Table of Content

15 September 2021, Volume 56 Issue 9

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Research Paper

Study on the development and application effect of an intelligent negative emotion improvement program for patients with coronary heart disease

HAO Ruixia, LI Yuling, XU Yong, YANG Lijie, HAN Xue

2021, 56(9):  1285-1292.  DOI: 10.3761/j.issn.0254-1769.2021.09.001

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Objective To evaluate the efficacy of an intelligent negative emotion improvement program for patients with coronary heart disease（CHD）. Methods Patients with CHD complicated with negative emotion admitted in the Department of Cardiology of a tertiary hospital in Shanxi Province from February to September 2020 were selected as subjects of the study. 38 patients admitted from February to May 2020 were included in the control group and treated with routine psychological nursing. 39 patients in the experimental group were included from June to September 2020 and treated with the intelligent negative emotion improvement program. The scores of self-rating anxiety scale,self-rating depression scale,Pittsburgh sleep scale and nurses’ satisfaction were compared between the 2 groups before and after the intervention. Results After the intervention,the scores of Self-rating Anxiety Scale,Self-rating Depression Scale and Pittsburgh Sleep Scale in the experimental group were lower than those in the control group,and the difference was statistically significant（P<0.05）. Conclusion The implementation of the intelligent negative emotion improvement program for patients with CHD can improve patients’ anxiety and depression,improve their sleep quality.

A comparative study on the unmet needs of home care and the willingness to purchase services of the elderly living alone and non-living alone

ZHANG Jiwen, FAN Huan, XIAO Shuqin, YANG Fangyu, WU Ying

2021, 56(9):  1293-1298.  DOI: 10.3761/j.issn.0254-1769.2021.09.002

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Objective To compare the differences in the unmet needs of home care and the purchase intention of home care services between the elderly living alone and non-living alone in urban communities in Beijing,and to provide references for the development of targeted home care service countermeasures. Methods A convenience sampling method was used to conduct a questionnaire survey of 5 457 home-based elderly people in 6 urban areas of Beijing from February to August 2017. The propensity score matching method（PSM） was used to match the elderly living alone with the elderly non-living alone at 1:1,and the differences in the unmet needs of home care and the willingness to purchase services between the 2 groups were compared. Results After PSM matching,a total of 1072 elderly people living at home（536 each living alone/not living alone）were included in the comparative analysis. The results showed that the proportion of unmet care needs of physical daily care（17.4%）,instrumental care （21.9%）,disease management （42.6%） and social support （33.2%） of the elderly living alone were higher than those of the elderly non-living alone,and the differences were statistically significant（P<0.05）. Among the elderly who are willing to purchase care services,compared with the elderly who are not living alone,the elderly living alone have a stronger willingness to purchase several items of health guidance（65.5%）,door-to-door service（61.9%）,emergency assistance（63.2%） and housekeeping service（63.2%） than those who are not living alone（P<0.05）. Conclusion Compared with the elderly non-living alone,the unmet needs of home care for the elderly living alone and their willingness to purchase services mainly focus on the aspects of daily life care,disease and health management,safety care and social support. Aiming at the unmet needs of home care for the elderly living alone,we should formulate targeted home care strategies,so as to effectively reduce the proportion of insufficient needs of home care for the elderly living alone,and improve their health level and quality of life.

Comparison of the performance of 5 screening tools for sarcopenia in preoperative patients with gastric tumor

LU Jinling, XU Qin, CHEN Li, DING Lingyu, HUA Hongxia, XU Xinyi

2021, 56(9):  1299-1304.  DOI: 10.3761/j.issn.0254-1769.2021.09.003

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Objective To compare the performance of 5 screening tools for sarcopenia in preoperative patients with gastric tumor. Methods We conducted a survey among a convenience sample of 270 patients who would undergo gastric tumor surgery in a tertiary class A hospital from May to October in 2020. The Questionnaire of Strength,Assistance with Walking,Rise from a Chair,Climb Stairs and Falls（SARC-F）,Questionnaire of Strength,Assistance with Walking,Rise from a Chair,Climb Stairs,Falls and Calf Circumference（SARC-CalF）,Ishii Score Chart,Mini Sarcopenia Risk Assessment Based on 7 Items（MSRA-7） Questionnaire and Mini Sarcopenia Risk Assessment Based on 5 Items（MSRA-5） Questionnaire were used in preoperative patients. Based on the diagnostic standard for sarcopenia proposed by Asian Working Group for Sarcopenia in 2019（AWGS 2019）,we used SPSS 20.0 and MedCalc 19.0.4 software to calculate the sensitivity,specificity and predicted value. Receiver operating characteristic curve（ROC） was also drawn to calculate the area under curve（AUC）. Additionally,the optimal cut-off value of each screening tool was determined by calculating Youden index. Results In preoperative patients with gastric tumor,the incidence of sarcopenia was 8.76% and the prevalence of the risk of sarcopenia was 3.42%~73.76%. Additionally,the sensitivity and specificity of the above 5 screening tools in preoperative patients with gastric tumor were 26.09%~95.65% and 28.33%~ 98.75%,respectively,and AUC of the 5 tools ranged from 0.696 to 0.901. Among them,the AUC of SARC-CalF questionnaire was relatively higher（0.901）,and its sensitivity（82.61%）and specificity（92.08%） were also good with the optimal cut-off value being 10 points. Conclusion The above 5 screening tools for sarcopenia all had certain clinical practicability and accuracy,and the SARC-CalF questionnaire had better sensitivity,specificity and accuracy for screening sarcopenia in preoperative patients with gastric tumor.

