Table of Content

20 September 2023, Volume 58 Issue 18

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Special Planning—Nursing Care in Organ Transplantation

Application of nurse-led discharge preparation in perioperative lung transplant patients

GAO Chunhua, LIN Yan, YU Chao, REN Yayu, CHU Junqing, ZHANG Shuai, DONG Zhenyuan, ZHOU Li

2023, 58(18):  2181-2188.  DOI: 10.3761/j.issn.0254-1769.2023.18.001

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Objective To investigate the effect of specialty nurse-led discharge preparation in the perioperative period of lung transplantation patients. Methods Based on the transition theory，literature analysis and expert meetings，the hospital discharge preparation service plan for lung transplant patients was established. We selected 33 lung transplant patients in a tertiary hospital in Zhejiang Province for this study based on convenience sampling，and they were divided into an experimental group and a control group by random number method. The experimental group received the discharge preparation service program led by specialty nurses，and the control group received routine perioperative management of lung transplantation. Data from admission to 3 months after discharge were collected. Between the 2 groups，they were compared on readiness for hospital discharge，reintubation，readmission，and part 2 of Partners at Care Transitions Measure（PACT-M2）. Results A statistically significant difference was found in the scores for readiness for hospital discharge，reintubation rate，and Chinese version PACT-M2（P<0.05）. There was no significant difference in the number of readmissions 1 month and 3 months after discharge between the 2 groups（P>0.05）. Conclusion Specialized nurse-led discharge preparation services for lung transplant patients can improve their readiness for discharge and enhance the quality of self-care at home.

A qualitative study of the psychological experience of patients waiting for a second kidney transplantation

WANG Yuxia, XU Yihong, TANG Xinyi, CHEN Xiaofei, PAN Hongying

2023, 58(18):  2189-2194.  DOI: 10.3761/j.issn.0254-1769.2023.18.002

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Objective To describe the real psychological experience of patients waiting for a second kidney transplantation，so as to provide references for clinical medical staff to formulate targeted intervention strategies. Methods The descriptive qualitative research method was adopted. 15 patients waiting for a second kidney transplant were recruited from a hospital in Zhejiang Province by purposive sampling. Semi-structured interviews were performed to collect data，and qualitative content analysis was conducted to analyze the data. Results 4 themes were extracted，including the strong desire for a second kidney transplant，feeling guilty and worried for waiting a second kidney transplant，feeling deeply grateful for the medical staff’s support and being confidence for a successful second kidney transplant. Conclusion Clinical medical staff should attach importance to the psychological experiences of patients waiting for a second kidney transplant and construct patient-centered psychological intervention schemes by cultivating patients’ positive emotions，enhancing support level to improve their quality of life.

Construction of a preoperative prehabilitation program for liver transplant recipients

SUN Huihui, ZHANG Bingliang, LOU Lianyu, SUN Ju, XIN Tingting, MENG Fanjuan, XU Qingguo

2023, 58(18):  2195-2202.  DOI: 10.3761/j.issn.0254-1769.2023.18.003

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Objective To construct a preoperative prehabilitation program for liver transplant recipients，so as to provide practical guidance for the promotion of prehabilitation in liver transplant recipients. Methods From June to September 2022，the first draft of preoperative prehabilitation program for liver transplant recipients was constructed by literature review and panel meeting. From September to October 2022，22 liver transplantation nursing experts and liver transplantation medical experts from Shanghai，Beijing，Taiyuan，Jinan，Qingdao，Tianjin，Fuzhou and Hangzhou were interviewed by Delphi method for 2 rounds to revise the preoperative prehabilitation program for liver transplant recipients，and then Analytic Hierarchy Process was used to calculate the weight of each item. Results The response rates in the 2 rounds of consultations were 100%. Authoritative coefficients in the 2 rounds of expert consultations were 0.840 and 0.880. The Kendall’W in the 2 rounds of expert consultations were 0.132 and 0.219，and the difference was statistically significant（P<0.001）. The coefficient of variation of items in the second round was 0~0.13. The final preoperative prehabilitation program for liver transplant recipients consisted of 3 first-level items，9 second-level items，and 48 third-level items. Conclusion The preoperative prehabilitation program for liver transplant recipients has reliability and scientificity，which can provide references for prehabilitation in liver transplant recipients.

