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Table of Content

    15 April 2021, Volume 56 Issue 4
    Research Paper
    Establishment and application of an early warning scoring information system for neonates
    FENG Xiaofang,HUANG Xiaoxia,QIAN Xiaorong,CHEN Yan,ZHANG Liping,SUN Caixia
    2021, 56(4):  485-489.  DOI: 10.3761/j.issn.0254-1769.2021.04.001
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    Objective To establish and apply an information system of early warning scoring for neonates,so as to provide clinical nurses in neonatal departments with a rapid and dynamic method of assessing the conditions of patients,and to improve their ability to perform homogeneous early warning assessment. Methods 100 neonates hospitalized in a neonatal department from July to December 2019 in a tertiary hospital of Wenzhou City were selected as an observation group,and the early warning scores of neonates were evaluated using an information system. 100 neonates hospitalized from January to June 2019 were selected as a control group. The number of oxygen inhalation cases,oxygen inhalation time,the number of invasive mechanical ventilation cases,the number of cases transferred to NICU,the length of hospitalization,the accuracy of the early warning score,and the time consuming of the scoring were compared as the comparison indicators by artificial early warning scoring. Results The number of invasive mechanical ventilation cases and the number of cases transferred to NICU in the observation group were lower than those in the control group(P<0.05). There was no significant difference in the number of oxygen inhalation cases,the time of oxygen inhalation and the length of hospital stay;the differences were statistically significant(P<0.05). The accuracy rates of early warning scoring for nurses were significantly improved,and the time consuming for scoring decreased significantly with statistical differences(all P<0.05). Conclusion The neonatal early warning scoring information system has obvious advantages in improving the accuracy of scores and saving time,improving the ability of nurses of different ages to make early warning assessments of neonatal conditions,and early detection of potentially critically ill children. Early intervention and early treatment can reduce the incidence of adverse events and improve clinical outcomes.

    The effects of ICU nursing human resources in tertiary hospitals in Henan on the quality of nursing and patient outcomes
    FENG Yating,CHEN Changying
    2021, 56(4):  490-495.  DOI: 10.3761/j.issn.0254-1769.2021.04.002
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    Objective To investigate and analyze the status of ICU nursing human resources,the quality of nursing and patient outcomes in tertiary hospitals in Henan and thereby to provide reasonable suggestions to optimize ICU nursing human resources,improve the quality of nursing and patient outcomes. Methods The self-designed questionnaire was employed to investigate the status of ICU nursing human resources,the quality of nursing and patient outcomes in 20 tertiary hospitals in Henan. Results The total number of ICU beds of 20 tertiary hospitals in Henan was 1,101;the total number of registered nurses in ICU was 3,005,and the ratio of the number of beds and nurses in ICU was 1 ∶ (2.48±0.95). Nurses aged 25~35 accounted for 54.18% of the total number of registered nurses in ICU,while junior college nurses accounted for 53.18%,and nurses with less than 5 years working length accounted for 51.41%. The ratio of the primary,secondary and senior nurses was 1 ∶ 0.11 ∶ 0.01. The ratio of the number of beds and nurses in ICU was positively correlated to the mortality rate and the incidence of pressure injury in critically ill patients, the incidence of related blood flow infection in central venous catheter and the incidence of urinary tract infection in the catheter(P<0.05). The proportion of intermediate professional titles in registered nurses in ICU was negatively correlated to the mortality rate of critically ill patients and the incidence of ventilator associated pneumonia(P<0.05). The proportion of junior professional titles in registered nurses in ICU was positively correlated to the mortality rate of critically ill patients(P<0.05). The proportion of registered nurses with bachelor’s degree in ICU was negatively correlated to the mortality rate of severe patients,the rate of unexpected 48-hours return to intensive care,the incidence of ventilator associated pneumonia and the incidence of related blood flow infection in central venous catheter(P<0.05). Conclusion The status of ICU nursing human resources in tertiary hospitals in Henan was not reasonable,and it influences the quality of nursing and patient outcomes. Hospital leadership should attach great importance to human resources in ICU,and adjust the structure of nursing staff by professional title and education background,in order to guarantee the nursing quality and medical safety.

