Table of Content

10 February 2024, Volume 59 Issue 3

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New Progress and Application of Research Methods

Analysis of design type，data integration and common problems of mixed method research in nursing studies

HU Yan, JING Feng

2024, 59(3):  261-266.  DOI: 10.3761/j.issn.0254-1769.2024.03.001

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The application of mixed method paradigm in nursing research has increased，which enriches the methodological diversity of nursing research，but there are some problems in application，such as mixed logic ambiguity，imprecise research design and weak result integration. This paper mainly analyzed the design type，data integration and common problems of mixed method research in nursing field，so as to promote rigor design and methodology quality of this research paradigm in nursing field.

The key points of quality criteria for expert consensus papers in nursing

WANG Zhiwen, HAN Shuyu

2024, 59(3):  267-270.  DOI: 10.3761/j.issn.0254-1769.2024.03.002

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The number of expert consensus publications has been increasing year by year as an industry guidance document. However，due to the lack of unified reporting guidelines and methodological standards，the current published expert consensuses in nursing exhibit inconsistent writing formats and varying quality. This article combines the quality evaluation points for expert opinions from the Jonna Briggs Institute in Australia，focusing on 6 aspects，covering the authority of the expert team，clarity of viewpoint expression，adequacy of evidence-based foundation，standardization of the consensus-reaching process，taking into account of interests of relevant research populations，and the potential for application in specific clinical settings. These points are introduced as review criteria for expert consensus papers，aiming to provide references for improving the quality and standardization of expert consensus papers in the future.

Writing essentials and common issues in randomized controlled trials on nursing

HU Rong, WANG Chunfeng

2024, 59(3):  271-275.  DOI: 10.3761/j.issn.0254-1769.2024.03.003

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Randomized controlled trial（RCT） is the most rigorous scientific method of evaluating interventions and validating new techniques in nursing. Scientific research papers are not only the carrier of scientific knowledge dissemination，but also an important way of academic thoughts exchange. However，the quality of published randomized controlled studies in nursing research is uneven，and the paper writing are not standard. Based on existing literature review，CONSORT statements，and experience in writing and reviewing papers，the authors expound on the overall structure of RCTs and the essentials of each section，and summarize the common issues，to provide references for researchers to standardize the writing of RCTs in nursing.

Writing and quality evaluation of qualitative research papers in nursing

LIU Jun’e, WANG Ying, SUN Liu

2024, 59(3):  276-280.  DOI: 10.3761/j.issn.0254-1769.2024.03.004

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Qualitative research has made important contributions to nursing practice and theory construction. Based on the authors’ rich experiences in conducting and teaching qualitative studies，this paper proposed some suggestions on the use of qualitative research，writing and quality evaluation of qualitative research papers. It aims to deepen the understanding of nursing researchers to qualitative research，so as to improve the quality of qualitative research in nursing papers.

Basic procedures and issue analysis of nursing systematic reviews

FAN Lei, SONG Jihong, CHEN Shaohua, YANG Xinru, ZHAO Yaman, WU Jieling

2024, 59(3):  281-286.  DOI: 10.3761/j.issn.0254-1769.2024.03.005

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Through comprehensive and systematic collection of existing evidence，systematic review adopts clinical epidemiological methods, strictly evaluates the quality of evidence, qualitatively or quantitatively combines research results, and finally provides a reliable basis for solving a focused clinical problem. The number of systematic reviews has increased rapidly. With references to the Checklist，this review discussed the typical issues with current systematic reviews in nursing，and highlighted the crucial components for reporting systematic reviews at every essential step.

Analysis and recommendations for issues in scale-based research papers in the field of nursing

WANG Kefang, XU Dongjuan, WANG Yaqi

2024, 59(3):  287-291.  DOI: 10.3761/j.jssn.0254-1769.2024.03.006

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Scales are crucial instruments for measuring variables in the field of nursing research. Its development process needs to follow the basic procedures strictly. This paper describes the basic steps involved in nursing scale development，with a focus on ensuring accuracy and reliability at each stage where issues may arise. It also provides a comprehensive analysis of common problems found in current nursing scale development papers and offers suggestions and solutions. The aim is to provide a reference for nursing professionals engaged in scale-related research and to enhance the quality of nursing scale development papers.

