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    20 May 2024, Volume 59 Issue 10
    Research Paper
    Application of a management plan for microaspiration of oropharyngeal secretions in ICU patients with tracheal intubation
    DENG Wei, LI Xiaozhen, WANG Ying, TAN Liping, ZHOU Baochun, TIAN Fengmei, HUANG Hui, ZOU Jie, TANG Wen, XU Sujuan
    2024, 59(10):  1157-1163.  DOI: 10.3761/j.issn.0254-1769.2024.10.001
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    Objective To construct and apply a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients. Methods Based on evidence summaries and expert consultation,a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients was constructed,consisting of 19 items covering 7 aspects including identification of risk factors,position management,tube and cuff selection,cuff management,mechanical ventilation management,pain and sedation management,removal of oropharyngeal and subglottic secretions,and oral care. Convenience sampling was used to select 141 ICU intubated patients from a tertiary A comprehensive hospital in Suzhou from June,2022 to September,2023. Patients were divided into an experimental group(n=72) and a control group(n=69) according to the wards. The experimental group received the management plan for microaspiration of oropharyngeal secretions in ICU intubated patients. The control group received the nursing bundle for ventilator associated pneumonia(VAP). The incidence and time from intubation to microaspiration and VAP,duration of mechanical ventilation,ICU length of stay,and disease outcome were compared between the 2 groups. Results The incidence of microaspiration of oropharyngeal secretions,the duration of mechanical ventilation,time from intubation to microaspiration showed significant differences between the 2 groups(P<0.05). There were no significant differences in the incidence of ventilator associated pneumonia,ICU length of stay,and disease outcome between the 2 groups(P>0.05). The time from intubation to VAP in the experimental group was 7.5 days, and that in the control group was 3.8 days. Conclusion The application of the management plan for microaspiration of oropharyngeal secretions in ICU intubated patients is beneficial for reducing the incidence of microaspiration,delaying the time from intubation to microaspiration and VAP,and shortening the duration of mechanical ventilation.

    Construction and application of a quality control information system for the entire process of neonatal breastfeeding in hospital
    FENG Xiaofang, ZHENG Bingqing, CHEN Shuang, HUANG Xiaoxia, SUN Caixia
    2024, 59(10):  1164-1170.  DOI: 10.3761/j.issn.0254-1769.2024.10.002
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    Objective To construct a quality control information system for the entire process of neonatal breastfeeding and evaluate its application effect. Methods Based on the “evidence-based guidelines for breastfeeding of inpatient newborns” and combined with clinical practice,hazard analysis and critical control point methods were applied to construct a quality control information system for the entire breastfeeding process,which includes medical order reminder module,knowledge assessment module,breast milk outside the hospital management module,breast milk inventory reminder module,and adverse feeding record module. The pure breastfeeding rate,qualified rate of breast milk quality,and incidence of adverse events of hospitalized newborns before the application of the system(June and August 2021) and after the application of the system(June and August 2022) were compared. Results After the implementation of the system,the pure breastfeeding rate of hospitalized newborns increased from 15.12% to 28.05%,with a statistically significant difference(χ2=4.170,P=0.041). The qualified rate of breast milk quality increased from 68.44% to 96.79%,with a statistically significant difference(χ2=531.853,P<0.001). The incidence of adverse events decreased from 5.81% to 0,with a statistically significant difference(P=0.026). Conclusion The quality control information system for the entire process of breastfeeding accurately identified risks and warning signs against them,standardized the management of breast milk outside the hospital,improved the qualification rate of breast milk quality and pure breastfeeding rate,reduced adverse events of breastfeeding,and ensured the effectiveness and safety of breastfeeding.