    Establishment and enlightenment of a predictive model for decreased skeletal muscle mass in maintenance hemodialysis patients
    DU Xiaoju,ZHANG Hailin,YIN Lixia,CHEN Guanjie,GUO Gui,LI Xiaoliang,ZHANG Yongping,ZHOU Qifan
    2021, 56(4):  496-501.  DOI: 10.3761/j.issn.0254-1769.2021.04.003
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    Objective To construct a predictive model of decreased skeletal muscle mass in maintenance hemodialysis patients and to apply it in clinical practice to evaluate the effects of the model. Methods A total of 304 maintenance hemodialysis patients in a tertiary hospital in Lianyungang were selected as the training set by convenience sampling method,and various indicators of the decreased skeletal muscle mass group(n=74) and the non-decreased skeletal muscle mass group(n=230) were analyzed by univariate analysis. Logistic regression analysis was used to construct the prediction model and the model was simplified it. The area under the ROC curve was used to test the model effects,and 309 maintenance hemodialysis patients in a tertiary hospital in Xuzhou were selected to externally verity the effects of the model. Results The study finally included 4 factors,namely gender,BMI,calf circumference and predialysis creatinine,to construct the risk prediction model. The area under the ROC curve of this model was 0.911;the area under the ROC curve of the simplified model was 0.911;the accuracy rate of practical application was 75.40%. Conclusion The risk prediction model constructed in this study can predict the risk of decreased skeletal muscle mass in patients undergoing maintenance hemodialysis,and all the indicators are simple and easy to obtain,thus providing references for medical staff to carry out early indenfication and take preventive care interventions for high-risk patients in the early stage.

    Construction of an early cardiac rehabilitation nursing practice program for patients after emergency percutaneous coronary intervention
    GU Yuqing,ZHU Lili,LI Qingyin,ZHAO Dongyun,HAN Yu,WU Yuan,ZHANG Jun
    2021, 56(4):  502-507.  DOI: 10.3761/j.issn.0254-1769.2021.04.004
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    Objective To construct an early cardiac rehabilitation nursing practice program for patients after emergency percutaneous coronary intervention(PCI),and provide a reference for early cardiac rehabilitation in patients with acute myocardial infarction after emergency PCI. Methods A research team was established to formulate a draft of the early cardiac rehabilitation nursing practice program for patients with emergency PCI based on the literature review combined with clinical experience. 2 rounds of Delphi expert letter inquiries were conducted,and the items based on the opinions of the expert letter inquiries were modified. Results In the first round,16 experts were consulted,and the effective response rate of the questionnaire was 100%.In the second round,16 experts were consulted,and the effective response rate of the questionnaire was 93.75%. The expert authority coefficient was 0.875;the coefficient of variation of items in the second round was 0.09~0.21;the Kendall’s concordance coefficient was 0.64(P<0.001);the importance value was 4.27~4.80. Eventually,a nursing practice program for early cardiac rehabilitation for patients after emergency PCI was formed,including 5 first-level indicators(exercise rehabilitation,advanced rehabilitation methods,health education,daily life guidance,and energy consumption) and 56 secondary indicators. Conclusion The early cardiac rehabilitation nursing practice program constructed in this study is scientific,reliable and closely integrated with the clinical practice,with strong theoretical bases and clinical practical value.

    Special Planning-Orthopaedics Nursing
    Establishment of a nursing quality evaluation indicator system for orthopedic rehabilitation
    CAI Libai,LIU Yanjin,GUO Yuru,WANG Qi,ZHAN Yuxin,LIU Yangyang,CUI Miaoran,ZHAO Hui
    2021, 56(4):  508-514.  DOI: 10.3761/j.issn.0254-1769.2021.04.005
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    Objective To establish an evaluation indicator system of nursing quality for orthopedic rehabilitation,and to provide references for related clinical evaluation. Methods From June to August 2020,the research group established the first draft of orthopedic rehabilitation nursing quality evaluation index system based on the framework of the three-dimensional “structure-process-outcome” quality model,literature review and semi-structured interviews,and then 23 experts from 10 provinces in China were consulted through Delphi technique. The final nursing quality evaluation system and index weight for orthopedic rehabilitation were analyzed by analytic hierarchy process. Results The recovery rates of 2 rounds of expert consultations were 92.60% and 92.00%. The authority coefficients were 0.909 and 0.917. The Kendall harmony coefficients were 0.272 and 0.318,respectively. The average importance value of indexes ranged from 3.65 to 5.00,and variation coefficients of each item ranged from 0 to 0.22. The final nursing quality evaluation indicator system for orthopedic rehabilitation consisted of 3 first-level indicators(structure indicators,process indicators,outcome indicators),9 second-level indicators(human resources,management system,facilities and equipment,nursing evaluation,nursing practice,health education,follow-up management,nurse outcomes,patient outcomes),and 56 third-level indicators. Conclusion The nursing quality evaluation indicator system for orthopedic rehabilitation was scientific and reliable,which can provide scientific references for evaluating nursing quality for orthopedic rehabilitation.

