Table of Content

10 July 2024, Volume 59 Issue 13

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Special Planning——The Practice and Effectiveness of the Action Plan for Improving Nursing Services

Implementing the Action Plan for Improving Nursing Services—reflections and actions for a new era

WU Xinjuan, WANG Yu

2024, 59(13):  1541-1547.  DOI: 10.3761/j.issn.0254-1769.2024.13.001

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Nursing care，as an important part of the healthcare system，is vital to promoting people’s health and improving the level of medical and healthcare services. At present，nursing in China faces challenges such as talent shortage，uneven service quality and insufficient service supply，as well as opportunities such as growing demand for nursing services and diversification of service modes. To better address the challenges and seize the opportunities，the National Health Commission and the State Administration of Traditional Chinese Medicine have jointly issued the “Action Plan for Further Improving Nursing Services （2023-2025）” （hereinafter referred to as the “Action Plan”）. The article discusses how the Action Plan should be implemented from 3 aspects：focusing on the overall development and scientific management of nursing personnel，enhancing the level of humanisation and personalisation of nursing services，strengthening the intelligent construction of nursing services，and promoting the socialisation and universality of services，so as to provide an opportunity for comprehensively promoting the construction of nursing personnel and the quality development of nursing work in the new era，and improving people’s health. It discusses how to implement the Action Plan and put forward ideas to comprehensively promote the construction of the nursing team and nursing work in the new era，and improve people’s health and quality of life.

Construction and practice of a multidisciplinary collaborative nursing management model in the integrated ward for pan-vascular disease patients

BAO Xiangying, FENG Jia, ZHAO Hua, LAN Meijuan

2024, 59(13):  1548-1554.  DOI: 10.3761/j.issn.0254-1769.2024.13.002

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Objective To explore the construction and practical effects of a multidisciplinary collaborative nursing management model of “organization-training-emergency response-integration-quality control” for pan-vascular disease patients in integrated wards. Methods On the basis of literature research and expert meetings，a multidisciplinary collaborative nursing management model for patients with pan-vascular disease in intergrated wards has been formed. It includes the implementation of accurate dynamic and intelligent overall allocation of beds in the hospital，the formulation of multidisciplinary training programs，the establishment of an emergency and critical case treatment guarantee mechanism，the construction of a standardized path for the joint management of multidisciplinary nursing teams，and the establishment of an intelligent and homogeneous nursing quality control chain. From July 2022 to December 2023，the program was implemented in the cardio-cerebrovascular ward of a tertiary A hospital in Zhejiang province，and indicators such as the average length of stay，cure and improvement rate，and cardiopulmonary resuscitation success rate were collected，and the satisfaction of patients with pan-vascular disease was investigated. Results During the application of multidisciplinary collaborative nursing management model for patients with pan-vascular disease，5416 patients were admitted，with an average length of stay of 6.11±0.73 days，a cure and improvement rate of 98.06%（5 311/5 416），a cardiopulmonary resuscitation success rate of 94.12%，and no adverse events. The overall satisfaction score of patients improved from 92.74±1.68 points in the 4th quarter of 2022 to 98.21±0.55 points in the 4th quarter of 2023（P<0.001）. Conclusion The construction of the multidisciplinary collaborative nursing management model in the integrated pan-vascular ward has explored a new path for the hospital to cultivate cross-professional nursing personnel，promoted effective resource integration，and optimized the health management path，effectively improved the utilization rate of existing resources in the hospital and patients’ medical experience.

Investigation and research of care services for geriatric osteoporotic fractures in hospitals across 621 hospitals

SU Qingqing, GAO Yuan, SONG Mi, QIU Chen, SHAO Mengqi, SU Xiaojing, TANG Nan, WANG Qingmei

