Table of Content

15 June 2019, Volume 54 Issue 6

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Research Paper

The development and application of a risk prediction model for hepatic encephalopathy in patients with liver cirrhosis

WANG Na, LI Juan, LI Xia, LIANG Luwen, GAN Xiuni, WANG Xiaomei

2019, 54(6):  805-811.  DOI: 10.3761/j.issn.0254-1769.2019.06.001

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Objective To explore the risk factors associated with hepatic encephalopathy in patients with cirrhosis and evaluate the effects of a prediction model.Methods A total of 276 cirrhotic patients in a tertiary hospital were involved from July to September in 2018,and indicators of hepatic encephalopathy group (n=31) and non-hepatic encephalopathy group(n=245) were compared. The prediction model was developed by independent risk factors,and the model to predict the effects were tested by the area under the ROC cure.Results The study found that previous hepatic encephalopathy,total bilirubin,transjugular intrahepatic portosystemic shunt and hepatorenal syndrome were the independent factors of hepatic encephalopathy. Based on these independent risk factors,a predicted model for hepatic encephalopathy in cirrhotic patients was constructed. The model was P=e ^x/(1+e ^x),and X=-3.791 +2.19 × previous hepatic encephalopathy+0.685 × total bilirubin+2.490 × transjugular intrahepatic portosystemic shunt+2.914 × hepatorenal syndrome. The area under the ROC curve of this model was 0.840(95%CI：0.757~0.924),with the sensitivity of 0.839,the specificity of 0.776. And the verification of this prediction model showed the sensibility of 90.5%,the specificity of 85.0% and the accuracy of 85.5%,showing the effects of this model were satisfied.Conclusion The prediction model of hepatic encephalopathy has satisfactory prediction effects. It can be used to predict the risk of hepatic encephalopathy in cirrhosis patients,providing the reference for management and preventative treatment for high-risk cirrhosis patients.

Clinical study of bioelectrical impedance assisted assessment of volume in hemodialysis patients

LI Qianqian, WEI Lili, PANG Xufeng, LIU Yun, WAN Xiangyu, ZHU Yamei, HE Yalan, XU Qinjuan

2019, 54(6):  812-816.  DOI: 10.3761/j.issn.0254-1769.2019.06.002

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Objective Using bioelectrical impedance method to evaluate the volume of hemodialysis patients and provide a new method for evaluating volume.Methods From December 2016 to October 2017,108 maintenance hemodialysis patients from three tertiary hospitals in Jiangsu Province were selected. Patients were randomly divided into the experimental group and the control group. The volume of patients in the control group was evaluated by clinical assessment method,and the experimental group was evaluated by bioelectrical impedance assessment. Before and half a year after follow-up,blood pressure,rate of reaching the standard of family blood pressure,rate of volume control,and left ventricular mass index(LVMI) were compared between two groups.Results Diastolic blood pressure, compliance rate of volume control and left ventricular mass index before dialysis showed no significant difference between the two groups(P>0.05).Three months and 6 months after intervention,the systolic blood pressure before dialysis and rate of reaching the standard of family blood pressure in the experimental group were significantly higher than those in the control group(P<0.05).Conclusion Bioelectrical impedance assisted assessment can improve systolic blood pressure and rate of reaching the standard of family blood pressure.

Development and application of oral feeding process in premature infants

NIE Jiao, LIU Xiaoshu, WANG Jinxiu, TU Manmei, LEI Jiafang, FU Fang

2019, 54(6):  817-821.  DOI: 10.3761/j.issn.0254-1769.2019.06.003

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Objective To formulate the oral feeding process in premature infants and evaluate its effects.Methods Convenience sampling method was used to recruit premature infants hospitalized from January to December 2017 as the experimental group that received care according to oral feeding process. While premature infants hospitalized from January to December 2016 were selected as the control group and received routine feeding care. Complication rates,time to full oral feeding,length of tube feeding,and length of hospital stay were compared between two groups.Results Rates of apnea,vomiting,SpO₂<85% in the experimental group were lower than those in the control group with statistically significant difference(P<0.05). Length of tube feeding and time to full oral feeding were shorter in the experimental group(P<0.05). The average length of hospital stay was shorter in the experimental group(P<0.05).Conclusion The implementation the oral feeding process in premature infants can enhance safety and shorten progress of feeding.

