Table of Content

15 January 2020, Volume 55 Issue 1

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Research Paper

Construction and application of early rehabilitation scheme for Intensive Care Unit patients

HAN Runing, LI Xiuchuan, ZHAO Shibing, LI Yajun, CHEN Lianfang, DUAN Huan, YANG Tingting

2020, 55(1):  8-15.  DOI: 10.3761/j.issn.0254-1769.2020.01.001

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Objective To construct and implement the early rehabilitation scheme for prevention of Intensive Care Unit acquired weakness（ICU-AW） in order to reduce the incidence of ICU-AW and improve clinical nursing outcomes of ICU patients. Methods Literature analysis and Delphi method were applied to construct the early rehabilitation scheme for prevention of ICU-AW. 70 patients admitted in one comprehensive ICU at a tertiary hospital in Anhui Province from October 2018 to April 2019 were randomly divided into an experimental group and a control group （35 patients in each group）. The control group was given routine rehabilitation nursing in ICU,while the experimental group was given the early rehabilitation scheme developed in this study. After intervention,Medical Research Council（MRC） muscle strength assessment,Barthel index evaluation form,the incidence of ICU-AW and the length of ICU stay were used to evaluate the effects of intervention. Results The constructed scheme contained four parts,including early exercise,psychological nursing,nutrition support and effect evaluation,and 32 specific rehabilitation contents. In this study,the muscle strength and Barthel index score of the experimental group were significantly higher than those in the control group（P<0.001） on the day of ICU discharge;the length of ICU stay was shorter in the experimental group（P<0.05）;the incidence of ICU-AW was significantly lower than that in the control group（P<0.05）. Conclusion The constructed early rehabilitation scheme for the prevention of ICU-AW is scientific and reliable. The implementation of the scheme can decrease the incidence of ICU-AW and improve the clinical nursing outcomes of patients.

Evidence-based construction of early activity nursing quality sensitive index system for patients with mechanical ventilation in ICU

XUE Youru, GUO Bingxiu, SHAO Huihui, ZHANG Wei

2020, 55(1):  16-21.  DOI: 10.3761/j.issn.0254-1769.2020.01.002

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Objective To establish an evidence-based early activity nursing quality sensitive index system for ICU patients with mechanical ventilation,which is used to guide nursing practice and provide references for evaluation of early activity nursing quality. Methods With the Donabedian model as the theoretical framework,the Johns Hopkins evidence-based nursing method was used for evidence synthesis,and was combined with semi-structured interviews to form a consultation questionnaire consisting of 3 first-level indicators,9 second-level indicators and 31 third-level indicators. Through two rounds of expert consultation,the early activity nursing quality sensitive index system for patients with mechanical ventilation in ICU was determined. Results The positive coefficients of two rounds of expert consultation were both 100%;the expert authority coefficients were 0.854 and 0.870 respectively;the coordination coefficients were 0.312 and 0.394. The final nursing quality sensitive index system included 3 first-level indicators,7 second-level indicators and 28 third-level indicators. Conclusion The nursing quality sensitive index system for ICU patients with mechanical ventilation for early activity is a scientific,reliable and highly credible evaluation system,which can provide a theoretical basis for the development of interventions for early activities of patients with mechanical ventilation.

Evidence-based practice to promote breast milk expression among postpartum women with neonatal-maternal separation

DENG Yongfang, HE Fang, FU Bailing, GUO Xiaoping, HE Jingyan, LIANG Qiuxia, LIU Canhong, LIANG Qiqi, GU Ying, LIN Yan

2020, 55(1):  22-27.  DOI: 10.3761/j.issn.0254-1769.2020.01.003

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Objective To implement evidence-based practice of breast milk expression behaviors among postpartum women with neonatal-maternal separation and explore its influences on lactation. Methods Evidence-based nursing was used to obtain best evidence. The model of evidence-based continuous quality improvement was adopted as the theoretical framework. From May to December 2018,the best evidence was applied to separated mothers according to four stages：evidence acquisition,current situation review,evidence introduction and effect evaluation. The changes of breast milk expression compliance and lactation volume were observed before and after the application of evidence. Results A total of 12 items of evidence were applied. Breast milk expression compliance was improved after evidence implementation. The number of women who transported breast milk to neonatology department increased. The initial time of breast milk transportation after delivery was brought forward. The total estimated lactation volume per woman in the first seven days after delivery was increased. Conclusion Evidence-based nursing is useful to manage breast milk expression behaviors among postpartum women with neonatal-maternal separation,optimize lactation success and increase the amount of milk,which can provide references for breastfeeding management for women with neonatal-maternal separation.

