Table of Content

20 February 2022, Volume 57 Issue 4

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Research Paper

A qualitative study on the motivation of blood glucose management behavior changes in pregnant women with gestational diabetes mellitus

HUANG Na, ZHOU Yingfeng, LI Li, ZHU Jialei, WANG Ling, ZHAO Minhui

2022, 57(4):  389-394.  DOI: 10.3761/j.issn.0254-1769.2022.04.001

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Objective To understand the motivation of blood glucose management behavior changes in pregnant women with gestational diabetes mellitus（GDM）,in order to provide suggestions and evidence for promoting good blood glucose management in GDM patients. Methods Purposive sampling method was used to select 28 pregnant women with gestational diabetes mellitus from September to December 2020 in 4 hospitals in Shanghai for semi-structured in-depth interviews. Content analysis was used to analyze and refine the theme. Results The motivation of blood glucose management behavior change of GDM pregnant women includes perceiving the severity of the disease,perceiving the risk of bad blood glucose management behaviors,and perceiving the benefits of healthy blood glucose management behavior. Conclusion Clinical nursing staffs can improve the awareness of GDM pregnant women on the severity of disease and the risk of bad blood glucose management behaviors,and improve the awareness of GDM pregnant women on healthy blood glucose management behaviors,so as to improve their motivation to change their poor blood glucose management behavior and unhealthy lifestyles.

Special Planning-Cardiovascular Nursing

Formulation and application of cardiac rehabilitation grading nursing program in patients with severe coronary artery disease

WU Yue, LI Qingyin, ZHAO Dongyun, YANG Yang, ZHU Lili

2022, 57(4):  395-400.  DOI: 10.3761/j.issn.0254-1769.2022.04.002

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Objective To develop and implement a grading program of cardiac rehabilitation（CR）nursing intervention among the patients with severe coronary artery disease. Methods In July 2019,we started a specialized group to analyze the characteristics and difficulties of CR nursing among the patients with severe coronary artery disease through literature review and clinical practice. We formulated a program of cardiac rehabilitation grading nursing care and carried out it for clinical application and data collection during August 2019 to January 2021. Results Since the launch of CR grading care,a total of 817 patients with severe coronary artery disease have been included;519（63.5%）patients had underground activities before being discharged,and 13（1.6%）patients had adverse events. Conclusion The program can effectively provide the suitable CR nursing and satisfy the rehabilitation needs among patients with severe coronary artery disease.

Construction and application of APP in out-of-hospital health management for patients with chronic heart failure

QIU Xiaoqin, HUANG Caixian, FU Guifen, LAN Chunhan, LU Zhihong, SHI Ying

2022, 57(4):  401-407.  DOI: 10.3761/j.issn.0254-1769.2022.04.003

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Objective To build an APP of out-of-hospital health management for patients with chronic heart failure（CHF）,and to verify its value. Methods A“heart management” system,consisting of patient version mobile terminal,medical version mobile terminal and computer version management terminal,was constructed for the out-of-hospital health management of 150 CHF patients discharged from a tertiary A hospital in Guangxi from April 2017 to April 2018. 150 discharged CHF patients were divided into an intervention group and a control group by random number table method,with 75 cases in each group. The control group adopted routine out-of-hospital health management,and the intervention group implemented out-of-hospital health management based on the“heart management” system on the basis of the control group. The self-management ability,quality of life,6 min walking results,the incidence of major adverse cardiac events and event-free survival were compared between the 2 groups before intervention,3 months,6 months and 1 year after intervention. Results The self-management ability,quality of life and 6 min walking results of the 2 groups were statistically significant（P<0.005）. At the same time,there was no significant difference in quality of life between the 2 groups except after 3 months of intervention. At the other time points,the indexes of the intervention group were significantly better than those of the control group. The rate of re-admission of the patients in the intervention group was lower than that of the control group（χ²=4.298,P=0.038）. The event-free survival rate was higher in the intervention group than it in the control group（χ²=8.912,P=0.003）. Conclusion The“heart management” system provides scientific and efficient means of continuous care for CHF patients,and realizes intelligent out-of-hospital health management,which helps to effectively improve CHF patients’ self-management ability,reduce the incidence of adverse cardiac events,and improve quality of life.