Special Planning--Perinatal Nursing

Observation on the effect of group health care model during pregnancy in childbirth outcome of pregnant women with gestational diabetes

YAN Meiqin, WANG Jiao, LIU Yina, ZHANG Huijun, REN Yonglian

2021, 56(9):  1305-1311.  DOI: 10.3761/j.issn.0254-1769.2021.09.004

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Objective To explore the effect of group pregnancy health care model on the delivery outcome of pregnant women with gestational diabetes. Methods The convenience sampling method was adopted to select pregnant women who had established a card and had regular obstetric check-ups in a tertiary A-level maternity and child hospital in Taiyuan from May to December 2018 as the research subjects. The random number table method was used to divide them into an experimental group and a control group,with 92 cases in each group. The experimental group adopted the group pregnancy health care model,and the control group received the conventional pregnancy health care model to compare the differences in delivery outcomes and psychological status between 2 groups after intervention. Results After the intervention,the fasting and 2 h post-meal blood glucose levels of 2 groups were lower than those before the intervention（t=-4.286、P=0.021）,and the blood glucose level of the experimental group decreased significantly（t=-3.512、P=0.039）;the natural delivery rate of the experimental group（χ ²=7.276）,the perineum injury rate（χ ²=7.698） and the incidence of macrosomia（χ ²=5.821） were lower than those of the control group,and the difference was statistically significant（all P<0.05）. The anxiety scale score in the experimental group was（37.63±5.62） points,and（50.67±8.69） in the control group. The difference between 2 groups was statistically significant（t=5.374,P=0.039）;the depression scale score in the experimental group was（41.16±3.12）points and （54.13±4.22）in the control group,and the difference between 2 groups was statistically significant（t=7.125,P=0.044）. Conclusion Compared with the traditional model,the group pregnancy health care model can effectively increase the natural delivery rate of pregnant women with gestational diabetes,improve the delivery outcomes,and reduce the occurrence of negative emotions.

The decision-making behavior and influencing factors of blood glucose management in pregnant women with gestational diabetes mellitus

HUANG Na, ZHOU Yingfeng, LI Li, LIU Qiaoyan, ZHU Jialei, WANG Ling, PAN Xiuhong, GUO Nafei

2021, 56(9):  1312-1317.  DOI: 10.3761/j.issn.0254-1769.2021.09.005

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Objective To describe the status of blood glucose management decision-making behavior of pregnant women with gestational diabetes mellitus（GDM）and to explore its influencing factors. Methods A total of 1 127 pregnant women with GDM from 6 hospitals in Shanghai and Jiangsu province were investigated with the blood glucose management protection motivation questionnaire,knowledge questionnaire,decision-making behavior questionnaire and general information questionnaire. Results The score of decision-making behavior in blood glucose management of pregnant women with GDM was 69.30±6.85,which is at a high level. Gestational age,vulnerability,severity,response efficacy,self-efficacy and response costs were influencing factors of blood glucose management decision-making behavior in pregnant women with GDM（P<0.05）. Conclusion Nursing professionals should strengthen GDM pregnant women’s protection motivation of blood glucose management,especially for women who during the third trimester. This study suggested that GDM women’s decision-making behavior of blood glucose management could be improved through increasing patient’s cognition of disease severity and vulnerability,enhancing response efficacy and self-efficacy,and reducing response costs.

Development and reliability and validity tests of the tool of nursing support needs for women with epidural analgesia during labor