2024, 59(13):  1555-1561.  DOI: 10.3761/j.issn.0254-1769.2024.13.003

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Objective To examine the current state of care services for geriatric osteoporotic fractures in Chinese hospitals and to provide a basis for the improvement of these services and the formulation of related policies. Methods In September to November 2023，a stratified convenience sampling method was used to investigate the implementation of care services for elderly patients with osteoporotic fractures in 621 hospitals across 31 provinces （autonomous regions and municipalities） in China. A self-designed questionnaire was utilized for this purpose. Results A total of 621 hospitals participated in the survey，with 432（69.57%） tertiary hospitals and 189（30.43%） secondary hospitals. Over 95% of hospitals provided health education on diet，medication，fall prevention，and early functional exercise for elderly fracture patients. Less than 80% of hospitals provide specialized training on osteoporosis treatment and secondary fracture prevention for medical staff. Only 263 hospitals（42.35%） routinely conduct bone density tests for patients over 50 years old with fractures，while 221 hospitals（35.59%） routinely conduct bone metabolic biochemical tests for such patients. Less than 50% of hospitals provide specialized services，such as geriatric osteoporotic fracture clinics，for elderly patients with osteoporotic fractures. Additionally，39.77% of hospital departments have not developed postoperative care plans for elderly patients with osteoporotic fractures. The lack of specialized care teams（91.63%），insufficient investment in care resources（88.08%），and the absence of policy support（77.45%） are identified as the primary factors impeding the provision of care services for elderly patients with osteoporotic fractures in hospitals. Although some care services in tertiary hospitals are superior to those in secondary hospitals（P<0.05），they are still far from adequate. Conclusion The development of care services for elderly patients with osteoporotic fractures in Chinese hospitals needs improvement. It is recommended to further standardize and enhance the content and methods of health education，intensify clinical assessments related to osteoporosis in elderly fracture patients，improve the professional care capabilities of medical staff，and at the same time，the state should introduce relevant policies to support and promote the construction and development of hospital care services for elderly osteoporotic fracture patients.

Construction and application of an intelligent discharge follow-up information system for patients with cancer pain

LI He, ZHANG Meiyun, YU Sufen, TANG Linna, SHI Xiaolan

2024, 59(13):  1562-1567.  DOI: 10.3761/j.issn.0254-1769.2024.13.004

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Objective To construct and apply an intelligent follow-up information system for patients with cancer pain， providing references for improving the efficiency of hospital follow-up and promoting pain management of patients at home. Methods The intelligent discharge follow-up system for patients with cancer pain includes 2 platforms，namely a patient self-report platform and an administrator operation platform. The administrator operation platform consists of 5 modules，namely the workbench module，the follow-up plan module，the follow-up results module，the health education module and the data statistics module. In January 2022，the system was officially put into clinical application. The use of the system was analyzed，and patients’ completion rate，medication compliance，incidence of moderate and severe pain and satisfaction with pain control were compared before（from January 2020 to December 2021） and after（from January 2022 to November 2023） the application of the system. Results At present，this system has been applied in 95 cancer-related wards of our hospital. From January 2022 to November 2023，the number of people who should be followed up was 4 248，and the number of people who actually completed the follow-up was 4 127；the rate of follow-up completion was 97.2%；the rate of timely completion of the follow-up was 94.9%；the rate of automatic follow-up by the system was 40.1%；the rate of patient abnormality report was 31.9%；the rate of timely treatment of patient abnormality report was 89.1%. After the application of the system，the completion rate of pain follow-up was increased，and the difference was statistically significant（P<0.001）. After the application of the system，the medication compliance rate of patients with cancer pain increased from 86.9% to 91.0%；the incidence of moderate and severe pain decreased from 6.8% to 5.2%；the satisfaction with pain control increased from 81.0% to 83.5%（P<0.05）. Conclusion The intelligent discharge follow-up system for patients with cancer pain can effectively improve the discharge follow-up efficiency and promote the management of patients with cancer pain at home.

A study of strategies to improve the management of the operative limb in patients undergoing coronary intervention through radial artery puncture

FENG Xiaofang, TENG Yanwen, ZHU Xuemeng, LI Wenyu, LI Mingming, LAI Shuyi, CHEN Dongxue, CHEN Xiaoyan, SUN Caixia