Effects of psychological contract intervention on subjective well-being promotion among new pediatric nurses

LI Youwei, LU Qunfeng, SUN Jingmin, NIU Jun, SHAO Zhenzhen

2020, 55(1):  28-31.  DOI: 10.3761/j.issn.0254-1769.2020.01.004

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Objective To investigate the effects of intervention based on the theory of psychological contract on subjective well-being among new pediatric nurses. Methods A total of 112 newly recruited nurses from 2016 to 2017 were selected to carry out training on subjective well-being in a pediatric tertiary hospital in Shanghai. An one-year training program based on the theory of psychological contract was developed,including comprehensive pre-employment training,individualized training mechanism and incentives,timely and effective communication model,to provide multiple supports and incentives on life,work,feeling and profession. The General Well-Being Schedule and psychological contract scale were used to evaluate the effects of the intervention. Results After intervention,psychological contract fulfillment increased gradually,and the score of subjective well-being was higher than before（P<0.05）. Conclusion Nurse subjective well-being promotion intervention based on psychological contract can enhance subjective well-being among new pediatric nurses,stabilize pediatric nursing team,but it needs to be further improved and to become a continuous program.

Special Planning-Wound Care

Application research of skin temperature monitoring in early warning of pressure injury

JIANG Xiaoqiong, CAI Fuman, HOU Xiangqing, DENG Haisong, LING Xiangwei, GUO Hailei, LU Zhongqiu

2020, 55(1):  32-38.  DOI: 10.3761/j.issn.0254-1769.2020.01.005

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Objective To explore the application value of skin temperature in early warning of pressure injury through analyzing the correlation between skin temperature and pressure injury and quantifying the risk level by temperature indicator. Methods A total of 415 inpatients from comprehensive ICU,neurosurgical ICU,respiratory ICU,emergency department ICU and CCU in a tertiary hospital in Wenzhou were selected by continuous cluster sampling. Demographic and clinical data were obtained,as well as daily skin temperature of sacral area. The correlation between skin temperature and pressure injury was analyzed by Spearman rank correlation. The X-tile analysis was used to acquire the optimal cutoff value of skin temperature,and the prediction effect was evaluated by the receiver operating characteristic curve. The occurrence risk of pressure injury with different skin temperature was compared by Kaplan-Meier survival curve analysis and COX proportional hazard regression model. Results There was a negative correlation between the relative skin temperature of sacral area and the occurrence of pressure injury（P<0.001）. The optimal cutoff value of this indicator for predicting pressure injury was -0.1 ℃. The area under the receiver operating characteristic curve of this indicator was 0.901,with the Youden index of 0.753,the sensitivity of 85.37%,the specificity of 89.89%. When the relative temperature in sacral area was below -0.1 ℃,the incidence of pressure injury increased significantly,with the highest incidence rate on the 4th and 5th day after admission（3.44%）. The risk was 6.63 times higher than that of the temperature above -0.1 ℃[HR=6.36,95%CI（3.91~10.36）]. Conclusion Skin temperature monitoring can effectively predict the occurrence of pressure injury. It is recommended to pay close attention to changes of the skin temperature at sacral area on the 4th and 5th day after admission. The decreased skin temperature（the relative temperature≤-0.1℃） means the higher risk of pressure injury,and precautions should be taken timely to reduce the incidence of pressure injury.

Comparative study of two methods of protecting skin for patients with chronic wounds treated by negative pressure wound therapy

JIANG Qixia, WANG Jiandong, DONG Shan, PENG Qing, HUANG Xiuling

2020, 55(1):  39-44.  DOI: 10.3761/j.issn.0254-1769.2019.01.006

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Objective To explore the effect of two skin protecting methods in negative pressure wound therapy （NPWT） for chronic wounds in order to prevent NPWT-related moisture-associated skin damage（MASD）. Methods A total of 132 patients with chronic wounds were enrolled and randomly divided into two groups,66 cases in each group. During NPWT,the intervention group used a leak-proof paste for protecting peri-wound skin,and the control group was applied with a multi-polymer free pain skin protective dressing for protecting peri-wound skin. Both groups were treated for 14 days and then followed up with standard moisture therapy until healed or 3 months. Primary outcome：incidence of MASD around wound during NPWT;secondary outcomes：frequency of leakage alarm,skin impregnation frequency,the reduction rate of wound area,depth during NPWT,and rate of wound healing,and healing time during the follow-up. Results A total of 6 cases were dropped. In the full analysis set,the MASD incidence,the frequency of leakage alarm and skin impregnation in the intervention group were less than those in the control group（P<0.05）. The difference in the reduction rate of wound area between the two groups was significant（P<0.05）. The difference in the depth reduction rate between the two groups was no significance（P>0.05）. At the end of the follow-up period,the rate of wound healing in the intervention group was higher than that in the control group（P<0.05）,and healing time of both groups was close（P>0.05）. Conclusion The research proved that two protecting skin methods had some effects on protect peri-wound skin and preventing NPWT-related MASD.The leak-proof paste method was better and it played an important role in ensuring NPWT,improving wound treatment outcomes and promoting wound healing and it is suitable for patients with different types and locations of chronic wounds.