ZHU Shurong, WEI Birong, GUO Shengbin, LIN Ying

2021, 56(9):  1318-1324.  DOI: 10.3761/j.issn.0254-1769.2021.09.006

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Objective To develop the questionnaire of nursing support needs of women with epidural analgesia during labor, and to test its reliability and validity. Methods Based on Maslow’s theory of hierarchical needs and Lazarus’s stress and coping model, using literature review and semi-structured interviews, the pre-trial questionnaire item pool of nursing support needs for women with epidural analgesia during labor was preliminarily formed, and the questionnaire was adjusted and revised through pre-survey.Using the convenience sampling method, 205 women who gave birth in a tertiary hospital in Fujian Province from September to October 2019 were selected. The data was analyzed to determine the reliability and validity of the questionnaire. 375 women from November to December 2019 were selected for confirmatory factor analysis to further test the factor structure of the questionnaire. Results The questionnaire of nursing support needs for women with epidural analgesia during labor was formed, which included 4 dimensions, namely physiological comfort needs, emotional support needs, information support needs and technical support needs, with 32 items in total. 4 common factors were extracted by exploratory factor analysis and the cumulative variance contribution rate was 63.224%. The averaging calculation of content validity index of the questionnaire was 0.969, and the content validity index of items range from 0.833 to 1.000. The total Cronbach’s α coefficient of the questionnaire was 0.917, and the total test-retest reliability coefficient was 0.821. The results of confirmatory factor analysis showed that the model fits well, indicating that the factor structure of the questionnaire was stable. Conclusion The questionnaire had good reliability and validity, which can guide the medical staff to accurately evaluate the needs of women with epidural analgesia during labor, and provide the basis for them to develop personalized nursing plan, so as to improve their delivery experience.

Nursing care of a patient with mirror syndrome complicated with acute heart failure/

JIANG Yang, SHEN Mingyan, FENG Zhixian

2021, 56(9):  1325-1328.  DOI: 10.3761/j.issn.0254-1769.2021.09.007

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To summarize the rescue and nursing experience of a 29 ⁺ weeks pregnant woman with mirror syndrome complicated with acute heart failure. Nursing points include first aid and nursing of pregnancy complicated with acute heart failure,observation and nursing of active bleeding after termination of pregnancy,postpartum volume management,sequential therapy of mechanical ventilation after operation and nursing of nasal high flow oxygen,and psychological nursing by stages. Through the targeted nursing measures,the patient had a good prognosis and was discharged successfully 8 days after admission.

Quality evaluation of clinical practice guidelines on perinatal bereavement care:a systematic review

SHEN Qiaoqiao, FENG Xiangang, LIANG Yunyi, ZUO Qianqian, ZHANG Zhengmin, GAO Yulin

2021, 56(9):  1329-1334.  DOI: 10.3761/j.issn.0254-1769.2021.09.008

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Objective To identify all guidelines on perinatal bereavement care and to synthesize the recommendations of guidelines based on the critical appraisal of their methodological quality. Methods We conducted a systematic retrieval of the relevant guidelines on perinatal bereavement care published or updated from January 2010 to August 2020 in authoritative domestic and foreign guideline development websites,professional association websites,Chinese and English databases and Google search engines. The quality of the guidelines meeting inclusion and exclusion criteria was assessed independently by 4 appraisers using the Appraisal of Guidelines for Research and Evaluation Instrument Ⅱ. The recommendations related to caring for families experiencing perinatal death were synthesized. Results A total of 5 guidelines were included in this study. The average standardized scores of quality evaluation for the 6 areas were 91.11% for scope and purpose,90.55% for involved stakeholder,73.24% for rigor of development,81.67% for clarity of presentation,60.00% for application,and 60.83% for editorial independence.For overall quality,a guideline was Grade A and 4 were Grade B. After extraction and integration,5 stages and 32 recommendations related to caring for families experiencing perinatal death were concluded. Conclusion There is still a lack of guidelines for perinatal bereavement care at home and abroad,and the overall quality of developed guidelines needs to be improved,and contents need to be refined. We can combine the international guidelines with the domestic clinical situations,screen and localize the evidence-based recommendations to guide the development of domestic perinatal bereavement care.

Research progress of maternal psychological health issues after emergency cesarean section：a review

JIN Wei, XIAO Qi, YANG Lingyan, ZENG Tieying

2021, 56(9):  1335-1339.  DOI: 10.3761/j.issn.0254-1769.2021.09.009

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Emergency cesarean section is a necessary means to ensure the life safety of pregnant women and fetuses with acute and critical illness. In recent years,there are increasing concerns on the mental health issues of parturients undergoing emergency cesarean section. This paper reviewed the overview of the emergency cesarean section,the psychological health problem,influencing factors and countermeasures of parturients after emergency cesarean section,aiming to help clinicians understand the psychological health status of parturients after emergency cesarean section,and provide references for the formulation of prevention and intervention measures.

Specialist Practice and Research

Current status and influencing factors of participating satisfaction with surgical treatment decision-making in patients with renal transplantation

CAO Yayu, LIU Huirong, PENG Yujiao, YANG Quan, YANG Sirui, TAO Yanling, WEN Xianxiu