2024, 59(13):  1568-1574.  DOI: 10.3761/j.issn.0254-1769.2024.13.005

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Objective Improving the limb management strategy for patients undergoing coronary intervention through radial artery puncture and observe the application effect，and to provide scientific basis for the prevention of limb complications. Methods From March 2023 to February 2024，patients who underwent coronary intervention in the Cardiovascular Department of a Tertiary A hospital in Wenzhou City were selected. They were randomly divided into an experimental group of 241 cases and a control group of 236 cases using a random number table method. After surgery，they were all treated with a rotary hemostatic device for compression hemostasis. The experimental group implement improvement strategies for surgical limb management, specifically underwent a reverse Barbeau test upon returning to the ward after surgery to achieve non-occlusive compression，followed by decompression every hour. The compression intensity of the control group was guided by palpating the distal radial artery pulsation，and the first decompression was performed 1 hour after surgery，followed by decompression at intervals of every 2 hours. The main evaluation indicators are the incidence of surgical limb complications and simplified Chinese version of General Comfort Questionnaire（GCQ） scores in 2 groups of patients，while the secondary evaluation indicators are the duration of compression and the number of decompression times in both groups. Results The incidence of postoperative complications in the experimental group was 14.11%，which was statistically significant compared to 44.49% in the control group（χ²=53.308，P<0.001）. The GCQ score of the experimental group was（77.71±5.43） points，which was higher than （74.66±5.83） points in the control group，and the difference was statistically significant （t=-3.354，P=0.001）. The compression duration of （172±52） minutes and decompression frequency of 2（2，3） in the experimental group were lower than（289±60） minutes and 4（3，4） in the control group，and the differences were statistically significant（P<0.001）. Conclusion The non-occlusive compression method of the radial artery based on the reverse Barbeau test can significantly reduce limb complications in patients undergoing coronary intervention，shorten the duration of hemostatic compression，reduce the number of depressions，and improve patient comfort. It provides objective basis for nursing staff to evaluate the intensity of hemostatic compression and the timing of decompression.

Application of a bedside ultrasound-guided intestinal cleaning program in patients with severe acute pancreatitis

JIN Xiaolei, HUANG Rui, HUI Xueying, GUO Xiangyong, ZHANG Yuezhong, HOU Xiaohong, NI Qingqiang, FANG Wei, WANG Yuping

2024, 59(13):  1575-1580.  DOI: 10.3761/j.issn.0254-1769.2024.13.006

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Objective To investigate the application effect of a bedside ultrasound-guided intestinal cleaning program in patients with severe acute pancreatitis. Methods A total of 51 patients with severe acute pancreatitis admitted to the ICU of a tertiary A hospital in Shandong from March to September 2023 were selected by convenience sampling method，and they were divided into an experimental group and a control group according to random number table method. The experimental group was given the bedside ultrasound-guided intestinal cleaning program，and the control group was given the routine intestinal cleaning program. Acute gastrointestinal injury ultrasonography score，the incidence of grade Ⅲ acute gastrointestinal injury and intra-abdominal pressure were compared between the 2 groups before intervention，on the 3rd and 5th day. Results There was an interaction effect between time and group in the comparison of acute gastrointestinal injury ultrasonography scores in the 2 groups（F=7.478，P<0.001）；simple effect analysis showed that acute gastrointestinal injury ultrasonography scores in the experimental group were lower than those in control group on the 3rd and 5th day，with statistically significant differences（P<0.05）. The incidence of grade Ⅲ acute gastrointestinal injury in the experimental group （23%） was lower than that in the control group（60%），with statistically significant differences（P<0.05）. The intra-abdominal pressure had an interaction effect between the 2 groups（F=47.128，P<0.001）；simple effect analysis showed that the intra-abdominal pressure in the experimental group was lower than that in the control group on the 3rd and 5th day，with statistically significant differences（P<0.05）. Conclusion The bedside ultrasound-guided intestinal cleaning program can improve acute gastrointestinal injury and reduce intra-abdominal hypertension in patients with severe acute pancreatitis.