The status and influencing factors of kinesiophobia in elderly patients with chronic heart failure

QIN Jingwen, XIONG Juanjuan, PAN Xin, GONG Kaizheng

2022, 57(4):  408-414.  DOI: 10.3761/j.issn.0254-1769.2022.04.004

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Objective To investigate the status and influencing factors of kinesiophobia in elderly patients with chronic heart failure （CHF） . Methods A total of 260 elderly CHF inpatients were recruited from the Department of Cardiology,Affiliated Hospital of Yangzhou University from October 2020 to July 2021. General data questionnaire,Chinese version of the Tampa Scale for Kinesiophobia Heart,Symptom Status Questionnaire-Heart Failure,Self-Efficacy for Exercise,Social Support Rating Scale and Medical Coping Modes Questionnaire were used for investigation. Univariate analysis and binary Logistic regression were performed to analyze the influencing factors. Results In 260 elderly patients with CHF,the incidence of kinesiophobia was 65%.Logistic regression analysis showed that education level of junior high school or below （OR=3.369,95%CI：1.249-9.091） ,course of disease <5 years （OR=2.908,95%CI：1.303~6.487） ,heart failure symptoms （OR=1.083,95%CI：1.036~1.132） ,exercise self-efficacy （OR=0.425,95%CI：0.234~0.772） ,coping mode （confronting） （OR=0.878,95%CI：0.790~0.975） ,coping mode （avoidance） （OR=1.222,95%CI：1.062-1.406） and coping mode （resignation） （OR=1.327,95%CI：1.095-1.608） were the influencing factors of kinesiophobia in elderly CHF patients. Conclusion Elderly patients with CHF have a high incidence of kinesiophobia,and patients’ education background,course of disease,heart failure symptoms,exercise self-efficacy and coping mode are influencing factors,among which educational background has the greatest impact.Clinical nursing staff can focus on elderly CHF patients with low educational level and a long course of disease,and can also develop intervention measures to promote them to participate in physical activities and exercise to improve their exercise endurance.

The experiences of patients with myocardial infarction returning to society after being discharged from the hospital：a meta synthesis of qualitative studies

SUN Minmin, WU Juan, LI Wenxia, WANG Yinan, WANG Li

2022, 57(4):  415-423.  DOI: 10.3761/j.issn.0254-1769.2022.04.005

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Objective The aim of this study was to perform a meta-synthesis of findings of myocardial infarction（MI）patients’ experiences of recovery after returning to society. Methods We searched databases including the Cochrane Library,Joanna Briggs Institute Library,PubMed,Embase,Web of Science,PsycINFO,CINAHL,CBM,WanFang,CNKI and VIP. All of the qualitative research on the real experience of MI patients returning to society after being discharged from the hospital were collected. The search time limit is from the establishment of the databases to November 2021. The JBI critical appraisal tool for qualitative research in Australia was used to evaluate the quality of the included studies,and the results were summarized and integrated by integrating methods. Results A total of 13 original studies were included. 47 findings were collected,and then the similar results were grouped into 11 new categories,and finally these categories were integrated into 3 synthesis results. Integration result 1：living with psychological loads,and the patients were facing physical and mental challenges. Integration result 2：reflecting on the value of life and strive to change one selves. Integration result 3：recognition of the world,and desire for outside help. Conclusion Although MI patients have been treated to save lives,they are still living under different degrees of pressure after discharging from the hospital. The future life is full of uncertainty,and each person’s coping ability is different. Health care workers and members of the public society need to pay more attention to their feelings and needs after returning to society,and to provide necessary health care knowledge and living skills to help them learn to coexist with the disease and better adapt to social lives.