2021, 56(9):  1340-1345.  DOI: 10.3761/j.issn.0254-1769.2021.09.010

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Objective To understand the status of the participating satisfaction of kidney transplantation recipients in surgical decision-making and to analyze the influencing factors. Methods With convenient sampling,a total of 272 patients after renal transplantation in the organ transplantation center of a tertiary hospital from November 2020 to January 2021 in Chengdu were investigated by the general information questionnaire for kidney transplantation recipients,the decision-making expectation scale,the questionnaire on the degree of participation of the patient’s family in surgical decision-making,the questionnaire on the degree of patient’s knowledge of surgical decision-making,and the questionnaire on the satisfaction of the patient’s participation in surgical decision-making. Results The total score of patients’ satisfaction with treatment decision-making participation after renal transplantation was（78.84±11.47）,in which the information dimension was（70.70 ±17.14）,the communication and negotiation dimension was （79.69±13.75）,the decision-making dimension was （80.73 ±12.47）,and the total satisfac-tion and confidence dimension were（84.25±12.67）. Age,payment method of medical expenses,degree of family members’ participation in decision-making and knowledge of treatment decision-making were the influencing factors of renal transplantation recipients’ satisfaction with surgical treatment decision-making（P<0.05,respectively）. Multiple linear regression analysis showed that the degree of knowledge of treatment decision-making was an independent factor influencing the satisfaction of kidney transplantation recipients with participation in treatment decision-making（P<0.001）. Conclusion The satisfaction level of renal transplant patients’ participation in treatment decision-making is moderate and needs to be improved. The patients’ informed degree with treatment decisions is the main factor affecting their satisfaction. Based on the patients’ age and participation of patients’ family members,the medical staff should make a comprehensive evaluation of the patients’ informed degree and also the personalized decision-aid for patients.

Current knowledge level of oxygen therapy among clinical nurses

QI Xiaojiu, WANG Huiting, LIU Yu, YANG Jing, QIAO Hongmei, TIAN Jiali, TANG Li’an, ZHANG Su

2021, 56(9):  1346-1351.  DOI: 10.3761/j.issn.0254-1769.2021.09.011

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Objective To learn about the current status of nurses’ knowledge concerning oxygen therapy,so as to provide the references for implementing training programs to promote safer oxygen therapies. Methods A self-designed questionnaire was carried out from May 4th to June 30th,2019 to investigate the mastery of knowledge concerning oxygen therapy among nurses who are the members of internal medicine nursing committee,association,critical care nursing committee,geriatric nursing committee and community nursing committee in certain nurse associations. The questionnaire is consisted of 5 parts,namely the content of the oxygen therapy from doctors’ prescription,demographic characteristics of the subjects,the indication of oxygen therapy,the assessment of oxygenation status and implementing oxygen therapy（practicing,monitoring and evaluation）. Results 2 789 nurses participated the survey,among which there were 2 719 effective and valid questionnaire,with the response rate of 97.49%. 87.75% of nurses are aware that the oxygen therapy should be undertaken based on the prescription. Only 18.50% of nurses insist that the target saturation should be included in the prescription. 82.42% of nurses mistakenly believe that the oxygen therapy could treat the underlying diseases which lead to the hypoxaemia. Over 95.29% of nurses believe that breathlessness could be relieved by oxygen therapy,while this is a common mistake. 3.49% of nurses could indicate the correct saturation range of the needed continuous monitoring. Except for chronic obstructive lung disease,the correct answer rates of nurses to several diseases risking of hypercapnia are less than 70.00%. 22.25% of nurses could indicate the correct target saturation for the patients with the risk of hypercapnia. Only 16.77% of nurses could indicate the correct time period of monitoring saturation once the oxygen therapy is paused. Conclusion Based on the results from the survey,the knowledge mastery of nurses on oxygen therapy needs to be improved. In order to correct the misunderstandings in oxygen therapy cognition and to provide more accurate and safer oxygen practice for the patients,the systematic training for the nurses should be developed and implemented.

External validation and comparison of 2 aspiration risk prediction models in patients receiving nasogastric feeding

SUN Wenjing, XIE Liling, HUANG Longxian, YOU Hailing, QU Furong, ZUO Yan

2021, 56(9):  1352-1356.  DOI: 10.3761/j.issn.0254-1769.2021.09.012

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Objective To externally validate the Classification and Regression Tree and the Nomogram model for risk prediction in patients receiving nasogastric feeding constructed in the earlier stage of this study,and to evaluate the clinical practicability and effectiveness of the 2 models. Methods Convenience sampling method was applied to collect the information of nasogastric feeding patients from July 2019 to July 2020 in a tertiary hospital of Chongqing. The patients were divided into an aspiration group and a non-aspiration group according to the incidence of aspiration. The ROC curves were drawn to evaluate the performance of the 2 models. Results The area under the ROC curves of the Nomogram and Classification and Regression Tree was 0.91（95%CI:0.89~0.98）and 0.92（95%CI:0.91~0.95）,respectively. The sensitivity,specificity and accuracy in 2 groups were 89.2% and 64.9%,89.7% and 96.6%,89.6% and 89.0%,respectively. Conclusion Both the Nomogram and the Classification and Regression Tree can predict the aspiration risk of nasogastric feeding patients effectively. The prediction performance of the Classification and Regression Tree is slightly better than that of the Nomogram.