Nursing care of a patient with diabetic nephropathy undergoing xenogeneic islet transplantation after kidney transplantation

LIU Jingjing, LIU Lifang, XIE Jianfei, LIU Jia, WU Xiaoxia

2023, 58(18):  2203-2206.  DOI: 10.3761/j.issn.0254-1769.2023.18.004

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To summarize the nursing experience of a patient with diabetic nephropathy who underwent xenogeneic islet transplantation after kidney transplantation. The key points of nursing mainly include：establishing a multidisciplinary diagnosis and treatment team before surgery，improving relevant examinations and preparations，and ensuring the safety of surgery；postoperative dynamic anticoagulant therapy and bleeding observation and nursing to prevent rejection and infection. The goal-oriented blood glucose management was implemented in the whole process，and systematic health education and personalized psychological nursing were carried out.After careful specialized nursing，the patient recovered on the 26th day of hospitalization and was discharged from hospital. Up to now，the patient has completely separated from exogenous insulin treatment.

Evidence summary for compliance management of immunosuppressive agents in adult renal transplant recipients

SHEN Mingyan

2023, 58(18):  2207-2215.  DOI: 10.3761/j.issn.0254-1769.2023.18.005

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Objective To search，evaluate and summarize the best evidence on the management of immunosuppressive drug adherence in adult renal transplant recipients，so as to provide references to clinical decision making. Methods BMJ Best Practice，UpToDate，British Nephrology Association，Organization for Improving the Prognosis of Global Nephropathy，American Association of Intensive Care Nurses，Medical Pulse，Mays Medicine，Chinese Medical Association Organ Transplantation Credit Association and other websites，Joanna Briggs Institute of Australia evidence-based health care center database，Cochrane Library，Embase，EBSCO，Web of Science，PubMed，China Biomedical Database，CNKI，Wanfang were searched by the computer. Guidelines，evidence summaries，best practices，expert consensuses，systematic reviews on the assessment of adherence to immunosuppressive drugs and management of interventions in renal transplant recipients were retrieved. The time for the search was from database creation to July 31，2022. Literature quality evaluation and data extraction was performed by 2 investigators. Results A total of 13 articles were involved，including 2 guidelines，1 evidence summary，4 expert consensuses，3 systematic reviews and 3 meta-analyses. 38 pieces of best evidence were generated in 3 areas，namely healthcare worker training，adherence assessment，and adherence intervention. Conclusion The results of this study could assist nurses to manage adherence to immunosuppressant medication in renal transplant recipients and provide an evidence-based basis for improving the quality of transplant care.

Research progress of return-to-work assessment tools for organ transplant patients

RAO Yuxin, LU Fangyan, WEI Xuefu

2023, 58(18):  2216-2222.  DOI: 10.3761/j.issn.0254-1769.2023.18.006

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The evaluation of the return-to-work status of organ transplant patients can timely understand the return-to-work ability，psychosocial adjustment ability and readiness level of the patients，help medical staff to formulate and implement a vocational rehabilitation program for the patients，increase the rate of return-to-work，and develop the physique and mentality. This paper reviews the major contents，characteristics，advantages and limitations of the assessment tools for organ transplant patients，and compares the basic conditions and clinical applications of the scales. It aims to provide references for clinical nurses to choose appropriate assessment tools. Meanwhile，it provides some theoretical bases for clinical nurses to create a program of vocational rehabilitation for organ transplant patients.

Specialist Practice and Research

Development and validation of risk prediction model for post-traumatic stress disorder in ICU transferred patients

CHENG Zhiqiang, ZHANG Baozhen, XIA Jiaoyun, LI Xiaxin, YAN Xianfeng, ZHOU Yujue, YAN Chengkun, FU Huanxu