Nurses’ knowledge,attitudes and practice towards prevention of medical device related pressure injury in intensive care units：a cross-sectional study

WEI Xiaojing, YAN Fan, JING Mengjuan, LI Liming, WANG Zhixia

2020, 55(1):  45-49.  DOI: 10.3761/j.issn.0254-1769.2020.01.007

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Objective To explore the knowledge,attitudes and practice（KAP） status of preventing medical device related pressure injury（MDRPI） among clinical nurses working in ICU,and to examine factors affecting nurses’ KAP. Methods Questionnaire was used to measure nurses’ KAP of preventing MDRPI. Data was collected from 1,664 nurses in 18 tertiary hospitals and 18 secondary hospitals in Henan Province to analyze nurses’ KAP of preventing MDRPI and to explore its influencing factors. Results A total of 1,610 valid questionnaires were collected. The scores of overall KPA,knowledge,attitudes,and practice were 136.93±20.42,50.21±11.28,38.14±5.46 and 48.58±9.03,respectively. The results from multiple linear regression analysis showed that hospital level was the main influencing factor of nurses’ knowledge of preventing MDRPI;hospital level,professional title,position and department category were the main influencing factors of nurses’ attitudes of preventing MDRPI;knowledge,attitudes,age,gender and position were the main influencing factors of nurses’ practice of preventing MDRPI. Conclusion Nurses working in ICU have a positive attitude towards the prevention of MDRPI,but their knowledge and practice need to be improved. According to different characteristics of nurses,nursing managers should carry out training on the knowledge of prevention of MDRPI to establish a positive attitude,so as to drive the change of nursing practice and improve the quality of nursing in ICU.

Development and application of clinical decision support system for pressure injury

XIA Dongyun, SHI Tingqi, LU Wei, LU Yao, CHENG Jianping, FU Qiaomei, WU Ling

2020, 55(1):  50-54.  DOI: 10.3761/j.issn.0254-1769.2020.01.008

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Objective This research is to develop a clinical decision support system for pressure injury（PI）and explore its application effect in clinical PI management. Methods A Research & Development team was set up to build a PI knowledge base and a database of nursing documents,and to design human-computer interaction rules,in order to realize functions such as dynamic assessment and early warning,intelligent interpretation and recommendation,real-time monitoring and analysis,etc. Indicators before and after the application,including the ratios of timely risk assessment upon hospital admission,the rates of qualified implementation of risk assessment-based preventive measures,the rates of defect in nursing records,the occurrences of hospital acquired PI,and the occurrence of hospital acquired PI in high-risk patients. Results After applying the clinical decision support system for PI,the ratio of timely risk assessment upon hospital admission increased from 84.78% to 95.94%;the rate of qualified implementation of risk assessment-based preventive measures increased from 90.15% to 99.13%;the rate of defect in nursing records decreased from 16.42% to 8.70%;and the differences were statistically significant（P<0.001）. The occurrence of hospital acquired PI and the occurrence of hospital acquired PI in high-risk patients were both lower. Conclusion The clinical decision support system for PI provides nurses with accurate and objective decision-making basis,thus effectively improves the quality of PI care and upgrades management efficiency.

Effects of nursing care on malignant fungating wounds：a meta-analysis

LIU Yan, FAN Xianghong, WANG Yan

2020, 55(1):  55-61.  DOI: 10.3761/j.issn.0254-1769.2020.01.009

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Objective To identify some nursing care initiatives and their effects when taking care of tumor patients with malignant fungating wound（s） and then provide evidences for nursing practice. Methods We performed a systematic research in Cochrane Library,PubMed,Elsevier ScienceDirect,Web of Science,CNKI,Wanfang Data and VIP to collect studies about the effects of nursing care on malignant fungating wounds published from inception to March 2019. Data was analyzed by RevMan 5.3 after literature screening,data extraction,and quality appraisal according to criteria in Cochrane Reviewer’s Handbook by two reviewers independently. Results 11 studies were recruited,including 703 cases. Meta analysis showed that compared to the control group,alginate dressing including silver ions,cat litter based on silica gel and vacuum suction might be more useful to reduce moderate odor of malignant fungating wounds[RR=0.58,95%CI（0.38,0.90）,P=0.010];however,metronidazole and green tea were not better choices to reduced odor of malignant fungating wounds[RR=0.63,95%CI（0.30,0.96）,P<0.001];alginate dressing including silver ions and green tea were more likely to reduce exudation of malignant fungating wounds,no matter it was moderate or severe[RR=0.66,95%CI（0.45,0.95）,P=0.030;RR=0.38,95%CI（0.17,0.88）,P=0.020];besides,applying vacuum suction or cat litter based on silica gel might not be more helpful to alleviate pain mildly [RR=1.46,95%CI（1.06,2.00）,P=0.020] when comparing to the control group,and alginate dressing including silver ions and continuous nursing might also not be better methods to improve quality of life of tumor patients with malignant fungating wound（s） in a degree[RR=6.05,95%CI（3.74,8.36）,P<0.001]. Conclusion alginate dressing including silver ions,cat litter based on silica gelor vacuum suction can be effective measures to decrease the odor of malignant fungating wounds,unfortunately,whether they are capable of pain and improving life quality of cancer patient with such wounds still needs more reliable evidences. Recently,alginate dressing including silver ionsandgreen tea may play a more important role in diminishing moderate or severeexudation of malignant fungating wounds. Since evidences to deal with malignant fungating wounds in nursing care are still unsufficient recently,and sample size varies in each study,more high-quality studies are needed for future research.