Nursing Management

The current situation of the cultivation and development of specialty nurses in tertiary hospitals in China

DING Yanming, WU Xinjuan, TIAN Junye, ZHANG Peiying, XIAO Yanyan, WANG Xiuying

2021, 56(9):  1357-1362.  DOI: 10.3761/j.issn.0254-1769.2021.09.013

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Objective To investigate the status of training and development of specialty nurses in tertiary hospitals in China,and to provide suggestions for further standardization of the training and use of specialty nurses. Methods Using a convenient sampling method,from August to September 2018,792 tertiary general or specialized hospitals from 31 provinces,autonomous regions and municipalities directly under the central government were selected as the survey objects. The survey was done by using a self-designed questionnaire through the questionnaire star（an online questionnaire platform）. Results The number of specialty nurses in all tertiary hospitals reached 45.5（18.0,100.0）persons,involving a variety of specialty nurses. The education background is mainly undergraduate;most of the specialty nurses have intermediate titles;the provincial nursing society trains the most specialty nurses. The role of specialty nurses in clinical practice is mainly reflected in specialized nursing（97.3%）,nursing management（81.2%）,nursing teaching（77.5%）,nursing research（61.9%） and so on. At present,there are post management system （92.0%）,examination system （69.8%）,promotion system（49.4%）and salary system（38.0%）. Managers are sati-sfied with the clinical roles of specialist nurses,and it is believed that the following factors can affect the clinical roles of specialty nurses:insufficient supportive policy （80.9%）,excessive clinical workload（79.3%）,unclear role orientation（67.9%） and unclear job responsibilities（57.6%）. Managers believe that there are still problems of non-certification（63.6%）,uneven quality（58.0%） and lack of uniform certification（54.5%） in the training of specialist nurses. Conclusion This study provides a basis for nursing managers to further standardize the training and use of specialized nurses. The overall quality of specialty nurses is high and plays an important role in clinical specialized nursing. Managers should further improve the promotion system and salary system of specialty nurses in order to improve their enthusiasm and initiative in their work. At the same time,managers should give more support to specialty nurses,including policy support and clear job responsibilities. Continuing education and training institutions should homogenize the quality of specialized nurses and promote the development of specialized nursing.

A survey and analysis on current status of the training and work for gerontological nurse specialists in 30 provinces in China

CHEN Hongxiu, YANG Xin, HU Xiuying, DENG Baofeng, MA Hongmei, ZHANG Ailing, FANG Haiyun, SHI Zeya, DING Fu, WANG Chuanxia, QI Hengmei, HUANG Yi, ZHANG Junmei, MA Xiuhua, LU Liping, WANG Shen, SHA Liyan, CAO Junhua

2021, 56(9):  1363-1368.  DOI: 10.3761/j.issn.0254-1769.2021.09.014

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Objective To investigate and analyse the training and work status of gerontological nurse specialists（GNSs） in China,in order to provide a reference for the improvement of the training system of GNSs and the use of them. Methods A total of 1939 questionnaires were collected, of which 1 731 questionnaires were included in the final analysis. The effective rate of questionnaires was 89.27%. A cross-sectional survey was conducted from April 2019 to January 2020 among all the GNSs trained in 13 training bases in China from Jan 2014 to April 2019. The questionnaire included general information,training,and work status of GNSs. Results GNSs are distributed in all levels of medical institutions in 30 provinces across the country. 20.28% of GNSs expected that the length of GNS training can be extended to more than 3 months. About a half of GNSs believed that it was necessary to strengthen the training in the aspects of geriatric nursing knowledge and skills as well as scientific research capabilities. 35.24% of GNSs said that their units had no job responsibilities for GNSs. GNSs played an important role in geriatric clinical nursing,education,management and research. Conclusion The coverage of GNSs in our country is extensive,but the distribution of them is uneven. Moreover,the training system for GNSs still needs to be strengthened and perfected,and the position management system needs further exploration and clarification.

Community Care

Construction of a service quality evaluation index system for Internet Nursing Service based on Service Quality Gap Model

WANG Xuerui, CHEN Yan, WANG Qing, XIA Dongyun, XU Ling

2021, 56(9):  1369-1376.  DOI: 10.3761/j.issn.0254-1769.2021.09.015

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Objective Based on the Service Quality Gap Model （SERVQUAL）,we construct the quality evaluation index system to improve our country’s “Internet Nursing Service”. Methods According to systematic literature research,semi-structured interviews,Delphi and sequence diagram method,we establish the quality evaluation index system for medical institutions to carry out “Internet Nursing Services”. Results We conducted 2 rounds of expert letter inquiries from September to November in 2020. The effective recovery rates of the 2 rounds of questionnaires were both 100.0%;the expert authority coefficient was 0.82;the Kendall harmony coefficients were 0.178 and 0.262 respectively. The final “Internet Nursing Service” quality evaluation index system includes 6 first-level indicators,18 second-level indicators and 66 third-level indicators. Conclusion The constructed “Internet Nursing Service” quality evaluation index system is scientific and practical,with comprehensive content,and can provide theoretical and practical bases for the development of "Internet Nursing Service" quality evaluation and service guidelines in China.