2023, 58(18):  2223-2229.  DOI: 10.3761/j.issn.0254-1769.2023.18.007

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Objective To construct a risk prediction model for post-traumatic stress disorder（PTSD） in ICU transferred patients and to conduct internal and external validation. Methods Convenient sampling method was used to select 514 ICU patients from 2 tertiary hospitals in Jiangxi Province from October 2022 to May 2023 as the survey subjects. Univariate factor and multivariate logistic regression analysis were employed to determine risk factors and construct predictive models. The discrimination and calibration of the prediction model were evaluated through the area under the receiver operating characteristic（ROC） curve and the Hosmer-Leme-show test，and the clinical usefulness of the prediction model were evaluated through the Decision Curve Analysis. Results The predictive factors for PTSD in ICU transferred patients were gender，history of mental illness，sedatives，mechanical ventilation，ICU hospitalization time，and delusional memory. The constructed model was as follows：Logit P=Gender × 1.366+History of Psychological Disorders × 1.221+sedatives × 1.018+mechanical ventilation × 1.378+ICU hospitalization time × 0.546+delusional memory × 0.929-6.793. The area under the ROC curve was 0.898（95% CI 0.865~0.932），with sensitivity of 82.9%，specificity of 83.2%，maximum Youden index of 0.661，critical value of 0.393，and critical score of 60 points. The Hosmer-Leme-show test results display χ² value=11.312，P=0.185. The internal and external validation showed that the areas under the ROC curve were 0.855 and 0.867，respectively. The calibration curve showed that the observed curve fitted well with the predicted curve，and the model calibration was good. The DCA shows that the model has good clinical effectiveness. Conclusion The prediction model constructed in this study has good predictive performance and can provide theoretical basis for clinical medical staff to identify high-risk populations of PTSD in the early stage.

Study on status and influencing factors of chemotherapy related symptom cluster among lung cancer patients

YE Yanxin, QIN Lan, LUO Jiahui, ZENG Kai, LIU Suting, YU Ya, LIANG Jingwen, ZHANG Lili

2023, 58(18):  2230-2237.  DOI: 10.3761/j.issn.0254-1769.2023.18.008

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Objective To explore the current status and latent classes of the chemotherapy related symptom cluster of lung cancer patients，and to analyze the differences in 4 aspects of society，disease，physiology and behavior among different classes. Methods Through convenience sampling，lung cancer patients undergoing chemotherapy were recruited from a tertiary hospital in Guangzhou from October 2020 to November 2021. Basic Information Questionnaire，International Physical Activity Questionnaire-Short Form，Exercise Self-Efficacy Scale，Chinese Version of Brief Fatigue Inventory，Athens Insomnia Scale，Chinese Version of Brief Pain Inventory and Patient Health Questionnaire-9 were used for investigation. Exploratory latent class analysis（LCA） was performed by Mplus 8.3. SPSS 25.0 was applied for univariate analysis and logistic regression to identify the factors influencing the latent classes. Results 294 effective questionnaires were collected，and the effective recovery rate was 91.88%. There were 84.4% of lung cancer patients with chemotherapy related symptom cluster，which could be divided into a “high symptom group”（53.6%） and a “low symptom group”（46.4%） by latent class analysis. Logistic regression analysis showed that work status，BMI，physical activity，exercise self-efficacy，time of diagnosis and albumin were the influencing factors of latent classes of symptom cluster in lung cancer patients undergoing chemotherapy. Conclusion The chemotherapy related symptom cluster of lung cancer patients are heterogeneous and can be divided into 2 latent classes. Patients who are unemployed，have the BMI<18.5，and have low physical activity，exercise self-efficacy，and albumin levels are more likely to be in the “high symptom group”.

A qualitative study on the experience of caregiving and coping among parents of adolescents with non-suicidal self-injury

XIE Meixiang, LI Huiping, SUN Chunyan, WANG Li, SHAO Hua, LIU Xiaoyu, CAI Minyi, CUI Hong

