Table of Content

10 April 2023, Volume 58 Issue 7

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Special Planning-Breast Cancer Care

Evidence-based practice of lymphedema prevention and nursing care after breast cancer surgery

GUO Yuanzhi, ZHANG Hongmei, ZHAO Pei, WANG Qi, LI Yuhuan, WANG Shufen, YU Yang

2023, 58(7):  773-780.  DOI: 10.3761/j.issn.0254-1769.2023.07.001

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Objective Evidence-based practice of lymphedema prevention and nursing after breast cancer surgery was carried out with knowledge transformation theory，and its application effect was discussed. Methods The group standard “Prevention and Care of Lymphedema after Breast Cancer Surgery” was applied into clinical practice from August 2021 to June 2022 by searching for evidence，introducing evidence into clinical scenarios，developing evidence-based protocols，baseline review，evaluating and analyzing the promoting and obstructive factors. The prevention and nursing knowledge and skills of breast cancer lymphedema among medical staff and lymphedema prevention behavior scores of breast cancer patients before and after the application of the Group Standard were compared and the implementation rate of the review items were compared. Results After the implementation of the evidence-based practice，the knowledge and skills of medical staff was significantly higher than that before the implementation，and the difference was statistically significant（t=4.074，P<0.001）. The self-care behavioral ability of lymphedema in breast cancer patients was significantly higher than before，with statistical significance（t=11.459，P<0.001）. The implementation rate of the examined items increased from 33.33%~100% to 77.14%~100%. Conclusion The Group Standard should be applied to clinical practice，which can promote the improvement of relevant systems and norms，improve the knowledge and skills of medical staff，and improve the prevention awareness and behavioral ability of breast cancer patients with lymphedema.

Barriers and facilitators of adherence to complete decongestive therapy in patients with breast cancer related lymphedema：a theory-based qualitative study

WU Peipei, WANG Ying, SHEN Aomei, QIANG Wanmin, YANG Huili, LIU Xinxin

2023, 58(7):  781-787.  DOI: 10.3761/j.issn.0254-1769.2023.07.002

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Objective To explore the barriers and facilitators factors of adherence to complete decongestive therapy（CDT） in patients with breast cancer related lymphedema（BCRL）. Methods Based on the Health Action Process Approach theory，from September 2021 to February 2022，12 patients with BCRL undergoing CDT were purposely selected for semi-structured in-depth interviews. Data were collected and analyzed using the Colaizzi seven-step analysis method. Results The extracted barriers of CDT included insufficient risk perception，negative outcome expectation，low self-efficacy，lack of behavioral intention，lack of action and coping plan. The facilitators included perceived benefits of treatment，perceived harm of edema，enhanced self-efficacy，motivation of treatment，and construction of a new normal life. Conclusion The adherence of CDT in patients with BCRL is affected by a series of barriers and facilitators. In the future，targeted intervention strategies can be formulated based on the theory of health action process approach to improve the treatment adherence.

Status and influencing factors of self-advocacy in breast cancer patients with chemotherapy

HE Li, HU Luhong, CUI Jinrui, DENG Yan, CHU Yanxiang, WANG Weidi, WANG Qianyun

2023, 58(7):  788-793.  DOI: 10.3761/j.issn.0254-1769.2023.07.003

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Objective To investigate the level of self-advocacy ability of female breast cancer patients with chemotherapy，and to analyze its influencing factors，so as to provide references for clinical implementation of targeted intervention. Methods A total of 240 breast cancer patients with chemotherapy were investigated by general data questionnaire，Female Self-Advocacy in Cancer Survivorship Scale，Social Support Rating Scale，and Sense of Coherence Scale. Results The self-advocacy score of 240 breast cancer chemotherapy patients was（68.89±10.66）；there was a positive correlation between self-advocacy and social support（r=0.723，P<0.001）；it was also positively correlated with the sense of coherence（r=0.569，P<0.001）. The results of multiple linear regression analysis showed that age，educational level，social support and the sense of coherence were the influential factors of self-advocacy ability of breast cancer patients with chemotherapy，which explained 61.4% of the total variation. Conclusion The self-advocacy ability of breast cancer patients with chemotherapy is at medium level，and there are some problems in self-decision-making，effective communication with medical staff and seeking social support. Medical staff should pay attention to patients with advanced age and low education level，and help patients improve their sense of coherence and their ability to obtain and use social support，so as to improve the level of self-advocacy of patients.

