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Table of Content

    15 September 2020, Volume 55 Issue 9
    Research Paper
    Establishment of an early risk prediction model for patients with acute respiratory distress syndrome in ICU
    JING Chenchen,SUN Shuqing,QIN Dechun
    2020, 55(9):  1285-1291.  DOI: 10.3761.j.ssn.0254-1769.2020.09.001
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    Objective To establish a predictive model for ICU medical staff to early predict the risk of occurrence of acute respiratory distress syndrome(ARDS).Methods A total of 223 patients who were admitted to the ICU between January 2017 and April 2018 and met the criteria were enrolled in this case-control study. They were classified into an ARDS group(n=69) and a non-ARDS group(n=154). The clinical data between the groups were compared. A risk prediction model was established by binary logistic regression,and the effectiveness of the model was verified by the area under the ROC curve.Results Age(OR=1.136),lung injury prediction score(OR=2.328),UK national early warning score(OR=2.830) and pneumonia severity index(OR=1.033) were included in this ARDS early risk prediction model. The model formula was Z=0.128 × age+0.845 × lung injury prediction score +1.040 × national early warning score+0.032 × pneumonia severity index -20.059. The area under the ROC curve of this model was 0.926 with a sensitivity of 0.906,a specificity of 0.812 and the Youden index of 0.718.Conclusion The risk prediction model described here can effectively predict the occurrence of ARDS in ICU patients,and all 4 indicators can be obtained in the early stage of ICU,thus providing references for ICU medical staff to take preventive care interventions for patients with different risk stratifications in the early stage.

    The application effects of ABCDEF bundle care in ICU patients with mechanical ventilation
    CHEN Mengxia,MOU Yuanfen,CHEN Yanling,GUO Li
    2020, 55(9):  1292-1296.  DOI: 10.3761/j.issn.0254-1769.2020.09.002
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    Objective To implement and evaluate application effects of ABCDEF bundle care in mechanically ventilated patients in intensive care unit(ICU). Methods The prospective randomized trial was conducted in ICU of our hospital from December 2017 and March 2019 in 70 mechanically ventilated ICU patients. Patients meeting inclusion criteria were randomly allocated into an observation group(n=35) and a control group(n=35). The control group received the conventional treatment,while the observation group was implemented with ABCDEF bundle care. The duration of intervention lasted 10 days. The incidences of delirium,duration of mechanical ventilation,the dosage of sedatives and analgesics,the unplanned extubation rate,mortality,the length of ICU stay,and expenses were analyzed and compared in 2 groups. Results The outcomes in the observation group were associated with lower likelihood(P<0.05) of 5 outcomes,namely incidence of delirium,duration of mechanical ventilation,the dosage of sedatives and analgesics length of ICU stay,and expenses. There were no significant differences in unplanned extubation rate,mortality between 2 groups(P>0.05). Conclusion ABCDEF bundle care showed clinically significant and meaningful improvements in outcomes including delirium,duration of mechanical ventilation,the dosage of sedatives and analgesics. It improved prognosis of ventilated ICU patients. ABCDEF bundle provides a safe,effective,economical and feasible strategy for ICU patients with mechanical ventilation.

    Study on differential characters of symptom clusters and predictors of breast cancer patients during chemotherapy
    HUANG Qingmei,GENG Zhaohui,WU Fulei,ZHANG Wen,CAI Tingting,HUANG Yueshi,YUAN Changrong
    2020, 55(9):  1297-1303.  DOI: 10.3761/_issn.0254-1769.2020.09.003
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    Objective To identify distinct subgroups of breast cancer patients who were experiencing differential symptom burdens, and to analyze the risk indicators for patients with high symptom burdens. Methods A cross-sectional study design was used, and fatigue, anxiety, depression and sleep disturbance were reported by patients of a tertiary hospital in Shanghai from January 2016 to January 2017. Latent Class Model(LCM) was used to identify the characteristics of potential patient subgroups who were experiencing differential symptom burdens, and Multinominal logistic regression was conducted to identify risk indicators for patients with high-risk symptom burdens. Results 3 latent classes of symptoms were identified, which were named as “high symptom burden class”, “high psychological-related symptom burden class” and “low symptom burden class” according to the symptom characteristics of patients in different classes, accounting for 25. 0%, 19. 7% and 55. 3%, respectively. Compared to patients in the low symptom burden class, patients in the high symptom burden class reported significantly lower quality of life scores(F=55. 499, P<0. 001). Patients in the “high symptom burden class” were characterized by significantly lower level of exercise self-efficacy(OR=0. 949, P=0. 019), while patients in the “high psychological-related symptom burden class” were characterized by personality traits of intermediate type(OR=6. 189, P=0. 007), no breast cancer resection(OR=4. 718, P=0. 020), and low exercise self-efficacy level(OR=0. 926, P=0. 002). Conclusion Distinct subgroups of patients with different symptom characters were identified, and quality of life for patients with high-risk symptom burdens were significantly poorer, while exercise self-efficacy can be used as one of the important risk indicators for recognition of high-risk patient groups. For symptom management of breast cancer patients in the future, patients should be assigned into different class memberships, so that subgroups with high symptom burden can be located and person-centered intervention tailored to an individual’s symptom cluster can be offered.