Standards

Expert consensus on limb management of patients with transvenous temporary cardiac pacing

Radioactive Interventional Nursing Professional Committee of Chinese Nursing Association, （Writing Committee：LIU Huafen, ZHOU Jiali, HUANG Zheng, HUANG Zheng, ZHANG Zhixia, LIANG Jingyu, CAI Zhongxiang, CHEN Fuhong, ZHOU Yunying, XIANYU Yunyan, YAN Lin, YU Huidan, PENG Huizhen, ZHU Jian, TIAN Yuan, ZHANG Yan, JIANG Hejun, ZHANG Su）

2024, 59(13):  1581-1583.  DOI: 10.3761/j.issn.0254-1769.2024.13.007

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Objective To form the expert consensus on the limb management of patients with transvenous temporary cardiac pacing，standardize the limb management of patients with transvenous temporary cardiac pacing，and reduce complications related to the limb. Methods Using evidence-based methods，the evidence in this field was searched，evaluated and summarized，and relevant recommendations and research conclusions were extracted and classified by the level of evidence quality，and then the first draft of the consensus was formed. From December 2023 to January 2024，through 2 rounds of expert consultation and 4 rounds of expert meetings，the content was adjusted and the consensus was reached. Results Totally 16 experts participated in the consultation. The positive coefficient is 100%；the authoritative coefficient is 0.847 and 0.836；the average value of each index is more than>3.8；the coefficient of variation is less than 0.21. The Kendall’s harmony coefficient of the 2 rounds of expert consultation is 0.372 and 0.314，respectively，which were statistically significant. The consensus covers the preoperative，intraoperative and postoperative on limb management of patients with transvenous temporary cardiac pacing. Totally 11 themes were involved，including the preoperative preparation，position and catheter fixation in operation，position and catheter fixation in postoperative，activity，turn and transfer，duty shift on limb，nursing care after withdrawal of the catheter，prevention of deep vein thrombosis of the operative limb and prevent infection. Conclusion The consensus is highly scientific，and it is helpful to standardize the limb management of patients with transvenous temporary cardiac pacing.

Specialist Practice and Research

Construction and validation of a fatigue risk nomogram model in patients with chronic obstructive pulmonary disease

RU Yunxin, LAI Lixin, LIANG Facun, YANG Weihong, ZHANG Quanying, SHEN Guodi, LI Xue

2024, 59(13):  1584-1591.  DOI: 10.3761/j.issn.0254-1769.2024.13.008

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Objective To develop and validate a fatigue risk nomogram model in Chronic Obstructive Pulmonary Disease（COPD） patients. Methods A prospective study design was adopted，and 430 COPD patients recruited from a tertiary A hospital in Huzhou City from January to December 2022 were conveniently selected for model construction，and 129 patients were recruited from the same hospital from January to June 2023 for external validation of the model. The general information questionnaire，Pittsburgh Sleep Quality Index，2-item Generalized Anxiety Disorder Scale，2-item Patient Health Questionnaire，modified British Medical Research Council Dyspnea Index，International Physical Activity Questionnaire，and Fatigue Severity Scale were used for questionnaire survey.The risk prediction model and nomograms model were constructed using Logistic regression analysis and R 4.3.2 software，and the area under the receiver operating characteristic（ROC） curve was used to test the prediction effect of the model. Results Univariate and binary logistic regression analysis results showed that age（OR=1.095），gender（OR=2.077），dyspnea（OR=3.309），sleep quality（OR=1.979），anemia（OR=3.289），the number of acute exacerbation（OR=2.991） were independent influencing factors for fatigue in COPD patients. The internal evaluation and external validation results of the model showed that the areas under the curve are 0.912 and 0.844 respectively，and the Hosmer-Lemeshow goodness of fit test P values were 0.806 and 0.526 respectively. The average absolute errors were 0.013 and 0.019 respectively. Conclusion The COPD fatigue risk prediction model constructed in this study has good prediction effect. The visual nomogram is intuitive，convenient and easy to operate. It can provide a tool for early screening of fatigue in COPD patients.