Evidence summary for prevention of medical adhesive-related skin injury in elderly patients

GUO Weiting, WANG Wenjun, CAO Yingjuan, MI Yuanyuan, Lü Xiaoyan, BAI Xue, YANG Jing

2020, 55(1):  62-67.  DOI: 10.3761/j.issn.0254-1769.2020.01.010

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Objective To retrieve,evaluate and integrate the relevant evidence of prevention of medical adhesive-related skin injury in elderly patients at home and abroad,and to summarize the best evidence. Methods We systematically searched for evidence on prevention of medical adhesive-related skin injury in BMJ,UpToDate,JBI,RNAO,SIGN,CGC,Cochrane Library,PubMed,EMbase,INS,ISTAP,CBM,Wanfang,CNKI,Taiwan academic literature database of China,including guidelines,systematic reviews,best practices information sheet,evidence summary,expert consensus and original research. The retrieval period was from the inception of databases to May,2019. Results A total of 11 articles were included,including 3 guidelines,1 evidence summary,3 expert consensus,3 randomized controlled trials and 1 cohort study. Six aspects were summarized：skin evaluation,skin protection,operational readiness,manipulation,observation and maintenance,supervision and training. Twenty items of best evidence were included. Conclusion Nurses should standardize the methods of medical adhesives sticking and removing,accurately identify high-risk groups,and take skin protection measures. In the application of evidence,the best evidence should be selected according to the clinical situation,so as to reduce the incidence of skin injury related to medical adhesives and improve the quality of nursing.

Specialist Practice and Research

Study on risk prediction model of in-hospital venous thromboembolism in middle-aged and elderly patients

LI Haiyan, LI Rong, ZHI Yanru, WANG Jinping, ZHANG Lingjuan, JIN Zhichao, QIAN Huohong, WANG Xiaohui

2020, 55(1):  68-73.  DOI: 10.3761/j.issn.0254-1769.2020.01.011

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Objective This study was to investigate the risk factors of venous thromboembolism （VTE） in middle-aged and elderly patients in hospital,and to establish a risk prediction model. Methods From January 2015 to December 2018,55 middle-aged and elderly patients who had VTE in a tertiary general hospital were received as VTE group. 108 patients with the same major diagnosis,age,sex and no VTE occurred in the same department in the same year were selected as non-VTE group. The general data of patients in two groups,the score of Caprini thrombosis risk assessment model,complications,related laboratory examination indicators,various possible risk factors and drug usage were retrospectively studied. The risk factors were screened out and the risk prediction model was constructed by logistic regression. A total of 54 cases of VTE and non-VTE patients in the same hospital from January 2013 to December 2014 were used to validate the model. Results Multivariate regression analysis showed that respiratory tract infection or respiratory failure,liver and kidney disease,drinking history,D-dimer and Caprini thrombosis risk grade were risk factors for VTE in middle-aged and elderly patients in hospital. The model constructed by the above risk factors had good predictive ability. Conclusion The thromboembolism risk prediction model can play an auxiliary role in predicting the occurrence of VTE in middle-aged and elderly patients in hospital. This model needs to be further validated and improved under the condition of multi-center and large samples.