    Nursing Safety Management
    The route cause analysis of nurse medication near-miss reporting barriers
    YU Miao,WANG Jianhui,LIU Xueming,MA Jiahui,JIA Yuna,BAI Tiejuan,LI Yuting
    2020, 55(9):  1304-1309.  DOI: 10.3761/j.issn.0254-1769.2020.09.004
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    Objective To explore the multiple mediating roles of Leadership-Member Exchange(LMX)and error management climate in the influence mechanism of transformational leadership on nurses’ medication near-miss reporting barriers.Methods A total of 877 nurses in 4 tertiary hospitals in Tangshan were investigated by general information questionnaire,transformational leadership scale,leader-member exchange relationship scale,error management climate scale and the barriers to medication near-miss reporting scale. The chain mediation model was constructed and verified.Results The indirect effect of transformational leadership on the barriers to medication near-miss reporting was established,and the total indirect effect value was 0.126. The chain mediating effect of LMX and error management climate in transformational leadership and barriers to medication near-miss reporting was 0.011,accounting for 8.73% of the total indirect effect.Conclusion The LMX and error management climate were found with multiple mediating effects between transformational leaders and medication near-miss reporting barriers. The head nurses should pay attention to the shaping of their own transformational leadership style,improve the relationship with nurses,create a positive error management climate,and reduce the barriers to medication near-miss reporting.

    Study on distribution characteristics and countermeasures of approximate errors in intravenous drug allocation in 4530 cases
    PAN Huili,LU Bin,YANG Yan,SONG Ping,XU Hong,LI Yan,WANG Hongmei
    2020, 55(9):  1310-1314.  DOI: 10.3761/j.issn.0254-1 769.2020.09.005
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    Objective To analyze the incidence and distribution characteristics of approximate errors in intravenous drug allocation so as to provide references to improve management mechanism and ensure safe infusion.Methods A retrospective analysis was conducted in 4 530 cases of approximate errors with registration data from January 2017 to December 2018 in a Pharmacy Intravenous Admixture Service of the hospital. According to 4 dimensions including the time of occurrence,drug type,the population of occurrence and the population of discovery,this study classifies,summarizes the characteristics and discusses the countermeasures.Results There were a total of 4 530 cases of approximate errors occurring in the stage of allocation,with the error rate of 1.26‰. According to the time of occurrence,2 752 cases(60.8%) occurred before allocation and 1 778 cases (39.2%) were in the process of allocation. According to the type of drugs,1 756 cases(98.76%) of errors happened on common drugs and 16 cases(0.9%) were total parenteral nutrition,and 6 cases(0.34%) were anti-neoplastic agents during the allocation process. According to the incidence of personnel,3 183 cases(70.26%) were pharmacists;1 168 cases(25.78%) were allocation nurses. According to the population of discovery,3 133 cases(69.16%) were allocation nurses;1 397 cases(30.84%) were pharmacists.Conclusion Intravenous drug allocation has been checked through multiple procedures in Pharmacy Intravenous Admixture Service,but there is still a certain incidence of approximate errors,and it is necessary to further optimize the management mechanism,improve the awareness and skills of safe delivery,and ensure the quality of intravenous infusion.

    A qualitative research on cognition and practice of NICU nurses on patient safety culture
    ZHAN Yuxin,LIU Yunfang,YANG Zhongshan,HAN Kexia,LI Suyun,YU Jiaohua
    2020, 55(9):  1315-1319.  DOI: 10.3761/j.issn.0254-1769.2020.09.006
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    Objective To further understand the cognition and practice of NICU(Neurosurgical Intensive Care Unit)nurses on patients’ safety culture,so as to provide references for promoting the construction of patients’ safety culture.Methods 12 nurses in NICU were interviewed in an in-depth semi-structured way by phenomenological research methods. The interview materials were transcribed,coded,analyzed,described and organized.Results The cognition of NICU nurses on patients’ safety culture can be summarized into 2 themes including high recognition and affirmation,and support of patients’ participation in patients’ safety. The obstacles affecting the construction of patients’ safety culture can be extracted into 5 themes,namely improper allocation of nursing human resources,lack of climate for all staff to participate in patients’ safety,lack of education and training system for patients’ safety,imperfect reporting mechanism of non-punitive adverse events and inadequate attention to psychological support of nurses.Conclusion Nurses play leading and exemplary roles in the construction of patients’ safety culture in hospitals. To explore the cognition of nurses on patients’ safety culture and the factors affecting their practical behaviors can provide a reference for the establishment of a scientific and systematic management system of patients’ safety culture.