    Community Health Promotion for the Elderly
    Application of a home-based exercise program in elderly patients with osteoporosis and frailty
    ZONG Xiaoyan, ZHU Lingzhi, WANG Xuefei, MO Yongzhen, XU Jiaren, OUYANG Xiaojun
    2024, 59(10):  1171-1179.  DOI: 10.3761/j.issn.0254-1769.2024.10.003
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    Objective To explore the application effect of multi-component home-based exercise in elderly patients with osteoporosis and frailty. Methods A total of 52 elderly patients with osteoporosis and frailty were recruited from the osteoporosis clinic of a tertiary hospital in Nanjing,Jiangsu Province from March to August 2022 using the convenience sampling method. Subjects were randomly divided into an experimental group and a control group with 26 cases in each group by the random number table. The experimental group was given the home-based exercise program,while the control group maintained the daily lifestyle. Short Physical Performance Battery(SPPB),grip strength,Frail Scale and Chinese Osteoporosis-targeted Quality of Life Questionnaire(COQOL) of the 2 groups were compared at 12 weeks and 24 weeks,and bone mineral density(BMD) was analyzed after 24-week intervention. Results The scores in the experimental group had significant statistical differences in SPPB,grip strength,Frail Scale and COQOL compared with those in the control group after 12-week and 24-week intervention(P<0.05). The BMD of total hip of the experimental group was significantly higher than it in the control group(P<0.05). Conclusion The home-based exercise program can help the elderly with osteoporosis and frailty to improve the physical function and upper body strength,improve the frailty state,and enhance the quality of life,and it may be one of the effective intervention methods to prevent and reverse the frailty state of osteoporosis patients.

    Development of an assessment scale of the aged care aptitude for the aged and test of its reliability and validity
    ZHOU Yaoling, XIA Jinyan, LIU Xue, LU Ying, YAN Qiaoyuan
    2024, 59(10):  1180-1186.  DOI: 10.3761/j.issn.0254-1769.2024.10.004
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    Objective To develop an aged care aptitude assessment scale and to test its reliability and validity. Methods Based on the family caregivers care aptitude model,self-management theory and holistic nursing model,and with reference to the national standard of “specification for ability assessment of older adults”,the first draft of the scale was formed through review of literature,semi-structured interviews,expert inquiry and pre-survey. From April to August 2023,675 aged caregivers in several communities in 9 provinces including Hubei,Guangdong etc. were investigated to test the reliability and validity of the scale. Results The aged care aptitude assessment scale included 3 dimensions and 33 items. The overall Cronbach’s α coefficient of the scale was 0.99;the split-half reliability was 0.92;the two-week test-retest reliability was 0.84;the overall content validity index of the scale was 0.94;the content validity index of each item was 0.83—1.00;exploratory factor analysis extracted 3 common factors;the cumulative variance contribution rate was 85.88%; confirmatory factor analysis were χ2/df=1.260、IFI=0.993、TLI=0.995、CFI=0.994、RMR=0.047、RMSEA=0.074. Conclusion The aged care aptitude assessment scale has good reliability and validity,and it can be used as an assessment tool to measure the level of aged care aptitude for the aged.

    Evidence summary of blood flow restriction training for elder patients with sarcopenia
    WANG Xin, LI Nuo, LIANG Shiyu, LI Chenyang, SHAO Lewen
    2024, 59(10):  1187-1194.  DOI: 10.3761/j.issn.0254-1769.2024.10.005
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    Objective To search,evaluate,and summarize the relevant evidence of blood flow restriction training in elderly patients with sarcopenia,and provide references for medical staff to guide elderly patients to carry out blood flow restriction training to prevent and treat sarcopenia. Methods Computer systems were used to search domestic and foreign databases,relevant guide websites,and professional association websites for guidelines,expert consensuses,expert opinions,clinical decisions,system reviews,recommended practice,and evidence summaries on blood flow restriction training for elderly patients with sarcopenia. The retrieval period was from the inception of databases to March 2023. There were 2 researchers who independently conducted literature quality evaluation,evidence extraction,and integration. Results A total of 14 articles were finally included,including 1 guideline,12 systematic reviews,and 1 expert opinion. A total of 27 pieces of best evidence were summarized from 7 aspects:exercise assessment,exercise mode,pressure parameters,exercise parameters,exercise effects,exercise safety,and evaluation methods. Conclusion This study summarized the best evidence for blood flow restriction training in elderly patients with sarcopenia. It is recommended that medical staff fully consider clinical practice when applying evidence,and develop personalized blood flow restriction training programs based on the exercise preferences and actual situations of the elderly to prevent and treat sarcopenia.