The experience of informal caregivers caring for patients with chronic heart failure at home：a meta-syn-thesis of qualitative studies

FAN Wenhai, LIU Yue, LI Chunxia, YU Mingming

2022, 57(4):  424-430.  DOI: 10.3761/j.issn.0254-1769.2022.04.006

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Objective To systematically review and synthesize the experience of informal caregivers caring for patients with chronic heart failure at home. Methods 9 databases,including Web of science,PubMed,Embase,The Cochrane Library,EBSCO,PsyclNFO,Sinomed,CNKI and Wanfang Data,were searched from their inception to May 2021 for the qualitative studies on experience of informal caregivers caring for patients with chronic heart failure at home. The study quality was evaluated using the qualitative research quality evaluation criteria of the Joanna Briggs Institute Evidence-based Health Care Center in Australia. The research results were summarized and integrated using the pooled integration method. Results A total of 15 articles were included and 38 complete findings were grouped into 10 categories according to their similarities. These 10 categories resulted in 3 synthesized findings：the change of the normal life（challenge,stress,and conflict）,the lack of external support（knowledge,resources,and expectations）,the gain of positive feelings（identification,benefits,growth）. Conclusion Nurses should pay more attention to the burden,stress,as well as needs of heart failure caregivers,improve their caregiving competency,and give professional support and emotional support to them. By these ways,quality of life of patients with heart failure can be ultimately improved.

Research progress on nurse-led risk communication strategies for high-risk groups of cardiovascular diseases

REN Hui, ZHANG Zhenxiang, LIN Beilei, LUAN Wenyan, MEI Yongxia

2022, 57(4):  431-436.  DOI: 10.3761/j.issn.0254-1769.2022.04.007

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This article reviews the composition of a risk communication team,nurse-led risk communication strategies and communication process for high-risk groups of cardiovascular disease in foreign countries,in order to provide references for nurses to carry out theoretical research and practical work of risk communication for these groups in China.

Research progress on influencing factors and interventions of patients returning to work after percutaneous coronary intervention

HANG Ying, LIU Machao

2022, 57(4):  437-443.  DOI: 10.3761/j.issn.0254-1769.2022.04.008

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Percutaneous coronary intervention has become the main treatment of cardiovascular diseases. Returning to work marks the transformation from disease to positive social status and is an important indicator of disease recovery. This paper reviews the concept,current situation,influencing factors,and interventions of patients returning to work after percutaneous coronary intervention,in order to provide references for the definition of returning to work,the formulation of comprehensive intervention measures and the research of nursing practice.

Standards

Expert consensus on risk assessment and prevention of venous thromboembolism in general surgical patients

The Surgical Nursing Committee of Chinese Nursing Association, The Nursing Group of Chinese Society of Surgery of Chinese Medical Associaton, （Writing Committee：MA Yufen, XU Yuan, WANG Xiaojie, DENG Haibo, WANG Lei, SUN Jianhua, LIU Ge, GUO Yaping, GENG Qian, WANG Yu, ZHU Liyun, LU Qiaodan, AN Ranxun）

2022, 57(4):  444-448.  DOI: 10.3761/j.issn.0254-1769.2022.04.009

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Objective To explore the expert consensus on risk assessment and preventive nursing of venous thromboembolism（VTE） in general surgical patients. Methods This consensus was drafted through a systemic literature review on VTE prevention and the interviews of nursing experts. The draft was thereafter reviewed by a total of experts in related fields,and it was finalized after 2 rounds of expert consultation. Results 4 domains with 26 components were established through a modified Delphi method. The effective recovery of the ques-tionnaire was 100%;the expert judgment coefficient was 0.960;the familiarity was 0.912;the authority coefficient was 0.936. The Kendall coefficients of the first and second level topics in the 2 rounds were 0.149 and 0.261,and 0.122 and 0.203,respectively,with statistically significant differences（P<0.05）. The consensus includes risk factors for VTE in general surgical patients,risk assessment,risk response,education and quality control,and it is applicable to perioperative patients of general surgery. Conclusion The consensus was based on the recommendations of 25 clinical nursing experts. The results are scientific,rigorous and authoritative,and can provide guidance for clinical nursing staff in the prevention and control of VTE in general surgical patients.