    A qualitative study on feelings and coping measures of junior nurses leaving after adverse events
    LÜ Yongli,GENG Li,DING Ying
    2020, 55(9):  1320-1323.  DOI: 10.3761/j.issn.0254-1769.2020.09.007
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    Objective To explore psychological feelings and self-coping measures of nurses with low seniority who resigned after adverse events,so as to provide supportive strategies and bases for medical institutions and nursing managers to strengthen the management of nurses with low seniority.Methods 7 junior nurses who left their posts after adverse safety incidents in a tertiary hospital were selected for in-depth interviews by qualitative research methods.Results Most interviewees believed that there was a close relationship between the adverse events and turnover as they suffered from the negative emotional pressure,the inability to self-recover,the lack of competence for work,the lack of coping strategies and organizational support to deal with adverse events,the occupational distress after the experience of adverse safety events.Conclusion Nursing managers should pay attention to the feelings of nurses with low seniority after the adverse events,help them alleviate psychological pressure in time,correctly deal with the adverse medical events,and do well in the management of nursing human resources,so as to reduce the turnover of nurses with low seniority and ensure the stability of nursing teams.

    The effects on oral administration safety management in cardiology nurses
    LÜ Yefang,WANG Xiaocan,HAN Jiangying,DING Ping,WANG Xiaoyan,ZHAO Ren
    2020, 55(9):  1324-1329.  DOI: 10.3761/j.issn.0254-1769.2020.09.008
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    Objective To investigate the effects of Comprehensive Unit-Based Safety Program(CUSP) in oral administration safety management in cardiology nurses.Methods The convenience sampling was used to select 34 nurses from 2 cardiology wards in a tertiary hospital. The safety management model of oral administration based on CUSP was adopted. 34 nurses were investigated by the Hospital Survey on Patient Safety Culture(HSOPS),Chinese Safety Attitudes Questionnaire(C-SAQ),Oral Medicine Safety Questionnaire of Knowledge,Attitude and Practice for Nurses,Theoretical Examination of Oral Administration in Department of Cardiology before and 6 months after the intervention.Results After the intervention,consent rates of items reflecting the nurses’ perception of patient safety culture were improved compared to those before(P<0.05). The scores of teamwork,safety climate,management perception,job satisfaction,working condition dimensions in nurses in the unit and the total score of C-SAQ were higher than those before the intervention(P<0.05). The scores of medication safety of knowledge,attitude and practice of nurses and the total score of nurse drug safety were higher than those before the intervention(P<0.05). The score of theoretical examination after the intervention was higher than that before the intervention(P<0.05).Conclusion The safety management of oral administration based on CUSP can effectively promote the establishment of safety culture in units,and improve the level of oral administration safety of nurses.

    Cardiovascular Care
    Application of a modified version of early cardiac rehabilitation program in patients with acute ST-segment elevation myocardial infarction treated by percutaneous coronary intervention
    FENG Shushuang,HUA Jun,WEI Ruihong,ZHANG Yaofeng,LIN Yongrong,LIN Ying,YANG Xuehui,LIN Bingxun,YUAN Yonghong,WANG Wei,LIU Hui
    2020, 55(9):  1330-1334.  DOI: 10.3761/j.issn.0254-1769.2020.09.009
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    Objective To evaluate the application and effects of a modified version of early cardiac rehabilitation program in patients with acute ST-segment elevation myocardial infarction treated by Percutaneous Coronary Intervention(PCI).Methods Totally 112 patients with acute ST-segment elevation myocardial infarction undergoing PCI enrolled in Coronary Care Unit(CCU) were randomized into a control group and an experimental group with 56 cases in each group. The experimental group was given a modified version of the early cardiac rehabilitation program,while the control group received routine exercise training. The Activity of Daily Living Scale(ADL),left ventricular ejection fraction(LVEF),the length of hospital stay and the incidence of adverse events were compared in both groups before the intervention and at 7th day after the intervention,and the satisfaction of patients was investigated through interviews.Results After a week of interventions,results of ADL and LVEF in the experimental group was significantly higher than those in the control group. The length of hospital stay in the experimental group was shorter than that in the control group. The differences of 3 statistical results were statistically significant(P<0.01). No adverse events occurred in both groups. Participants in the experimental group claimed that the modified rehabilitation program could be used to help them recover their self-care ability and rebuild their confidence to return to life according to patients own conditions as soon as possible,and all of them could cooperate actively.Conclusion The modified version of the early cardiac rehabilitation program is safe and effective that can be used to accelerate the rehabilitation of patients with acute myocardial infarction after PCI,increase LVEF,improve the daily self-care ability of patients,shorten the length of hospitalization,and improve the quality of life of patients.