    Research progress of extended reality technology for disability prevention in the elderly
    LI Huanhuan, ZHANG Wei, CHEN Xuemei, PANG Yajuan, ZHOU Xuan, ZHOU Lanshu
    2024, 59(10):  1195-1200.  DOI: 10.3761/j.issn.0254-1769.2024.10.006
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    China is currently experiencing rapid population aging,leading to a significant expansion of the elderly demographic. This aging process is accompanied by cognitive,motor,and sensory function decline and diseases,resulting in an increasing number of elderly individuals with disabilities. To address this challenge,extended reality technology offers a personalized,motivating,and human-computer interactive training environment that can effectively tackle the obstacles hindering active health and disability prevention in the elderly,such as inadequate infrastructure and motivation. This review summarized the current research status and effectiveness of extended reality technology in preventing disability among the elderly. Additionally,the review discusses the limitations and future prospects of extended reality technology in the context of elderly disability prevention,aiming to provide guidance for preventing disability in the elderly and promoting healthy aging.

    Research progress on the sense of belonging of the elderly in elderly care institutions
    PENG Sisi, LIU Jingying, LUO Ruzhen, DAI Lingyun, HU Jiaxin, LIU Yanhui
    2024, 59(10):  1201-1204.  DOI: 10.3761/j.issn.0254-1769.2024.10.007
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    Improving the sense of belonging of the elderly in nursing institutions is of great significance to enhance their sense of self-worth and self-identity,and further meet the spiritual needs of the elderly in nursing institutions. This paper reviewed the concept,current situation,evaluation tools and influencing factors of the elderly’s sense of belonging in nursing institutions,and proposes that there is a lack of tools to measure the sense of belonging of the elderly in nursing institutions,and the intervention strategies with caregivers as the core needs to be further explored.

    Specialist Practice and Research
    Development of review indicators and obstacle factors analysis of immunosuppressant medication compliance management in kidney transplant patients
    SHEN Mingyan, HAN Linqiu, XU Jing, WAN Pengxia, SHEN Rufen, YAO Yuanyuan, FENG Zhixian
    2024, 59(10):  1205-1211.  DOI: 10.3761/j.issn.0254-1769.2024.10.008
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    Objective To comprehensively evaluate the current clinical application status of evidence regarding immunosuppressive medication compliance management in kidney transplant patients,construct review indicators,analyze the obstacles and promoting factors,and further formulate reform strategies. Methods Using the Joanna Briggs Institute evidence-based health care model as the theoretical framework,clinical nursing issues were identified,and a systematic search,evaluation,and summarization of 38 items of evidence were conducted. An evidence-based practice group was established;review indicators were constructed;review methods were clarified. Baseline reviews of systems,healthcare professionals,patients,and their families were conducted from November 1,2022,to January 31,2023. According to the review results,the obstacles and promoting factors in the process of evidence-based practice were analyzed,and corresponding strategies were formulated. Results A total of 23 review indicators were constructed. Among them,the accurate execution rate of 15 indicators was less than 60%,and the accurate execution rate of 4 indicators was 0. The main obstacles include a lack of systems and processes in departments,poor knowledge,attitude,and practice of medical staff,a lack of standardized risk assessment,and a lack of information support for out-of-hospital management. The primary promoting factors are strong organizational leadership,multidisciplinary team support,and high participation enthusiasm of recipients and their families. Corresponding reform strategies are formulated accordingly,including process and system improvement,continuous quality monitoring,enhanced standardized training and assessment,electronic health intervention for medication compliance,and involving patients and their families in the medication compliance management process. Conclusion There is a significant gap between the evidence on immunosuppressive medication compliance management in kidney transplant patients and its clinical practice. It is essential to assess the obstacles and facilitators scientifically and comprehensively in clinical situations,employ targeted reform strategies,facilitate the translation of evidence into clinical practice,and enhance the quality of nursing care.