    The effect of a collaborative nursing model on patients with kinesiophobia after total hip replacement
    ZHANG Yaqin,LI Yanting,SHAN Dandan,SHEN Xingwei,CUI Xinxin,LI Chunhong
    2021, 56(4):  515-520.  DOI: 10.3761/j.issn.0254-1769.2021.04.006
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    Objective To explore the effect of a collaborative nursing care model on patients with kinesiophobia after total hip replacement(THA). Methods 92 patients with THA phobia in our hospital from August 2019 to July 2020 were selected as research subjects,among whom 46 patients admitted to hospital from February 2020 to July 2020 served in an experimental group,and 46 patients admitted to the hospital from August 2019 to January 2020 were selected into a control group. The experimental group was implemented with the collaborative nursing,and the control group was implemented with the conventional nursing. The differences of 2 groups in the scores of Tampa Scale for Kinesiophobia(TSK-11),Visual Analogue Scale(VAS),the Oxford Hip Score(OHS),and Readiness for Hospital Discharge Scale(RHDS) were compared before and after the intervention. Results After the intervention,the scores of TSK-11,VAS and OHS in the experimental group were lower than those in the control group,and the score of RHDS was higher than that of the control group(P<0.05). The scores of 2 groups of patients were statistically significant before and after the intervention(P<0.05). Conclusion The collaborative care model reduces the kinesiophobia,relieves the pain,promotes the recovery of hip joint function,and improves the patient’s readiness for discharge.

    A field research based on the best evidence of nursing care for the prevention of deep vein thrombosis after joint replacement
    WANG Yu,XU Yuan,MA Yufen,WANG Xiaojie,YANG Xu,CAO Jing,JIANG Ying,WANG Jingjing,SHANG Gaopeng,ZHU Liyun,LU Qiaodan,WU Xinjuan
    2021, 56(4):  521-526.  DOI: 10.3761/j.issn.0254-1769.2021.04.007
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    Objective To understand the work content of deep vein thrombosis (DVT) preventive care after hip and knee replacement,and to clarify the gap between the current practice and the best evidence. Methods From June to October 2019,we used the field research methods to conduct a 5-month participatory observation about the nursing work in the joint surgery ward in a level A tertiary hospital in Beijing. We used the three-level coding method of qualitative research to conduct field notes analysis. Results Through the care experience of participating in 391 cases of preventing DVT after hip and knee replacement,this study clarified the work content of preventive care,and extracted 4 work content themes,namely Education,Enforcement,Evaluation and E-recording,which fit with the best evidence. However,there is a partial gap between the implementation effect and the best evidence,and it still needs further development in enhancing health education and early activities promotion. Conclusion Through the field research,we have learned about the nursing work content in preventing DVT after hip and knee replacement,and the gap between the present situation and the best evidence and the possible reasons. Carrying out evidence-based nursing research and constructing scientific,normative and clinically feasible standardized preventive nursing plans are the best ways to prevent DVT after hip and knee replacement.

    Experiences of fear of falling in elderly patients following hip fracture surgery:a qualitative descriptive study
    ZHANG Huaguo,SI Wenteng,HE Yudi,SONG Mi,PI Hongying
    2021, 56(4):  527-533.  DOI: 10.3761/j.issn.0254-1769.2021.04.008
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    Objective This qualitative study aimed to explore the experiences of fear of falling in elderly patients following hip fracture surgery. Methods From December 2019 to May 2020,12 patients following hip fracture during postoperative rehabilitation period were recruited from a tertiary hospital in Henan province by maximum variation sampling. Semi-structured interviews were performed to collect data and qualitative content analysis was conducted to analyze the data. Results 3 themes regarding fear of falling were extracted,including perception of falling fear(disrupted life,negative emotions,a feeling of worrying about the future,inner strength);attitude and behavior towards fear of falling(cautious attitude,avoidance behavior,risky behavior with falling risk);the needs for home-based rehabilitation and nursing(the need for knowledge of prevention of falls and secondary fractures,the needs for life care,the needs for home-based rehabilitation,the needs for family and social support,and the needs for continuous care services). Conclusion The fear of falling was universal and multifaceted. Nurses should increase their understanding of falling fear,pay attention to their inner experience and home rehabilitation nursing needs. Continuous care services should be developed to reduce patients’ fear of falling,to promote postoperative rehabilitation and psychosocial adaptation,and to reduce the risk of falling and refracture.