Analysis of the trajectory of changes in dietary behavioral adherence in young and middle-aged patients with type 2 diabetes mellitus and the influencing factors

CAI Peixuan, LIANG Yiqing, WANG Jingjing, ZHAO Songqing, ZHANG Yi, CAO Songmei

2024, 59(13):  1592-1599.  DOI: 10.3761/j.issn.0254-1769.2024.13.009

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Objective To explore the potential categories and influencing factors of dietary behavioral adherence trajectories in young and middle-aged patients with type 2 diabetes mellitus. Methods A convenience sampling method was used to investigate 277 young and middle-aged patients with type 2 diabetes mellitus admitted to the Department of Endocrinology of a tertiary A hospital in Huai’an City，China，from September 2022 to March 2023. The baseline data were collected using a general information questionnaire，the Dietary Behavioral Compliance Scale for Patients with Type 2 Diabetes Mellitus，the Diabetes Self-Efficacy Scale，the Diabetes Knowledge Text，the Health Beliefs Questionnaire，and the Family APGAR Index Questionnaire. The baseline information was collected on the patients’ behavioral adherence trajectories a day prior to hospital discharge（T0），a week post-discharge（T1），a month post-discharge（T2），and 3 months post-discharge（T3） to assess the level of patients’ dietary behavioral adherence，using latent variable growth mixed models to identify trajectory categories，and univariate and multivariate logistic regression to analyze the influences on dietary adherence trajectories. Results A total of 3 trajectories of dietary behavior adherence in young and middle-aged patients with type 2 diabetes mellitus were identified，namely，low adherence-fluctuating group（49.8%），high adherence-slowly regressing group（31.4%），and medium adherence-continuously rising group（18.8%），and the results showed that age，literacy level，self-efficacy，health beliefs，and family caring were the factors influencing potential categories of dietary behavioral adherence for young and middle-aged patients with type 2 diabetes mellitus. Conclusion There is heterogeneity in the adherence trajectories of young and middle-aged patients with type 2 diabetes mellitus，and healthcare professionals can develop targeted interventions according to the influencing factors of the trajectory categories in order to improve their adherence.

Construction and validation of a risk prediction model for the delayed healing of venous leg ulcers

HUANG Siyuan, LIU Xinjun, YANG Xi, ZHANG Mingfeng, WANG Dan, XIONG Huarong, YAO Zuoyi, SHI Meihong

2024, 59(13):  1600-1607.  DOI: 10.3761/j.issn.0254-1769.2024.13.010

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Objective To construct and validate a risk prediction model for delayed healing of venous leg ulcer （VLU），so as to provide a reference basis for early identification of people at high risk of delayed healing. Methods Using a convenience sampling method，331 VLU patients attending vascular surgery departments in 2 tertiary A hospitals in Sichuan Province from January 2018 to December 2022 were selected as a modeling group and an internal validation group，and 112 patients admitted to another tertiary A hospital were selected as an external validation group. Risk factors for delayed healing in VLU patients were screened using univariate analysis，LASSO regression，and multivariate logistic regression analysis，and a risk prediction model was constructed using R software，and the predictive effects of the models were examined using the area under the receiver operating characteristic curve，the Hosmer-Lemeshow test，decision curve，and the bootstrap resampling for internal validation and spatial external validation were performed，respectively. Results The predictors that ultimately entered the prediction model were diabetes（OR=4.752），deep vein thrombosis（OR=4.104），lipodermatosclerosis（OR=5.405），ulcer recurrence（OR=3.239），and ankle mobility（OR=5.520）. The model had good discrimination（AUC：0.819 for internal validation and 0.858 for external validation），calibration（Hosmer-Lemeshow test：χ²=13.517，P=0.095 for internal validation and χ²=3.375，P=0.909 for external validation） and clinical validity. Conclusion The model constructed in this study has good differentiation and calibration，and it can effectively predict people at high risk of delayed healing of VLU，which facilitates targeted clinical interventions to improve ulcer outcomes and reduce the risk of delayed ulcer healing.

Enteral and Parenteral Nutrition

Construction of a risk prediction model for refeeding syndrome in patients with acute pancreatitis and its nursing implications