    Investigation on nutrition and dietary status of 106 cases of patients with chronic heart failure
    HUI Ning,ZHANG Wenjie,WU Beibei
    2020, 55(9):  1335-1340.  DOI: 10.3761/j.issn.0254-1769.2020.09.010
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    Objective To understand the nutritional status,dietary structure and intake of some micronutrients in oral feeding patients attacked by chronic heart failure,so as to provide scientific bases for guiding their rational diet and formulating relevant nutritional interventions.Methods A total of 106 oral feeding patients with chronic heart failure in Department of Cardiology of a tertiary hospital were investigated. The nutritional status of the patients was evaluated by the Heart Failure specific Mini Nutrition Assessment scale(MNA-HF),and the breakfast,lunch,supper and extra meals of the patients were recorded by 24-hour diet review. The total amount of dietary nutrients was calculated and compared with the Dietary Guidelines for Chinese Residents(2016),the Reference Dietary Intake of Chinese Residents(2013) and Jiangsu Dietary Survey Data in 2010 to 2012.Results 106 oral feeding patients with chronic heart failure were investigated by MNA-HF scale,and it was found that the incidence of nutritional risks or malnutrition was about 61.32%. The per capita daily intake of vegetables,soybeans and nuts in patients with heart failure accorded with the recommended values of Dietary Guidelines for Chinese Residents. Cereals,potatoes,beans,fruits,milk and dairy products have not yet reached the recommended values. Livestock and poultry,meat,aquatic products,eggs,oils and fats and salts all exceed the recommended values. The per capita daily intake of energy is about 5 316.66±659.15 kJ;the per capita daily intake of protein,fat and carbohydrates is about 62.27±23.24 g,51.27±37.81 g and 140.28±47.46 g,respectively;the energy supply ratios are about 20.34%,33.42% and 46.15%,respectively. The per capita daily intake of sodium and iron was higher than the recommended intake or appropriate intake(RNIs or AIs). The per capita daily intake of vitamin B1 and potassium was lower than that of RNIs or AIs.Conclusion The nutritional and dietary status of patients with chronic heart failure who take food by mouth is hardly optimistic. It was suggested that nurses could strengthen nutritional risk screening and dietary guidance for patients suffered with chronic heart failure,and formulate relevant interventions for patients with nutritional risks or malnutrition.

    Study on recovery time and influencing factors of swallowing function in patients with acquired dysphagia after cardiac surgery
    YU Jintian,CHEN Junshan,ZHANG Aiqin
    2020, 55(9):  1341-1345.  DOI: 10.3761/j.issn.0254-1769.2020.09.011
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    Objective To explore the recovery time of swallowing function and its influencing factors in patients with acquired swallowing disorder after cardiac surgery,so as to provide references for optimizing the rehabilitation program of acquired dysphagia.Methods A total of 85 patients with acquired swallowing disorders after cardiac surgeries who were admitted to a tertiary hospital in Nanjing from October 2018 to October 2019 were selected;demographic and clinical data was collected;the outcome and recovery time of swallowing function were the dependent variables;Kaplan-Meier method and Cox proportional hazards model were used to analyze the recovery time of swallowing function and its influencing factors.Results The recovery time of swallowing function in patients with acquired dysphagia after cardiac surgeries was 1-12 days,and the mean recovery time was 2.72±1.85 days. Cox proportional hazards analysis indicated that endotracheal intubation time(RR=0.987,P=0.004) and the first standardized swallowing assessment score (RR=0.828,P<0.001) after extubation had a significant impact on the recovery time of swallowing function in patients with acquired swallowing disorder after cardiac surgeries.Conclusion Endotracheal intubation time and the first standardized swallowing assessment score after extubation are independent influencing factors for the recovery of swallowing function in patients with acquired swallowing disorder after cardiac surgeries. In the future,it is still necessary to further clarify the recovery process of dysphagia and related prognostic indicators,so as to optimize the clinical practice and improve the prognosis of patients.