2023, 58(18):  2238-2244.  DOI: 10.3761/j.issn.0254-1769.2023.18.009

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Objective To describe and analyze the experience of parents of non-suicidal self-injury（NSSI） adolescents in caregiving and coping，and to provide a basis for developing family support programs. Methods It was a descriptive phenomenological study. Purposive sampling was used to select 19 parents of NSSI adolescents who sought medical treatment at a tertiary hospital in Guangzhou from August to October 2022. Face-to-face semi-structured interviews were conducted，and the Colaizzi 7-step analysis method was used to summarize and refine the themes. Results 4 core themes were identified：parents of NSSI adolescents experienced various negative emotions in caregiving，including helplessness，confusion，panic，self-blame，anger，and grief；parents created a positive family environment through acquiring relevant knowledge，improving communication，and increasing companion time；some parents lacked effective coping strategies and tended to use violent communication，strict prohibitions，or indulgence as a single strategy；external support was insufficient，and parents hoped to receive more help from schools，hospitals，and communities. Conclusion Parents of NSSI adolescents experienced complex negative emotions，and attempted to create a positive family environment to reduce their adolescent’s NSSI behavior. However，they still lacked effective coping strategies and hoped to receive more external support. Healthcare professionals should provide emotional support and positive guidance to parents，explore effective family intervention strategies，and collaborate with families，schools，and communities to promote the physical and mental health of adolescents.

Study on the behavioral characteristics and influencing factors of weight management in pregnant women

ZHANG Yan, ZHANG Guangyi, MA Pin, MI Guangli

2023, 58(18):  2245-2251.  DOI: 10.3761/j.issn.0254-1769.2023.18.010

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Objective To explore the potential categories and influencing factors of weight management behavior of pregnant women，and to provide references for the development of prenatal health education. Methods A total of 430 pregnant women who attended obstetric clinics in 5 hospitals in Ningxia Hui Autonomous Region from December 2021 to February 2022 were selected as survey subjects by convenience sampling method. The survey was conducted by general data questionnaire and weight management behavior part of the weight management knowledge and practice questionnaire for pregnant women. The potential categories of behavioral characteristics of weight management during pregnancy were analyzed，and the influencing factors of the potential categories were identified by univariate analysis and multivariate logistic regression analysis. Results The behavioral characteristics of weight management during pregnancy were divided into 4 potential categories，including a higher weight management behavior group with 92 cases（21.85%），a moderate weight management behavior and rational exercise nutrition group with 89 cases（21.14%），a moderate weight management behavior and unreasonable exercise nutrition group with 200 cases（47.51%），and a lower weight management behavior group with 40 cases（9.50%）. Multiple logistic regression analysis showed that educational level，gestational number，hospital type，planned pregnancy，marital status，diet care-giver during pregnancy，and participation in nutrition and weight management courses during pregnancy were the factors influencing the behavioral characteristics of weight management of pregnant women（P< 0.05）. Conclusion The weight management behavior of pregnant women has obvious classification characteristics. Medical staff should carry out targeted prenatal health education according to the pregnant women with different weight management behavior characteristics，improve their weight self-management level，and promote maternal and child health.

Case Study

Perioperative nursing care of a pediatric patient with laryngeal cleft complicated with laryngomalacia

WANG Huimei, GU Ying, CHEN Chao, SUN Yu, WANG Weiwei

2023, 58(18):  2252-2256.  DOI: 10.3761/j.issn.0254-1769.2023.18.011

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To summarize the perioperative nursing care of a patient with laryngeal cleft complicated with laryngomalacia after endoscopic laryngeal cleft repaired. The key aspects concerning nursing included the impose of importance on nutrition management to improve preoperative nutritional status，the implementation of aspiration risk assessment and prevention strategies to reduce the risk of aspiration pneumonia before surgery， the strengthening of postoperative care to prevent anastomotic rupture，the strengthening of airway management to improve postoperative pulmonary complications，the development of a care plan to improve discharge readiness. Following appropriate and successful perioperative treatment and nursing care，the patient was recovered and discharged from hospital 28 days after operation，and showed good recovery after 1 year of following up.

Nursing cooperation of a case of spinal nerve stimulator implantation in the treatment of lower extremity paralysis surgery

ZHU Yu, YU Yuanmeng, ZHANG Shuai, LIU Yunyang, ZHANG Song, BAI Hongrui, LIU Chunying

2023, 58(18):  2257-2260.  DOI: 10.3761/j.issn.0254-1769.2023.18.012

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To summarize the nursing cooperation experience of a spinal cord injury patient with spinal cord nerve stimulator implantation in the treatment of paralysis of both lower limbs. Rigorous perioperative care was provided for patients；multidisciplinary collaborative diagnostic and treatment teams were established and participated in；a surgical support system was established；close observation and timely feedback on the operation of electrophysiological monitoring was conducted to ensure the accuracy of surgical operations；the safety of surgical posture was assessed using the CORN Intraoperative Acquired Stress Injury Risk Assessment Scale；fine cooperation with patients during the awake period of surgery was to ensure accurate electrode placement；stringent risk management and control of incision infection and sound defense mechanisms were conducted. The patient’s surgery was successful，and a month after the surgery，the electrodes were turned on，and sensation appeared in the hip and left lower limb.