Specialist Practice and Research

Evidence-based nursing practice of postoperative delirium management during cardiac surgery under cardiopulmonary bypass

WU Qiansheng, ZENG Ying, WANG Lan, WANG Xiaoxiao, ZHOU Yanrong

2024, 59(3):  292-299.  DOI: 10.3761/j.issn.0254-1769.2024.03.007

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Objective To evaluate effectiveness of evidence-based nursing practice of postoperative delirium management during cardiac surgery under cardiopulmonary bypass. Methods The best evidence was selected for the prevention and management of delirium after cardiac surgery under cardiopulmonary bypass. From May 2022 to April 2023，the evidence-based nursing practice was developed and applied into the Department of Cardiovascular and Macro-vascular Surgery of a tertiary A general hospital in Wuhan. The nurses’ knowledge，belief and practice of postoperative delirium，incidence of postoperative delirium and subdelirium syndrome，the implementation rate of examination indicators were compared before and after the application of evidence. Results A total of 27 articles were finally included. Based on this，23 pieces of the best evidence were selected，and 27 review indicators were constructed. Through evidence-based practice，the scores of nurses’ knowledge，belief and practice questionnaire were significantly increased from（100.81±13.92） to （105.51±10.35）（P<0.05）. The implementation rate of 24 indicators was significantly higher compared with baseline review（P<0.05）. The incidence of delirium decreased from 43.5% to 34.7%（P=0.120）. The incidence of postoperative subdelirium syndrome decreased from 55.1% to 40.1%（P=0.010）. The duration of postoperative delirium and sub delirium significantly decreased，respectively（P<0.05）. Conclusion Evidence-based practice can reduce the incidence of subdelirium syndrome，and it can reduce postoperative delirium and the duration of subdelirium syndrome. It can improve nurses’ knowledge and practice of postoperative delirium care.

The effect of nursing intervention based on the integrated theory of health behavior change on the health behavior of patients with diabetes retinopathy

HU Zhe, LEI Dandan, ZHAO Yi, YANG Yang, GAO Yue

2024, 59(3):  300-307.  DOI: 10.3761/j.issn.0254-1769.2024.03.008

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Objective To explore the effect of nursing intervention based on the integrated theory of health behavior change（ITHBC） on the health behavior of patients with diabetes retinopathy（DR）. Methods 157 patients with diabetes retinopathy admitted from July to December 2022 in a tertiary A hospital in Wuhan，Hubei Province，were selected as the experimental group by convenience sampling method，while 156 patients with diabetes retinopathy hospitalized from January to June 2022 were selected as the control group，and routine nursing was carried out. The disease cognition scale scores，self-management scale scores，and quality of life scale scores were compared between the 2 groups before and after 6 months of intervention. Results After 6 months of intervention，the disease cognition scale scores，self-management scale scores，and quality of life scale scores of both groups improved，and the results in the experimental group were better than these in the control group，and the difference is statistically significant（P<0.05）. Conclusion Nursing interventions based on the ITHBC theory can help improve the disease cognition of DR patients，establish and maintain healthy behaviors，improve their self-management level，and improve their quality of life.