    Short-term and long-term clinical outcomes of same day discharge after percutaneous coronary intervention in patients:a systematic review and meta-analysis
    LI Yanan,LIU Shu,LIU Ping,YOU Aolin,LUAN Xiaorong
    2020, 55(9):  1352-1358.  DOI: 10.3761/j.issn.0254-1769.2020.09.014
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    Objective To systematically assess short-termed and long-termed clinical outcomes of same day discharge after percutaneous coronary intervention(PCI). Methods The Cochrane Library, Wiley online library, PubMed and EMBASE et al databases were searched for randomized control trials comparing same day discharge and overnight stay in the hospital after PCI. RevMan 5. 2 was used as the statistical software. Results 10 randomized control trials with a total number of 3 908 patients (1 844 patients were discharged on the same day and 2064 patients stayed overnight in the hospital) were included. The results showed that, compared with overnight hospitalization, the discharge on the same day after PCI had no significant effect on 24-hour incidence of adverse cardiac events [RR=0. 28, 95%CI(0. 05, 1. 64), Z=1. 42, P=0. 16] , 24-hour overall incidence of adverse cardiac events [RR=0. 67, 95%CI(0. 17, 2. 68), Z=0. 57, P=0. 57] , 30-day incidence of adverse cardiac events [RR=0. 83, 95%CI(0. 43, 1. 58), Z=0. 57, P=0. 57] , 30-day overall incidence of adverse events [RR=0. 94, 95%CI(0. 71, 1. 26), Z=0. 40, P=0. 69] , 30-day readmission rate [RR=1. 12, 95%CI(0. 76, 1. 66), Z=0. 57, P=0. 57] , one-year incidence of adverse cardiac events [RR=1. 03, 95%CI(0. 76, 1. 40), Z=0. 19, P=0. 85] and one-year overall incidence of adverse events [RR=0. 98, 95%CI(0. 76, 1. 25), Z=0. 19, P=0. 85] . The medical expenses were reduced and the patients’ satisfaction was improved, but the patients were not well prepared for discharge. Conclusions Discharge on the same day after PCI does not increase the occurrence of short-term and long-term adverse events. In the future, it can be carried out in the outpatient services for specific patient groups.

    Standards
    Expert consensus on surgical isolation techniques for lung malignancies
    WEI Yongting, CHUAI Wenjuan, CHEN Tinghui, WU Xiuhong, WANG Feng
    2020, 55(9):  1359-1359.  DOI: 10.3761/j.issn.0254-1769.2020.09.015
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    Objective To form the expert consensus on surgical isolation techniques for lung malignancies.Methods By retrieving international and national literature and interviewing relevant personnel,we formulated the first draft of a consensus on surgical isolation techniques for lung malignancies and the enquiry form. Experts are selected nationwide to conduct a round of letter consultation and a round of on-site demonstration. The corresponding items were modified in accordance with the opinions of the experts,and the level of evidence and recommendation level were marked and then a final consensus was formed.Results A total of 18 thoracic surgery experts and nursing experts from tumor surgery rooms were selected;the expert authority coefficient was 0.87;expert importance of each item was 4.92±0.23;coefficient of variation was 0.09 to 0.16. The feasibility was 4.54±0.65;coefficient of variation was 0.12 to 0.19. Expert coordination coefficient was 0.249(P<0.001). The consensus includes qualifications of operating room nurses,preoperative evaluation,surgical equipment and instruments,protection of incisions,surgical cavity exploration,management of device dressings,tumor resection,tumor removal,concurrent surgery and reconstruction surgery,use of irrigation fluid,and inventory. The above 11 aspects are applicable to traditional open surgery,small incision surgery and thoracoscopic surgery.Conclusion This consensus is based on the surgical isolation techniques for lung malignancies with detailed operating specifications for each aspect,which is easy for the surgical staff to implement and can guide clinical practice.

    Specialist Practice and Research
    Construction of early motor rehabilitation nursing program based on Modified Barthel Index grading for stroke patients
    JIN Jingfen, LI Mei, CHEN Yuanyuan, CHEN Jinhua, WANG Jianmiao, ZHANG Yuping, YANG Hongyan
    2020, 55(9):  1360-1365.  DOI: 10.3761/j.issn.0254-1769.2020.09.016
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    Objective An early motor rehabilitation nursing program for stroke patients based on Modified Barthel Index(MBI) grading was constructed to guide clinical nurses to perform precise early motor rehabilitation for stroke patients,in order to provide a basis for developing guidelines for rehabilitation nursing care of stroke patients.Methods Based on literature review and expert meetings,a draft of motor rehabilitation nursing program for stroke patients was constructed. The Delphi method was used to conduct 2 rounds of expert consultations to determine the early rehabilitation nursing program for stroke patients.Results In the first round,17 experts were consulted,and the response rate was 94.12%;in the second round,16 experts were consulted,and the response rate was 100%. The expert authority coefficient was 0.90. After 2 rounds,the coefficient of variation of items was 0 to 0.24,Kendall’s coefficient was 0.226(P<0.001) and the importance value was 4.13 to 5.00. Finally,an early motor rehabilitation nursing program classified by MBI was formed,including 5 first-level indicators(fully dependent,heavily dependent,moderately dependent,mildly dependent and basic self-care) and 47 second-level indicators(rehabilitation).Conclusion The nursing program constructed in this study is reliable and scientific,and it can provide references for the research and practice of rehabilitation training for stroke patients.