    Status and influencing factors of physical activity among liver transplant patients
    ZHOU Huiling, YANG Zhiyu, YAN Jingwen, XU Leibo
    2024, 59(10):  1212-1217.  DOI: 10.3761/j.issn.0254-1769.2024.10.009
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    Objective This study aimed to investigate the physical activity status of liver transplant patients,explore the relevant influencing factors,and provide a basis for developing a physical activity management program for this population. Methods A convenience sampling method was used from January to May 2023 to investigate 250 liver transplant patients in a tertiary hospital in Guangzhou,using a general situation questionnaire,international physical activity questionnaire,exercise fear scale,and organ transplant patient symptom and happiness scale. Ordinal logistic regression analysis was used to analyze the relevant influencing factors of physical activity in liver transplant patients. Results 240 valid questionnaires were collected,and the median total metabolic equivalent of physical activity in liver transplant patients was 2 433(506,30263) MET-min/week patients. Ordinal logistic regression analysis revealed that body mass index(BMI),time to transplantation,postoperative follow-up,fear of exercise,and quality of life were significant factors influencing physical activity in liver transplant patients(P<0.05). Conclusion Liver transplant patients have lower levels of physical activity,mainly with light activity intensity such as walking. Medical staff need to pay attention to the management of physical activity in liver transplant patients,especially for obese and low-quality of life patients. Postoperative follow-up should be strengthened to improve their fear of exercise and promote early and regular exercise.

    Development and reliability and validity tests of Oral Health Caring Ability Assessment Scale for Caregivers of Infants and Young Children
    YANG Liu, LI Zhihui, KONG Yan, YU Guiling
    2024, 59(10):  1218-1225.  DOI: 10.3761/j.issn.0254-1769.2024.10.010
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    Objective To develop an Oral Health Caring Ability Assessment Scale for Infants and Young Children Caregivers and test its reliability and validity,so as to provide a scientific tool for assessing the oral health caring ability of them. Methods Based on the IMB Skills Model,the initial version of the scale was formed through literature review,expert consultation,and pre-investigation. From May to July 2023,a total of 218 caregivers of infants and young children who were treated in the child health department of a tertiary A specialized hospital in Qingdao were selected by convenience sampling for project analysis and reliability and validity test. From August to September 2023,we selected 330 caregivers of infants and young children who were treated in the child health department of 3 tertiary A general hospitals in Shandong and Hunan Provinces by convenience sampling to further verify the stability of the scale structure. Results The Oral Health Caring Ability Assessment Scale for Caregivers of Infants and Young Children included 4 dimensions,including feeding knowledge,oral cleaning and examination knowledge,oral health caring attitude and oral health caring behavior skills,with a total of 27 items. According to exploratory factor analysis,4 common factors were extracted and the cumulative variance contribution rate was 62.022%. The Cronbach’s α coefficient of the questionnaire was 0.938;the split-half reliability was 0.774;the test-retest reliability was 0.990. The content validity index at the scale level was 0.957,and the content validity index at the item level was 0.833~1.000. Confirmatory factor analysis showed that the model fitted well and the factor structure of the scale was stable. Conclusion The Oral Health Caring Ability Assessment Scale for Caregivers of Infants and Young Children has good reliability and validity,which can be used to assess the level of oral health caring ability for caregivers of infants and young children accurately.

    Safety in Operating Room Nursing
    Construction and application of a nursing list for whole process of day surgery based on the theory of limited time
    YUAN Fang, FENG Qin, QIAN Yuanfang, WU Wan, LIU Zhonghui, HU Shuangshuang
    2024, 59(10):  1226-1232.  DOI: 10.3761/j.issn.0254-1769.2024.10.011
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    Objective Based on the limited time theory,taking tonsillectomy day operation as an example,the whole process nursing list of day operation was constructed,and its application effect was evaluated. Methods The nursing service list of tonsillectomy was constructed based on literature research,field observation and expert correspondence. A total of 197 patients who underwent tonsillectomy in the day ward of a tertiary A general hospital in Hangzhou,Zhejiang Province were selected. Among them,98 patients from April to June 2023 were taken as an experimental group and treated with the whole-process nursing list of daytime tonsillectomy constructed in this study,and 99 patients from January to March 2023 were taken as a control group and routine nursing was adopted. The anxiety degree,postoperative pain score,postoperative complication rate and patients’ satisfaction with nursing service were compared between the 2 groups. Results Anxiety scores before operation and at discharge,pain scores at 6 h,12 h and 24 h after operation,and incidence of complications such as infection and gastrointestinal reaction within 14 days after operation in the experimental group were lower than those in the control group,with statistical significance(P<0.05). The satisfaction of nursing service in the experimental group(99.40±0.69) score was significantly higher than that in the control group(90.36±1.04) score,and the difference was statistically significant(P<0.001). Conclusion The use of tonsillectomy day whole-process nursing list can improve perioperative anxiety,relieve postoperative pain and reduce the incidence of postoperative complications,and improve patient satisfaction.