Posttraumatic growth in breast cancer patients and their spouses and its relationship with positive psychological capital

LIU Ying, ZHEN Qian, WANG Xiaozhuang, ZHANG Jiaoxiao, ZHANG Yaping, WANG Dexin, WANG Xiqi

2023, 58(7):  794-799.  DOI: 10.3761/j.issn.0254-1769.2023.07.004

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Objective To investigate the post-traumatic growth status of breast cancer patients and their spouses，and to explore the effect of the positive psychological capital of patients and spouses on their own and each other’s post-traumatic growth. Methods From March to June 2021，a total of 130 pairs of female breast cancer patients and their spouses in a tertiary hospital in Tianjin were investigated by convenience sampling method and completed the investigation，using the general information questionnaire，Posttraumatic Growth Inventory，and Positive Psychological Capital Scale. Results The posttraumatic growth scores of breast cancer patients and their spouses of（2.43±1.11）（2.34±1.27） were significantly lower than the theoretical median value of 3.5，which were in the lower middle level（P<0.001）. The total score of positive psychological capital of patients was lower than that of spouses（P=0.033）. In the dimension of patients’ positive psychological capital，the level of resilience was relatively low. Subject-object interdependence model analysis showed that the positive psychological capital of patients and their spouses positively predicted their posttraumatic growth（Ps<0.001）. Positive psychological capital positively predicted the posttraumatic growth of spouses in breast cancer patients（P<0.05），but the partner effect on spouses was not significant（P>0.05）. Conclusion The posttraumatic growth level of breast cancer patients and their spouses is in the lower middle level. The level of patients’ resilience is relatively low. The partner effect of positive psychological capital of patients and spouses on posttraumatic growth is asymmetric，and the support of positive psychological capital of spouses and patients’ posttraumatic growth is insufficient.

Meta-synthesis of qualitative research on the experience of peer support for breast cancer patients

WU Yuan, ZHANG Yuxi, WANG Nannan, ZHANG Huichao

2023, 58(7):  800-807.  DOI: 10.3761/j.issn.0254-1769.2023.07.005

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Objective To systematically evaluate qualitative studies on the experience of peer support for breast cancer patients, and to provide references for the application of peer support in breast cancer patients. Methods We searched databases including the Cochrane Library, Embase, PubMed, CINAHL, Web of Science, PsycINFO, CNKI, WanFang, VIP and CBM to collect qualitative research on the experience of peer support for breast cancer patients. The retrieval period was from inception to May 2022. The quality of the included studies was evaluated based on Joanna Briggs Institute Critical Appraisal Tool for qualitative research. The results were integrated by the method of aggregative integration. Results A total of 12 studies were included, and 55 results were extracted and summarized into 10 categories, which were synthesized into 3 integrated results：motivations of breast cancer patients to participate in peer support, benefits of breast cancer patients participate in peer support, and challenges of breast cancer patients to participate in peer support. Conclusion Participation in peer support brings multiple benefits to breast cancer patients. In future research, it is necessary to improve the matching mechanism between the 2 sides of support, develop the standardized peer support protocols, and enrich the form of peer support, in order to promote the continuous improvement and development of peer support application in breast cancer patients in China.

Evidence summary of the prevention and management in breast cancer patients for aromatase inhibitors-induced musculoskeletal symptoms

