hepatic resection

WANG Yina, XU Yihong, LIU Xiaolin, WU Wenjin, YAN Mengya, WANG Meijuan, GAO Yang, YANG Dan, PAN Hongying, XU Juling

2023, 58(12):  1496-1503.  DOI: 10.3761/j.issn.0254-1769.2023.12.013

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Objective We systematically retrieved and evaluated risk prediction models for liver failure after hepatic resection，so as to provide a reference for constructing higher quality risk prediction models for liver failure after hepatic resection. Methods CNKI，Wanfang，sinomed，PubMed，web of science，Embase，Cochrane Library，CINAHL databases were searched for studies on the construction of risk prediction models for liver failure after hepatectomy. The literature was independently screened by 2 researchers and the information was extracted，and the risk of bias and applicability of the included literature was evaluated according to the Predictive Modelling Study Data Extraction Form and the Risk of Bias Assessment Tool. Results A total of 18 studies on the construction of risk prediction models for liver failure after hepatectomy were included，involving 21 models with an area under the subject working characteristic curve of 0.690~0.883. The independent predictors that were repeatedly reported by the models were total bilirubin，residual liver volume，platelet count，prothrombin time，albumin concentration，liver stiffness，and extent of liver resection. Some predictors are controversial，including male，laparoscopic surgery，liver-muscle ratio. The risk of bias in all studies is high，mainly due to insufficient sample size，poor treatment of continuous variables，lack of model performance assessment and over-fitting of models. Conclusion The existing models for predicting the risk of liver failure after hepatectomy are still in the development stage，and there are certain commonalities and controversies in the predictors，which can be further improved by conducting model validation studies or developing localized prediction models with good performance in the future.

The experience of fertility preservation decision-making in child-bearing period women with cancer：a qualitative Meta-synthesis

ZHANG Wenyu, ZHANG Jingjing, GUO Chang, ZHANG Xu, WU Mingjin, YAN Jinsong

2023, 58(12):  1504-1511.  DOI: 10.3761/j.issn.0254-1769.2023.12.014

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Objective To systematically integrate the qualitative research on the experience of fertility preservation decision-making in child-bearing period women with cancer，in order to provide the references for providing decision-making aids and increasing decision-making satisfaction. Methods Databases of CNKI，VIP，Wanfang，PubMed，Web of Science，Cochrane Library，Embaseand Sinomed were retrieved on qualitative research about the experience of fertility preservation decision-making in child-bearing period women with cancer. The retrieval period is from the establishment of the databases to June 2022. Results A total of 15 studies were included，and 58 available research results were extracted，which were then classified into 14 new categories，and finally 5 integrated re-sults were formed：difficulties on decision-making process，accompanied experience of negative emotion；multiple wor-ries and concerns about their own health and their children；dilemma of decision-making；demand of support for decision-making；positive coping patterns. Conclusion Child-bearing period women with cancer usually lacked sup-port for decision making and harbored much stress on themselves，which leads to much psychological burden，when they faced decision-making on fertility preservation. Therefore，medical staff should understand the decision-making needs of patients，and should provide aid on scientific decision making，which can help patients release decision-mak-ing pressure and reduce decision-making conflicts.

Review

Research progress on discharge readiness of breast cancer patients after surgery

YE Jian, GENG Xiaoli, WANG Xinran

2023, 58(12):  1512-1516.  DOI: 10.3761/j.issn.0254-1769.2023.12.015

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The assessment of discharge readiness for patients with breast cancer after surgery can help nursing staff understand their nursing needs，in order to provide targeted discharge guidance，reduce the hospitalization rate of patients，and improve the quality of life after discharge. In this paper，the definition and clinical value of postoperative discharge readiness of breast cancer patients were described，and a comprehensive analysis was made from the aspects of age，education level，medical expenses，patients’ own state，disease factors，discharge guidance and social support，and the measures to improve discharge readiness were summarized and analyzed from the different perspectives of preoperative，postoperative，in-hospital and out-of-hospital. In summary，it is proposed to develop more targeted assessment scales for patients’ own needs，so as to improve patients’ discharge readiness，improve patients’ postoperative quality of life，and provide references for clinical intervention research.

Research progress of wound care in patients with epidermolysis bullosa acquisita

ZHOU Ziyi, WANG Feixia, PAN Zhe, LI Weizhen, ZHONG Zifeng

2023, 58(12):  1517-1522.  DOI: 10.3761/j.issn.0254-1769.2023.12.016

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Epidermolysis bullosa acquisita is a rare autoimmune blistering disease with bullae formation on the skin and erosions on the mucous membranes. Integrated wound management promotes wound healing，reduces patient discomfort，and improves patient quality of life through medication care，wound care，injury prevention，nutritional support，and comorbidity care.This paper reviewed the staging of epidermolysis bullosa acquisita，wound assessment tools，factors affecting wound healing，and integrated wound management methods，with the aim of providing a reference for improving related research and improving the quality of nursing practice in China.