Influencing factors and nursing enlightenment of the fear of progression in patients with inflammatory bowel disease：a latent profile analysis

WANG Qingyu, LIN Zheng, LEI Yang, ZHOU Meijing, WANG Mi, SUN Caiyun, GU Junyi, ZHU Zhanhui, TANG Lichen, BIAN Qiugui

2024, 59(3):  308-316.  DOI: 10.3761/j.issn.0254-1769.2024.03.009

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Objective To explore the potential categories and influencing factors of the fear of progression in patients with inflammatory bowel diseases（IBD）. Methods IBD patients who received inpatient treatment in a tertiary hospital in Nanjing from July 2022 to July 2023 were selected as the study subjects by convenience sampling method. The General Demographic Information Questionnaire，the Chinese version of the Fear of Progression Questionnaire-Short Form（FoP-Q-SF），the Chinese version of Inflammatory Bowel Disease Self-efficacy Scale（IBD-SES），and Social Support Rating Scale（SSRS） were administered to the participants. We applied one-way ANOVA and Logistic regression analysis to identify the factors associated with the potential categories of the fear of progression. Results A total of 303 returned questionnaires（out of the 310） were valid，resulting an effective response rate of 97.74%. According to the results of latent profile analysis，we classified the respondents into 3 categories by the fear of progression，namely “low risk fear of disease adaptation group”（n=127，41.91%），“medium risk fear of illness distress group”（n=139，45.88%），“high risk fear of dysfunction group”（n=37，12.21%）. 3 groups showed statistically significant differences in permanent address，self-rated financial pressure，current disease status and self-efficacy（P<0.05）. Conclusion Patients with IBD had obvious differences in characteristics on the fear of progression. Nursing personnel should formulate personalized intervention strategies based on the classification characteristics of the fear of progression of IBD patients. Moreover，nurses should focus on improving patients’ self-efficacy and promoting patients to treat medical care，stress and emotion management correctly.

Nursing Management

Construction and verification of a clinical fall prevention information system

FU Rongjuan, DING Fu

2024, 59(3):  317-323.  DOI: 10.3761/j.issn.0254-1769.2024.03.010

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Objective The clinical fall prevention information system is developed and its effect is verified，providing references for the prevention of clinical falls through information technology. Methods Based on the screening-assessment-intervention-evaluation process recommended by the toolkit，a clinical fall prevention information system was constructed through the steps of team formation and group discussion. The system includes 2 modules of fall prevention clinical practice and fall adverse event management，and 5 basic functions of fall risk assessment，structured risk point screening，personalized intervention measures，evaluation report and intervention prescription，and adverse event reporting. From September to December 2021，the system was tested in 6 departments with a high incidence of falls in a tertiary A hospital in Chongqing，and the application effect of the system was verified from 5 aspects：friendliness of the system interface，professional guidance，improvement of patient participation，reduction of fall incidence and injury rate. Results 68.9% of nurses thought that the system was user-friendly；82.7% thought that the system was professional and instructive；75.3% thought that the system could improve patients’ participation in fall prevention. After trial of the system，the incidence of falls and injury decreased，but the statistical difference was not obvious（P>0.05）. Conclusion This system realized multi-team cooperation to jointly pay attention to patients’ falls，and it was well recognized by nurses in terms of professional guidance and improving patients’ participation in fall prevention. At the same time，due to the short trial and verification time，narrow scope and small sample size of this system，its fall prevention effect needs to be further promoted and verified.

The current situation and influencing factors of patient perception for humanistic care in 30 provincial hospitals

ZHANG Fengjian, ZHANG Haixin, LIU Yilan, PAN Shaoshan, GUO Shujie, XIN Xia, YANG Yan, XI Huiqin, LI Xiue, CHENG Yuanjuan, MO Beirong, LI Weihua, ZHANG Xiaohong, WANG Fang, WANG Hongxia

