Table of Content

15 August 2021, Volume 56 Issue 8

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Research Paper

Construction and application of a traditional Chinese medicine continuing care program for patients with acute ischemic stroke

JIN Jie,ZHONG Meirong,YU Xiuting,YANG Tiantian,FAN Kuiyu,HUANG Xiaojie

2021, 56(8):  1125-1132.  DOI: 10.3761/j.issn.0254-1769.2021.08.001

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Objective To construct a traditional Chinese medicine（TCM） continuous care program and to evaluate its application effect in discharged patients with acute ischemic stroke. Methods A total of 102 patients with acute ischemic stroke hospitalized in the Department of Encephalopathy of a tertiary hospital in Guangxi from June 2019 to June 2020 were selected as the research subjects by convenience sampling method. They were randomly allocated into an experimental group（n=51） and a control group（n=51）.The experimental group was carried out with the TCM continuous care program on the basis of routine nursing,while the control group received the routine nursing. At the time of discharge and 1 month,2 months and 3 months after discharge,the 2 groups of patients were investigated and evaluated by a simple Fugl-Meyer Assessment Scale（FMA） and Stroke Specific Quality of Life Scale（SS-QOL）. Results There was no significant difference in FMA score and SS-QOL score between the experimental group and the control group at the time of discharge（P>0.05）. A month after discharge,there was no significant difference in the FMA score between the experimental group and the control group（P>0.05）,but the SS-QOL score in the experimental group was higher than that in the control group（P<0.05）.The scores of FMA and SS-QOL in experimental group were significantly higher than those in the control group at 2 and 3 months after discharge（P<0.05）. 3 months after discharge,the clinical efficacy of the experimental group was significantly better than that of the control group（P<0.05）. The analysis of variance of repeated measurement data showed that the interaction between groups,time,and inter-groups and time had statistically significant effects on FMA score and SS-QOL score（P<0.05）. Conclusion The constructed TCM continuous care program is scientific and feasible,which can effectively improve the limb motor function of patients with acute ischemic stroke and improve their quality of life at home.

Psychological experience of emergency medical staff in the treatment of attempted suicide patients：a qualitative study

LIU Yu’e,HU Deying,TENG Fen,YU Ting,FENG Xia

2021, 56(8):  1133-1137.  DOI: 10.3761/j.issn.0254-1769.2021.08.002

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Objective To analyze the psychological experience of the emergency medical staff in general hospitals in the treatment of attempted suicide patients,so as to provide references and bases for the clinical development of corresponding interventions and the improvement of mental health services for suicide patients. Methods Using descriptive phenomenological research method,semi-structured in-depth interviews were conducted from December 1 to 10,2019 with emergency medical staff from 2 general hospitals in Hubei Province who had the experience of providing health-care services to attempted suicide patients,and the data was analyzed with the Colaizzi 7-step analysis method. Results The psychological experience of the emergency medical staff was divided into emotional experience and cognitive experience. Emotional experience includes sympathy and regret,incomprehension and puzzlement,worry and pressure;cognitive experience can be summarized as the insufficient ability to deal with psychological problems of suicide patients,new cognition of their own professional roles,and rational thinking of mental health services. Conclusion The emergency medical staff have different degrees of negative emotions when receiving the suicide patients. They have some difficulties and challenges in the prevention of suicide related knowledge and communication skills,and in providing mental health services for suicide patients. Authorities should pay attention to preventing suicide patients from re-suicide,easing the negative emotions of medical staff,developing suicide prevention knowledge and communication skills training,promoting patients’ physical and psychological treatment,and preventing and reducing patients’ suicide.

Special Planning——Emergency Care

Optimization and effect evaluation of in-hospital emergency process for extracroporeal cardiopulmonary resuscitation

XIN Chen,GUO Xiaojing,REN Shiyuan,WANG Wei,SUN Huiting,GAI Yubiao

2021, 56(8):  1138-1144.  DOI: 10.3761/j.issn.0254-1769.2021.08.003

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Objective By optimizing the in-hospital process of extracorporeal cardiopulmonary resuscitation,the rescue time is shortened and the occurrence of adverse events is reduced. Methods In October 2018,our hospital established a medical failure mode and effect analysis management team. The healthcare failure mode and effect analysis model was applied to analyze the shortcomings of extracorporeal cardiopulmonary resuscitation emergency process,and the emergency process was optimized through literature reviews,expert discussions and consultations,so as to construct standardized extracorporeal cardiopulmonary resuscitation in-hospital emergency process and apply it to the clinic in January 2019. After 2 years of clinical application,we analyzed and compared the risk priority index before and after the optimization process,the time spent in each link and the occurrence of adverse events. Results After the optimization of the emergency process,the risk priority index dropped from（217.63±20.60） points to（102.73±39.95） points;the time spent in each link was shortened;the incidence of various adverse events decreased,and the differences were statistically significant（P<0.05）. Conclusion The application of healthcare failure mode and effect analysis to optimize the in-hospital emergency process of extracorporeal cardiopulmonary resuscitation can effectively improve the delay of first aid and reduce the occurrence of adverse events.