Clinical Practice

Postoperative nursing care of 3 children with congenital long-gap esophageal atresia undergoing gastrostomy

ZHENG Lili, LÜ Danni, TANG Xiaomin, CHEN Lili, ZHANG Ting, FU Cangcang, ZHU Jihua, WANG Jinyan

2021, 56(9):  1377-1379.  DOI: 10.3761/j.issn.0254-1769.2021.09.016

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This paper summarized the postoperative nursing of 3 children with long-gap esophageal atresia undergoing gastrostomy. Key points of care include：continuous low negative pressure suction of proximal esophagus to prevent aspiration pneumonia;good care of diet perfusion,the skin around gastrostomy and the tube;psychological nursing for parents. After careful treatment and care,3 children were successfully treated with delayed esophageal end-to-end anastomosis 4 to 7 months after birth.

Nursing care of critically ill children with PICC tip positioning guided by ultrasound and intracardiac electrogram

WANG Longjun, WANG Dan, FANG Yanyan, HE Xiao, JIN Ge, LIU Yan, YAO Song, XU Haili

2021, 56(9):  1380-1382.  DOI: 10.3761/j.issn.0254-1769.2021.09.017

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To summarize the nursing experience of 44 critically ill children with PICC catheter tip localization guided by ultrasound and intracardiac electrogram. The key points of nursing care included：measured and recorded the length of the catheter in sections before the catheter insertion;obtained the intracardiac electrogram in time and observed the change of P wave;when the insertion length of catheter reached to the predicted length,the phased array probe was used to obtain the four-chamber heart section under xiphoid,and indirectly guided the catheter tip in the optimal position according to the different ultrasonic signs produced by normal saline injection. After catheterization the first chest X-ray showed that the catheter tip was in optimal positions in 40 cases and the catheter tip was too deep in 4 cases.

Nursing care of early complications in 14 cases after parental living intestine transplantation

LIU Jingjing, HUANG Feiyan, WANG Caina, ZHU Li

2021, 56(9):  1383-1386.  DOI: 10.3761/j.issn.0254-1769.2021.09.018

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To summarize the nursing points of early complications in 14 cases after parental living intestine transplantation and to provide references for clinical nursing. Key points of nursing：to set up an interdisciplinary cooperation team and carry out targeted treatment and nursing care according to the different characteristics of early postoperative complications;to predictively assess and prevent anastomotic vascular thrombosis;to early detect bleeding and actively assist in hemostasis treatment;to monitor infection signs and carry out infection controlling strategies strictly;to strengthen the management of transplanted enterostomy and the monitoring of rejection,and alert to acute rejection. Among transplant recipients in this group,there were 5 cases of bleeding,5 cases of infection,2 cases of acute rejection,1 case of giving up treatment,1 case of death within 30 days after transplantation. With timely and accurate monitoring,treatment and nursing care,12 cases survived and had perfect digestion and absorption function. In（20.58±5.79） d after the transplantation,the patients were out of parenteral nutrition and returned to normal oral feeding gradually.

Evidence Synthesis Research

The psychosocial adaptation experience of young and middle-aged patients with acute myocardial infarction:a qualitative meta-synthesis

YU Hongyu, YANG Qiaohong, LI Yaoxia, KE Qiqi

2021, 56(9):  1387-1393.  DOI: 10.3761/j.issn.0254-1769.2021.09.019

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Objective To analyze and summarize the psychosocial adaptation experience of young and middle-aged patients after their first-time acute myocardial infarction. Methods We searched databases including PubMeds,Embase,the Cochrane Library,Web of Science,Scopus,CNKI,WanFang data,VIP and Sinomed from inception to November 2020,to collect qualitative studies on the psychosocial adaptation experience of young and middle-aged patients after their first-time acute myocardial infarction. The quality of included studies was evaluated according to JBI Critical Appraisal Tool for qualitative studies in Australia. The results were integrated by integrating methods. Results A total of 14 studies were included. 48 complete findings were grouped according to their similarities to form 4 categories. The integration results were finally obtained. The psychosocial adaptation experience of young and middle-aged AMI patients is a process of diversified performance,stage characteristics and multiple factors. Conclusion Nurses should pay attention to and understand the psychosocial adaptation of young and middle-aged patients with AMI,so that targeted interventions can be provided to help patients return to work and society better and improve their quality of life.