Effects of different cuff pressures on compression of forearm hematoma in geriatric patients with coronary heart disease

QIAO Jimin, SHE Liping, CHANG Yun

2020, 55(1):  74-77.  DOI: 10.3761/j.issn.0254-1769.2020.01.012

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Objective To compare the effects of different cuff pressures on compression of forearm hematoma after transradial coronary intervention in elderly patients with coronary heart disease. Methods From March 2016 to February 2019,94 patients with forearm hematoma after interventional treatment in a tertiary hospital were randomly divided into the experimental group and the control group using random number table,with 47 patients in each group. Hematoma was compressed by a sphygmomanometer cuff inflation. The sphygmomanometer cuff inflation pressure of the experimental group and the control group was higher than systolic blood pressure by 30 mmHg（1 mmHg=0.133 kPa） and 20 mmHg,respectively,and the pressure was decompressed for 1 min after 5 min of compression,for 5 repeated cycles,in which the control group was decompressed to 0 mmHg,and the experimental group was decompressed to the patients’ diastolic pressure. The comfort and pain of the patients in both groups were observed. The arm circumference,forearm tension and swelling were observed right after the compression and 30 min after the compression. Results During the compression process,there was no significant difference in the comfort and pain between two groups（P>0.05）. Immediately after the compression,there was no significant difference in the degree of swelling of the forearm between the two groups（P>0.05）. Immediately after the compression and 30 min after the compression,the improvement of arm circumference and forearm tension in the experimental group was better than those in the control group,and the differences were statistically significant（P<0.05）. After 30 min of compression,degree of forearm swelling in the experimental group was lower than that in the control group,and the difference was statistically significant（P<0.01）. Conclusion Keeping the sphygmomanometer cuff inflation pressure higher than patients’ systolic blood pressure by 30 mmHg, releasing pressure to patients’ diastolic pressure after five mins maintenance, maintaining pressure for one min and repeating for five circles can be beneficial to improve patients’ arm circumference, forearm tension and swelling degree.

Investigation on knowledge and attitude for cardiac rehabilitation of patients with acute myocardial infarction in 7 hospitals in Zhejiang Province

ZHU Haixiang, YE Zhihong, JIN Jinhua, WANG Manjun, NING Li, HAN Xiaoxue

2020, 55(1):  78-83.  DOI: 10.3761/j.issn.0254-1769.2020.01.013

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Objective To investigate knowledge and attitude towards cardiac rehabilitation（CR） of patients with acute myocardial infarction in Zhejiang Province. Methods Totally 195 patients with acute myocardial infarction in 7 hospitals in Zhejiang Province were conveniently included and investigated by a self-designed questionnaire. Results The mean score of knowledge about CR in 195 patients was 21.31±5.35;awareness about CR was 40.05±4.36. Educational level,economic burden,history of Percutaneous Coronary Intervention（PCI） and history of CR had impact on scores of knowledge and attitude towards CR（P<0.05）. Barriers for participating CR programs were long distance,heavy economic burden,older age,and lack of knowledge about CR（P<0.05）. Conclusion Knowledge and attitude about CR among patients with acute myocardial infarction in Zhejiang Province are in the middle and low level. Long distance,heavy economic burden,older age,and lack of knowledge about CR are barriers to participate in CR. Medical staff should strengthen the dissemination of CR knowledge for patients with acute myocardial infarction,and the holistic condition of the Hospital-Family-Community should be fully applied in carrying out CR projects.

Construction of a nursing quality evaluation index system for neurosurgery ICU

ZHAN Yuxin, YU Jiaohua, YUE Gefen, XU Nina, WANG Xianke, MI Yuanyuan, LI Suyun, ZHAO Shiyu, ZHANG Lihua

2020, 55(1):  84-89.  DOI: 10.3761/j.issn.0254-1769.2020.01.014

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Objective To establish an evaluation index system of nursing quality in neurosurgery ICU in accordance with China’s conditions,in order to provide a scientific reference for the evaluation and monitoring of nursing quality in neurosurgery ICU. Methods Based on the three-dimensional quality model of “structure-process-outcome”,the domestic and foreign literatures were retrieved;clinical practice and individual needs of patients were integrated;the index entry pool was set;the inquiry content was determined by semi-structured interview method. Finally,the index system and its weight were determined by Delphi method and analytic hierarchy process. Results The recovery rates of two rounds of expert consultation were 96.67% and 100%;the authority coefficients were 0.8975 and 0.900;the judgment coefficients were 0.956 and 0.962;the familiarity coefficients were 0.838 and 0.837,and the Kendall harmony coefficients were 0.219 and 0.226,respectively. The final evaluation index system of nursing quality in neurosurgery ICU included three first-level indicators,namely,structure indicators,process indicators and outcome indicators,17 second-level indicators and 104 third-level indicators. Conclusion The evaluation index system of nursing quality in neurosurgery ICU established in this study is comprehensive and practical,which can provide objective and quantitative quality evaluation tools for nursing managers,guide the clinical practice of nurses,and promote continuous nursing quality improvement in neurosurgery ICU.