HE Hongmei, YU Fang, LIN Lihua, SHU Fang

2024, 59(13):  1608-1615.  DOI: 10.3761/j.issn.0254-1769.2024.13.011

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Objective To explore the risk factors affecting the occurrence of refeeding syndrome in patients with acute pancreatitis，to establish a risk prediction model and verify it，and provide enlightenment for clinical nursing management. Methods A total of 260 patients with acute pancreatitis in our hospital from January 2021 to March 2023 were selected and divided into a refeeding syndrome group and a non-refeeding syndrome group according to whether refeeding syndrome occurred. Logistic regression analysis was performed on the related factors，and the risk model of array diagram was constructed and verified. Results Of the 260 patients with acute pancreatitis，56 developed refeeding syndrome，with an incidence of 21.54%. The results of factor analysis showed that high grade of gastrointestinal function，additional protein supplementation during feeding，NRS score and rapid infusion of nutrient solution were independent risk factors for refeeding syndrome in patients with acute pancreatitis （OR>1，P<0.05）. High serum prealbumin concentration before feeding and high serum albumin concentration before feeding were independent protective factors（OR<1，P<0.05）. The results of Hosmer-Lemeshow goodness-of-fit test showed that χ²=8.019，P=0.432；the area under the ROC curve was 0.915（P<0.001，95%CI：0.865~0.965）；the sensitivity was 83.30%；the specificity was 87.90%；the maximum Youden index was 0.712. The model regression equation Logit（P）=1.899 × additional protein supplementation in feeding+1.549 × gastrointestinal function classification+0.683 × NRS score+0.031 × nutrient solution infusion rate-0.018×prefeeding serum albumin-0.038 × prefeeding serum albumin-9.836. Conclusion The risk prediction model of refeeding syndrome in patients with acute pancreatitis established in this study has good accuracy and discrimination，which can predict the risk of refeeding syndrome in patients with acute pancreatitis for clinical nursing staff and formulate individualized prevention strategies as soon as possible.

Summary of the best evidence for nutritional management in patients with severe pneumonia

YOU Junjie, LIU Bo, CHEN Mengling, SHEN Yushan, ZHENG Silin, HUANG Min

2024, 59(13):  1616-1623.  DOI: 10.3761/j.issn.0254-1769.2024.13.012

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Objective To summarize the best evidence of nutrition management in patients with severe pneumonia，aiming to offer evidence-based guidance for clinical healthcare professionals. Methods All evidence on nutrition management in patients with severe pneumonia was retrieved from various databases and websites including BMJ Best Practice，UpToDate，National Guideline Clearinghous（NGC），Guidelines International Network（GIN），Registered Nurses’ Association of Ontario（RNAO），National Institute for Health and Care Excellence（NICE），Cochrane Library，OVID，PubMed，Embase，Web of Science，CINAHL，Chinese Medical Journal Full-text Database，CNKI，VIP，Wanfang，CBM，American Society for Parenteral and Enteral Nutrition（ASPEN），European Society for Clinical Nutrition and Metabolism（ESPEN），Society of Critical Care Medicine（SCCM） and European Society of Intensive Care Medicine（ESICM）. The retrieved evidence included clinical decisions，guidelines，systematic reviews，expert consensuses and evidence summaries. The search period ranged from January 1st，2012 to December 31st，2022. There were 2 researchers who independently assessed the quality of the included studies and then extracted and summarized the evidence by topic. Results A total of 13 articles were involved，including 3 clinical decisions，4 guidelines，1 systematic review，and 5 expert consensuses. A total of 24 pieces of evidence were summarized across 6 aspects which encompassed team building，nutrition screening and assessment，nutritional requirements，nutrition intervention，nutrition monitoring，and health education. Conclusion The production process of this evidence summary followed standardized procedures，ensuring comprehensive content. Medical professionals should integrate clinical conditions，patient factors，and family preferences to select the most optimal evidence in order to enhance patient prognosis and improve medical quality.

Nursing Management

Regional differences and dynamic evolution of nursing human resource allocation in the western region