    Establishment of quality indicator system for nursing in pediatric continuous blood purification
    ZHAO Xiaoshuang,ZHANG Baorong,ZHANG Dan,GUAN Ruixin,HU Lili,ZHANG Jiping
    2020, 55(9):  1366-1371.  DOI: 10.3761/j.issn.0254-1769.2020.09.017
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    Objective To develop a quality indicator system for nursing care in pediatric continuous blood purification.Methods A comprehensive method,including literature review,semi-structured interviews,Delphi method and analytic hierarchy process,was adopted to establish a quality indicator system for nursing in pediatric continuous blood purification.Results 2 rounds of expert consultations resulted in the effective response rates of 100% and 91.67%,with the authority coefficients of 0.88 and 0.90,and the coordination coefficients of 0.160 and 0.256 respectively. The final evaluation indicators for nursing quality in pediatric continuous blood purification included 3 first-level indicators,13 second-level indicators,and 57 third-level indicators.Conclusion The quality evaluation indicator system for nursing care in pediatric continuous blood purification is highly practical with scientific,which can provide references for evaluation criteria of nursing quality in pediatric continuous blood purification.

    Effects of nutritional management based on the system management theory in patients with Crohn’s disease
    YOU Lili,WANG Tiantian,YANG Hong,ZHANG Yue,ZHU Wenbo,YAO Yuying,KANG Xiaofeng,GUAN Yuxia
    2020, 55(9):  1372-1375.  DOI: 10.3761/j.issn.0254-1769.2020.09.018
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    Objective To analyze effects of system management in patients with Crohn’s disease.Methods A self-comparison method was adopted in this study. A total of 45 patients with Crohn’s disease were recruited from Department of Gastroenterology,Peking Union Medical College Hospital. Nutritional management was applied during enteral nutrition therapy. Nutrition status and adverse effects were recorded on the day of enrollment,1 month,3 months and 6 months after receiving enteral nutrition,respectively. Repeated measures ANOVA was used to analyze the differences of evaluation indicators at different time points.Results After 6 months of interventions,nutritional indicators(weight,NRS2002,TP,Alb,HGB) were significantly increased,while inflammatory indicators(ESR,hsCRP) were significantly decreased(P<0.05). The incidences of intestinal symptoms and adverse reactions decreased gradually.Conclusion Nutritional management based on the system management theory can effectively improve the nutrition status of patients and the quality of care.

    TCM Nursing
    Effects of acupoint application therapy based on midnight-noon ebb-flow for gastrointestinal function in patients undergoing gynecological laparoscopy
    GUI Ping,YE Shuhua,XIE Yuying,HE Haixia,LI Chunyan,YANG Yang,LIN Meizhen
    2020, 55(9):  1376-1380.  DOI: 10.3761/j.issn.0254-1769.2020.09.019
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    Objective To investigate effects of midnight-noon ebb-flow combined with acupoint application on gastrointestinal function of patients after gynecological laparoscopy.Methods 108 patients after laparoscopy in Guangzhou from August 2017 to December 2018 were selected as research subjects who were randomly allocated into group A(midnight-noon ebb-flow combined with acupoint application therapy),group B(rhubarb Shenque acupoint application therapy without time control) and group C (midnight-noon ebb-flow combined with placebo). In addition to the above intervention,all patients received routine nursing care during the study. The gastrointestinal function,including the time of first defecation,the time of first passage of flatus(“gas-out time”) and the recovery time of bowel sound,as well as adverse events,were measured daily.Results The recovery of gastrointestinal function among 3 groups were statistically significant after treatment(P<0.05). The time of first defecation,the time of first passage of flatus and the recovery time of bowel sound in Group A were less than those in the other 2 groups(P<0.05). The time of first defecation and first passage of flatus in Group B was less than that in Group C(P<0.05). But there was no significant difference in recovery time of bowel sounds between Group B and Group C. Meanwhile,Group A ranked with the least adverse events(abdominal distension,nausea,vomiting,abdominal pain and etc.),followed by Group B.Conclusion Acupoint application therapy based on midnight-noon ebb-flow can effectively promote the recovery of gastrointestinal function and reduce the adverse events related to gynecological laparoscopy.