    Self-management dilemma in patients with hemophilic arthropathy:a qualitative study
    XU Yuan,WANG Yangyang,WANG Yu,LI Wenli,WANG Jingjing,CAO Haiying,YANG Xu
    2021, 56(4):  534-538.  DOI: 10.3761/j.issn.0254-1769.2021.04.009
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    Objective To further understand the dilemma experience of self-management in patients with hemophilic arthropathy(HA),so as to provide references for the development of self-management intervention programs that meet the needs of patients. Methods With phenomenological research methods,a semi-structured in-depth interview was conducted among 13 patients with HA who were scheduled to undergo joint replacement surgery in an orthopedic ward of a tertiary Level A hospital in Beijing. Colaizzi 7-step analysis method was used to collect the data,to analyze and refine the theme. Results The self-management difficulty of HA patients mainly includes 2 factors,namely internal factors and external factors. The internal factors include the lack of attention on self-management of disease,differences in knowledge acquisition approaches,and high economic pressure. The external factors include the uncertainty about the disease,limited coverage of social support,poor drug accessibility,and response to the public health emergencies. Conclusion Patients with HA still have many problems and obstacles in self-management. Health care workers can help patients correctly understand and implement disease management through health education in multiple ways,and meanwhile give full play to the role of the family. Furthermore,the telemedicine platform could also be utilized to explore a new mode of disease self-management for patients with rare diseases.

    Specialist Practice and Research
    Application research of playful situational cognitive intervention in school-aged children undergoing ophthalmic surgeries with general anesthesia
    HAN Sai,REN Yongxia,LIU Xuyao,ZHAO Yue
    2021, 56(4):  539-544.  DOI: 10.3761/j.issn.0254-1769.2021.04.010
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    Objective To explore the effects of playful situational cognitive intervention applied on the preoperative health education of school-aged children undergoing ophthalmic surgeries with general anesthesia. Methods From August 2019 to January 2020,80 school-aged children undergoing ophthalmic surgeries with general anesthesia in an eye hospital in Tianjin were recruited and divided into an experimental group and a control group according to their admission time. In addition to the routine preoperative education,the experimental group received playful situational cognitive intervention as well,including methods such as playful operation situation cognition videos,object inspiration and operation situation role play;the control group only received the routine preoperative interview and education. The preoperative anxiety state,compliance during anesthesia induction,emergence delirium degree and the incidence of post-hospitalization behavioral change were compared. Results After the intervention,compared with the results in the control group,the scores of preoperative anxiety,induction compliance and emergence delirium were significantly lower in the experimental group(P<0.05);the incidences of post-hospitalization behavioral change were 15% in the experimental group and 35% in the control group,which showed significant differences(P<0.05). Conclusion Playful situational cognitive intervention could effectively relieve children’s preoperative anxiety,improve anesthesia induction compliance,reduce the incidence of emergence delirium and post-hospitalization behavioral changes.

    Construction and application of closed loop management system for medical device-related pressure injuries in ICU
    HUANG Qingping,ZHANG Jianrong,NONG Lirong,YANG Fengling,ZHANG Shuqing,XU Liuqin,NING Qinrong,WU Qingmei
    2021, 56(4):  545-549.  DOI: 10.3761/j.issn.0254-1769.2021.04.011
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    Objective A closed-loop management system for ICU medical device-related pressure injuries(MDRPI)was developed,so as to explore the effects of its application in clinical management. Methods The closed-loop management system of ICU MDRPI was constructed and it was composed of risk assessment,clinical nursing decision-making,quality and safety management. It is convenient to extract critically ill patients from ICU wards of a tertiary hospital in Guangdong province. The data before and after the implementation of the closed-loop management system for 6 months was compared,including the assessment rate of MDRPI in ICU,the assessment rate of MDRPI hospitalization,the screening rate of high-risk patients,the implementation rate of clinical nursing decision-making,and the incidence rate of MDRPI in ICU. Results Before and after the implementation of the closed-loop management system,the evaluation rate of MDRPI of ICU patients increased from 64.3% to 96.8%;the evaluation rate of MDRPI hospitalization increased from 44.9% to 98.2%;the screening rate of high-risk MDRPI patients increased from 51.3% to 98.9%;the implementation rate of clinical nursing decision increased from 39.6% to 95.8%;the incidence rate of MDRPI in ICU decreased from 15.9% to 7.3%. The differences were statistically significant(P<0.001). Conclusion The construction and application of ICU MDRPI closed-loop management system can help ICU nurses scientifically and objectively evaluate and make decisions on MDRPI nursing programs,standardize ICU MDRPI management process,and effectively reduce the incidence of ICU MDRPI.