Special Planning——Artificial Airway Management

Development and analysis of Expert Consensus on Nursing Care for Prevention of Adult Oral Tracheal Intubation Unplanned Extubation/Tianjin Nursing Quality Control Center

WANG Ying, XIA Xinhua, WANG Xinran, TIAN Yongming, CHEN Rongxiu, SHEN Aomei

2019, 54(6):  822-828.  DOI: 10.3761/j.issn.0254-1769.2019.06.004

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Objective To establish expert consensus on nursing standard for prevention of adult oral tracheal intubation unplanned extubation.Methods Studies from domestic and foreign were retrieved and the ‘Prevention of Tracheal Intubation Unplanned Extubation Cluster Care Package’ drawn up by Tianjin Nursing Quality Control Center as well as professional experience were taken into consideration. Expert Delphi mail questionnaire was developed according to the key issues of nursing care. Forty experts from Beijing,Tianjin,Shanghai,Guangdong,Sichuan,Hunan and Hebei were invited to complete 3 rounds of Delphi expert consultation and 2 rounds of expert meeting. Each item was revised and adjusted considering objective evidence and expert opinions.Results The positive coefficients of experts in three rounds of Delphi expert consultation were all 100%,and the degrees of expert authority were all 0.87. The average assignment values of experts to the importance of items were 4.86±0.35,4.94±0.27,and 4.97±0.16,and the Kwbdall's W were 0.135,0.174,and 0.262,respectively(all P<0.001). At last,experts agreed on 23 items under 6 dimensions of nursing care.Conclusion The consensus strictly follows the standardized process of literature study--draft construction--Delphi inquiry--onsite meeting,and integrates the resources of nursing quality control centers from several provinces and cities,and multi-disciplinary experts' suggestions. It is professional,scientific,rigorous and authoritative. The consensus can not only provide guidance for clinical nursing practice,but also lay a foundation for the formulation of guidelines and standards in this field. However,further theoretical and empirical studies are needed to verify the consensus.

Effects of bedside wheelchair seating in patients with severe acute pancreatitis combined with mechanical ventilation

WANG Yuguang, YE Rui, MA Jia, LIU Lili, WANG Hongwei, LIANG Ziwei, LIU Dongmei, CAI Tongxin, REN Xiuhui, ZHANG Xiwei

2019, 54(6):  829-834.  DOI: 10.3761/j.issn.0254-1769.2019.06.005

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Objective To explore the application effects of bedside wheelchair seating in patients with severe acute pancreatitis and acute respiratory distress syndrome undergoing mechanical ventilation.Methods Semi-experimental research method was used. We set up a management team for bedside wheelchair sitting,and implemented early activities using bedside wheelchair seating. A total of 30 patients were selected as the experimental group between March 2016 and July 2018,and were treated with beside wheelchair seating. A total of 28 patients were selected as the control group between January 2014 and February 2016,and received routine treatment. The incidence of ICU acquired debilitation,the length of mechanical ventilation,the length of stay in ICU,the oxygenation index before withdrawing tracheal tube(30 min from the ventilator),and the incidence of adverse events in two groups were compared.Results The incidence of ICU acquired debilitation in the experimental group and in the control group was 26.60% (8 cases) and 57.14% (16 cases),and the difference was statistically significant(P<0.05);the length of mechanical ventilation was (5.94±1.05) d and (8.47±1.45) d,the length of stay in ICU was (7.11±0.99) d,(9.93±2.06) d,and the differences were statistically significant(P<0.05). The oxygenation index was (294.20± 21.18) mmHg and(290.96±27.36) mmHg without statistically significant difference(P>0.05);the incidence of adverse events was 3.30% (1 case)and 0.00% (0 cases),respectively,and the difference was not statistically significant(P>0.05).Conclusion The bedside wheelchair sitting can effectively help patients to prevent the occurrence of ICU acquired debilitation,shorten the length of mechanical ventilation and stay in ICU. It is safe and effective,and has good clinical application value.