    Nursing Management
    Study on impact of Head Nurse Listening Day on pediatric nurses
    LIU Huayan,ZHU Lihui,XIE Jianhui,LI Yan,XIAO Pin,SU Zhenhui,LONG Yan,FENG Huayan,TAN Lingfang,ZENG Shan,DENG Luyao,DUAN Weiwei
    2020, 55(9):  1381-1386.  DOI: 10.3761/j.issn.0254-1769.2020.09.020
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    Objective To explore the application effect of Head Nurse Listening Day,in order to seek scientific and reasonable interventions to improve the psychological resilience of pediatric nurses,to promote the organizational climate among nurses,and to reduce the occurrence of recessive absenteeism.Methods In 2018,our hospital carried out lean 10S management. The cluster random sampling method was utilized to enroll 87 nurses as research subjects from the neurology department,hematology department and rehabilitation department where pediatric patients with chronic diseases were hospitalized. The subjects were randomly allocated into a control group (45 nurses) and a trial group(42 nurses). From January to December 2018,a group was set up to carry out Head Nurse Listening Day with Listening-Relief-Interaction as the main contents. A baseline survey was conducted by a set of instruments,including Conner-Davidson Resilience Scale(CD-RISC),Nurse Organizational Climate Perception Scale,and Stanford Presentation Scale(SPS-6). A two-to-two correlation analysis of 3 scales was used,and then the Head Nurse Listening Day was launched. The 2 groups of nurses were reinvestigated in December 2018 by above 3 scales and the results were compared with these of the baseline survey.Results The CD-RISC scores were positively correlated with the scores of Nurse Organizational Climate Perception Scale before and after the intervention,and they were negatively correlated with the SPS-6 scores. The SPS-6 scores were negatively correlated with the scores of Nurse Organizational Climate Perception Scale,and the differences were statistically significant(P<0.05). The scores of CD-RISC and Nurse Organization Climate Perception Scale after intervention were better than those before,and the SPS-6 scores were lower than these after intervention,and the differences were statistically significant(P<0.05).Conclusion The application of Head Nurse Listening Day can improve the psychological resilience and the organizational climate,and reduce the incidence of recessive absenteeism among pediatric nurses.

    Nursing Education
    Standardized training program on core competence of psychiatric nurses and the curriculum design
    CHENG Gen,SHAO Jing,WANG Yong,YAO Hongping,YAO Xiuyu
    2020, 55(9):  1387-1393.  DOI: 10.3761/j.issn.0254-1769.2020.09.021
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    Objective To help improve standardized training program,this study explored the components of core competence for psychiatric nurses. Methods Based on literature review and interview results,a questionnaire was designed to measure the core competence and standardized training program for psychiatric nurses. Altogether,28 experts on psychiatric nursing,nursing management and nursing education from 8 regions across the country engaged in two rounds of Delphi consulting to determine the core competence of standardized training program and develop the training content. Results The response rate was 93.3% and 100% in the two rounds of consultation,respectively,while the authority coefficients were 0.864 and 0.87,and the Kendall’ W was 0.359 and 0.326(P<0.01),respectively. The core competence consists of 7 components with 37 items of training contents. Conclusion The standardized training content addressed the features of psychiatric nursing,meet the needs of standardized training of psychiatric nurses,using diverse training and assessment methods.

    Community Care
    Cognitive function and depression in community-dwelling elderly:a longitudinal study
    LI Zheng,ZOU Haiou,WANG Lingyun,YAO Xiuyu,LI Shuya,LI Xiaoxue,ZHOU Ying,GU Jianing,ZHANG Haiyu,ZHAO Yu,YIN Min
    2020, 55(9):  1394-1398.  DOI: 10.3761/jissn.0254-1769.2020.09.022
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    Objective To explore the cross-lagged effect between cognitive function and depression in the elderly in communities.Methods Based on the longitudinal study,the cross-lagged panel model was used to analyze the cognitive function and depression performance of elderly people in 2013 and 2017. The cross-lagged effect was analyzed by the structural equation model.Results ①The results of ANOVA showed that the cognitive function and the depressive behavior have a decreasing trend with time,and the decline level of women is more severe;②The correlation analysis showed that the baseline cognitive function score was positively correlated with the follow-up cognitive function score(r=0.632,P<0.001);the baseline depression score was positively correlated with the follow-up depression score(r=0.485,P<0.001);the follow-up cognitive function score was negatively correlated with the follow-up depression score(r=-0.166,P=0.002);the baseline cognitive function score did not have correlation with the baseline and follow-up depression scores(P>0.05);③The results of cross-lagged regression analysis showed that the cognition at baseline positively predicted cognition at follow-up( β=0.718,P<0.001) and depressive symptoms at follow-up( β=-0.133,P=0.004);the depressive symptoms at baseline positively predicted those at follow-up( β=0.518,P<0.001).But there was no significant predicted effect between cognition at baseline and depressive symptoms at baseline( β=-0.155,P=0.006).Conclusion The baseline cognitive function level of the elderly in the community have a predictive effect on the follow-up of depression,while the baseline depression level have no predictive effect on the follow-up of cognitive function,and the relationship between the cognition and depression should be further explored.