    Analysis of influencing factors of self-management behavior in patients with inflammatory bowel disease
    ZHOU Meijing,LUO Dan,LIN Zheng,ZHANG Hongjie,BIAN Qiugui,LIU Meihong,REN Shurong,GU Zijun,SUN Caiyun,WANG Mi
    2021, 56(4):  550-555.  DOI: 10.3761/j.issn.0254-1769.2021.04.012
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    Objective To explore the effects of resilience,acceptance of illness and social support on self-management behavior among patients with inflammatory bowel disease(IBD). Methods By using the convenient sampling method,200 patients with IBD were selected from December 2019 to August 2020 in a tertiary hospital in Nanjing. General information questionnaire,social support rating scale,acceptance of illness scale,resilience scale for IBD,self-management behavior scale for IBD were used to conduct the investigation. We established the structural equation model by AMOS 26.0 software. Results The score of self-management behavior of patients with IBD was(139.00±21.13). Patients’ resilience and acceptance of illness had direct positive effects on self-management behavior,and the effect values were 0.294 and 0.453 respectively(all P<0.05). Patients’ resilience has indirect positive effects on self-management behavior,with effect values of 0.371(P<0.001). Social support could affect self-management behavior indirectly through resilience and(or) acceptance of illness,and the total effect value was 0.158(P<0.05). Resilience,acceptance of illness and social support can explain 50.1% of the total variation of self-management behavior. Conclusion The self-management behavior of patients with IBD was at a moderate level. Resilience,acceptance of illness and social support of patients with IBD had positive impacts on their self-management behavior. Nurses can promote patients’ self-management behavior by positive psychological interventions,helping patients set phased goals,and obtaining positive support from their families and colleagues.

    Development and reliability and validity test of the risk factor assessment scale for intraoperative acquired pressure injury
    GAO Xinglian,GUO Li
    2021, 56(4):  556-560.  DOI: 10.3761/j.issn.0254-1769.2021.04.013
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    Objective To compile and test the reliability and validity of the risk factor assessment scale for intraoperative acquired pressure injury,aiming to provide a scientific and objective stress injury assessment tool for operating room nurses. Methods The first draft of the scale is formed by 2 rounds of Delphi method on the basis of evidence. The convenience sampling was adopted to select 6 713 surgical patients from November 2019 to January 2020,covering 7 hospitals in 7 major regions of East China,South China,Central China,North China,Northeast China,Southwest China,and Northwest China for clinical multi-center research. The reliability and validity of the risk factor assessment scale for intraoperative acquired pressure injury were tested and the ROC curve was drawn. Results The risk factor assessment scale for intraoperative acquired pressure injury includes 10 items in 2 dimensions. The positive coefficients of 2 rounds of letter consultations were 100%;the authority coefficients were 0.874 and 0.885;the coordination coefficients were 0.164 and 0.170. The overall Cronbach’s α coefficient of the scale was 0.648;the half-reliability was 0.705;the content validity was 0.989. The ROC curve was used to determine the critical value of the preoperative and intraoperative. The cut-off value of the risk factor assessment scale for acquired pressure injury were 8.5 and 7.5,and the area under the curve were 0.779 and 0.776. Conclusion The risk factor assessment scale for intraoperative acquired pressure injury in Chinese inpatients has good reliability and validity and it can be used in clinical practice widely.

    Development and validation of blood glucose management protection motivation questionnaire for patients with gestational diabetes mellitus
    HUANG Na,ZHOU Yingfeng,LI Li,ZHANG Mengxing,WANG Kairong
    2021, 56(4):  561-566.  DOI: 10.3761/j.issn.0254-1769.2021.04.014
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    Objective To develop a blood glucose management protection motivation questionnaire for patients with gestational diabetes mellitus(GDM) and to test its reliability and validity. Methods Based on Protection Motivation Theory and according to the "Clinical Nursing Practice Guideline for Gestational Diabetes Mellitus",the primary questionnaire was formulated through literature review,patient semi-structured interviews and expert consultations. 7 experts and 408 patients with GDM were selected to test the reliability and validity. Results The protection motivation questionnaire contains 35 items in 7 dimensions. The content validity index of the questionnaire was 0.976. Cronbach’s α coefficients of the questionnaire was 0.901 and split-half reliability of the questionnaire was 0.965;Cronbach’s α coefficients of 7 dimensions ranged from 0.850 to 0.953 and split-half reliability of 7 dimensions ranged from 0.905 to 0.961. Exploratory factor analysis identified 7 principal factors,which accumulatively explained 75.32% of total variance. Confirmatory factor analysis indicated good model fit. Conclusion Blood glucose management protection motivation questionnaire has good reliability and validity,which can be used to evaluate GDM pregnant women’s blood glucose management protection motivation,and to analyze and predict their blood glucose management behavior.