2024, 59(3):  324-329.  DOI: 10.3761/j.issn.0254-1769.2024.03.011

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Objective To understand the current status and influencing factors of patient perception for humanistic care in China hospitals，and to provide a basis for developing nursing humanistic care measures and improving the quality of nursing humanistic care services. Methods A total of 30，099 outpatients and inpatients from 107 hospitals in 30 provinces（autonomous regions and municipalities） from July to August 2022 as survey subjects. A general information questionnaire and the Relational Caring Questionnaire-Patient Form were used for a cross-sectional survey，and a single-factor analysis was used to analyze the influencing factors of patient relationship care. Results Finally，29 108 valid questionnaires were collected，and the effective questionnaire recovery rate was 96.7%. The patient evaluation of relationship care was（65.72±8.61） points. Single-factor analysis showed that gender，age，marital status，children’s situation，education level，occupation，place of residence，average family income，medical insurance type，visiting department，and location of the visiting hospital，and whether or not surgery were influencing factors of patient relationship care（P<0.05）. Conclusion The evaluation score of caregiver-patient relationship care among Chinese hospital patients is above average，but there is still room for improvement in western and rural regions，seriously ill and outpatient patients，low-income and low-medical insurance reimbursement populations，and non-surgical patients. Medical institutions at all levels should optimize and improve nursing humanistic care services based on influencing factors，and further enhance patients’ perception of nursing humanistic care.

Bibliometric analysis of large-scale nurse health cohort studies

LI Yamin, LI Xuting, YU Qiang, YANG Jiaxin, CHEN Yamin, CHEN Zengyu, NING Meng, LI Sini, TIAN Yusheng, WU Xinjuan

2024, 59(3):  330-337.  DOI: 10.3761/j.issn.0254-1769.2024.03.012

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Objective To analyze the situation and study trend of large-scale nurses’ health cohort studies based on Web of Science，to help design clinical guidelines and scientific research for nursing staff in China. Methods Articles of large nurses’ health cohort studies published from 1993 to 2023 were retrieved from Web of Science （WOS） Core Collection. Citespace and Bibilometrix were used to perform the bibliometric analysis. Results 2882 studies were included in this study. Total volume of papers was enlarging by year. Clustering results showed that the main keywords could be divided into 3 categories：risks of women’s health，risks of cardiovascular disease and reproducibility. Results of keywords burst showed that lifestyle，cardiovascular disease，women reproductive health and mental health were the highlights of studies in recent 5 years. Conclusion Research on large-scale nurse health cohorts holds significant scientific significance. It is recommended to establish a nationwide large-scale nurse health cohort as soon as possible. In the study，appropriate exposure factors should be selected，with reproductive health，mental health，and psychiatric disorders being the primary outcome measures，and chronic physical illnesses being the secondary outcome measures. By systematically describing the factors influencing the physical and mental health of nurses in China，we can better safeguard their well-being and promote the development of the nursing discipline.

Enteral and Parenteral Nutrition

Construction and application of a management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients

WU Bainü, MI Yuanyuan, ZHENG Yi, ZHANG Liuliu, ZHANG Maomao, ZHU Ping, LIU Chunli, WU Bing, QIANG Yan

2024, 59(3):  338-344.  DOI: 10.3761/j.issn.0254-1769.2024.03.013

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Objective To explore the application effect of enteral nutrition-related diarrhea in postoperative esophageal cancer patients. Methods Based on literature search and expert meeting，a management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients was constructed. A convenience sampling method was used to select a total of 68 patients with enteral nutrition-related diarrhea after esophageal cancer surgery admitted to the thoracic surgery department of a tertiary A cancer hospital in Jiangsu Province. Among them，patients admitted from January 2022 to December 2022 were set as an experimental group. The experimental group was implemented the management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients. Those admitted from January 2021 to December 2021 were set as a control group with routine nursing. Then，the time of stopping diarrhea，the King’s of Stool Chart（KSC-Tr） diarrhea score，and abnormal incidence of nutrition-related indexes，electrolytes abnormalities（low sodium，low potassium，and low calcium） were compared between 2 groups. Results The time of stopping diarrhea，KSC diarrhea score after 3 days of intervention and the time to achieve target feeding volume of the experimental group were lower than those in the control group，and the difference was statistically significant（P<0.05）. There were no significant differences in hemoglobin，albumin，prealbumin after 3 days of intervention，the incidence of electrolyte abnormalities（low sodium，low potassium，and low calcium） after 3 days of intervention，and the BMI index after 7 days of intervention between 2 groups（P>0.05）. Conclusion The management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients can reduce the time of diarrhea，improve the severity of diarrhea，and shorten the time to achieve the target feeding，but has no significant change in the incidence of electrolyte abnormalities.