YANG Jingjing, LIU Tingting, CHEN Jieting

2024, 59(13):  1624-1631.  DOI: 10.3761/j.issn.0254-1769.2024.13.013

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Objective To explore the regional differences in nursing human resource allocation and the dynamic evolution in the western region，in order to provide a scientific and effective basis for the balanced allocation of nursing human resources. Methods Dagum’s Gini coefficient，kernel density estimation method and Markov chain were employed to analyze the regional differences，dynamic evolution and trend prediction of nursing human resource allocation in 12 provinces（autonomous regions and municipalities） in western China from 2011 to 2020. Results From the point of view of regional differences，the overall regional differences in the allocation of nursing human resources are on a downward trend and stem mainly from intra-regional differences；the overall regional differences between urban and rural areas stem mainly from inter-regional differences. From the perspective of dynamic evolution，nursing human resources have been continuously upgraded and the absolute difference in the allocation level has gradually increased. From the perspective of trend prediction，the transferring probability between different types of nursing human resource allocation in the west is low，and spatial factors have a polarizing effect on it. Conclusion The level of nursing human resources allocation in the western region has gradually increased，and the overall development goes towards the level of equalization，and the level of nursing human resources allocation in each type is stable and significantly affected by spatial factors. The government should establish regional，urban，and county nursing specialty alliances as well as innovative information-based nursing service models，and implement nursing talent training mechanisms to improve the balanced allocation of nursing human resources in the western region.

Study on the working status and influencing factors of specialist nurses in 72 tertiary hospitals in Anhui Province

LI Zhiju, WU Yihua, ZHANG Jianfeng, REN Chunxia

2024, 59(13):  1632-1638.  DOI: 10.3761/j.issn.0254-1769.2024.13.014

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Objective The aim of this study is to analyze the current situation and influencing factors of specialist nurses’ work in 72 tertiary hospitals in Anhui Province which can provide suggestions for the training and use of specialist nurses. Methods Using stratified sampling，a survey of 2，400 specialist nurses in 72 tertiary hospitals across the province were recruited and investigated by a self-administered questionnaire on the current work status and competencies of specialist nurses，from December 2022 to January 2023. The one-way ANOVA and multiple linear regression methods to analyze the influencing factors. Results A total of 2，248 valid questionnaires were returned from specialist nurses，with a validity rate of 93.67%. Specialist nurses scored （19.07±5.11） for their current work status and（17.07±2.84） for their ability to work. The results of multiple linear regression analyses showed that the level and nature of the hospital，title，position，method of obtaining training qualifications，working time in the speciality after training，and the competence of the specialist nurses were the factors influencing the current status of the specialist nurses’ work（P<0.05）. Conclusion The current status of specialist nurses’ work in tertiary hospitals in Anhui Province is relatively satisfactory，and it is influenced by the level and nature of the hospital，the way of training and selection，and factors of the specialist nurses themselves. It is recommended to pay attention to the subsequent use and training of specialist nurses to improve their ability to work and provide high-quality professional care to patients.

Intractable Diseases Care

Perioperative care of a child undergoing autologous vascular bypass grafting complicated by severe lower limb ischemia with extracorporeal membrane oxygenation

PAN Yu, PAN Xiangying, ZHOU Bin, JIN Jiajia

2024, 59(13):  1639-1644.  DOI: 10.3761/j.issn.0254-1769.2024.13.015

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To summarize the nursing experience of a child with severe cardiopulmonary failure caused by fulminant myocarditis who underwent autologous vascular bypass grafting after severe lower limb ischemia during extracorporeal membrane oxygenation therapy. The key points of nursing include：①keeping the distal perfusion tube unobstructed before surgery to avoid aggravation of ischemia of the affected limb；physical precautions for deep vein thrombosis are strictly implemented to ensure the patency of the saphenous vein. ②intraoperative nursing cooperation for the conversion of venous-arterial-venous extracorporeal membrane oxygenation to venous-venous extracorporeal membrane oxygenation. ③on the premise of ensuring systemic perfusion after surgery，the blood pressure should be strictly controlled to prevent the rupture of the grafted vessel；to strengthen the management of coagulation to prevent bleeding and thrombosis；different position management of both lower limbs to keep the grafted blood vessels patency；to develop individualized exercise programs to enhance nutrition and promote rapid recovery；to give individualized psychological nursing care including childlike fun and sense of security，and eliminate children’s negative emotions；to develop systematic health guidance and follow-up to improve the quality of family care for children. After treatment and nursing care，the postoperative grafted blood vessels were well anastomosed with no limb ischemia，and there was no swelling of the limb in the saphenous vein donor area. After 41 days of the treatment，the extracorporeal membrane oxygenation was withdrawn. The child recovered and discharged after 122 days；after 2 years of follow-up，the child could walk normally and recovered well.