    Construction and application of home-based continuous care platform for patients with nasopharyngeal carcinoma
    LIAO Tingting,YANG Li,WANG Rensheng,LIAO Jinlian,QIU Liyan,LI Lin,SUN Xihui
    2020, 55(9):  1399-1404.  DOI: 10.3761/j.issn.0254-1769.2020.09.023
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    Objective To evaluate the design and intervention effects of a home-based continuous care platform of nasopharyngeal carcinoma(NPC) patients based on patient needs,and to provide NPC patients with access to acquire disease nursing knowledge and skills to improve their post-hospital life quality and health outcomes.Methods The home-based continuous care platform for NPC patients has 2 parts,including system management platform and operation platform. From April to June 2019,80 patients with NPC who were initially treated in the Radiotherapy Department of a tertiary hospital in Nanning city and discharged after radiotherapy and chemotherapy were selected as the study subjects. They were allocated into an experimental group and a control group by random number table method,with 40 cases in each group. On the basis of routine discharge guidance,the experimental group used home-based continuous care platform for nursing intervention;the control group was given routine nursing after discharge. 6 months after the intervention,the satisfaction of platform design,self-care compliance,the degree of complications and the evaluation of quality of life were compared between 2 groups.Results The use rate of the platform was 98% and the overall satisfaction was(62.00±7.41),which were at a high level;the compliance of self-care in the experimental group was significantly higher than that in the control group(P<0.05);the incidence of complications was significantly lower than that in the control group(P<0.05);the evaluation of quality of life was better than that in the control group(P<0.05).Conclusion The NPC home-based continuous care platform is conducive to the development of scientific and systematic extension of nursing services,so as to improve the quality of life of patients with NPC and it is worthy of further promotion in the clinics.

    Evidence Synthesis Research
    Evidence summary for key tasks of discharge planning in hospitalized patients
    WANG Hui,WANG Ying,LIU Yu,WANG Binghua,YUE Xiao,KE Jian,HU Kaili,YANG Chunzi
    2020, 55(9):  1412-1419.  DOI: 10.3761/jissn.0254-1 769.2020.09.026
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    Objective To select,evaluate and summarize the best available evidence for key tasks of discharge planning in all hospitalized patients,so as to provide references for clinical practice of discharge planning.Methods We searched National Institute for Health and Clinical Excellence,New Zealand Guidelines Group,Scottish Intercollegegiate Guidelines Network,National Guideline Clearinghouse,Guidelines International Network,Joanna Briggs Institute,Registered Nurses’ Association of Ontario,Centers for Medicare Medicaid Services,Health Service Executive,medlive,UpToDate,Cochrane library,CINAHL,Pubmed,CNKI,Wanfang Database,CBM,CQVIP,to collect literature of discharge planning,including standards,guidelines,expert consensuses,government documents,best/recommended practices,summary of evidence,systematic evaluation,systematic reviews. 3 researchers independently evaluated quality of literature and extracted the evidence that met the quality standards.Results 19 articles were enrolled,including 3 standards,5 guidelines,3 expert consensuses,1 expert opinion,2 government documents,1 recommended practice toolkit,1 evidence summary,1 clinical decision,and 2 systematic reviews. Totally 33 pieces of evidence were selected from admission to discharge based on 5 periods of the timeline,including in 24 hours after admission,during hospitalization,in 24 hours before discharge,on discharge day and after discharge.Conclusion This study summarized the best evidence for key tasks of discharge planning for inpatients,and hospitals can develop personalized discharge plans for various diseases to promote safe and effective discharge of patients.

    Best evidence summary of nutritional assessment and management in patients with liver cirrhosis
    PANG Yongli,FANG Hengying,LUO Yuanrong,GU Jiaojiao,CHEN Miaoxia
    2020, 55(9):  1420-1425.  DOI: 10.3761jissn.0254-1769.2020.09.027
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    Objective To search,evaluate,and summarize the best evidence for nutritional assessment and management in patients with cirrhosis.Methods Cochrane Library,CINAHL,Joanna Briggs Institute Library,BMJ BestPractice,UpToDate,European Association for the Study of the Liver,the Korean Association for the Study of the Liver,American Association for the Study of Liver Diseases,Medline,Elsevier,Web of Science,Embase,PubMed,Wanfang and CNKI were searched to collect the literature.Results A total of 10 pieces of literature were included,among which 6 were originated from abroad and 4 were from China,including 8 guidelines,1 expert consensus,and 1 systematic review. A total of 21 pieces of best evidence were collected,mainly involving 7 aspects of nutrition risk screening,nutrition assessment,energy and protein intake,frequency of meals,meals,management of complications and health education in patients with liver cirrhosis.Conclusion The best evidence of nutritional assessment and management of patients with liver cirrhosis is abundant in content,but some evidence was from foreign evidence-based resources,while localization remains to be done at the time of application.