Clinical effects of different dressings on prevention of neck skin injury after tracheotomy

ZHENG Xiaolin, LIU Litian, SU Guixia, ZHAO Hui, YIN Zhigai

2019, 54(6):  835-838.  DOI: 10.3761/j.issn.0254-1769.2019.06.006

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Objective To compare the effects of three nursing methods in preventing neck skin injury of tracheotomy patients.Methods A total of 168 cases of tracheotomy patients were randomly divided into 3 groups with 56 cases in each group：the liner gauze(Group I),the hydrocolloid dressing(Group Ⅱ),and the liner foam dressing(Group Ⅲ). The incidence of neck skin injury,the service length of liner dressing,the time of dressing replacement,the difficulty of dressing replacement,and average cost were compared in three groups,and the effects of three nursing methods in preventing neck skin injury in tracheotomy patients were evaluated.Results There were 13 cases,5 cases,and 1 case of skin injury in group Ⅰ~Ⅲ,respectively. There was significant difference in the incidence and severity of skin injury among three groups (P<0.05). The service length of liner dressing from low to high was Group Ⅰ,Group Ⅱ and Group Ⅲ,respectively. The time spent in replacing dressing from low to high was Group Ⅲ,Group Ⅰ and Group Ⅱ,respectively. The difficulty of replacing dressing from low to high was Group Ⅲ,Group Ⅰ and Group Ⅱ,respectively. The average cost from low to high was Group I,Group II and Group III,respectively.Conclusion Foam dressing can effectively prevent neck skin injury in patients underwent tracheotomy,and it has long length of service,short replacement time,is easier to operate,and more suitable for patients with tracheotomy,but economic cost is slightly higher.

Establishment and clinical evaluation of artificial airway strategy in neurological coma patients

HU Na, LI Chunlin, DU Xiaoliang, FANG Jifeng, XU Chuan, ZHAO Kai, ZHANG Huaqiu

2019, 54(6):  839-842.  DOI: 10.3761/j.issn.0254-1769.2019.06.007

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Objective To explore the effects of application of artificial airway strategy in neurological coma patients.Methods The clinical data of 283 neurological patients(Glasgow Coma Scale,GCS<6) with artificial airway were collected. Totally 161 patients admitted from 2013 to 2015 were selected as the control group and received routine airway management. The comprehensive artificial airway strategy was performed in 122 patients who were selected as the experimental group hospitalized from 2016 to 2018. The characteristics of sputum and subglottic secretion,incidence of pulmonary infection,length of stay in neurosurgical intensive care unit and average duration of hospitalization were analyzed before and after intervention.Results For the experimental group,the volume of sputum and subglottic secretion were significantly decreased(P<0.001). Compared with the control group,the pulmonary infection rate was remarkably decreased to 32.8% (P<0.01). Length of stay in neurosurgical intensive care unit and average duration of hospitalization were reduced in the experimental group than the control group (P<0.01 and P<0.001). The score for evaluation of the performance efficiency of comprehensive airway management was 94.6±1.8.Conclusion Application of comprehensive airway management in coma patients can improve the characteristics of sputum,reduce the pulmonary infection rate,shorten duration of hospitalization,and improve the prognosis.

Effects of early mobilization on mortality in patients with mechanical ventilation in Intensive Care Unit during hospitalization：a cumulative meta-analysis

YANG Liping, ZHANG Zhigang, ZHANG Caiyun, WEI Huaping, MENG Wenbo, YUE Weigang, YAO Li, DING Nannan, TIAN Jinhui

2019, 54(6):  843-849.  DOI: 10.3761/j.issn.0254-1769.2019.06.008

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Objective To evaluate the effects of early mobilization on mortality in patients with mechanical ventilation in Intensive Care Unit by a cumulative meta-analysis.Methods Databases including CNKI,CBM,WanFang Data,PubMed,Embase,Web of Science,and The Cochrane Library were searched from inception to December 30,2018,to collect randomized controlled trials(RCTs) about early mobilization in patients with mechanical ventilation in Intensive Care Unit. Two reviewers independently screened literature,extracted data,and assessed risk of bias of included studies. A cumulative meta-analysis according to chronological order was performed using STATA 12.0 software,and the trial sequencing analysis(TSA) method was used to assess the reliability and authenticity of the results.Results A total of 16 studies including 1,928 patients were included. The cumulative meta-analysis results showed that the cumulative effect of early mobilization could not increase the mortality during ICU(OR= 1.43,95% CI 0.83 to 2.48) and hospitalization(OR=0.92,95% CI 0.72 to 1.18) in patients with mechanical ventilation. TSA results showed that the cumulative information did not cross the traditional threshold or the TSA threshold,and did not meet the expected information. Therefore,there was no statistical difference in mortality between the intervention group and the control group.Conclusion Existing evidence suggests that early mobilization does not increase the mortality of patients with mechanical ventilation. Due to the limitation of quantity and quality of research,more studies are needed to confirm the above conclusions.