Effect of optimization of mobile stroke unit treatment process on patients with acute ischemic stroke

GUO Xiukai,JIANG Xiuxia,ZHANG Ruimin,LIU Weidong,WANG Fengyun,ZHANG Meng,ZHANG Liyong,WANG Jiyue

2021, 56(8):  1145-1150.  DOI: 10.3761/j.issn.0254-1769.2021.08.004

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Objective To explore the effect of optimizing the treatment process of Mobile Stroke Unit（MSU） on patients with acute ischemic stroke（AIS）. Methods A retrospective analysis was performed on 30 patients with AIS intravenous thrombolysis treated by MSU in our hospital from January to June 2020. Among them,18 patients who received intravenous thrombolysis after MSU process optimization were included in the experimental group,and 12 patients who received intravenous thrombolysis before MSU process optimization in the early operation were included in the control group.The clinical data of the 2 groups was collected,and the nursing efficiency and clinical outcome of the 2 groups were compared. Results In the experimental group,the success rate of the first venous puncture,the time from calling 120 to intravenous thrombolysis,the time from MSU arriving at the scene to intravenous thrombolysis,and the time from onset to intravenous thrombolysis were better than those in the control group,with statistical significance（P<0.05）. There was no significant difference between the time from onset to call 120,the time from call 120 to MSU arrival,the proportion of symptomatic intracranial hemorrhage within 24 h after intravenous thrombolysis,and the ratio of Modified RankinScale（MRS）≤2 at 90 d after thrombolysis（P>0.05）.Conclusion The optimization of the treatment process can effectively shorten the time from onset to intravenous thrombolysis,call 120 to intravenous thrombolysis and the time from MSU to intravenous thrombolysis,and it can also significantly improve the work efficiency of nurses and the quality of patient treatment.

The improvement and application of a rapid response system of in-hospital first aid

ZHOU Sanlian,WANG Lihua,REN Yuqin,JI Jianhong,CAO Huling,CHEN Limin

2021, 56(8):  1151-1157.  DOI: 10.3761/j.issn.0254-1769.2021.08.005

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Objective To build a “3P” management model of in-hospital first aid and to evaluate the effects of its application,which provides references for improving the quality of emergency care management. Methods Through literature review,emergency management expert group discussion and 2 rounds of Delphi expert consultations,the “3P” management model index system was established and applied in the clinic from April 2017 to March 2018. Results The effective recovery rates of the 2 rounds of the questionnaire were both 100%. The authority coefficients of the experts in the second round of the questionnaire was 0.907;the judgment basis coefficient was 0.947;the familiarity coefficient was 0.867. The Kendall harmony coefficients of the importance of the first,second and third level indicators were 0.233,0.128 and 0.272,respectively. The Kendall coefficients of the operability of the first,second and third level indicators were 0.211,0.135 and 0.277;the differences were statistically significant（P<0.05）;the final "3P" management model includes 3 first-class indicators（1P：first-aid skills retraining,2P：first-aid process re-optimization,3P：first-aid materials re-allocation）,13 second-class indicators and 34 third-class indicators. After clinical application,the score of nurses’ comprehensive first-aid skills practice assessment increased from（69.07±4.80） to（85.40±2.68）;the EMSS start-up time of unexpected IHCA patients was shortened from（6.12±1.85） min to（1.26±0.60） min;the CPR start-up time was shortened from （2.72±1.35） min to （0.78±0.06） min;the defibrillation start-up time was shortened from （8.51±3.12） min to（1.43±0.94） min;the first-aid success rate of unexpected CA patients in hospital increased from 55.56% to 83.79%. The differences were statistically significant（P<0.05）. Conclusion The "3P" mode of in-hospital first aid has good reliability,scientificity and practicablity,which can provide references for improving the quality of emergency care.

Construction of an emergency rescue competence index system for public health emergency among community nurses

LIN Yin,ZHU Xuehua,CHEN Ying

2021, 56(8):  1158-1164.  DOI: 10.3761/j.issn.0254-1769.2021.08.006

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Objective To construct an emergency rescue competence index system for public health emergency among community nurses. Methods A draft of the index system was developed based on literature reviews and qualitative interviews. Delphi method was employed to conduct 2 rounds of consultations among 20 experts to revise the draft. Analytical Hierarchy Process and average distribution method were used to measure the weight of each index. Results The response rates of the 2 rounds of expert consultation questionnaire were 90% and 100% respectively,and the effective rates were 100%. Expert authority coefficients were both 0.866;Kendall’s coefficients of concordance were 0.174 and 0.224,and both were statistically significant（P<0.001）. The final index system comprised public health emergency prevention capacity,preparedness capacity,rescue capacity and recovery capacity 4 first-level indexes,15 second-level indexes,and 51 third-level indexes. Conclusion The index system for public health emergency among community nurses constructed in this study could provide a scientific tool for evaluating community nurses’ emergency rescue ability of public health emergencies,and provide a reference for relevant departments to further optimize the emergency education and training mode of community nurses.