JING Feng, WANG Yuanyuan, XING Weijie, XU Lei, HU Yan

2023, 58(7):  808-815.  DOI: 10.3761/j.issn.0254-1769.2023.07.006

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Objective To retrieve，evaluate and summarize domestic and foreign latest evidence on the prevention and management in breast cancer patients for aromatase inhibitors-induced musculoskeletal symptoms. Methods We systematically searched relevant guideline networks and association websites，as well as Cochrane Library，JBI，PubMed，Web of Science Core Collection，Embase，CINAH，CNKI，VIP，Wanfang，and CBM to collect guidelines，expert consensuses，systematic reviews，and meta-analyses，best practices and recommended practices related to preventions and management about breast cancer patients for aromatase inhibitors-induced musculoskeletal symptoms. The retrieval period was from the inception of databases to July 12，2022. There were 2 researchers who independently evaluated the quality of included literature，and extracted and summarized the evidence. Results A total of 21 articles were incorporated，including 1 guideline，3 expert consensuses，and 17 systematic reviews or meta-analyses. Finally，37 pieces of best evidence including 8 aspects were summarized，namely incidence，clinical features，symptom assessment，risk assessment，prevention，pharmacotherapy，non-pharmacotherapy，and management strategy. There were 17 pieces of Level-1 evidence. Conclusion The best evidence for prevention and management in breast cancer patients for aromatase inhibitors-induced musculoskeletal symptoms could provide references to develop the plan of symptom management and conduct the best clinical practice of clinicians and nurses，but the best evidence should be selected according to the clinical situations and patients’ preferences.

Research progress on early identification and preventive measures of cardiotoxicity induced by anthracycline chemotherapy in breast cancer

ZHOU Yanjun, LI Qiuyue, HU Yule, YANG Haojie, ZHAO Fang, LIANG Tao

2023, 58(7):  816-821.  DOI: 10.3761/j.issn.0254-1769.2023.07.007

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Anthracycline-induced cardiotoxicity（ACT） is the primary cause of survival death in breast cancer patients receiving chemotherapy，which not only limits the clinical application of drugs to a certain extent，but also poses a serious threat to the long-term prognosis，quality of life and life of patients. Early identification and intervention of ACT can improve the survival benefit of patients and reverse negative outcomes. This article reviews the risk factors，assessment tools and preventive measures of cardiotoxicity in patients with breast cancer undergoing anthracycline chemotherapy，aiming to provide references for clinical nursing care，improve the quality of life of patients and maximize the survival benefit of patients. It also provides a basis for further clinical exploration of effective preventive measures.

Specialist Practice and Research

Status and influencing factors of social isolation in elderly patients with maintenance hemodialysis

YIN Yanru, ZHOU Hongchang, LIU Mengru, LIANG Facun, RU Yunxin, YANG Wenjuan, NING Yunfeng, DING Min

2023, 58(7):  822-828.  DOI: 10.3761/j.issn.0254-1769.2023.07.008

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Objective To investigate the status and influencing factors of social isolation in elderly patients with maintenance hemodialysis（MHD）. Methods Using the convenience sampling method，230 elderly patients with MHD in a tertiary hospital in Huzhou were selected from January 2022 to May 2022. A cross-sectional study was conducted using general information questionnaire，Lubben Social Network Scale 6，the Family APGAR，Hamilton Depression Scale，UCLA Scale and Social Support Rating Scale. Variables with statistical significance in univariate analysis were incorporated into binary Logistic regression for multivariate analysis. Results The social isolation score of 230 elderly patients with MHD was（12.27±4.44）；the family isolation score was（7.69±1.93），and the friend isolation score was（4.58±3.30）. The incidence of social isolation，family isolation and friend isolation were 45.2%，10.9% and 60.4% respectively. Logistic regression analysis showed that age，dialysis age，monthly income，self-rated health，social participation，family support and social support were the influencing factors of social isolation in elderly patients with MHD（P<0.05）. Conclusion Elderly patients with MHD have a higher level of social isolation；the incidence of friend isolation is higher than that of family isolation. Clinical medical staff can focus on elderly MHD patients with old age，long dialysis age，poor health，low economic level，less social participation，low family or social support. According to relevant influencing factors，intervention measures will be formulated to improve the social isolation of elderly MHD patients and promote physical and mental health.