    Community Care
    A comparison of end-of-life care preferences between nursing home residents and community-dwellers
    WEI Yitao,XIAO Huimin,LIN Shaowei
    2021, 56(4):  567-573.  DOI: 10.3761/j.issn.0254-1769.2021.04.015
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    Objective To explore the differences of End-of-Life(EOL) care preferences between nursing home residents and community-dwelling older adults in Fuzhou,China. Methods A total of 487 older adults were recruited from 7 nursing homes and 15 communities in Fuzhou during October 2016 to June 2017,and they were investigated by End-of-Life Preferences Questionnaire(EOLPQ). Propensity score matching was used to balance the personal information of 2 groups,and the differences in the care preferences were analyzed. Results There were significant differences in the preferred places of care or death and the attitudes towards death between 2 groups(P<0.05). There were no significant differences between 2 groups in 4 aspects,including the rank of importance in care patterns,the degree of importance in disease information,the person they are most willing to discuss EOL care with,and whether they refuse to rely on various of life-sustaining treatments when the treatment is impossible(P>0.05). Conclusion Both nursing home residents and community-dwelling older adults prefer hospice care at the end of their life. They are more willing to discuss EOL care with their family members. However,community-dwellers are more sensitive to the topic of death. The EOL care preferences of the elderly is related to their life situation.

    Basic Nursing
    A cost-effectiveness analysis of peripherally inserted central catheter versus totally implanted venous port
    WANG Kairong,ZHOU Yingfeng,ZHANG Xiaoju,LU Zhenqi,WANG Liying,XUE Mei
    2021, 56(4):  574-580.  DOI: 10.3761/j.issn.0254-1769.2021.04.016
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    Objective To compare the cost-effectiveness of PICCs and PORTs from catheter insertion to removal,and to provide economic evidence to choose the more cost-effective central venous access devices(CVADs) for medium- to long-term use. Methods 444 patients who received medium- to long-term chemotherapy by PICCs in a tertiary hospital in Shanghai from January 2016 to October 2019 and 477 patients with PORTs in this hospital from January 2013 to October 2019 were included by convenience sampling method. Data was collected from a retrospective cohort study. A cost-effectiveness analysis was conducted from the hospital perspective to compare the total costs,effectiveness index,cost-effectiveness ratio and incremental cost-effectiveness ratio(ICER) of PICCs and PORTs in total dwelling time,3-6 month,6-9 month and 9-12 month dwelling time of subgroups respectively. Results For the total dwelling time,3-6 month,6-9 month and 9-12 month dwelling time,the average total cost per day or the average total cost were all significantly lower in PICCs than those in PORTs(P<0.001). The effectiveness indexes were all slightly lower in PICCs than those in PORTs. The cost-effectiveness ratios were all lower in PICCs than those in PORTs. The ICERs were 543.50,234 411.00,120 092.25 and 109 164.00 respectively. Conclusion When catheter dwelling time was less than 12 months,PICCs were more cost-effective than PORTs. Therefore,PICCs should be recommended as the more cost-effective CVADs for medium- to long-term use from economic evaluation perspective. Furthermore,the ICER can be applied for decision-making. If the ICER was below the willingness-to-pay value,PICCs and PORTs were all acceptable cost-effective options;otherwise,PICCs were more cost-effective.

    Clinical Practice
    The nursing care of domestic long-distance transport in critically ill children supported by ECMO
    ZHU Yanjuan,HONG Xiaoyang,ZHAO Zhe,YANG Mei
    2021, 56(4):  581-584.  DOI: 10.3761/j.issn.0254-1769.2021.04.017
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    The nursing experience of domestic long distance transportation in critically ill children with the support of extracorporeal membrane oxygenation(ECMO) was summarized,including the formulation of transport plans,transport goods,the preparation of children and notification of the target department,transferring to the ambulance stretcher,transferring to the ambulance,management of children during transferring and ECMO,handover after transport,the processing of complications and accidents,etc. Through careful planning,teamwork and targeted nursing management,all the 34 critically ill children with ECMO support arrived safely in long-distance transportation,and no child died. Finally,children were successfully taken offline and recovered and discharged.