Nursing care of a patient with paroxysmal nocturnal hemoglobinuria secondary to splenic rupture after cesarean section

LI Chuansheng,MI Yuanyuan,ZHANG Zhenyu,LIU Lingyun,ZHOU Qin,LIANG Liyan,CHU Jing

2021, 56(8):  1165-1168.  DOI: 10.3761/j.issn.0254-1769.2021.08.007

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The nursing experience of a patient with paroxysmal nocturnal hemoglobinuria secondary to spleen rupture after cesarean section was summarized. The experience includes rapid establishment of venous access after rupture,close monitoring of blood pressure and intra-abdominal changes;the reduction of blood hemolysis during blood transfusion,the observation and prevention of embolism;management of plasma exchange;the application of ekulimab injection can avoid the occurrence of adverse reactions; carrying out protective isolation to reduce the risk of infection;psychological care and health education for patients to help them build confidence in overcoming diseases. After careful treatment and nursing care,the patient was discharged 16 days after admission.

Specialist Practice and Research

Effects of intelligent grip strength system in functional exercise of patients with PICC

JU Yang,ZHANG Yinying,ZHOU Juzhen,XU Jianfen,LI Jingdan,YUE Chunhua,DONG Yexin

2021, 56(8):  1169-1173.  DOI: 10.3761/j.issn.0254-1769.2021.08.008

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Objective To investigate the effects of intelligent grip strength system on PICC function exercise,so as to prevent catheter-related thrombosis in patients. Methods By convenience sampling,100 tumor patients with PICC who met the inclusion and exclusion criteria were divided into an experimental group and a control group by a random number table method. The patients in the control group used the traditional grip strength ball,while the patients in the experimental group used the intelligent grip strength system with the intelligent grip ball as the carrier for functional exercise. 28 days after catheterization,the scores of functional exercise compliance and the incidence of catheter-related thrombosis were compared between the 2 groups. The time average velocity of the axillary vein was compared 14 and 28 days after PICC catheterization,respectively. Results The total score of functional exercise compliance in the experimental group was higher than that in the control group,and the incidence of catheter-related thrombosis in the experimental group was significantly lower than that in the control group,and the differences were both statistically significant（P<0.05）. The time average velocity of the axillary vein in the experimental group was significantly higher than that in the control group 14 and 28 days after catheterization（both P<0.05）. Conclusion The intelligent grip strength system can significantly improve the compliance of PICC functional exercise in patients,effectively improve the upper limb venous blood circulation,and reduce the incidence of catheter-related thrombosis.

Construction of a risk prediction model for postoperative lower extremity lymphedema after surgery for endometrial cancer and its prediction effect

LÜ Yongli,GENG Li,WAN Yinglu,YANG Jiao,HU Ying,XIN Xiaoyan,ZHANG Keke

2021, 56(8):  1174-1179.  DOI: 10.3761/j.issn.0254-1769.2021.08.009

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Objective To identify the risk factors for lower extremity lymphedema（LEL） following surgery for endometrial cancer patients,to build a prediction model and to verify the prediction effect. Methods A total of 181 eligible patients admitted to a gynecological oncology ward from January 2016 to December 2017 were selected by convenience sampling and were divided into a LEL group（n=41） and a non-LEL group（n=140）. Data of the 2 groups was compared to determine the potential risk factors,and Logistic regression analysis was performed to construct the prediction model.The area under the receiver operating characteristic curve（AUC） was used to test the prediction effect of the model.A total of 78 endometrial cancer patients hospitalized in the same ward from January 2018 to January 2019 were selected to verify the model. Results The risk prediction model for postoperative LEL in endometrial cancer patients included 5 predictors of lymph node dissection（OR=10.683）,pathological stage（OR=9.232）,peritoneal wash cytology（OR=19.486）,lower extremity deep vein thrombosis（OR=12.008）,and radiotherapy（OR=4.636）. Model formula：Z=2.369 × lymph node dissection+2.223 × pathological stage+2.970 × peritoneal wash cytology +2.486 × lower extremity deep vein thrombosis +1.534 × radiotherapy -5.518.The AUC of the prediction model was 0.825 with the sensitivity of 0.707,the specificity of 0.871,and the Youden index of 0.578. Validation with 78 cases showed that the AUC was 0.793;the sensitivity was 0.875;the specificity was 0.677.The accuracy rate was 74.35%,indicating satisfactory prediction effects. Conclusion The prediction model for LEL following surgery for endometrial cancer patients has good prediction effects,which might provide references for nursing staff to take preventive interventions as early as possible.