Postoperative care of a patient with Bentall combined with left ventricular assist device

HU Yaling, SONG Jianping, GUO Zhiran, HUANG Jinying, DONG Shuang

2023, 58(18):  2261-2264.  DOI: 10.3761/j.issn.0254-1769.2023.18.013

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To summarize the postoperative nursing practice of a patient with Bentall combined with a left ventricular assist device. Key points of care were as follows. To begin with，we closely monitored the cardiac function of the patient to prevent right heart failure，including timely adjustment of the pump speed of the left ventricular assist device through goal-oriented volume management，intermittent nitric oxide inhalation therapy to maintain appropriate pulmonary artery pressure and avoidance of electrolyte disorders to prevent arrhythmia. Secondly，we monitored coagulation function to prevent bleeding and thrombosis. Then，the postoperative infection should be prevented as early as possible. At the early stage，we implemented individualized rehabilitation training and provided individualized psychological nursing for the patient. The patient recovered well and was transferred to the general ward 13 days after the operation.

Evidence Synthesis Research

Evidence summary of exercise intervention in patients undergoing knee arthroplasty

HUANG Yaruo, LI Yanlin, YANG Qiongjun, HU Rui, GUAN Xueyan, YU Wenfan, TAN Yapeng, TIAN Ying

2023, 58(18):  2265-2272.  DOI: 10.3761/j.issn.0254-1769.2023.18.014

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Objective To search，evaluate and summarize the best evidence of perioperative exercise for patients undergoing knee arthroplasty，and to provide a basis for developing early clinical rehabilitation exercise. Methods The databases of BMJ Best Practice，Up To Date，PubMed，Cochrane Library，Web of Science，Embase，Scopus，Science Direct，JBI EBP Database，SinoMed，CNKI，Wanfang，VIP，Medlive，American College of Sports Medicine，American Academy of Orthopaedic Surgeons，National Guideline Clearing House of the United States，National Institute for Health and Care Excellence of the United Kingdom and other databases were searched for evidence of sports in patients undergoing knee arthroplasty. Literature were searched，including clinical decision-making，guidelines，evidence summaries，systematic reviews and expert consensuses. The retrieval time limit was from January 2012 to November 2022. 2 researchers who had received training of evidence-based knowledge evaluated the quality of the included literature，and extracted and summarized the evidence. Results A total of 15 articles were involved，including 2 clinical decision papers，2 guidelines，7 systematic reviews and 4 expert consensuses. 26 pieces of evidence of the perioperative exercise of patients undergoing knee arthroplasty were summarized from 7 aspects，including exercise benefits，multidisciplinary teams，matters for attention，exercise timing，exercise type，exercise frequency and intensity，discharge and follow-up guidance. Conclusion The best evidence of perioperative exercise of patients with knee arthroplasty summarized in this study is more scientific and comprehensive. In the future clinical application，we should select evidence based on the real clinical situation，and make a safe，scientific and individualized exercise plan for patients to promote their rehabilitation.

Summary of the best evidence for the prevention and management of PICC secondary catheter tip malposition in neonates

SHEN Ting, YU Ting, NIE Ling, YIN Yujing, TAO Yi, MA Yuelan, LIU Yongshu, JIANG Ling