Evidence Synthesis Research

Evidence summary of early mobilization in awake patients on extracorporeal membrane oxygenation

LIANG Jiangshuyuan, ZENG Fei, LAN Meijuan, GU Peipei, CAI Lingyun, GUO Luyao, ZHU Yan, GUO Ge

2024, 59(3):  345-352.  DOI: 10.3761/j.issn.0254-1769.2024.03.014

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Objective To retrieve，evaluate and summarize the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation，and to provide a reference for clinical practice. Methods UpToDate，BMJ Best Practice，Registered Nurses’ Association of Ontario，National Guideline Clearinghouse，National Institute for Health and Care Excellence，Yimaitong，Joanna Briggs Institute Library，Cochrane Library，CINAHL，PubMed，SinoMed，CNKI，Wanfang Database，Vip Database and Extracorporeal Life Support Organization Website were researched to collect the literature，including clinical guidelines，expert consensuses，evidence summaries，systematic reviews，and well-designed original studies. The time limit for retrieval was until June 2023. The quality of literature and the level of evidence were evaluated by the evaluation criteria and evidence grading system of JBI Evidence-Based Health Care Center. Results 14 pieces of the literature were included，including 2 clinical guidelines，4 expert consensuses，5 systematic reviews，2 cohort studies and 1 case series. Totally 33 pieces of evidence were summarized，covering 7 aspects：adaptation conditions for the implementation of awake ECMO，team composition，comprehensive assessment，pre-mobilization preparation，mobilization content，prevention and control of adverse events，and effect evaluation. Conclusion The study summarizes the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation. It is suggested that medical institutions establish a professional team for the early mobilization of awake ECMO patients，apply the best evidence to standardize the early mobilization process，and formulate an individualized mobilization program.

Meta-analysis and nursing implications of ketoacidosis caused by sodium-glucose transporter 2 inhibitors

ZHANG Ruoxuan, ZHAO Jian, MU Lining

2024, 59(3):  353-361.  DOI: 10.3761/j.issn.0254-1769.2024.03.015

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Objective To strengthen nursing awareness and attention，and improve the quality of medication and nursing care，Meta-analysis was used to evaluate the occurrence of sodium-glucose transporter 2 inhibitor related ketoacidosis. Methods Relevant randomized controlled trials were searched in 6 databases，such as CNKI，PubMed，Embase，and the Clinical trial platform，and the literature was screened based on inclusion and exclusion criteria. The search time was from the establishment of databases to January 2023. Revman 5.4.1 was used for quality evaluation and Meta-analysis. Results 24 randomized controlled trials were included. The Meta-analysis results showed that sodium-glucose transporter 2 inhibitors increased the incidence of ketoacidosis（RR=2.52，95%CI [1.82，3.49]，P<0.001）. Subgroup analysis showed that the sodium-glucose transporter 2 inhibitors increased the incidence of ketoacidosis in patients with type 2 diabetes（RR=2.42，95%CI[1.70，3.43]，P<0.001），cardiovascular disease（RR=2.32，95%CI[1.59，3.39]，P<0.001），and chronic kidney disease（RR=2.82，95%CI[1.73，4.58]，P<0.001）. Cargliflozin（RR=3.21，95%CI[1.43，7.18]，P=0.005），Daggliflozin（RR=2.73，95%CI[1.51，4.93]，P<0.001），and Sogliflozin（RR=1.92，95%CI[1.06，3.50]，P=0.030） increased the incidence of ketoacidosis，while Engliflozin（RR=1.80，95%CI[0.79，4.11]，P=0.160） did not have a significant effect. When the eGFR of patients≤60（mL/min/1.73m²）（RR=2.74，95%CI[1.63，4.60]，P<0.001），the duration of medication≤12 month（RR=3.31，95%CI[1.79，6.12]，P<0.001），or the duration of medication>12 month（RR=2.19，95%CI[1.23，3.91]，P=0.008），the sodium-glucose transporter 2 inhibitors increased the occurrence of ketoacidosis. Conclusion For patients receiving sodium-glucose transporter 2 inhibitors treatment regardless of whether they are complicated with diabetes，especially those with heart and kidney diseases，in the early and middle stages of medication，with eGFR≤60 ml/（min·1.73m²），and those with other susceptibility factors，we should strengthen the observation of patients’ medication，optimize medication care，and early identify and intervene in the occurrence of ketoacidosis.