Special Planning——Nursing Risk Management

The construction and clinical application of information management system for protective restraint

WANG Hui, YIN Shiyu, WANG Ying, YANG Ting, HU Kaili

2019, 54(6):  850-854.  DOI: 10.3761/j.issn.0254-1769.2019.06.009

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Objective To construct an information management system for protective restraint,for guiding clinical nurses to make scientific decisions and use constrained appliances reasonably.Methods Through literature review,expert consultation,group discussion and other methods,main contents of the management system were established. By collaborating with the computer center,a standardized system for assessment,reporting,monitoring for inpatients was built,and put into clinical application after trial operation and clinical debugging.Results The concordance rates for using protective constraint before and after the implementation of information system were 78.102% and 97.321%,respectively,and the rates of protective constraint were 0.906% and 0.799%,respectively,the differences were statistically significant(P<0.05). After the implementation of information system,the accuracy rate of assessment,the execution rate of standardized measures,the rate of dynamic observation,and the rate of shift turnover were getting improved,and the differences were statistically significant(P<0.05).Conclusion The information management system for protective constraint can replace experience management to help nurses scientifically,objectively evaluate and decide on the constraints and timing,regulate body constraint process,and guide nurses to timely report,dynamically monitor and accurately feedback.

The effect of HELP to prevent the occurrence of delirium in hospitalized elderly patients

HUANG Yan, ZHANG Meng, GAO Langli, XIE Dongmei, YUE Jirong, ZHAO Wenting, ZHANG Xuemei

2019, 54(6):  855-860.  DOI: 10.3761/j.issn.0254-1769.2019.06.010

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Objective To explore the effect of the Hospitalized Elderly Life Program (HELP) on the prevention of delirium in hospitalized elderly patients.Methods A Chinese version of the HELP was developed. We assessed risk factors related to delirium,and used the multi-disciplinary team work to develop targeted and individualized non-drug interventions. Two hundred hospitalized elderly patients were randomly divided into the intervention group and the control group,each group had 100 elderly patients. Patients in the intervention group adopted routine nursing methods combined with the HELP program for 2 weeks,and the control group adopted routine nursing methods. We compared the incidence of delirium,activities of daily living,cognitive function and length of stay between two groups.Results The incidence of delirium was 5.2% in the intervention group and 13% in the control group. The difference was statistically significant (P<0.05). At the same time,the activities of daily life and cognitive function of the intervention group were better,length of stay was shorter than that in the control group (P<0.05),the difference was statistically significant (P<0.05).Conclusion The HELP program can effectively prevent the occurrence of delirium in hospitalized elderly patients,and good for improvement of activities of daily life and cognitive function,and it can shorten the length of stay.

A survey of non-psychiatric inpatients suicides from 45 general hospitals in Hubei Province,China

DING Xiaoping, HU Deying, WAN Qing, LIU Yilan, WANG Shujie, HAN Yanhong, LU Ruifei, MAO Shiqing, XU Ke