    Evidence summary for the prevention and nursing of neonatal intraoperative acquired pressure injury
    ZHANG Panpan, TIAN Yingying, TAO Fuying, CUI Xiaohua, SHI Qinchuan, ZHU Zhu
    2024, 59(10):  1233-1240.  DOI: 10.3761/j.issn.0254-1769.2024.10.012
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    Objective To retrieve and integrate relevant evidence on the prevention and nursing of neonatal intraoperative acquired pressure and provide a reference basis for nursing practice. Methods According to the “6S” model retrieval strategy,we searched for published articles including the following topic words,such as prevention,assessment,management,and nursing care of neonatal intra-operative pressure injury from establishment of databases until August 2,2023. We got the related references from clinical decision-making websites,guidelines network,professional association websites,domestic and foreign databases. Results Totally 14 articles were included,including 1 clinical decision support,4 clinical guidelines,3 evidence summaries,2 systematic reviews and 4 expert consensuses. Finally,31 pieces of best evidence were summarized from 5 aspects of risk factors,risk assessment,observation and preventive measures,nursing measures after the occurrence of pressure injury,education and training. Conclusion Multidisciplinary collaborative participation based on the obtained evidence is an effective strategy,which can be applied to the prevention and nursing care of neonatal intraoperative acquired pressure injury. Appropriate preventive and nursing programs should be made according to the actual situation and clinical environment,so as to reduce the incidence of neonatal intraoperative acquired pressure injury and to ensure the safety of neonatal perioperative nursing care.

    Research progress on cleaning quality control of Da Vinci surgical robot system
    MENG Shanshan, YAO Zhuoya, GENG Junhui, LI Manchun, ZHAN Meng, DING Lina, YIN Yue, WANG Peixi
    2024, 59(10):  1241-1247.  DOI: 10.3761/j.issn.0254-1769.2024.10.013
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    With the continuous development of surgery,the amount of Da Vinci robot surgery has increased year by year,and Da Vinci robot has been widely used in the field of surgery. However,due to its structural characteristics,robot surgical instruments are difficult to clean after contamination,which poses a great challenge to the cleaning technology of nurses in central sterile supply department(CSSD). At present,there are still some problems in the cleaning quality management of Da Vinci robotic surgical instruments,such as inadequate pre-treatment,non-standard manual cleaning process,and inconsistent cleaning quality evaluation methods,which bring great hidden dangers to patients’ medical safety. Therefore,scientific and effective cleaning quality control is very important to prevent nosocomial infection and ensure the life safety of patients.This paper reviews the cleaning process and quality control on Da Vinci robotic surgical instruments by consulting,screening,sorting and summarizing domestic and foreign relevant literature of the cleaning and management,and combining with the actual clinical work of the disinfection supply center,and aims to provide theoretical references for the formulation of guidelines and clinical practice for the personnel of CSSD.