Evidence summary of nutritional support in patients with inflammatory bowel disease

LI Miaomiao, XIONG Yu, LUO Jian

2021, 56(9):  1394-1400.  DOI: 10.3761/j.issn.0254-1769.2021.09.020

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Objective To retrieve and obtain the relevant evidence of nutritional support in patients with inflammatory bowel disease（IBD）,and to summarize the best evidence. Methods We systematically searched for the evidence on nutritional support for IBD patients in BMJ Best Practice,UpToDate,JBI,RNAO,SIGN,NICE,ESPEN,Cochrane Library,PubMed,CINAHL,Springer Link,Elsevier Science Direct,Ovid,Medlive,CNKI,CBM,Wan Fang and other databases,to collect relevant guidelines,systematic reviews,expert consensuses and original research. The retrieval period was from the inception to June 18,2020. JBI evidence appraisal and recommendation system was used to evaluate quality of studies and level of evidence. Results Totally 17 articles were selected,and a total of 21 pieces of best evidence were summarized from 6 aspects,including the diet of IBD,nutritional risk screening and nutrition assessment,energy and protein intake,micronutrient monitoring,nutritional support therapy,personnel support. Conclusion This study summarizes the available evidence on nutritional support for IBD patients,in order to provide evidence-based information for the clinical use of medical staff. Medical staff should make targeted choices and apply the best evidence based on clinical scenarios and patient preferences.

Evidence summary of management of feeding difficulty in people with dementia

XU Niying, REN Xinyan, WANG Xixi, SHEN Rui, GAI Jiaxing, WANG Junjie

2021, 56(9):  1401-1407.  DOI: 10.3761/j.issn.0254-1769.2021.09.021

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Objective To evaluate and summarize the evidence related to feeding difficulty in people with dementia for health care workers and decision makers. Methods All evidence on management of feeding difficulty in people with dementia was retrieved from domestic and foreign databases from January 2016 to December 2020,including clinical decisions,guidelines,expert consensuses,recommended practices,evidence summaries and systematic reviews. The researchers evaluated and collected the evidence according to relevant literature evaluation criteria. Results A total of 17 articles were included in this study,including 1 clinical decision,3 guidelines,3 expert consensuses,1 recommended practice,1 evidence summary,and 8 systematic reviews. A total of 40 pieces of best evidence were summarized from 3 aspects of organization policy,education,and practice. Conclusion Evidence involves a wide range and rich contents,and scientific and effective management measures can reduce the occurrence of feeding difficulty. In the process of clinical transformation of evidence,we should carefully select evidence,analyze the gap between evidence and clinical practice,and construct an evidence-based practice plan for feeding difficulty in people with dementia.

Evidence summary for prevention of deep venous thrombosis in patients after joint replacement

WANG Yu, XU Yuan, WANG Xiaojie, SUN Jianhua, MA Yufen, PANG Dong, ZHU Liyun, LIU Ge, CAO Jing, LU Qiaodan, WU Xinjuan

2021, 56(9):  1408-1414. 

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Objective To comprehensively retrieve and analyze evidence related to deep vein thrombosis（DVT）prevention after joint replacement and to summarize the best evidence. Methods We systematically searched for evidence on DVT prevention after joint replacement in BMJ Best Practice,UpToDate,JBI,YiMaiTong,GIN,NGC,NZGG,NICE,SIGN,NHMRC,CPG Infobase,CINAHL,EMBASE,PubMed,WOS,Wanfang and CNKI databases to collect relevant clinical decisions,evidence summaries,clinical guidelines and expert consensuses. The timeframe of data search ran from January 2015 to November 2020. 2 researchers independently evaluated the quality of the articles,and classified the evidence according to the Joanna Briggs Institute evidence-based pre-grading system（2014 edition）. Results A total of 13 articles were included,including 3 clinical decisions,2 evidence summaries,4 guidelines and 4 expert consensuses. Combined with professional judgment,16 pieces of best evidence in 6 aspects were summarized,including risk assessment,health education,preventive measures of nursing care,mechanical prophylaxis,pharmacological prophylaxis,and promotion of clinical implementation of preventive measures. Conclusion The best evidence summarized on the prevention of DVT in patients after joint replacement can provide evidence for clinical nursing work.

Review

Research progress of assessment tools for freezing of gait in patients with Parkinson’s disease

LI Yingshuang, LÜ Peihua, XU Yanhua, SONG Hailing

2021, 56(9):  1415-1419.  DOI: 10.3761/j.issn.0254-1769.2021.09.023

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Freezing of gait（FOG） is common in patients with Parkinson’s disease（PD）. The incidence of FOG in PD patients in China is close to 50%. In order to effectively respond to and control FOG,it is important to choose scientific and effective assessment tools for objective and accurate evaluation. The application status of the common assessment tools for FOG in patients with PD at present is introduced in this review,in order to explore the advantages and disadvantages of these tools,so as to provide the basis for the selection of the best evaluation tools for patients.