Specialist Practice and Research

Intervention study of applying intermittent pneumatic compression devices with different duration in lumbar fusion surgery

FAN Zhiying, JIAO Wencang, WANG Yahong, ZHANG Huimin, ZHENG Xican

2022, 57(4):  449-454.  DOI: 10.3761/j.issn.0254-1769.2022.04.010

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Objective To investigate the effect of applying the intermittent pneumatic compression devices（IPCD）with different duration on hemodynamics of deep venous thrombosis（DVT） during lumbar fusion surgery. Methods Using the convenient sampling method,a total of 61 patients who received lumbar fusion surgery in the spinal surgery department of a tertiary A hospital in Zhengzhou from June 2020 to March in 2021 were randomly divided into an experimental group and a control group. On the basis of the routine nursing care,the patients in both groups started to use the IPCD immediately after the surgery. 2 groups both employed it twice with the interval time of 15 minutes. The duration of application was for 30 minutes in the control group and 40 minutes in the experimental group respectively. The incidence of DVT,coagulation indexes,hemodynamics and intraoperative blood loss were compared between the 2 groups. Results Finally,a total of 60 patients were included. There was no symptomatic deep venous thrombosis in the 2 groups,but 2 cases（6.7%） in the control group and 1 case（3.3%）in the experimental group had intramuscular venous thrombosis,with no statistical difference（ χ²=0.351,P=0.554）. The results of repeated measurement analysis of variance on patients’ coagulation indexes and hemodynamics showed that the time effect of fibrinogen and femoral vein peak velocity,the interaction between groups and time,and the grouping effect were statistically significant,respectively（F_time=222.466 and 45.899,P_time<0.001;F_interactive=12.707 and 4.873,P_interactive<0.001 and=0.009;F_{between groups}=10.052 and 43.975,P_{between groups}=0.002 and 0.008）. There was no significant difference in intraoperative blood loss between the 2 groups（t=0.189,P=0.851）. Conclusion The use of IPCD during lumbar fusion surgery for 40 minutes is much better than 30 minutes each time,for twice in total in promoting fibrinogen dissolution and accelerating the peak velocity of femoral vein blood. It can effectively improve the blood hypercoagulability and reduce the risk factors of intraoperative DVT.

The construction of a diet and nutrition management program for patients after metabolic and bariatric surgery

LI Zhiwen, PAN Yingli, QIN Jingjing, ZHANG Yingchun, NI Cuiping

2022, 57(4):  455-462.  DOI: 10.3761/j.issn.0254-1769.2022.04.011

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Objective To construct a diet and nutrition rehabilitation program for patients after weight loss and metabolism,and to provide references for clinical nursing work. Methods The first draft of diet and nutrition rehabilitation program after weight-loss metabolism was prepared by retrieving domestic and foreign literature. From July to September 2021,15 experts were consulted by Delphi method for 2 rounds of correspondence to seek their opinions,and the final draft was formed. Results The recovery rate of the 2 rounds of expert inquiries was 100%（15/15） and the expert authority factor was 0.854. Kendall’s Coordination Coefficient was 0.227 and 0.578（P<0.01）,and the final program consisted of 5 primary indicators,18 secondary indicators and 37 tertiary indicators. Conclusion The diet and nutrition rehabilitation program after metabolic and bariatric surgery developed in this study is scientific and reliable,which can provide references for postoperative nursing practice in the future.

Establishment and validation of a risk prediction model for intraoperative hypothermia in patients undergoing laparoscopic surgery

LI Li, YAN Yan, FANG Xin, ZHAI Yonghua

2022, 57(4):  463-468.  DOI: 10.3761/j.issn.0254-1769.2022.04.012

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Objective To construct a risk predictive model of intraoperative hypothermia for patients undergoing laparoscopic surgery and to verify the predictive effect of the model. Methods 1043 patients who underwent laparoscopic surgery and met the inclusion and exclusion criteria were selected in our hospital from June to October 2020,using the convenience sampling method. They were randomly assigned to a modeling group and a verification group at a ratio of 7 ∶ 3. The influencing factors of patients with intraoperative hypothermia（n=407） and patients without intraoperative hypothermia（n=323） in the modeling group were compared,which is conducive to the random forest algorithm to sort the influencing factors and build the prediction model. Results The incidence of intraoperative hypothermia was 55.75% in the modeling group and 54.95% in the validation group. In the importance score of random forest algorithm variables,basic body temperature,operating room temperature,BMI,operation time and other indicators have a high contribution to the model classification,with clinical significance. The area under the receiver operating characteristic curve of the predictive model is 0.797;the sensitivity is 78.74%;the specificity is 64.03%;the accuracy is 72.20%. Conclusion The prediction model based on random forest algorithm is effective,which is of great significance to identify the key factors of intraoperative hypothermia in patients undergoing laparoscopic surgery and intervene timely and effectively.