2019, 54(6):  861-867.  DOI: 10.3761/j.issn.0254-1769.2019.06.011

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Objective To understand the characteristics and influencing factors of suicidal behaviors of non-psychiatric inpatients in general hospitals in Hubei Province.Methods Using stratified-typical-target sampling method,50 general hospitals in Hubei Province were selected according to the ratio of 1∶1. All adverse event reporting system databases received between January 1st,2015,and December 31st,2017 were collected and analyzed to identify any events that involved suicide or suicide attempts occurred in the above hospitals.Results Totally 169 cases of non-psychiatric inpatients suicides were reported in 45 general hospitals. The incidence of inpatients suicidal behaviors in general hospitals was 3.48/100,000 admissions,the incidence of inpatients suicidal behaviors in secondary hospitals was 1.10 times higher than that in tertiary hospitals. Inpatients whose age≥60,with primary or junior high school education,unemployed or peasants,suffering from malignant tumors or chronic diseases,were more likely to commit suicide. Suicidal behaviors in hospitalized patients were more common in the spring,at 00：00-07：59 and within 1 week,mainly in the ward. The main suicide way was jumping from the buildings. The suicide completion rate was as high as 49.1%. Eleven hospitals had serious medical disputes due to suicide. The causes of suicide were mainly physical illness,family relationship,and family economy.Conclusion The incidence of inpatients suicidal behaviors in general hospitals is high. Administrators should provide training for healthcare providers on characteristics and influencing factors of inpatients suicidal behaviors,to improve focus and attention of healthcare providers towards suicide among inpatients.

Quality appraisal and content analysis of clinical practice guidelines on prevention and management of medication errors

TAN Ran, ZENG Xiantao, CAO Yingjuan, Lü Xiaoyan, SHEN Lin, XIA Jinghua

2019, 54(6):  867-872.  DOI: 10.3761/j.issn.0254-1769.2019.06.012

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Objective To evaluate the quality of clinical practice guidelines concerning prevention and management of medication errors,to provide recommendations for reducing medication errors improving medication safety among nurses.Methods The included guidelines recruited from international guideline websites,websites of academic societies or institutions,and electronic databases(from inception to January 31st 2019)were evaluated and analyzed.Results Ten guidelines were included. Four of them were evidence-based and the other six were expert consensus. One evidence-based guideline was rated according to AGREE II as A,three were rated as B,and the quality was relatively high. All 6 expert consensus guidelines were rated as included. Totally 27 items of recommendation were summarized from 10 guidelines.Conclusion The quality of the included guidelines for prevention and management of medication errors is good in general. Recommendations can offer evidence for regulated medication,and improve safety of medication.

Specialist Practice and Research

Adherence and associated factors of non-vitamin K antagonist oral anticoagulants therapy in patients with non-valvular atrial fibrillation

WU Shanshan, HUANG Yuanping, XIE Shuo, XU Yingjie, WANG Lizi

2019, 54(6):  878-881.  DOI: 10.3761/j.issn.0254-1769.2019.06.014

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Objective To investigate adherence and associated factors of non-vitamin K antagonist oral anticoagulants(NOACs) therapy,as well as reasons of discontinuance in patients with non-valvular atrial fibrillation(NVAF).Methods By convenience sampling,133 patients with NVAF on NOACs therapy from March 2016 to March 2018 were followed up to collect data about duration of anticoagulation,reasons for cessation and adverse events. Kaplan-Meier and Cox regression were used to explore adherence of NOACs and associated factors.Results One hundred and one(75.9%)and 32(24.1%) patients took dabigratran and rivaroxaban,respectively. The duration of anticoagulation in patients was 182 days. The duration time in patients taking dabigratran and rivaroxaban were 182 and 305 days,respectively. Survival table showed that the cumulative proportion of patients still taking the medicine at 3 months,6 months and 1 year was 72.5%,50.6% and 32.3%. Patients with paroxysmal AF,no heart failure and no stroke were associated with poor adherence of NOACs. Patient preference was the main reason for anticoagulant cessation.Conclusion Adherence of NOACs in patients with NVAF is poor with high rate of drug cessation. Multidisciplinary cooperation is needed for patients with paroxysmal AF,no heart failure and no stroke,to strengthen anticoagulation management and follow-up at the peak of drug discontinuation for the purpose of improving the quality of anticoagulation.