A qualitative research on the dual coping experience of patients with spinal cord injury and their spouses

DAI Qing,LI Lunlan,LIAO Chenxia,GAO Xin,HUANG Hui,YUAN Haowei

2021, 56(8):  1180-1186.  DOI: 10.3761/j.issn.0254-1769.2021.08.010

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Objective To explore the dual coping experience of patients with spinal cord injury and their spouses and to provide a reference for the targeted intervention strategies. Methods 12 spinal cord injury patients and their spouses admitted in a tertiary hospital in Anhui from April 2020 to March 2021 were selected by the purposive sampling and were interviewed in a semi-structured way. Colaizzi 7-step analysis was used to summarize and extract the themes. Results The final analysis yielded a total of 9 generic categories belonging to 3 categories based on the systemic transactional model. These were positive coping（face together,consistent disease beliefs,changing communication attitudes）,negative coping（difficulty in adaptation,excessive protective behavior,avoidance or conflict）,difficulties and challenges（loss of intimacy,seeking external support,building a new normal mode）. Conclusion Active coping and negative coping coexist in patients with spinal cord injury and their spouses. Medical staff should pay attention to the active dual response guidance of patients and their spouses,focus on couple-centered coping interventions,in order to better cope with the disease and improve clinical outcomes.

Application of calf circumference in evaluating decreased skeletal muscle mass in maintenance hemodialysis patients

DU Xiaoju,ZHANG Hailin,YIN Lixia,CHEN Guanjie,LI Xiaoliang,WANG Zhenglingxue,GUO Gui,ZHOU Qifan

2021, 56(8):  1187-1192.  DOI: 10.3761/j.issn.0254-1769.2021.08.011

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Objective To explore the relationship between calf circumference and skeletal muscle index（SMI）,handgrip strength,and usual gait speed in maintenance hemodialysis（MHD） patients,and to investigate the effect of calf circumference in the evaluation and diagnosis of sarcopenia. Methods A cross-sectional study was conducted in 613 MHD patients（379 men and 234 women）from 2 tertiary hospitals in Lianyungang city and Xuzhou city,Jiangsu Province by the convenience sampling method. The SMI of the patients was measured by bioelectrical impedance analysis,and the indicators such as handgrip strength,usual gait speed and calf circumference were measured. The correlation between calf circumference and SMI,handgrip strength,and usual gait speed was analyzed. The area under the receiver operating characteristic curves（AUC） was used to test the accuracy of calf circumference to predict decreased skeletal muscle mass（DSMM）,low muscle strength,low physical performance and to diagnose sarcopenia. Results The calf circumference of MHD patients was positively correlated with SMI,handgrip strength,and usual gait speed. The optimal cut-off values of calf circumference for predicting DSMM were 32.7 cm（with the AUC of 0.909,the sensitivity of 0.889,the specificity of 0.799） in men and 30.2 cm（with the AUC of 0.837,the sensitivity of 0.744,the specificity of 0.808） in women. The optimal cut-off values of calf circumference for predicting sarcopenia were 32.7 cm（with the AUC of 0.889,the sensitivity of 0.907,the specificity of 0.745）in men and 29.7 cm （with the AUC of 0.844,the sensitivity of 0.766,the specificity of 0.797） in women. Conclusion Calf circumference is positively correlated with SMI,handgrip strength,and usual gait speed. When the calf circumference is less than 32.7 cm in men and 29.7 cm in women,it indicates that the patients are very likely to suffer from DSMM and sarcopenia.

Development of a middle-range theory of adaptation to chronic illness based on the Roy’s Model

WANG Xiyi,YE Zhihong

2021, 56(8):  1193-1200.  DOI: 10.3761/j.issn.0254-1769.2021.08.012

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Objective This study aimed to develop a middle-range theory of adaptation to chronic illness derived from the Roy’s Model using a six-steps approach. Methods Based on an analysis of the Roy’s Model, methods of literature search, literature categorization,concepts synthesis,schema formation,statements illustration, and empirical evidence were adopted as operational strategies for theory development. Results This study generated a middle-range theory of adaptation to chronic illness to explain a nursing phenomenon of adaptation in chronic care. Core elements of the middle-range theory of adaptation to chronic illness were refined, namely stimuli,cognition and adaptation processing, physical function, self-concept, role function, interdependence, adaptation, and maladaptation,with observable variables. Besides,theory schema,statements, and empirical evidence were established. Conclusion Using reasonable strategies, this generated theory with good utility is expected to provide guidance of nursing research,education,and practice for chronic care.