Research progress and nursing enlightenment on family resilience of children with chronic diseases

SUN Xiangyu, QIAN Jialu, WANG Man, SUN Yaping, YU Xiaoyan

2023, 58(12):  1523-1528.  DOI: 10.3761/j.issn.0254-1769.2023.12.017

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Chronic diseases in children often place a heavy burden on their families. A high level of family resilience can help the family develop the potential positive forces，improve the caring ability of family members and family cohesion，enhance the family happiness，and improve the clinical outcome of children. In this paper，the origin，concept and theoretical model of family resilience were summarized，and the research progress of family resilience assessment tools，influencing factors and intervention programs for children with chronic diseases were reviewed，in order to provide references for medical staff to carry out relevant research and formulate intervention programs.

Nursing Instruments Innovation

Development and application of a novel retractor for transaxillary endoscopic thyroid surgery

WANG Ming-ling, CHEN Zhilan, CAO Xinying, WANG Kai, CHEN Baoyun, JIA Gaolei

2023, 58(12):  1529-1532.  DOI: 10.3761/j.issn.0254-1769.2023.12.018

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Objective To develop a novel retractor for transaxillary endoscopic thyroid surgery and to explore its clinical application effect. Methods A retractor device for transaxillary endoscopic thyroid surgery was designed and developed，and we performed a retrospective study with random sampling design. A total of 80 thyroid cancer patients undergoing transaxillary endoscopic unilateral thyroidectomy in Xuzhou Central Hospital from January 2020 to May 2022 were selected as the research subjects. According to the type of the retractor used to expose the surgical field during surgery，the patients were divided into a control group and a test group，with 40 patients in each group. The patients in the control group underwent surgery with conventional retractor，while patients in the test group underwent surgery with the novel retractor device. The clinical indicators，incidence of recurrent laryngeal nerve injury and cosmetic score were recorded and compared between the 2 groups. Results The surgery time and recurrent laryngeal nerve exposure time were significant shorter in the test group（t=-2.647，-12.554，P<0.05）. Besides，the occurrence of recurrent laryngeal nerve injury in the test group were significant less than that in the control group（χ²=4.507，P<0.05）. Furthermore，the cosmetic score at 1-month post-surgery in the test group was higher than that in the control group，with statistical significance（t=-8.635，P<0.001）. Conclusion The full exposure of the new endoscopic thyroid retractor can shorten the operation time and reduce the chance of recurrent laryngeal nerve injury. In addition，the racquet design of the retractor can narrow the surgical incision and increase the cosmetic effect.

Design and application of the intelligent body pressure measuring mattress

ZHOU Yan, GUO Fangda, LIN Jingjing, XU Hong, XU Huina, LI Li, DU Quner

2023, 58(12):  1533-1536.  DOI: 10.3761/j.issn.0254-1769.2023.12.019

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Objective To design and produce an intelligent body pressure measuring mattress and to test its effectiveness in bedridden patients. Methods The body pressure measuring mattress consists of latex mattress，film pressure sensor，measuring machine and display host. From January 2022 to September 2022，110 bedridden patients in a tertiary care hospital were selected. The random number table method was used to randomly divide them into an experimental group with 55 cases and a control group with 55 cases according to the time of admission. The experimental group received the self-designed intelligent body pressure measuring mattress that consists of latex mattress，film pressure sensor，measuring machine and display host，whereas the control group used Shanghai Sanma brand inflatable mattress. The degree of comfort within 7 days，the average number of patients turn over times in 24 hours，and the incidence of pressure injury were compared. Results The average comfort score in the experimental group was（8.92±0.66），which was significantly high（P<0.01） than （6.03±1.76） in the control group，and the mean number of 24 h turns in the experimental group was（7.48±1.41），which was significantly less（P<0.01） than （11.98±0.07） in the control group. The incidence of stress injury in the experimental group was 1.9%，which was significantly lower（P<0.05） compared to 9.1% measured in the control group. Conclusion The intelligent body pressure measuring mattress can conduct real-time posture monitoring of bedridden patients，providing scientific turning basis for nursing staff，while improving the comfort of bedridden patients，and reducing the workload of nursing turning over；therefore，decreasing the incidences of pressure injury.