    Nursing experience of elderly patients with endotracheal intubation using automatic airway management system
    GAO Yanhong,LUO Zheng,WANG Xiaoyuan
    2021, 56(4):  585-588.  DOI: 10.3761/j.issn.0254-1769.2021.04.018
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    This study aims to summarize the nursing experience of 4 elderly patients with endotracheal intubation using automatic airway management system. The main points of nursing experience include the care of elderly patients with endotracheal intubation,the application of automatic airway management system,the care of intubation catheter cuff and subglottic secretion suction. No ventilator associated pneumonia occurred in the 4 patients during catheterization and they were successfully extubated.

    Perioperative nursing of a patient with percutaneous intramyocardial septal radiofrequency ablation
    MAO Yue,YANG Danyan,FENG Jia,ZHU Beibei
    2021, 56(4):  589-592.  DOI: 10.3761/j.issn.0254-1769.2021.04.019
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    To summarize the perioperative nursing of a patient with hypertrophic obstructive cardiomyopathy who underwent chemical ablation and radiofrequency ablation with Liwen operation. Nursing points include preoperative psychological nursing care,preoperative preparation,and emergency plan. Postoperative attention should be paid to volume management,hemodynamic monitoring,early implementation of stage I cardiac rehabilitation,active prevention of the occurrence of complications,and discharge guidance. After careful treatment and nursing care,the patient was discharged from the hospital on the 8th day.

    The skin nursing care of 5 cases of glioblastoma patients with tumor-treating fields
    DAI Jingjing,CHEN Zhipeng,PENG Yuling,WANG Zheng
    2021, 56(4):  593-595.  DOI: 10.3761/j.issn.0254-1769.2021.04.020
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    The skin nursing experience of 5 cases of glioblastoma patients with tumor-treating fields was summarized. The nurses performed preventive skin care,including health education,skin assessment and preparation,the use and replacement of sensors. The skin adverse reaction observation and nursing were carried out in time,including dermatitis,ulcers and infection. The detailed discharge instruction and follow-up were conducted. No serious adverse reaction was observed in 5 patients in this group,and the nursing effect is good.

    Evidence Synthesis Research
    Clinical work experience of male nurses:a meta-synthesis
    ZHOU Hang, MA Fang, ZHANG Yi, WU Yi, WANG Yanjiao
    2021, 56(4):  596-603.  DOI: 10.3761/j.issn.0254-1769.2021.04.021
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    Objective To systematically evaluate the qualitative research on the work experience of male nurses,and to provide the evidence for the growth and management of male nurses. Methods Chinese and English databases including Pubmed,Psyc INFO,Cochrane Library,JBI,Embase,Web of Science,CINAHL,CNKI,VIP,CBM,Wanfang were searched for qualitative studies on work experience of male nurses from the inception to September 2020. The JBI Critical Appraisal Tool for qualitative studies in Australia was used to evaluate the quality of studies. The results were synthesized by the Meta integration method. Results 17 studies were included in the final review. Totally 48 findings were extracted;7 new categories were generated;3 integrated results were synthesized as following,① "Double edged sword" situation brought by male roles;②Transformation of professional identity of male nurses;③ Male nurses’ desire for opportunities and success. Conclusion Male roles not only bring advantages to male nurses,but also bring a lot of troubles. Hospital and nursing leaderships should pay attention to male nurses’ advantages in work,take measures to improve male nurses’ professional identities,and make training plans for male nurses’ career development,so as to improve their clinical work experience.

    Effectiveness of management of medication compliance to antiretroviral therapy in HIV/AIDS patients:an overview of reviews
    GAO Yan, ZHANG Qing, SUN Meiyan, ZHANG Lin, LU Hongzhou
    2021, 56(4):  604-610.  DOI: 10.3761/j.issn.0254-1769.2021.04.022
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    Objective To overview the systematic reviews of effectiveness of management of medication compliance to antiretroviral therapy(ART) in HIV/AIDS patients. Methods CNKI,CBM,JBI,The Cochrane Library,databases were searched to identify the relevant systematic reviews. 2 researchers screened systematic reviews and extracted the data independently. AMSTAR 2 scale and GRADE system were used to assess the quality of included systematic reviews. Results A total of 16 systematic reviews were included in this study. Results showed that the quality of 12 systematic reviews were rated as very low,and the quality of 4 systematic reviews were rated as low. The application of mobile technology can improve medication adherence of HIV/AIDS patients, and the evaluation methods of medication adherence are diverse. Conclusion The application of mobile technology can improve medication adherence of HIV/AIDS patients. However,existing studies are insufficient. The overall effectiveness of management of medication compliance to ART in HIV/AIDS patients needs to be further explored and validated by subsequent high-quality and large-sample studies.