Symptom clusters and the effects on quality of life among breast cancer patients receiving aromatase inhibitors

WEN Cuiju,WANG Yueni,SUN Hongjuan,YU Xinying

2021, 56(8):  1201-1207.  DOI: 10.3761/j.issn.0254-1769.2021.08.013

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Objective To investigate the symptom clusters and the quality of life of breast cancer patients receiving aromatase inhibitors（AI） and to analyze the correlation of the symptom clusters and the quality of life. Methods With the adoption of a cross-sectional study,260 breast cancer patients who were undergoing AI treatment in a Beijing Cancer Hospital were surveyed from the time range between April 2020 to January 2021. The demographic data,MD Anderson symptom inventory,medical outcomes study 36-items short-form health survey were used for investigation. Results 254 valid questionnaires were collected and analyzed. Through principal component analysis,3 groups of symptom groups were extracted,namely disease symptom cluster,treatment-related-psychological symptom cluster and gastrointestinal symptom cluster. The results showed that the scores of physical component score and mental component score were（38.51 ± 12.03） and （43.06 ± 14.29） respectively. The results of multiple linear regression analysis showed that the more severe the disease symptom cluster,the more severe the treatment-related psychological symptom cluster,the higher the BMI and the lower the education level,the worse physical health will be. With the extension of oral AI,the physical health improved. The more severe the treatment-related psychological symptom cluster,the worse the mental health will be. Conclusion Breast cancer patients receiving AI experienced multiple symptoms clusters. There was a negative correlation between symptom clusters and quality of life. It’s necessary to pay more attention to the patients accepting outpatient AI treatment. Targeted interventions need to develop to relieve symptom clusters and improve the quality of life.

Nursing Management

Current status of infusion of vasoactive agents of nurses：a nationwide survey

ZHONG Zhuqing,QIN Ning,GAO Xueqin,KANG Xiaofeng,DING Siqing,LIU Yaping,LI Qingyin

2021, 56(8):  1208-1215.  DOI: 10.3761/j.issn.0254-1769.2021.08.014

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Objective To investigate the current status of infusion of vasoactive agents of Chinese nurses and compare the differences between different hospitals. Methods Convenience sampling method was used to conduct a descriptive online survey in 31 provinces from July to August,2020. The contents of the survey include demographic characteristics,current application of vasoactive agents,the use of vascular access and nursing practice of vasoactive agent infusion. Results A total of 7 873 qualified samples were collected. Indwelling needles（93.92%）were the most common vascular access for vasoactive agent,followed by central venous catheters（61.27%）,and steel needles accounted for the least（15.11%）. The proportion of nurses in tertiary hospitals or cardiovascular specialist hospitals using central venous catheters was relatively higher than that in non-tertiary hospitals or general hospitals（P<0.001）. Blood pressure,heart rate and respiration rate were 3 commonly used indicators for both evaluation and observation. Compared with the nurses in tertiary hospitals,there is a relatively higher proportion of nurses in non-tertiary hospitals who do not change the infusion site,use adjustable infusion apparatus or manual speed control,think that changing the height of syringe pumps does not affect the stability of the infusion,do not pump back before locking,press quick infusion key or make a rapid injection of normal saline when the blood returns,and do not perform ECG monitoring for all patients when infusing vasoactive agents（P<0.05）. Meanwhile,there is a higher proportion of nurses in general hospitals who inject other agents fleetly through T-pipe,do not pump back before locking,press quick infusion key or rapid inject normal saline when blood returns and do not perform ECG monitoring for all patients when infusing vasoactive agents,compared with nurses in cardiovascular specialist hospitals（P<0.001）. Conclusion The nursing practice of infusing vasoactive agents has safety risks. Thus,the nursing standards for intravenous infusion of vasoactive agents need to be revised,and nurse managers are advised to conduct standardized management and supervision.

Nursing Education

Status investigation on the training demand of syndrome differentiation and nursing of 44 773 traditional Chinese medicine hospital nurses

WEI Mian,YE Ran,XU Guihua,TU Wenjing

2021, 56(8):  1216-1221.  DOI: 10.3761/j.issn.0254-1769.2021.08.015

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Objective To understand the training demand of syndrome differentiation and nursing of traditional Chinese medicine（TCM） hospital nurses,so as to provide bases for further carrying out syndrome differentiation and nursing ability training and cultivating TCM nursing talents. Methods With convenience sampling method,a self-compiled questionnaire was distributed among 44 773 TCM nurses from 676 hospitals in China from January and April 2020. Results Among 44 773 TCM nurses,hospitals which 40 190 nurses working for carried out syndrome differentiation and nursing training,and 36 668 nurses attended syndrome differentiation and nursing training after employment. 64.15% of nurses believed that the level of teaching staff was the primary factor affecting the training effect,and the other main factors were evaluation mode（52.15%） and training mode （49.68%）. The self-evaluation of syndrome differentiation ability of nurses scored（77.15±18.75）;the score of nursing ability was（77.71±18.26）. 75.08% of nurses had higher learning demands for the nursing ability. 53.43% of nurses selected“half part-time” training mode; 79.30% of nurses chose experienced TCM medical associations with TCM nursing experts as training teachers; 70.94% of nurses chose the combination of online and offline training mode. Conclusion The TCM nurses had medium self-evaluation and high training demands on the syndrome differentiation and nursing;training content,quality of teacher,evaluation system and training mode should be further perfected,so as to improve the effect of syndrome differentiation and nursing training.