Longitudinal study of anxiety and depression during treatment of HIV-infected patients

CHEN Weimei, SHI Yirong, MIAO Qiqi, CHENG Lin, LI Shaxi, HE Yun, WANG Hui, XU Liumei

2019, 54(6):  882-885.  DOI: 10.3761/j.issn.0254-1769.2019.06.015

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Objective To investigate the dynamic trends of anxiety and depression levels in HIV-infected patients at different time points.Methods A total of 247 HIV-infected patients in outpatient department of a hospital were selected as subjects. General information questionnaire and Hospital Anxiety and Depression Scale were used to investigate anxiety and depression of HIV-infected patients before taking medicine,taking medicine for 3 months,taking medicine for 6 months. The scores of anxiety and depression in HIV-infected patients and CD4⁺ T lymphocyte count were analyzed by repeated measurement analysis of variance to explore the temporal effects.Results Before taking medicine,the anxiety and depression scores of HIV-infected patients were(19.04±2.34) and(17.05±2.48),respectively. The CD4⁺ T lymphocyte count was(281.00±146.35)/mm³. The levels of anxiety and depression were improved,and the CD4⁺ T lymphocyte counts gradually increased after taking medicine. Repeated measurement analysis of variance showed that the differences in scores of anxiety and depression and CD4⁺ T lymphocyte count among HIV-infected patients were statistically significant at different time points(F=11.33,P<0.001;F=11.68,P<0.001;F=156.02,P<0.001).Conclusion With the prolongation of antiviral drugs,the levels of anxiety and depression in HIV-infected patients are gradually reduced. Targeted interventions should be evaluated and implemented in a timely manner for different treatment periods.

The establishment of nursing assessment system for hospitalized elderly stroke patients

ZHAO Jie, CHANG Hong, FAN Kaiting

2019, 54(6):  886-890.  DOI: 10.3761/j.issn.0254-1769.2019.06.016

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Objective To establish an hospitalized elderly stroke patients nursing assessment system to assess the health problems in this population.Methods Delphi method was used to organize the recommendations from 24 experts that specialized in geriatric care,neurological care,health management,nursing management and critical care. In accordance with two rounds of expert advices and clinical experience,some items were revised.Results The response rates of two rounds,both were 100%. The authority coefficient of experts in the second round was 0.825,and the coordination coefficients of three level indicators were 0.534,0.295,0.320,respectively（P<0.001）. The final design concluded with 4 first-level indicators,including general medical assessment,physical function status,social participation,mental health status,14 second-level indicators and 40 third-level indicators.Conclusion Delphi expert consultation method demonstrated that the scale is scientific and reliable and can provide a basis for clinical nurses to make nursing strategies. However,this hospitalized elderly stroke patients nursing assessment system needs further verification and improvement.

Development and application of closed-loop information management system for breastfeeding in NICU

WEI Li, ZHU Feng, HUANG Chen, LIN Jiami, WANG Tingting, PAN Hongying

2019, 54(6):  891-895.  DOI: 10.3761/j.issn.0254-1769.2019.06.017

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Objective To conduct closed-loop management for breastfeeding in NICU using the concept of closed-loop information management to ensure the safety of breastfeeding and improve the efficiency of nursing work.Methods A multidisciplinary collaborative management team was established,existing problems in original breastfeeding management procedure were analyzed,and a closed-loop management information scheme for breastfeeding was established and developed. Information sharing between nursing information system and doctors’ order system was realized. Doctors’ orders for breastfeeding and formula were scientifically integrated.Results From January to December,2016,before implementation of closed-loop information management of breastfeeding,there were 1 accident and 2 near miss due to breastfeeding information checking errors. After implementation,from January to December,2017,breastfeeding-related accidents and near miss were reduced to 0 case. Before implementation,volume of breast milk collection,transcription of feeding list,computer entry of implementation of doctor’s orders for feeding were manually calculated,working hours were 2 per day,and working hours for calculation of breastfeeding rate were 8 per month. After implementation,the system automatically generated the information without manually calculation.Conclusion Application closed-loop information management for breastfeeding can ensure breastfeeding safety and reduce the workload of nursing staff.