Development and application of decision aid of breast reconstruction surgery among breast cancer patients

WANG Yan, WANG Xiaoyuan, SHI Liyuan, Li Jing, ZHANG Qingyue, YIN Zhuming, QIANG Wanmin

2020, 55(1):  90-95.  DOI: 10.3761/j.issn.0254-1769.2020.01.015

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Objective To investigate the effects of application of decision aid of breast reconstruction in breast cancer patients after mastectomy. Methods We developed the breast reconstruction decision aid for breast cancer patients based on the literatures at home and abroad,expert meeting and group discussion. A total of 42 patients hospitalized for breast cancer surgery from October to December,2017,were recruited as the control group,and 39 patients admitted from January to March,2018,were enrolled as the intervention group. In addition to routine nursing,the intervention group received the breast reconstruction surgery decision aid,while the control group only received routine nursing. The results of intervention were evaluated by Decision Conflict Scale（DCS）,Preparation Decision Making （PrepDM） and Hospital Anxiety and Depression Scale （HADS） at admission and one day before operation;Decision Regret scale（DRS） and HADS were used at one month,six months and one year after operation. Results The decision preparation score one day before operation in the intervention group was significantly higher than that of the control group（P<0.05）,and the decision conflict score of the intervention group was significantly lower（P<0.05）. There was no significant difference in the anxiety and depression scores between the intervention group and the control group one day before surgery. Anxiety and depression scores in the intervention group were significantly lower than those in the control group one year after surgery（P<0.05）. During postoperative follow-up,the decision regret scores of the intervention group were significantly lower than those of the control group at one month,six months and one year after surgery（P<0.05）. Conclusion The breast reconstruction surgery decision aid can effectively improve patients’ decision preparation,alleviate long-term anxiety and depression,and reduce long-term decision regret.

Practice of standardized management of allergic rhinitis immunotherapy clinics for pediatric patients

YAN Haiou, YANG Mei, JIANG Qin

2020, 55(1):  96-101.  DOI: 10.3761/j.issn.0254-1769.2020.01.016

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Objective To implement standardized management of allergic rhinitis immunotherapy clinics for pediatric patients and explore its effects. Methods 101 pediatric patients with allergic rhinitis immunotherapy were selected in a tertiary hospital from January 2017 to January 2018 by convenience sampling. Integrated management team was established;new communication methods between patients and medical staff were established through newly developed specific immunotherapy APP platform;continuing nursing for patients was performed by a series of standardized management. Effects on symptom control,quality of life and level of family management were analyzed Results The VAS score of nasal congestion in pediatric patients decreased from（8.23±1.15） to（4.07±2.35）;the nasal resistance TR decreased from（0.27±0.14）Pa/（cm ³·s） to （0.15±0.08）Pa/（cm ³·s）;the total quality of life was reduced from（92.67±5.17） to （66.54±4.86）;the total score of family management scale was increased from（151.20±5.75） to （189.05±5.97） after one-year standardized management. The differences were statistically significant（P<0.05）. Conclusion The standardized management of allergic rhinitis immunotherapyclinic for pediatric patients can effectively improve the compliance of pediatric patients and parents,improve the control level of rhinitis,reduce family pressure and improve family function and quality of life.

Nursing Management

Study on initiative disclosing medical adverse events by doctors and nurses

YU Lina, QIAN Xinyi, SHENG Jing, WANG Ting, YU Shanzhen, LUO Cui, CHEN Xiaoyan

2020, 55(1):  102-106.  DOI: 10.3761/j.issn.0254-1769.2020.01.017

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Objective To understand experience and attitude of doctors and nurses for initiative disclosing medical adverse events. Methods A self-developed questionnaire was used to investigate 564 doctors and nurses from 2 tertiary hospitals in Wuhan. Results For the aspect of experience：71.0% of doctors and 50.4% of nurses indicated that they had experience of initiative disclosing medical adverse events;68.3% of doctors and 57.1% of nurses were satisfied with the results;3.3% of doctors and 2.6% of nurses indicated that disclosure had a negative impact on doctor-patient or nurse-patient relationship;55.2% of doctors and 59.3% of nurses indicated that they had the support from the leadership;86.3% of doctors and 56.6% of nurses were in favor of disclosure as a requirement. In the aspect of experience：74.3% of nurses and 86.3% of doctors had no training experience. 64.5% of doctors and 87.1% of nurses indicated their willingness to participate in the training in the future. For the aspect of attitude：for Grade Ⅰ events,Grade Ⅱ events,Grade Ⅲ events and Grade Ⅳ events,378（67.0%）,348（61.7%）,327（58.0%） and 219（38.8%） cases were in favor of initiative disclosure. For the aspect of degree：for Grade Ⅰ events,Grade Ⅱ events,Grade Ⅲ events and Grade Ⅳ events,359（63.7%）,384（68.1%）,330（58.5%） and 237（42.0%） cases supported partial disclosure. Conclusion Some doctors and nurses have initiative disclosure experience and the results are relatively positive. Doctors and nurses support initiative disclosure of medical adverse events but still have concerns. Hospital administrators should strengthen training for medical staff on initiative disclosing medical safety adverse events.