First aid and nursing care of a child with abdominal multi-organ burn complicated with liver laceration

SHEN Qingqing, LI Hejun, ZHANG Xuebing, YANG Chen

2024, 59(13):  1645-1649.  DOI: 10.3761/j.issn.0254-1769.2024.13.016

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To summarize the nursing experience of a pediatric patient with multiple organ burns in the abdominal cavity and liver laceration caused by a fireworks explosion. The following nursing points were implemented：immediate activation of a multidisciplinary trauma rescue team upon admission to initiate emergency measures for traumatic shock；implementation of target-oriented fluid management to expedite postoperative intestinal function recovery；active control of abdominal infection to minimize the risk of septic shock；thorough and accurate assessment was conducted to prevent postoperative complications such as gastrointestinal hemorrhage，bile-leakage，gallbladder perforation，and delayed intestinal necrosis；nutritional screening and assessment was performed to develop personalized nutritional support programs；emphasis should be placed on pain assessment to implement individualized analgesia measures；the provision of high-quality psychological support focusing on addressing psychological trauma. The child was successfully discharged 36 days after surgery and exhibited satisfactory recovery during the two-month follow-up period.

Evidence Synthesis Research

Summary of the best evidence for the xerostomia and thirst management in maintenance hemodialysis patients

LIU Pengcheng, MA Qin, WANG Wei, HU Dongyan, TAN Liping, JIANG Xiaomei

2024, 59(13):  1650-1656.  DOI: 10.3761/j.issn.0254-1769.2024.13.017

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Objective To search，evaluate and summarize the relevant evidence of management on xerostomia and thirst of maintenance hemodialysis（MHD） patients，and provide the evidence for clinical medical staff to relieve the symptoms of xerostomia and thirst in MHD patients. Methods We search guideline websites such as the BMJ Best Practice，UpToDate，NICE，GIN，NGC，CMA Infobase，Medlive，and databases such as Cochrane Library，JBI，PubMed，Embase，CINAHL，CNKI，Wanfang，VIP，SinoMed related to interventions on xerostomia and thirst of MHD patients. The literature types include guidelines，expert consensuses，clinical decisions，best practice，evidence summaries，systematic reviews，randomized controlled trials. The search period is from January 1，2013 to September 30，2023. Results A total 12 pieces of the literature were included，including 3 systematic reviews and 9 randomized controlled trials. A total of 19 pieces of evidence were summarized in 6 aspects，including evaluation，basic interventions，oral local interventions，auricular acupressure，dialysis scheme，Chinese herbal medicine combined with acupoint therapy and Chinese herbal medicine therapy. Conclusion Blood purification medical staff should comprehensively consider MHD patients and specific clinical situations，and make interventions to relieve the symptoms of xerostomia and thirst of MHD patients，relieve their physical and mental pain and improve their quality of life.

Palliative care quality assessment tools based on the cancer patient experience：a systematic review

CHU Yunyi, JIANG Zifang, HE Zefan, ZHANG Jiaxin, CHEN Yanfei

2024, 59(13):  1657-1665.  DOI: 10.3761/j.issn.0254-1769.2024.13.018

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Objective To systematically evaluate the measurement properties and methodological quality of the palliative quality assessment tools based on the cancer patient experiences，and to provide an evidence-based basis for the selection of a high-quality assessment tool for healthcare professionals. Methods Systematic search of PubMed，Embase，Web of Science，CINAHL，CNKI，Wanfang database，VIP database，and China Biomedical Literature database for studies related to the evaluation of the measurement properties of the self-report palliative care quality assessment tools for cancer patients. The search period from the date of creation to December 10，2023. There are 2 researchers who independently conducted literature screening and data extraction according to the COSMIN selection criteria，and used the COSMIN Risk of Bias Inventory and Quality Criteria Scale to measure the academic characteristics and form the final recommendations. Results A total of 19 studies involving 8 assessment tools for cancer patients were included. The final 6 assessment tools were recommended at level B. 2 assessment tools are recommended at level A. Conclusion The SF-QCQ-PC and the Self-Report Palliative Care Quality Assessment Tool for Terminal Cancer Patients can be provisionally recommended. However，further validation of its measurement properties is still needed.