Development of a Needs Scale for Breast Cancer Patients and the test of its reliability and validity

ZHENG Fenshan, CAO Peiying, HUA Xinglong, LI Chunyu

2022, 57(4):  469-475.  DOI: 10.3761/j.issn.0254-1769.2022.04.013

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Objective To develop a scientific and comprehensive needs scale for breast cancer patients,and to test its reliability and validity. Methods Guided by Maslow’s Hierarchy of Needs Theory,a draft of the scale was developed through literature review and Delphi expert consultation. From November 2019 to July 2020,313 and 419 cases of breast cancer patients in 7 general hospitals and specialized oncology hospitals in Jilin,Shandong,Hubei,and Inner Mongolia Autonomous Region were selected for 2 rounds of large-sample questionnaire survey. SPSS 26.0 and AMOS 26.0 were used to conduct item analysis and reliability and validity test on the data of the 2 rounds of survey respectively. Results The final needs scale for breast cancer patients includes 3 need categories,6 dimensions and 40 items. The correlation coefficient between the dimensions and total score of the scale and the total score of SF-SUNS-C was 0.479~0.771（P<0.01）. 6 common factors were extracted by exploratory factor analysis,which could explain the total variance of 62.123%;confirmatory factor analysis showed that the scale factor structure was stable. Total scale Cronbach’s α coefficient was 0.959,and the test-retest reliability was 0.937. Conclusion The developed breast cancer patient needs scale has good reliability and validity and it is considered reliable and effective. It can be used to evaluate the needs of breast cancer patients at different stages and to be promoted and applied in clinical use.

Clinical Practice

Post-operative care of 7 patients with Stanford type A aortic dissection complicated with superior mesenteric artery ischemia

WANG Yuwei, LI Hui, LI Yinling, ZHAO Lihui

2022, 57(4):  476-480.  DOI: 10.3761/j.issn.0254-1769.2022.04.014

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This article summarizes the postoperative nursing experiences of 7 patients with Stanford type A aortic dissection with superior mesenteric artery ischemia. Nursing points include dynamic monitoring of abdominal symptoms and signs;anticoagulant therapy to prevent postoperative thrombosis;prevention and care of complications;providing nutritional support to promote recovery;moderately moving limbs and providing rehabilitation exercise guidance. After careful treatment and care, 7 patients were discharged from the hospital.

Nursing care of 2 cases of lung transplantation patients with graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

LIN Yan, YU Chao, WANG Fengtao, GAO Chunhua, ZHANG Shuai, CHU Junqing

2022, 57(4):  481-485.  DOI: 10.3761/j.issn.0254-1769.2022.04.015

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To summarize the nursing experience of 2 cases of lung transplantation in patients with versus host disease after allogeneic hematopoietic stem cell transplantation. Nursing points include observation and prevention of rejection reaction;strictly implementing prevention and control measures to reduce the risk of infection;through various rehabilitation training,promoting the recovery of respiratory function;conducting nutritional screening and developing nutritional support programmes;timely assessment of psychological state,individual psychological counseling. With aggressive treatment and care,2 patients recovered well and were transferred out of the intensive care unit.