The experience of body image experience in burn patients：a meta-synthesis of qualitative studies

FENG Qifan, TU Famei, WU Jimin, LIU Pingping, LIU Jiachen, ZHANG Siyi, ZHANG Xin

2024, 59(3):  362-370.  DOI: 10.3761/j.issn.0254-1769.2024.03.016

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Objective To systematically evaluate and integrate qualitative research related to the psychological experiences and perceptions of body image in burn patients. The goal is to provide a reference basis for developing targeted intervention measures in clinical practice. Methods The databases of CNKI，Wanfang，VIP Chinese Science and Technology Periodical Database，China Biomedical Literature Service System，PubMed，Web of Science，Embase，Medline，Cochrane Library，PsycINFO，and Scopus were applied in our study. Relevant qualitative studies on the body image experience of burn patients from the establishment of the databases until December 2022 were collected. The quality of the included literature was assessed using the 2016 edition of the Joanna Briggs Institute （JBI） Centre for Evidence-based Health Care in Australia，and the results of the literature were integrated using aggregative integration. Results A total of 12 pieces of literature were included，from which 40 research findings were extracted. These findings were ultimately summarized into 4 integrated results：diverse traumatic perceptions of body image changes faced by burn patients，active exploration and negative coping strategies towards body image changes faced by burn patients，emotional information needs and post-traumatic growth. Conclusion Burn patients experience various body image issues that hinder their return to normal life. It is crucial for healthcare professionals to timely attend to the physical and mental well-being of the patients，identify body image disorders，assist families in meeting emotional needs，support patients in self-adjustment，and promote positive outcomes.

Review

Research progress on influencing factors and training of nurses’ compassion

LI Jiaoyue, YANG Li, SU Aihua, LAN Mengfei, ZHANG Hongqiang, QI Yixuan

2024, 59(3):  371-377.  DOI: 10.3761/j.issn.0254-1769.2024.03.017

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Compassion is an important part of nurses’ professional quality，and it is also the basis of effective nurse-patient communication and humanistic care. Improving nurses’ compassion is helpful to provide high-quality nursing services to patients. This study reviews the definition of compassion，the factors affecting compassion and the training methods to improve compassion，analyzes the shortcomings of existing training methods，and puts forward the prospects for future research，so as to provide a theoretical foundation for future compassion training among nurses.

Research progress on application of machine learning in discharge preparation service for patients

HU Huanting, HONG Sisi, JIA Yingying, SONG Jianping

2024, 59(3):  378-384.  DOI: 10.3761/j.issn.0254-1769.2024.03.018

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With the deepening of the reform of the medical and health system and the continuous optimization of the medical order，it is especially important to organize the development of admission and discharge standards and improve the service of preparing patients for discharge. In recent years，the research and application of machine learning technology in the medical field has been intensifying，and it has unique advantages in processing data and risk prediction research. Therefore，this paper reviews the development process，types of machine learning，the content and effects of its application in patient discharge preparation services，and the current problems，in order to provide references for healthcare professionals to implement the best clinical decisions and further improve the patient discharge preparation service model.