    The quality evaluation indicators for discharge planning:a scoping review
    YUE Xiao,WANG Hui,WANG Ying,WANG Binghua,KE Jian,JIANG Yaqian,HUANG Haishan,HU Kaili
    2021, 56(4):  611-617.  DOI: 10.3761/j.issn.0254-1769.2021.04.023
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    Objective We conducted a scoping review to systematically review the literature reporting discharge planning,and identify the quality evaluation indicators and its collection time,along with related tools. Then the differences between the quality evaluation indicators for discharge planning at home and abroad were explored. Methods Focusing on the quality evaluation indicators for discharge planning,we systematically searched the relevant databases,guidelines and government websites. The information,including research topic,research type,the first author/institution,year of publication,country,evaluation indicator,participants,collection time and method,evaluation tool,were also extracted and summarized. Results The quality evaluation indicators for discharge planning were divided into 3 dimensions,namely patient-related indicators,medical institution-related indicators,and caregiver-related indicators. A total of 167 papers were included and 26 indicators were extracted. There were 12 patient-related indicators,and the top 5 were readmission rate,patient satisfaction,quality of life,self-care ability and mortality. There were 9 medical institution-related indicators,and the top 3 were length of stay in hospital,frequency of outpatient/emergency visits,and medical expenditure. There were 5 caregiver-related indicators,the most common of which is caregiver satisfaction. The readmission rate,quality of life,self-care ability,frequency of outpatient/emergency visits,and activities of daily living had statistically significant differences among the top 10 evaluation indicators for discharge planning at home and abroad. Conclusion The medical institutions should not only monitor patient outcome indicators,but also audit related indicators of medical institutions and caregivers. The researchers should also unify core evaluation indicators and corresponding measurement tools,select sensitivity indicators,develop indicators that can be extracted by using Electronic Information System in the future.

    Research progress on influencing factors and management practice of pediatric palliative care
    DONG Shiqi,WANG Juan,DU Ruofei,TANG Han,GAO Xinyi,CHEN Yiyang,WEN Hua,CHEN Changying
    2021, 56(4):  618-622.  DOI: 10.3761/j.issn.0254-1769.2021.04.024
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    Pediatric palliative care(PPC) has become the standard of care for children with life-limiting illness. The article summarizes the connotation of PPC and its main influencing factors,domestic and foreign management practices,aiming to provide references for the development of PPC in China.

    Reflections on the current status of certification and re-certification of specialist nurses in palliative care
    HE Fang,HE Ruixian
    2021, 56(4):  623-627.  DOI: 10.3761/j.issn.0254-1769.2021.04.025
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    Demands for palliative care nursing are increasing with the trend in population ageing and social development. In February 2017,for the first time a nationwide policy was established for guaranteeing to implement palliative care nursing. It is imperative to cultivate and engage palliative care specialized nurses in China. This review described the current situation on application requirements,certification and re-certification among advanced countries and regions globally,where palliative care nursing is highly developed. Drawing upon extensive experience from foreign countries and combining with domestic conditions,we proposed suggestions and assumptions and provided references on the establishment of Chinese palliative care specialized nurse credentialing system.

    Progress in the application of the enhanced recovery after surgery of pediatric surgery
    ZHU Hongmei,ZHU Jihua,ZHENG Zhihui,WANG Peiying
    2021, 56(4):  628-634.  DOI: 10.3761/j.issn.0254-1769.2021.04.026
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    Enhanced recovery after surgery(ERAS) refers to the adoption of evidence-based perioperative optimization measures on the basis of multidisciplinary cooperation,aiming at reducing the physiological and psychological trauma stress of surgical patients,so as to realize the enhanced recovery of surgical patients.This paper summarized the application status of the concept of ERAS in perioperative period of pediatric surgery at home and abroad,including preoperative nursing,intraoperative precision management and postoperative nursing,and pointed out the deficiencies and future development direction,in order to lay a foundation for further research on the perioperative period of enhanced recovery of pediatric surgery in China.

    Review of symptoms and non-pharmacological interventions among breast cancer survivors undergoing adjuvant endocrine therapy
    JING Feng,XING Weijie
    2021, 56(4):  635-640.  DOI: 10.3761/j.issn.0254-1769.2021.04.027
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    Breast cancer has become the primary malignant tumor that threatens women’s health,and its incidence and fatality rate rank first among female malignancies. Endocrine therapy can effectively reduce the recurrence rate and mortality of breast cancer,but it also brings severe symptoms to patients. This article reviews the specific symptoms and non-pharmacological interventions related to endocrine therapy of breast cancer,with a view to providing references for clinical practice and nursing research.