Analysis of potential categories and influencing factors of care dependency trajectories among first stroke patients

HE Wenqian, GUO Yuanli, WANG Lianke, ZHOU Qianyu, WANG Panpan, ZHANG Peijia, ZHAO Mingyang, WANG Rongrong, YAO Zihui, HU Bo, WU Tiantian, WANG Yu, SUN Changqing

2023, 58(7):  829-835.  DOI: 10.3761/j.issn.0254-1769.2023.07.009

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Objective To analyze the potential categories and influencing factors of care dependency trajectory among first stroke patients. Methods From October 2021 to August 2022，278 first stroke patients in the Department of Neurology of a tertiary hospital in Zhengzhou were selected as the study subjects by the convenience sampling method. The Care Dependency Scale was used to investigate the patient’s care dependency level on 3 days after admission，at discharge and 1，3，6 months after discharge，and the latent growth mixture model，univariate analysis and multiple logistic regression were used for data processing. Results The developmental trajectory of 278 first stroke patients’ care dependency was divided into 4 latent subgroups，including low dependence-high recovery（42.1%），medium dependence-medium recovery（24.8%），medium dependence-high decline（13.3%） and high dependence-low recovery（19.8%）. The influencing factors included age，Charlson complication index value，stroke type，stroke severity，anxiety，depression and nutrition score（P<0.05）. Conclusion There are heterogeneous trajectories of care dependency in first stroke patients. Medical staff can make individualized interventions according to the influencing factors to reduce the degree of care dependence.

Development and psychometric validation of the Illness Perception Assessment Scale for Gout Patients

LI Qin, LIU Ting, ZHANG Shan, YAN Ju, ZHANG Yanran, MIAO Xiuxin

2023, 58(7):  836-842.  DOI: 10.3761/j.issn.0254-1769.2023.07.010

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Objective To develop an illness perception scale for gout patients，and to test its reliability and validity. Methods With the Common-Sense Model of Self-Regulation（CSM） as the conceptual framework，the initial scale was developed through literature analysis，qualitative interviews，and expert consultations. A questionnaire survey was conducted on 799 patients with gout who were treated or reviewed in a gout clinical medical center in Shandong Province from January 2021 to May 2021 to screen the items of the scale and test the reliability and validity of the scale. Results The illness perception scale for gout patients included 46 items in 6 dimensions. The exploratory factor analysis extracted 6 common factors with the cumulative variance contribution rate of 56.297%. Confirmatory factor analysis showed that the scale factor structure was stable. The item-level content validity index ranged from 0.865 to 1.000；the scale-level content validity index was 0.957. In the criterion-related validity analysis，the total score of the scale was positively correlated with the total score of the calibration scale（r=0.446，P<0.01）. The Cronbach’s alpha coefficient，split-half reliability and test-retest reliability of the scale were 0.941，0.784 and 0.965，respectively. Conclusion The illness perception scale for gout patients has good reliability and validity，which is suitable to evaluate the illness perception of gout patients.

Nursing Management

Textual analysis of China’s nursing and health policies from the perspective of policy instruments

YU Shuxin, LIN Rong, ZHU Xuehua

2023, 58(7):  843-849.  DOI: 10.3761/j.issn.0254-1769.2023.07.011

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Objective To study the use of policy instruments in nursing and health policies from 1978 to 2020，and to explore the distribution and framework of existing policy instruments，so as to provide references for the formulation and implementation of subsequent policies. Methods Based on Rothwell & Zegveld’s theory of policy instruments，this paper uses the content analysis method to construct a two-dimensional analysis framework of dimension X（basic policy instrument） and dimension Y（policy development stage），collating and quantifying the existing nursing health policy texts. Results 24 policy documents were finally included，and a total of 378 policy items were coded. In the X dimension，supply-oriented，demand-oriented，and environmental-oriented policy instruments accounted for 24.60%，14.02%，and 61.38%，respectively. In the Y dimension，the policy instruments in the budding exploration period，the supplementary improvement period，and the mature promotion period account for 23.02%，31.75%，and 45.24%，respectively. Conclusion At present，the overall use of nursing and health policy instruments in China is not coordinated. Supply-oriented policy instruments pay more attention to personnel training，and scientific and technological research and information construction need to be increased. Demand-oriented policy instruments are less applied and lack effective pulling effect. Environmental policy instruments are used too frequently and the internal ratio needs to be adjusted. It is suggested to further grasp the evolution rules of nursing health policy，improve the effect of policy implementation，and strengthen the integrity of policy.