    Evidence Synthesis Research
    A meta-analysis of symptom improvement effects of Internet-delivered cognitive-behavioral therapy in breast cancer survivors
    YU Lili, SONG Han, WANG Huining, SUN Xiaoling
    2024, 59(10):  1248-1254.  DOI: 10.3761/j.issn.0254-1769.2024.10.014
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    Objective To systematically evaluate the efficacy of Internet-delivered cognitive-behavioral therapy in improving symptoms of breast cancer survivors. Methods Randomized controlled trials of Internet-delivered cognitive-behavioral therapy for breast cancer survivors were searched in PubMed,Embase,Cochrane Library,PsycINFO,Web of Science,CNKI,VIP database,Wanfang database and Sinomed. Literature retrieval time was from the inception of the databases to February 2023. According to the inclusion and exclusion criteria,2 researchers independently screened the literature,extracted the data and evaluated the methodological quality,and used RevMan5.4 software for Meta-analysis. Results A total of 11 articles and 1476 cases were included. The results of the meta-analysis showed that the anxiety[SMD=-0.20,95%CI(-0.31~-0.10),P<0.001],depression[SMD=-0.16,95%CI(-0.27~-0.05),P=0.006],sleep quality[SMD=0.45,95%CI(0.25~0.66),P<0.001],insomnia symptoms[SMD=-0.71, 95%CI(-1.36~-0.06), P=0.030],fatigue symptoms[SMD=-0.22,95%CI(-0.37~-0.07),P=0.004],menopausal symptoms[MD=2.27,95%CI(0.77~3.76),P=0.003],sexual function[SMD=0.20,95%CI(0.02~0.37),P=0.020] and quality of life [SMD=0.24,95%CI(0.12~0.36),P<0.001] of breast cancer survivors who received the Internet-delivered cognitive-behavioral therapy intervention were better than those in the control group at the end of the intervention,and the differences were statistically significant. The outcome measures that could be analyzed by subgroups were integrated. The results showed that anxiety[SMD=-0.15,95%CI(-0.28~-0.01),P=0.030],depression[SMD=-0.16,95%CI(-0.29~ -0.03),P=0.020],sleep quality[SMD=0.36,95%CI(0.16~0.57),P<0.001] and quality of life[SMD=0.21,95%CI(0.06~0.36),P=0.006] in the intervention group were better than those in the control group at 6 months after baseline,and the differences were statistically significant. Conclusion The application of Internet-delivered cognitive-behavioral therapy can help reduce anxiety,depression and other negative emotions in breast cancer survivors,and it can effectively improve the quality of sleep and reduce insomnia symptoms. It can also reduce menopausal symptoms in breast cancer survivors,improve sexual function,and effectively improve the quality of life of patients.

    Summary of the best evidence for peripheral arterial catheters placement and management in pediatric intensive care unit
    ZHOU Min, FU Qin, WANG Linjuan, ZHENG Zerui, ZHANG Chuhao, ZHENG Xiaozhen, JING Jing
    2024, 59(10):  1255-1262.  DOI: 10.3761/j.issn.0254-1769.2024.10.015
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    Objective To retrieve,evaluate and summarize the best pertinent evidence on the placement and management of peripheral arterial catheters in critically ill children at home and abroad for clinical references. Methods A systematic search was conducted in related databases on the evidence of the placement and management of peripheral arterial catheters in critically ill children. The spectrum of eligible documents included clinical decisions,guidelines,evidence summaries,systematic reviews,expert consensuses,and norms. The search period was from the establishment of the databases to April 30,2023. The included literature was limited to English and Chinese languages. The quality of the literature was independently evaluated by evidence-based trained investigators and combined with professional judgment to extract information from the literature that met the quality standards. Results A total of 18 articles were included,including 3 guidelines,3 clinical decisions,8 evidence summaries,3 systematic reviews and 1 expert consensus. The best evidence included a total of 27 pieces of evidence in 4 areas,namely the assessment of indwelling peripheral arterial catheters,placement of peripheral arterial catheters,maintenance during the duration of indwelling peripheral arterial catheters,and removal. Conclusion This study summarized the most robust evidence pertaining to the management of peripheral arterial catheters in critically ill children,and provided an evidence-based basis for the standardized placement and management of peripheral arterial catheters in critically ill children. Nursing staff should carefully select and apply evidence according to the actual clinical situation,the wishes of children and parents.