Clinical Practice

Nursing care of a child with Castleman’s disease complicated with paraneoplastic pemphigus obstruction

GAO Yuqi,ZHU Jihua,FEI Ling

2021, 56(8):  1222-1224.  DOI: 10.3761/j.issn.0254-1769.2021.08.016

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The nursing care of a case of Castleman’s disease complicated with paraneoplastic pemphigus was summarized,including the care of impaired skin mucosal integrity,close observation of drug adverse reactions and psychological care. After careful treatments and nursing care,the rash basic scabby scattered in the body of the child and the oral damage were better than before. The child was discharged.

The hospital-community-family linkage nursing practice of elderly patients with stress injury at home

WANG Wei,ZHANG Xin,LI Yue,NIE Zhihong,ZHANG Dongmei

2021, 56(8):  1225-1228.  DOI: 10.3761/j.issn.0254-1769.2021.08.017

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We summarized the nursing experience of the hospital-community-family nursing model in the treatment of elderly patients with stress injury at home. The key points of nursing care were clarifying the responsibilities of the hospital and community,establishing hospital-community linkage nursing cooperation teams,and strengthening organization and management;strengthening the training of community medical staff in wound management skills to improve wound management capabilities;formulating home assessment scale for elderly patients with pressure injury to improve the wound assessment ability of community medical staff;timely consultations to guide community medical staff in wound management;establishing hospital-community two-way referrals and implementing hierarchical treatment;strengthening multidisciplinary collaboration and promoting wound healing;carrying out continuous home care,and improving the compliance of patients and caregivers with treatment and nursing. Among 30 patients with elderly pressure injury at home in this group,26 of them achieved wound healing and 4 improved,with a cure rate of 86.67%.

Evidence Synthesis Research

Evidence summary of sputum collection methods for patients with pulmonary tuberculosis

GONG Beibei,MI Yuanyuan,WEI Caiyun,HUANG Haimei,WU Jinyan,YU Mingliu,LIU Ningmei,ZHU Zheng

2021, 56(8):  1229-1235.  DOI: 10.3761/j.issn.0254-1769.2021.08.018

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Objective To summarize the best evidence of sputum collection methods for patients with pulmonary tuberculosis. Methods We searched websites and databases including, but not limited to, BMJ best practice, UpToDate, World Health Organization, Registered Nurses’ Association of Ontario, National Institute for Health and Care Excellence, Guidelines International Network, Infectious Diseases Society of America,Cochrane Library,CINAHL（EBSCO）, EMBASE（OVID）, PubMed, Web of Science, JBI, CNKI, Wanfang, VIP, and CBM. Guidelines,recommended practices,evidence summaries,expert consensuses, and systematic reviews regarding collection methods of sputum samples for patients with pulmonary were considered. 2 researchers independently assessed methodological quality of included papers and extracted data. Results A total of 13 papers were identified including 6 guidelines, 3 systematic reviews,and 4 expert consensuses. 24 pieces of evidence were categorized into 6 aspects including pre-collection evaluation,pre-collection intervention,collection methods,sputum sample evaluation and transportation,occupational protection, and patient education. Conclusion This evidence summary provided sufficient evidence-based information for healthcare professionals to conduct sputum specimen collection for patients with pulmonary tuberculosis. Healthcare professionals should also consider feasibility, appropriateness, meaningfulness, and effectiveness of evidence in local context before adopting a certain method of sputum collection.

Dysphagia in the intensive care unit：a meta-analysis of risk factors

QI Chunxia,LI Chunlin,ZHANG Yazhi,ZOU Zongying,HUANG Wenjuan,LI Yueting,LIU Shasha

2021, 56(8):  1236-1241.  DOI: 10.3761/j.issn.0254-1769.2021.08.019

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Objective To identify the risk factors of acquired swallowing disorders among patients in the intensive care unit by meta-analysis. Methods Electronic databases and references of included studies were searched. 2 reviewers screened the literature according to the inclusion and exclusion criteria,and extracted data,assessed the quality of included studies independently. Meta-analysis was conducted by Rev Man 5.3. Results A total of 23 studies were included,with a sample size of 6 145 cases. The statistically significant risk factors were age（OR=2.29）,endotracheal intubation time（OR=1.16）,tracheotomy（OR=4.03）,disease severity（OR=1.35）,craniocerebral injury（OR=3.18）,sepsis（OR=8.27）,and arrhythmia（OR=3.55）. Conclusion The results of meta-analysis showed that older age,extended intubation duration,tracheostomy,higher severity of medical illness,brain injury,sepsis,arrhythmia were independent predictors for ICU-acquired swallowing disorders.