An empirical study of the short-term effects of nurse bank model

HU Peng, LI Qin, YANG Yuan, LI Haiyang, ZHANG Chengjuan, LUO Min

2023, 58(7):  850-856.  DOI: 10.3761/j.issn.0254-1769.2023.07.012

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Objective To study the actual effects of the nurse bank model on nursing workload，labour costs and quality of care in experiment nursing units，and to provide references for improving the nurse bank model. Methods A panel of 67 nursing units in a tertiary teaching hospital was matched and empirically tested by propensity score matching（PSM） and differences-in-differences（DID） from Q2 2019 to Q1 2022. Results Although the nurse bank model has no significant effect on nursing manpower costs and quality of care in experiment nursing units，nursing workload was significantly increased at 5% level. The robustness of the empirical findings was verified by parallel trend tests，counterfactual test，placebo tests，and changing the matching approaches. Conclusion The nurse bank model increases the nursing workload in a short term and then solves the short-term shortage of nursing staff. The findings provide a reference for nurse staffing and use of nursing human resources.

Evidence Synthesis Research

Best evidence summary for home-based pulmonary rehabilitation measures in patients with chronic obstructive pulmonary disease

XIE Qionghua, LUO Yin, HAO Fujie, JIANG Yishan, GUO Aimin

2023, 58(7):  857-863.  DOI: 10.3761/j.issn.0254-1769.2023.07.013

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Objective To search，evaluate and summarize the relevant evidence of home-based pulmonary rehabilitation measures in patients with chronic obstructive pulmonary disease. Methods We systematically searched all evidence about home-based pulmonary rehabilitation measures for patients with chronic obstructive pulmonary disease in the UpToDate，BMJ Best Practice，Joanna Briggs Institute Library，Cochrane Library，Yimaitong，PubMed，Embase，CINAHL，Wanfang and CNKI. The types of literature include guidelines，systematic reviews，evidence summaries，clinical decisions，expert consensuses and randomized controlled trials. The retrieval time is from January 2017 to May 2022. Results A total of 11 pieces of literature were included，involving 1 guideline，8 systematic reviews and 2 expert consensuses. There were 28 pieces of evidence being summarized in 9 categories，including principle，significance，applicable population，safety，pre-rehabilitation evaluation，rehabilitation methods，assessment，quality control and health education. Conclusion The evidence summary process of this study is scientific and rigorous. Medical staff should formulate personalized home-based pulmonary rehabilitation programs according to the specific situation，so as to help the patients to improve health and quality of life.

Summary of the best evidence on exercise guidance programs for patients with ankylosing spondylitis

MA Xining, BAI Yanjuan, KONG Siming, HUANG Rong, ZHANG Jing, YAO Hui

2023, 58(7):  864-870.  DOI: 10.3761/j.issn.0254-1769.2023.07.014

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Objective To summarize the best evidence of exercise guidance programs for patients with ankylosing spondylitis based on the evidence，and to provide the basis for exercise therapy for patients with ankylosing spondylitis. Methods The computer system retrieved UpToDate，BMJ，OVID，CINAHL，Cochrane，Embase，Pubmed，Scopus，CNKI，Wanfang Database，Chongqing VIP，China Biomedical Database，Yimaitong and other guidelines on exercise programs for patients with ankylosing spondylitis，systematic reviews，Meta-analysis，expert consensuses，evidence summaries，randomized controlled trials，etc. The retrieval time was from January 1，2021 to January 1，2022. There were 2 nurses who independently screened the literature，evaluated the quality，and extracted the best literature，evidence and grading，and then summarized the best evidence for exercise guidance programs. Results A total of 16 articles，involving 1 guideline，6 systematic reviews，4 meta-analyses，and 5 expert consensus articles，were included. The best evidence for exercise guidance programs was summarized. There are 38 pieces of evidence in a total of 7 aspects，including pre-exercise evaluation，scope of exercise，exercise in different stages，sports content （project，exercise intensity，frequency，period），sports monitoring indicators，sports risk assessment and related precautions. Conclusion Based on the best evidence of ankylosing spondylitis exercise guidance programs summarized by evidence-based nursing，this study standardizes the theory and practice of rehabilitation exercise for patients with ankylosing spondylitis，and forms a scientific，standardized exercise guidance program with the best evidence.