Investigation on occupational exposure and protective behaviors of nurses at emergency departments in tertiary hospitals in Beijing

GUO Jinyu, SUN Hong, LIU Yingqing, ZHOU Wenhua, GE Baolan, WANG Lei

2020, 55(1):  107-112.  DOI: 10.3761/j.issn.0254-1769.2020.01.018

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Objective To understand the occurrence and protection status of three occupational exposures：needle-stick injury by nurses,blood exposure and workplace violence in the emergency department in tertiary hospitals in Beijing. Methods According to the schedule of the emergency department of each hospital,one group of nurses were selected from each hospital in 21 tertiary hospitals in Beijing to participate in the online survey. Self-designed online questionnaires were distributed and completed anonymously,including general information,the occurrence status and protective behaviors of needle-stick injury by nurses,blood exposure and workplace violence. Results A total of 1,150 questionnaires were collected,of which 1,102 were valid,with an effective rate of 95.83%. In the past year,the incidence rates of at least one needle-stick injury by emergency department nurses,blood exposure during blood collection,verbal violence,physical violence and sexual harassment were 37.8%,36.4%,68%,12%,and 5.3%,respectively. In different working areas at emergency department,the occurrence of needle-stick injury（χ ²=16.805,P=0.01）,verbal violence（χ ²=98.509,P<0.001） and physical violence（χ ²=79.916,P<0.001） were different. Among nurses with occupational exposure,92.8% were able to squeeze blood after needle-stick injury,flush with flowing water and disinfect;69.8% were able to flush and disinfect exposed parts after blood exposure in the process of blood drawing. Among nurses encountering workplace violence,41.3% explained patiently,and 30.0% adopted tolerance and avoidance. In addition,the reporting rate of all three types of occupational exposure was low（less than 30%）. Conclusion The incidence of occupational exposure in emergency department is relatively high. Nursing managers should attach importance to the construction of the work environment in emergency department,strengthen the training of pre-exposure protection in blood collection process and workplace violence,and strengthen the reporting and management of the three types of occupational exposure.

Nursing Education

Study on capacity training and its effects of emergency nurses for communication with patients with attempted suicide

LIU Qiuping, HU Deying, LIU Yilan, LIU Zhirong, WENG Hui, XIANG Li, FENG Xia, DENG Xianfeng

2020, 55(1):  113-117.  DOI: 10.3761/j.issn.0254-1769.2020.01.019

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Objective To develop the communication training scheme for emergency nurses to respond to patients with attempted suicide,and to explore the effects of application. Method Under the guidance of American Suicide Prevention Resource Center’s guideline and incentive interview techniques,40 emergency nurses were selected to receive three sessions of communication training. The effectiveness of the training was evaluated by the verbal and social interaction questionnaire and nurses communication training feedback questionnaire. Results After training,communication frequency and importance scores of emergency nurses increased;difficulty scores decreased.The differences were statistically significant（t₁=9.591,t₂=5.124,t₃=-4.494,P<0.05）. The approval degree to nursing from patients and doctors approval was higher than before. Conclusion Communication training can enhance communication ability of emergency nurses to respond to patients with suicide attempt,improve recognition of patients and doctors towards nursing,reduce suicidal ideation of patients and promote the hope of life.

Investigation on occupational status and training demand of family maternal and infant care providers in Fuzhou

HUANG Wenjuan, YAN Yilu, HU Rongfang

2020, 55(1):  118-122.  DOI: 10.3761/j.issn.0254-1769.2020.01.020

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Objective To investigate the occupational status and training demand of maternal and infant care providers in Fuzhou. Methods Totally 130 family maternal and infant care providers were selected from 9 housekeeper service companies in Fuzhou. A survey was conducted by a self-designed questionnaire from August to November 2018. Results The number of maternal and infant care providers with education level in junior high school and below was 116（89.3%）. In terms of the form of employment,68 maternal and infant care providers were self-employed（52.3%）;63 relied on the agency companies（48.5%）;36 were company employees（27.7%）. The overall training demand rate was 61.3%. There were statistically significant differences in the score of overall training demand among different levels of maternal and infant care providers（P<0.05）. The employment length and age were negatively correlated with the total score of training demand,with the r values of -0.266 and -0.436,respectively（P<0.01）. Conclusion The overall quality of family maternal and infant care providers was at a low level and standard management should be further implemented. The group’s willingness of training was not strong. It is suggested that regular training should be carried out with different levels of maternal and infant care providers to improve overall competency.