Evidence Synthesis Research

Best evidence summary of positioning management for preterm infants

LIN Nan, ZHU Jihua, XU Hongzhen, ZHOU Hongqin

2022, 57(4):  486-492.  DOI: 10.3761/j.issn.0254-1769.2022.04.016

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Objective To retrieve,evaluate and integrate relevant evidence on the positioning management of preterm infants to provide clinical references. Methods We searched Guidelines International Network（GIN）,National institute for Health and Care Excellence（NICE）,Scottish Intercollegiate Guide Network（SIGN）,National Guideline Clearinghouse（NGC）,Registered Nurses’ Association of Ontario（RNAO）,Joanna Briggs Institute（JBI）,BMJ Best Practice,PubMed,Embase,OVID,Wanfang Database,CNKI,Yimaitong and other websites on all evidence on the positioning management of preterm infants,including guidelines,evidence summaries,best clinical practice manuals,clinical decision-making and systematic reviews,and the search time limit is from the establishment of the databases to August 31,2020. Results Totally 10 articles were involved,including 3 guidelines,5 systematic reviews,1 technical report and 1 clinical decision support. Finally,21 pieces of best evidence about positioning assessment,positioning the preterm infants,positioning equipment and positioning management of exceptional case were summarized. Conclusion This study summarizes the current best evidence on the positioning management of preterm infants and provides an evidence-based basis for standardizing the positioning management of preterm infants. It is recommended that medical staff should consider the clinical situation when applying the evidence,and selectively apply the best evidence to promote health of preterm infants.

An overview of systematic reviews on efficacy of nonpharmacological management of preoperative anxiety in adult patients undergoing elective surgery

BAO Lei, ZHU Liqun, TANG Weiding, CHEN Jixiang, ZHOU Yingfeng, HAN Xiaoyun, SHU Fangfang, CAO Songmei, ZHUANG Ruo, YIN Ting

2022, 57(4):  493-501.  DOI: 10.3761/j.issn.0254-1769.2022.04.017

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Objective To overview the systematic reviews on efficacy of non-pharmacological management of preoperative anxiety in adult patients undergoing elective surgery. Methods In August 2021,CNKI,VIP Full-text database,Wanfang Full-text Database,China Biomedical Literature Database and Joanna Briggs Institute,the Cochrane Library,PubMed,Embase,CINAHL,and psycINFO databases were searched to collect systematic reviews or meta-analysis on the efficacy of non-pharmacological management of preoperative anxiety in adult patients undergoing elective surgery. 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 19 systematic reviews were included. The evaluation results showed that the methodological quality of 2 pieces of the literature was low and the methodological quality of 17 was critically low. Evidence for 9 non-pharmaceutical management interventions was evaluated. The results showed that optimization of preoperative management and application of non-pharmaceutical techniques had positive effects on preventing or alleviating preoperative anxiety. However,the grade of evidence quality is not high,and only a piece of evidence is intermediate. Conclusion Non-pharmacological management may relieve preoperative anxiety relatively. However,the methodological quality and evidence quality of the study are low,so it is necessary to use evidence carefully and carry out more standardized and rigorous studies.

Review

Progress and enlightenment of ECMO training at home and abroad

LU Xin, JIANG Zhixia, XU Lu, ZHANG Fang, XIANG Qianling, HE Manman

2022, 57(4):  502-506.  DOI: 10.3761/j.issn.0254-1769.2022.04.018

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Extracorporeal membrane oxygenation（ECMO） is used to rescue patients with severe cardiopulmonary failure,and nurses are important members of the ECMO team. This paper introduces the qualification requirements,training content,training methods and qualification accreditation of nurses participating in ECMO monitoring training at home and abroad,and puts forward relevant suggestions based on the current situation in China,in order to provide references for carrying out ECMO monitoring training in China and provide the guidance for managers to formulate relevant policies.

Research progress of discharge readiness assessment tools in family with hospitalized children

LÜ Luyang, WANG Huafen, LU Fangyan, WANG Yan, ZHENG Li

2022, 57(4):  507-512.  DOI: 10.3761/j.issn.0254-1769.2022.04.019

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The evaluation of the family discharge readiness of hospitalized children can timely understand the care needs of the family,help nursing staff to formulate and implement personalized follow-up plans for the children after discharge,and reduce the rate of readmission and unplanned visit of children. This paper reviews the major contents,characteristics,application and limitations of the discharge readiness assessment tools in family with hospitalized children at home and abroad. It aims to provide references for the localization of the development of discharge readiness assessment tools in family with inpatient children and clinical nurses to select appropriate assessment tools. Meanwhile,it provides some useful information for the improvement of the discharge planning for hospitalized children.