Application of motivational interview based on self-efficacy theory in caregivers of children with enterostomy

TANG Wenjuan, LU Qunfeng, QU Wenqian, LU Yanping, ZHOU Yan

2019, 54(6):  896-901.  DOI: 10.3761/j.issn.0254-1769.2019.06.018

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Objective To explore the effect of motivational interview intervention based on self-efficacy theory on caregivers of children with enterostomy.Methods According to literature research and previous studies,motivational interview program was formulated,which included designing motivational interview strategy,screening and training for interviewing nurses. Seventy-two caregivers of children with enterostomy were randomly divided into two groups by using digital random table method with 36 cases in the experimental group and 36 cases in the control group. Five motivational interviews were conducted in the experimental group on the basis of routine health education and follow-up during hospitalization and 1,2,3 months after discharge;while the control group only received routine health education and follow-up. Self-efficacy scores,anxiety levels and complications related to stoma were compared between two groups at 1,2,3 month after discharge.Results After 3 months of intervention,self-efficacy scores of caregivers in the experimental group were higher than the control group,and the anxiety level was lower than the control group（P<0.05）. The incidence of peristomal dermatitis in the experimental group was significantly lower than the control group（P<0.05）.Conclusion Motivational interview intervention can improve self-efficacy level of caregivers of children with enterostomy,reduce their anxiety level,and reduce the incidence of peristomal dermatitis in children with enterostomy.

Nursing Management

Construction of service quality evaluation index system for long-term care of disabled elderly in nursing home based on Service Quality Gap Model

LIU Xiaohui, ZHAO Qinghua, XIAO Mingzhao

2019, 54(6):  902-907.  DOI: 10.3761/j.issn.0254-1769.2019.06.019

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Objective Combining Service Quality Gap Model to construct a quality evaluation index system for long-term care for disabled elderly in nursing home.Methods Through literature review,semi-structured interviews,Delphi method and analytic hierarchy process,the quality evaluation indicators for long-term care for disabled elderly in nursing home were established.Results The effective recovery rates of two rounds inquiry were 100.0% and 85.7%,respectively. The expert authority coefficients were 0.885 and 0.875. The coordination coefficients were 0.252 and 0.275. The final evaluation indicators for long-term care of disabled elderly in nursing home included 10 first-level indicators,21 second-level indicators,and 66 third-level indicators.Conclusion The quality evaluation index of long-term care for disabled elderly in nursing home is highly scientific,which can provide reference for further development of evaluation criteria and service guidelines for long-term care quality of elderly patients with disability.

Nursing Education

The mediating role of perceived stress between self-directed learning ability and career decision-making self-efficacy among nursing interns

CHENG Qiuhong, ZHANG Hongmei, ZHANG Panpan, SHI Zhiyi, HUANG Lijie, GUO Rui, ZHANG Qin, JIANG Qiuhuan

2019, 54(6):  908-912.  DOI: 10.3761/j.issn.0254-1769.2019.06.020

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Objective To investigate the relationship among self-directed learning ability,perceived stress,and career decision-making self-efficacy among nursing interns.Methods A total of 923 nursing interns from a tertiary hospital in Henan Province were investigated with Career Decision-making Self-efficacy Scale,Self-rating Scale of Self-directed Learning,Chinese Perceived Stress Scale in late stage of clinical practice.Results The scores of career decision-making self-efficacy was positively correlated with self-directed learning ability（r=0.503,P<0.01）,and perceived stress acted as a mediator in self-directed learning ability and career decision-making self-efficacy,the intermediary effect accounted for 21.60% of the total effect.Conclusion Clinical nursing educators should attach importance to the cultivation of self-directed learning ability,stress monitoring and intervention of nursing interns,in order to enhance their confidence in career selection and improve the sense of career decision-making self-efficacy.

Community Care

Construction and application of homogenized nursing linkage mode for wound care in the region