Systematic review of pressure injuries risk prediction models in ICU patients

JIA Yingying,ZHANG Hong-yan,MA Yuanyuan,DENG Lu,HE Bo,YAN Fanghong,HAN Lin,MA Yuxia

2021, 56(8):  1242-1248.  DOI: 10.3761/j.issn.0254-1769.2021.08.020

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Objective To conduct a systematic review of pressure injuries risk prediction models in ICU patients,in order to provide evidence-based references for clinical nurses to conduct pressure injuries prediction models. Methods Cochrane Library, PubMed, Embase,CINAHL, Web of science,CNKI,VIP,Wanfang,and Chinese bio-medical databases were searched for the related studies on pressure injuries risk prediction models in ICU patients from the establishment of the databases to December 31, 2020. 2 researchers were selected to retrieve studies according to the inclusion and exclusion criteria, and critically evaluated the quality of studies based on the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies. Results 15 studies were included, containing 28 pressure injuries risk prediction models. The AUC（area under ROC curve） of 20 models were all over 0.7. Gender,age,diabetes mellitus, mechanical ventilation,length of ICU stay were the most important predictors of pressure injuries. Conclusion Studies of the pressure injury risk prediction model in ICU patients had high research quality, and the risk prediction models also had good predictive performance. Male, the aged, history of diabetes,mechanical ventilation and long stay in ICU were high risk factors for pressure injuries in ICU patients. Clinical nurses should choose models with better predictive performance based on clinical practice, so as to provide targeted preventions for patients.

The effect of home-based hospice care on the quality of life and emotion of patients with advanced cancer：a systematic review and meta-analysis

SU Mengyu,WANG Zhen,ZHANG Yuxi,WANG Ting,WU Jinfeng

2021, 56(8):  1249-1254.  DOI: 10.3761/j.issn.0254-1769.2021.08.021

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Objective To systematically evaluate the effect of home-based hospice care on the quality of life and emotion of patients with advanced cancer,and provide evidence-based bases for future research. Methods Randomized controlled trials of home-based hospice care for patients with advanced cancer were searched in CNKI,Wanfang,VIP,CBM,CINAHL,CENTRAL,PubMed,Web of Science and Embase. Two researchers independently screened the literatures and cross checked the quality of included literature,and the references were tracked. The quality of included studies was evaluated according to the quality evaluation method of Cochrane Handbook 5.1.0. RevMan 5.3 was used for meta-analysis. Results A total of 10 pieces of literature were incorporated,including 1 720 patients with advanced cancer. The results showed that home-based hospice care can improve the quality of life of patients with advanced cancer[SMD=0.41,95%CI（0.30,0.51）,Z=7.44,P<0.001],reduce depression[SMD=-0.29,95%CI（-0.45,-0.14）,Z=3.68,P<0.001],but it can not be considered that home-based hospice care can reduce anxiety of patients with advanced cancer[SMD=-0.15,95%CI（-2.12,1.82）,Z=0.15,P=0.880]. Conclusion Home-based hospice care can improve the quality of life of patients with advanced cancer,reduce the depression of patients,but it has not been found that it can reduce the anxiety of patients,so it needs high-quality and large sample size research to further explore.

Review

Application progress of virtual reality technology in ICU critically ill patients

LUAN Linlin,DING Min,LU Zhenling,ZHANG Juan,YU Qiaowen,YANG Lijuan

2021, 56(8):  1255-1260.  DOI: 10.3761/j.issn.0254-1769.2021.08.022

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Acquired weakness and delirium have a strong impact on rehabilitation and life quality of critically ill patients in intensive care unit（ICU）. In previous interventions, patients were mostly passively involved. With its unique features of perceptibility, interactivity,immersion and imagination,virtual reality technology can increase the participation of patients effectively and has become an auxiliary means to promote the rehabilitation of critically ill patients in ICU. This article summarizes the types, methods of application, precautions and application effects of virtual reality technology in ICU critically ill patients, and provides a reference for developing virtual reality technology in ICU in our country.

Progress in the research of symptom clusters assessment tools in children with leukemia

GU Jiaxin,WANG Ling,LIU Xiaoli,YAN Xia

2021, 56(8):  1261-1266.  DOI: 10.3761/j.issn.0254-1769.2021.08.023

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Leukemia is the malignant tumor with the highest incidence in childhood. Assessing the symptom group can help to understand the symptoms experienced by children from a broader perspective,which is useful for the joint management of symptoms. This article reviews the content,characteristics and application of symptom cluster assessment tools for children with leukemia at home and abroad. It is recommended to develop specific assessment tools suitable for the identification of symptom clusters in children with leukemia based on the characteristics of existing universal tools and the disease characteristics of children with leukemia,so as to provide references for effective management to improve the quality of life of children.