    Meta-synthesis of qualitative studies on the authentic experience of moral dilemmas of ICU nurses
    ZHAO Baosheng, WANG Juan, WANG Manli, SHI Junjie, DU Jun, LI Fengxia
    2024, 59(10):  1263-1269.  DOI: 10.3761/j.issn.0254-1769.2024.10.016
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    Objective To systematically evaluate the psychological feelings and real experience of ICU nurses’ moral dilemma,and the aim is to provide references for the formulation of targeted psychological intervention programs. Methods Pubmed,CINAHL,Embase,Web of Science,Cochrane Library,PsycNET,CNKI,Wanfang database,VIP database,and China Biomedical Literature Database were searched by computer to retrieve qualitative studies on psychological perceptions and real experiences of moral dilemmas of ICU nurses,and the search time was from the establishment of databases to March 2023. The quality of literature was evaluated using the 2016 version of the Australian JBI Centre for Evidence-Based Health Care Quality Evaluation Criteria for qualitative studies,and the results were integrated and analyzed by the Meta integration method. Results A total of 10 pieces of literature were included,including 3 phenomenological studies and 7 descriptive studies. The results of 27 studies were summarized into 8 new categories,and 3 integrated results were obtained:①The internal and external causes of moral dilemmas,including conflicting concepts of life and death,differences of the idea of the superior death,conflict of clinical decision-making,and insufficient organizational support;②The progressive effects of moral dilemmas,including aggravating negative emotional burden and breeding professional identity bias;③Coping strategies for moral dilemmas,including active self-debugging and seeking support from colleagues. Conclusion It is urgent to popularize the scientific concept of life and death of patients and families,deepen the concept of superior death of ICU nurses,and alleviate the conflict of nursing and patient decision-making. It is important to pay attention to the negative emotional state of ICU nurses,improve their professional identity,improve the self-adjustment ways of ICU nurses,and to provide multi-organization support for ICU nurses.

    Review
    The application of mobile blood glucose management in pregnant women with gestational diabetes:a scoping review
    WANG Qiaosong, ZHANG Kun, ZHANG Xueling, ZHENG Qirong, YANG Jingping, LIN Jingjing, LIN Rongjin
    2024, 59(10):  1270-1276.  DOI: 10.3761/j.issn.0254-1769.2024.10.017
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    Objective A scoping review of research on mobile glucose management in pregnant women with gestational diabetes mellitus was conducted to provide references for clinical providers to conduct mobile glucose management and related research. Methods Based on Arksey and O’Malley’s scoping review reporting framework,JBI Library,Cochrane Library,PubMed,Web of Science,Embase,CINAHL Complete,CBM,China National Knowledge In-frastructure(CNKI),and Wanfang Database were retrieved. The search time frame was from the establishment of the databases to February 14,2023. The included literature was screened,summarized and analyzed. Results A total of 65 publications from 11 countries were included,among which 38 were randomized controlled trials,27 were experimental studies. The vehicles relied on for mobile glucose management in gestational diabetes mainly included APPs,remote monitoring systems,professional websites,and social platforms,which could provide health education,glucose management monitoring and recording,social support,and glucose management follow-up and reminders to pregnant women. Most of the studies focus on the glucose index and drug use,pregnancy outcome,self-management,quality of life,user experience and resource cost of pregnant women. Conclusion Mobile glucose management carriers are geographically specific and have a positive effect on glucose control in gestational diabetes. Future studies need to further develop localized mobile glucose management intervention protocols and conduct more high-quality randomized controlled studies to verify their effectiveness.

    Research progress on self-care of patients with left ventricular assist devices
    SHI Yuxin, FU Qiang, WANG Huan, ZHAO Lin, WU Rong
    2024, 59(10):  1277-1281.  DOI: 10.3761/j.issn.0254-1769.2024.10.018
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    With the increase in the number of patients with heart failure and the improvement of medical care,the prevalence of patients with end-stage heart failure is increasing. Due to the limited donor supply for heart transplantation,the implantation of left ventricular assist devices has become a major alternative treatment option for patients with end-stage heart failure. Patients with left ventricular assist device have to face potential heart failure and long-term self-care related to left ventricular assist devices. It is of great significance to comprehensively evaluate the level of self-care behavior of patients with left ventricular assist devices and to formulate targeted self-care guidance programs to improve their prognosis. This article reviewed the concept and connotation,assessment tools,current status,influencing factors and intervention of self-care of patients with left ventricular assist devices,in order to provide theoretical basis and practical guidance for improving the self-care level of patients with left ventricular assist devices,so as to improve the quality of life and improve the prognosis of patients.