Hospital Infection Control

Current status of information tracking system in central sterile supply departments

QIAN Liming, JI Kanwen, ZHANG Qing

2020, 55(1):  123-126.  DOI: 10.3761/j.issn.0254-1769.2020.01.021

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Objective To understand the current status of implementation of information tracking system in hospital central sterile supply departments （CSSDs）,and to provide references for developing standards of processing quality management. Methods 1 972 CSSDs in China was involved in the survey by stratified sampling method. China Nursing Association CSSD committee delivered electronic questionnaires,which investigated whether CSSDs used tracking system,the tracking method and the function of tracking system. Results Among the investigated hospitals,1 633 CSSDs（82.81%） applied tracking system for sterile articles;894 CSSDs（54.75%） used manual tracking method;612 CSSDs（37.48%） used informationalized tracking method,and among which 505 CSSDs（82.52%） used tracking system for external equipment;474 CSSDs（24.04%） used tracking system as a mean of quality management. Conclusion CSSDs should develop a tracking procedure focusing on information tracking system in order to increase the traceability of external instruments,to improve the management function of tracking system,to take advantage of information tracking system,and to promote the construction of hospital information system.

Evidence Synthesis Research

Effects of high intensity interval training and moderate continuous training on cardiac rehabilitation：a meta-analysis

XIAO Jia, LI Dongying, HU Xiaoying, HU Yan

2020, 55(1):  134-140.  DOI: 10.3761/j.issn.0254-1769.2020.01.024

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Objective To explore the effects of high intensity interval training（HIIT） and moderate continuous training（MCT） in patients with cardiac rehabilitation Phase Ⅱ. Methods PubMed,Embase,Cochrane Library,CNKI,Wanfang database and China Biomedical Database were searched from inception to November 2018. Results Finally 9 articles were included,including 8 in English and 1 in Chinese,with a total of 473 patients. In the PhaseⅡ cardiac rehabilitation,HIIT compared with MCT significantly improved peak oxygen uptake [MD=2.13,95%CI（0.71,3.55）,Z=2.94,P<0.01],improved the left ventricular ejection fraction[MD=3.38,95%CI（1.31,5.46）,Z=3.19,P<0.01]. There were no differences in 6 min walking test[MD=30.10,95%CI（-1.31,61.52）,Z=1.88,P=0.06],left ventricular end-diastolic volume[SMD=0.14,95%CI（-0.40, 0.69）,Z=0.51,P=0.61],HDL[SMD=0.09,95%CI（-0.79, 0.97）,Z=0.21,P=0.83],LDL[SMD=-0.20,95%CI（-0.78,0.38）,Z=0.68,P=0.50] and quality of life[MD=0.37,95%CI（-8.25,8.99）,Z=0.08,P=0.93] between HIIT and MCT. Compared with MCT,subgroup analysis showed that HIIT significantly improved peak oxygen uptake in patients with heart failure accompanied by decreased ejection fraction[MD=2.35,95%CI（0.11,4.58）,Z=2.05,P=0.04] and left ventricular ejection fraction[MD=3.46,95%CI（0.96,5.96）, Z=2.72,P<0.01]. Conclusion In Phase Ⅱ cardiac rehabilitation,HIIT compared with MCT,can effectively improve the peak oxygen uptake and left ventricular ejection fraction,but there are no differences in improving patients’ quality of life and lipid metabolism.

Inspiratory muscle training in patients with mechanical ventilation：a meta-analysis

YAO Li, YANG Lin, YANG Liping, ZHANG Zhigang, ZHANG Caiyun, DING Nannan, TIAN Jinhui

2020, 55(1):  141-147.  DOI: 10.3761/j.issn.0254-1769.2020.01.025

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Objective To evaluate the effectiveness of inspiratory muscle training（IMT） among patients with mechanical ventilation（MV）. Methods We searched databases including Cochrane Library,PubMed,Web of Science,EMbase,CBM,CNKI and Wanfang Data. We used RevMan 5.3 software to conduct meta-analysis. Results A total of 21 RCTs including 1,014 patients were included in this meta-analysis. The meta-analysis showed that IMT could improve terminal maximal inspiratory pressure（MIP）,difference MIP,PaO₂ and SaO₂[WMD and 95%CI were 7.98（7.22,8.73）;5.76（4.23,7.29）;9.55（4.00,15.10）;2.00（1.15,2.85）];decrease duration of MV,duration of weaning and length of stay in ICU[SMD/WMD and 95%CI were -0.33（-0.52,-0.14）;-0.99（-1.50,-0.48）;-3.46（-5.36,-1.56）],and reduce mortality[RR=0.55,95%CI（0.33,0.91）,P=0.02]. Conclusion IMT was effective in improving MIP and respiratory muscle strength and endurance,improving patients’ oxygenation status,and reducing duration of MV,weaning,length of stay in ICU,and mortality.