WANG Jing, YANG Yaping, FANG Lina, FAN Zhimin

2019, 54(6):  913-916.  DOI: 10.3761/j.issn.0254-1769.2019.06.021

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Objective To establish a homogenized nursing linkage mode for wound care in the region to promote the homogenization of wound knowledge and skills in the region,and provide homogenized wound care for patients.Methods We developed a management software system for diagnosis and treatment collaboration for wound care in the region,and investigated the level of wound nursing care of nurses in Yangpu district,Shanghai,using self-designed survey questionnaire. From November to December,2016,seven international stoma therapists in Yangpu district were selected to form the team of teachers. From January to June,2017,30 nurses from six community health service centers engaged in wound care were selected as the experimental group,and received homogenized training. Thirty-two nurses from specialist team of a tertiary hospital were selected as the control group,and received routine specialist training. The differences in specialist theory,operation,and clinical practical nursing ability between two groups were compared.Results The results of baseline survey showed that the score of wound stoma team members was higher than that of community nurses, and the difference was statistically significant（t=-672.27,P<0.01）.There were no significant differences in scores of specialist theoretical knowledge and operational skills between community nurses receiving homogenized training and specialist team in tertiary hospital（P>0.05）. There was no significant difference in the clinical practical nursing ability between community nurses and specialist team in tertiary hospital（P>0.05）,the special nursing capacity in the two groups tend to be homogeneous.Conclusion The homogenized nursing linkage mode for wound care in the region is conducive to promoting the homogenization of specialized nursing capacity among different medical institutions.

Vascular Access Nursing

A comparative study on the application of central venous infusion port inserted at different sites in patients with breast cancer undergoing chemotherapy

WANG Yingxin, LIU Fei, ZHAO Xuan, LIU Qian

2019, 54(6):  917-921.  DOI: 10.3761/j.issn.0254-1769.2019.06.022

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Objective To compare the advantages and disadvantages of upper arm port and chest port in breast cancer patients.Methods Data of patients implanted central venous port from April 2017 to April 2018 at the Breast Disease Center of Peking University First Hospital was retrospectively analyzed. Length of surgery,postoperative complications,and quality of life were compared.Results A total of 171 cases with central venous port implantation were analyzed,including 95 cases of upper arm port and 76 cases of chest port. There was no case of failure. There was no significant difference in length of surgery between two groups（t=0.164,P=0.870）,and no significant difference in the incidence of postoperative complications（χ ²=0.164,P=0.897）,and no difference in all dimensions of quality of life（P>0.05）.Conclusion Upper arm port does not increase rate of complications,can gurantee quality of life for breast cancer patients,which should be promoted. Clinical staffs should help patients choose the best way to implant port based on the treatment duration,vascular condition and needs of patients.

Evidence Synthesis Research

Evidence summary for mechanical prophylaxis of venous thromboembolism in patients with intracerebral hemorrhage

LIU Ting, ZHAO Shunying, WANG Lingcong, XU Min

2019, 54(6):  935-939.  DOI: 10.3761/j.issn.0254-1769.2019.06.027

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Objective To retrieve,appraise and integrate the available evidence on mechanical prophylaxis of venous thromboembolism（VTE） in patients with intracerebral hemorrhage so as to provide reference for clinical practice to decrease the rate of VTE.Methods Using the method of evidence-based nursing,clinical question regarding mechanical prophylaxis for venous thrombosis with cerebral hemorrhage was raised. Relevant studies were retrieved by computer search. JBI evidence appraisal and recommendation system were used to evaluate quality of studies and level of evidence.Results A total of 16 items of best evidence were summarized,including mechanical device selection,application methods,time arrangement,contraindication of mechanical prevention and disease observation.Conclusion It is safe and effective for patients with cerebral hemorrhage to adopt mechanical measures to prevent venous thromboembolism. Clinical nurses can apply the best evidence to guide practice and improve nursing quality.

Overseas Knowledge

The reliability and validity of the Chinese version of Thirst Distress Scale with Heart Failure

ZHANG Wenfang,HAO Yanhua,TIAN Tian

2019, 54(6):  957-960.  DOI: 10.3761/j.issn.0254-1769.2019.06.032

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Objective To translate the English version of Thirst Distress Scale with Heart Failure（TDS-HF） into Chinese and test the reliability and validity of the Chinese version of TDS-HF.Methods The English version of TDS-HF was translated into Chinese and back translated and modified for cultural adaptation according to the guidelines. A convenience sample of 268 heart failure patients at one tertiary hospital in Tianjin was investigated using the Chinese version of TDS-HF to test its reliability and validity.Results The Cronbach’s α of the Chinese version of TDS-HF was 0.925. Both the scale-level content validity index and the item-level content validity index were 1. Factor analysis showed a single factor explaining 65.56% of the total variance. The score of TDS-HF was significantly associated with the thirst intensity score（r=0.601,P<0.001）.Conclusion The Chinese version of TDS-HF has been proved to be reliable and valid. It can be used for measuring thirst distress in patients with heart failure.