Research progress on discharge planning for hospitalized elderly patients with chronic diseases

LIU Yuan, CHEN Feifei, FEI Wenhai, XU Hongli, ZHANG Jiaxiang, LIN Xingfeng

2021, 56(9):  1420-1425.  DOI: 10.3761/j.issn.0254-1769.2021.09.024

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For the main group of the patients with chronic diseases,how to improve the quality of life of the patients during the stable period of the disease is one of the main focuses. This review synthesized the status quo of discharge planning services for hospitalized elderly patients with chronic diseases,including the conceptualization,assessment tools,intervention strategies,quality appraisal and influencing factors. To provide information bases for the development of discharge preparation service model for the elderly patients with chronic diseases in China,findings from this review can provide guidance for better maintenance and promotion of rehabilitation and health of elderly patients with chronic diseases.

Research progress on factors affecting the accuracy of drug inhalation techniques in patients with respiratory diseases

ZHAO Qian, NIU Mei’e, WU Zhenyun

2021, 56(9):  1426-1430.  DOI: 10.3761/j.issn.0254-1769.2021.09.025

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Inhalation therapy is an important treatment for patients with chronic respiratory diseases such as asthma and COPD. However,the accuracy of inhalation techniques for adults with chronic respiratory diseases is poor. In this article,we summarize the concept of the accuracy of inhalation technology and elaborate the methods,and then analyze the relevant factors affecting the accuracy of the inhalation technology in terms of patients,staff and devices. The intervention measures are introduced from the aspects of professional nurses for chronic respiratory disease,promoting the hierarchical medical system for chronic diseases of the respiratory system and developing the mobile medical models,aiming to provide a scientific basis for improving the accuracy of inhalation technology in adults with chronic respiratory diseases.

Nursing Instruments Innovation

Design and application of split prone position air cushion

SONG Chun, SONG Caiju, LI Changxia, LI Yan, ZHONG Xiuling, LI Li

2021, 56(9):  1431-1434.  DOI: 10.3761/j.issn.0254-1769.2021.09.026

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Objective To self-design a split prone positioning cushion and to investigate its effect on prone ventilation of patients with severe acute respiratory distress syndrome（ARDS）. Methods The split prone positioning cushion comprised of 4 parts,including the head and shoulder pad,the hip pad,the elbow pad and the leg pad. A randomized controlled trial was conducted with 60 patients with ARDS requiring prone ventilation in an intensive care unit of a tertiary hospital from March 2017 to November 2019. Participants were randomly allocated to an experimental group and an observation group,with 30 patients in each group. The experimental group used a split prone positioning cushion,while the observation group received the traditional prone position using a soft pillow to elevate the head-thoracic portion. Researchers compared the oxygenation（PaCO₂,PaO₂/FiO₂）,time of operation,duration of treatment and incidence of adverse events（pressure ulcers,ventilator pipeline bending and tube slip-off）between the 2 groups. Results After the treatment,the PaCO₂ in the experimental group was （30.37±2.41） mmHg,and PaO₂/FiO₂ was （288.23±19.34） mmHg. In the control group,PaCO₂ was （38.93±3.59） mmHg,and PaO₂/FiO₂ was（197.53±45.22） mmHg. The operation time was（3.60±0.56） min in the experimental group,and it was（5.63±1.00） min in the observation group. The cumulative time of prone position in experimental group was （46.20±3.40） h,and it was（33.23±2.69） h in the observation group. In the experimental group,the incidence of pressure injury was 23.3%,with the ventilator pipeline bending of 0. In the observation group,the incidence of pressure injury was 53.3%,with the ventilator pipeline bending of 70.0%. The differences were statistically significant between the 2 groups（P<0.05）. The incidence of pipeline slip in the experimental group was 0,and it was 6.7% in the observation group. There was no significant difference between the 2 groups（P=0.492）. Conclusion Compared with traditional ventilation in the prone position,the use of split prone positioning cushion in the prone position can effectively prolong the treatment time,improve the treatment effect,reduce the incidence of adverse nursing events and reduce the workload of medical staff.

Overseas Knowledge

Reliability and validity of Chinese version of the Rheumatoid Arthritis Pain Scale

JI Zihan, ZHANG Yuxia, CHEN Xiao

2021, 56(9):  1435-1440.  DOI: 10.3761/j.issn.0254-1769.2021.09.027

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Objective To translate the Rheumatoid Arthritis Pain Scale（RAPS） into Chinese and to evaluate its reliability and validity. Methods The Chinese version of RAPS was translated,back translated and modified for cultural adaptation according to Brislin translation model. After the content validity was tested by an expert committee,a convenience sample of 236 rheumatoid arthritis patients in a tertiary hospital in Shanghai was investigated using the Chinese version of RAPS to test the reliability and validity of the scale. Results The Chinese version of RAPS includes 24 items,and Cronbach’s α was 0.969. Cronbach’s α coefficient of each dimension was 0.881~0.954.The scale-level content validity index was 0.97,and the item-level content validity index were over 0.80. Factor analysis showed that a total of 3 factors were extracted explaining 73.582% of the total variance,namely physiological,sensory and emotional cognition. Conclusion The Chinese version of RAPS has good reliability and validity,and it can be used to evaluate the pain level of patients with rheumatoid arthritis in Chinese cultural background.