Early functional exercise to prevent adult ICU acquired weakness：a system review

XU Lu,JIANG Zhixia,LU Xin,WANG Ying,ZHANG Fang

2021, 56(8):  1267-1271.  DOI: 10.3761/j.issn.0254-1769.2021.08.024

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ICU acquired weakness affects the recovery of critically ill patients and the quality of life after discharge. Early functional exercise can reduce the incidence of ICU acquired weakness and promote the recovery of patients. In this article,the necessity of early functional exercise for ICU patients is described firstly. Secondly,the assessment of early functional exercise is also summarized,including the specific contents of the initial and continuous assessment of early functional exercise. Besides,the current status and problems of the research on the implementation of early functional exercise,including progressive functional exercise and goal-oriented functional exercise,are reviewed. Lastly,the impediments to the implementation of early functional exercise are analyzed,and the corresponding countermeasures are proposed. The purpose of this study is to provide a reference for clinical and nursing staff to implement early functional exercise effectively and safely.

Nursing Instruments Innovation

Design and clinical application of a special oxygen mouth guard for endoscopy

GAO Xiuzhen,HAN Lijun,ZHANG Cheng,NI Yanli,YOU Yongmei,CHEN Yiqing,YANG Lingling,LIU Wei,ZHU Shengjun,WANG Yijun,YANG Yulong,HE Chuanqi

2021, 56(8):  1272-1274.  DOI: 10.3761/j.issn.0254-1769.2021.08.025

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Objective To design a special oxygen mouth guard for endoscopy and to evaluate its clinical application effects. Methods The designed special oxygen mouth guard comprises 7 elements（such as mouth pad,nasal and oral oxygen inhalation tubes）. A total of 120 patients with common bile duct stones undergoing endoscopic retrograde cholangiopancreatography at the endoscopy center of a tertiary hospital in Shanghai from January to February 2021 were included,and they were randomly divided into an experimental group and a control group,with 60 patients in each group. In the experimental group,the special oxygen mouth guard was used. In the control group,traditional oxygen tube and mouth guard were used. The wearing time,oxygen saturation（SpO₂） fluctuations,nasal catheter displacement rate and medical staff satisfaction were evaluated and compared between 2 groups. Results The wearing time in the experimental group was（20.58±2.43） s,while it was（27.30±2.89） s in the control group,and the difference was statistically significant（t=-13.795,P<0.001）. The SpO₂ value in the experimental group was 2.00%（1.00%,2.75%）,while it was 3.00%（2.00%,4.00%） in the control group,and the difference was statistically significant（Z=-4.332,P<0.001）. The nasal catheter displacement rate in the experimental group was 0,while it was 18.33% in the control group,and the difference was statistically significant（χ²=-12.110,P=0.001）. The score of medical staff satisfaction in the experimental group was（28.35±1.39）,while it was（26.48±1.56） in the control group,and the difference was statistically significant（t=6.933,P<0.001）. Conclusion The special oxygen mouth guard for endoscopy is easy to wear,and it can reduce the fluctuations in SpO₂ and nasal catheter displacement rate,and improve the medical staff satisfaction and safety of ERCP.

Overseas Knowledge

The reliability and validity of the translated Chinese version of the Fathers’ Support Scale：Neonatal Intensive Care Unit

ZHANG Xueying,YIN Xuemei,ZHANG Xiaocui,KONG Li

2021, 56(8):  1275-1280.  DOI: 10.3761/j.issn.0254-1769.2021.08.026

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Objective To translate the English version of the Fathers’ Support Scale：Neonatal Intensive Care Unit（FSS-NICU） into Chinese,and to test its reliability and validity. Methods Through translation,back translation,and cross-cultural adaptation,the English FSS-NICU scale was translated into Chinese. From June 2020 to October 2020,226 fathers whose infants were hospitalized in the NICU of Tianjin Central Hospital of Obstetrics and Gynecology were included by a convenience sampling method for a questionnaire survey,in order to evaluate the reliability and validity of the translated Chinese scale. Results The Chinese version of the FSS-NICU scale contained 30 items. The item-total correlation coefficients of these items ranged from 0.498 to 0.708（P<0.001）. 4 common factors were extracted by exploratory factor analysis,and the factor cumulative variance contribution rate was 68.18%. The Cronbach’s α coefficient of the total scale was 0.931,and 0.839~0.942 for the 4 dimensions. The scale-level content validity index of the total scale was 0.949;the Guttman spilt-half reliability was 0.923. The test-retest reliability of the total scale was 0.896,and 0.854~0.929 for the 4 dimensions. Conclusion The Chinese version of the FSS-NICU has good reliability and validity,and it can be used to evaluate support needs of Chinese fathers whose infants are hospitalized in the NICU.