2023, 58(18):  2273-2281.  DOI: 10.3761/j.issn.0254-1769.2023.18.015

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Objective To retrieve，evaluate and summarize the best evidence for the prevention and management of peripherally inserted central catheter（PICC） secondary tip malposition in neonates，so as to provide a basis for clinical practice. Methods We searched UpToDate，BMJ Best Practice，Guidelines International Network，National Guideline Clearinghouse，National Institute for Health and Care Excellence，Scottish Intercollegiate Guidelines Network，Registered Nurses Association of Ontario，Intravenous Nurses Society，Cochrane Library，Joanna Briggs Institute，Embase，PubMed，Web of Science，CINAHL，SinoMed，CNKI，WanFang，VIP. The relevant literature on the prevention and management of PICC secondary catheter tip malposition in neonates were obtained，including clinical decision-making，recommended practice，best practice，guidelines，evidence summaries，systematic reviews，meta-analyses，and expert consensuses. The search time limit was from the establishment of the database to April 2023. There were 2 researchers who independently evaluated the quality of the literature and extracted evidence using unified standards，and the extracted evidence was integrated by the vascular access team of the hospital. Results A total of 12 articles were included，including 4 guidelines，1 clinical decision，2 expert consensuses and 5 Meta-analyses. Finally，35 pieces of best evidence were formed from 7 aspects，including pre-catheterization evaluation，catheter selection，placement site，catheter fixation and dressing change，observation and maintenance after catheterization，treatment of secondary catheter tip malposition，establishment and training of intravenous treatment team. Conclusion This study summarizes the best evidence for the prevention and treatment of PICC secondary catheter tip malposition in neonates. It is recommended that medical staff select evidence based on the actual situation of hospitals and neonates，and formulate relevant nursing measures to reduce the incidence of PICC secondary catheter tip malposition in neonates.

Review

Research progress on fear of progression among parents of children with cancer

MA Li, YANG Xiaozhen, NAN Ruiling, DU Yehui, PEI Juhong, XIE Qi, WANG Xinglei, DOU Xinman

2023, 58(18):  2282-2287.  DOI: 10.3761/j.issn.0254-1769.2023.18.016

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Fear of progression is common in parents of childhood cancer survivors，while fear will not only seriously affect their physical and mental health，but also reduce the social function of the family and the treatment compliance of the children. This paper reviewed the definition，occurrence，evaluation tools，influencing factors and interventions of fear of disease progression in parents of childhood cancer survivors. It is expected to provide references for medical staff to carry out research and targeted interventions in this area.

Research progress of disease communication intervention for spouses with cancer

LIU Zhiwei, ZHANG Zhenxiang, MEI Yongxia, CHEN Suyan, LIN Beilei

2023, 58(18):  2288-2292.  DOI: 10.3761/j.issn.0254-1769.2023.18.017

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There are problems of disease communication between couples with cancer. The spousal disease communication interventions play an important role in improving disease communication ability，intimacy and negative emotions in spouses with cancer. This paper reviewed the current status，influencing factors，interventions and effects of disease communication in couples with cancer. This paper aims to provide a reference for developing an intervention for disease communication in spouses with cancer.

Research progress of the Common-Sense Model of Self-Regulation in the management of chronic diseases

HUANG Yunmeng, LIU Yu, WANG Yangyang, HUANG Mingqian

2023, 58(18):  2293-2298.  DOI: 10.3761/j.issn.0254-1769.2023.18.018

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Understanding the disease cognitions of chronic patients is crucial for self-management of their disease. The common-sense model of self-regulation（CSM） outlines the process by which patients engage in self-regulation to understand and manage their disease，providing a theoretical framework for understanding the relationship between disease perceptions，coping procedures and health outcomes. This article reviews the development and evolution of CSM，its theoretical framework，and the current application in chronic disease management. The objective is to enhance healthcare professionals’ understanding of the model and its potential role in supporting the health management of chronic patients.

Research progress on the application of behavioral economics theory for the health management of chronic diseases

LIU Xian, DONG Mingqi, ZHU Shuting, SHAO Shengwen

2023, 58(18):  2299-2304.  DOI: 10.3761/j.issn.0254-1769.2023.18.019

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Individual behavioral decision making is closely related to disease prevention and prognosis management. Behavioral economics considers the multiple ways in which individuals behave irrationally，reveals decision biases that lead to suboptimal behavior，and leverages the predictability of these decision biases to create intervention opportunities for healthy behaviors. We summarized the theoretical foundations of behavioral economics and its application in the field of chronic disease health management，and further discussed its difficulties and challenges，in order to provide help for clinical nursing practitioners in the early prevention and long-term care intervention of chronic diseases.