Review

Research progress of derivation strategy in nursing field

YAN Lupei, LIU Li, HU Xiuying

2023, 58(7):  871-874.  DOI: 10.3761/j.issn.0254-1769.2023.07.015

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As an independent scientific knowledge system，nursing science is gradually improving its unique philosophical views，domains，theories and research in the field of nursing. Theory is widely used in clinical practice，nursing education and nursing research as the guiding framework and substantive content. This study introduces the definitions，connotations，and research methods of theoretical derivation strategy，summarizes the application scope of derivation strategies at home and abroad，and analyzes its role in improving the development of nursing disciplines，aiming to increase nursing researchers’ understanding of derivation strategy，stimulate research interests，and promote the application of derivation strategy in the field of nursing in China.

Research progress on transition readiness for liver transplant recipients from adolescents to adults

LI Zhiru, WANG Huafen, LU Fangyan, LÜ Luyang, BAO Ruijie, DONG Li

2023, 58(7):  875-880.  DOI: 10.3761/j.issn.0254-1769.2023.07.016

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The transition for liver transplant recipients from adolescents to adults is a high-risk period for adverse health outcomes. Lack of transition readiness will reduce treatment compliance，lead to high risk of graft function loss and mortality. However，the current transition readiness of adolescent liver transplant recipients is generally low，which seriously affects their long-term prognosis. This paper reviews the current situation，influencing factors and intervention strategies of liver transplant recipients in the transition period from adolescents to adults，so as to provide a reference for future research to ensure the safe transition of liver transplant recipients from adolescents to adults.

Application progress of awake self-prone positioning ventilation in patients with acute respiratory distress syndrome

WANG Yujiao, GAO Lan, MU Jingjing, ZHAO Xiaosu

2023, 58(7):  881-884.  DOI: 10.3761/j.issn.0254-1769.2023.07.017

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The awake self-prone positioning（ASPP） is an auxiliary position ventilation mode used in conscious patients. It can significantly improve oxygenation，reduce intubation rate and mortality in patients with acute respiratory distress syndrome. This article introduces the definition，indications，contraindications，starting and ending time，key monitoring contents，prevention and treatment of complications of ASPP ventilation，and summarizes the nursing difficulties in the application process. At the same time，this article puts forward suggestions to provide references for the nursing care of ASPP ventilation patients and improves their clinical outcomes.

Research progress on cognitive adaptation training for patients with severe mental illness

ZHAO Wei, WANG Yuling, LIU Zhihua, ZHANG Junfeng

2023, 58(7):  885-890.  DOI: 10.3761/j.issn.0254-1769.2023.07.018

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Cognitive adaptation training can bypass the cognitive deficits of patients with severe mental illness （SMI），use personalized compensation strategies and environment to support the development of patients’ adaptive behaviors，and improve their social function，medication adherence，quality of life and prognosis. In recent years，nurse-led cognitive adaptation training has developed into a mature nursing intervention after feasibility exploration and continuous improvement of research methods abroad，and it has been integrated into psychiatric wards as routine nursing. This paper reviews the application status，intervention contents and intervention effects of cognitive adaptation training in patients with SMI，and puts forward suggestions on cognitive adaptation training in psychiatric wards and community environments in China from 4 aspects，in order to provide references for the research and clinical practice on cognitive adaptation training in China.

Overseas Knowledge

Sinicization of the Tolerance for Mental Pain Scale and its reliability and validity in young adults living with HIV/AIDS

LI Yunxia, LEI Xianyang, NING Meng, LIU Yiting, XIE Jianping, CAO Guiying, LIU Qixiang, LI Yamin

2023, 58(7):  891-897.  DOI: 10.3761/j.issn.0254-1769.2023.07.019

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Objective To translate and cross-culturally adapt the English Tolerance for Mental Pain Scale （TMPS-10） into Chinese and test its reliability and validity in young HIV/AIDS patients. Methods We sinicized the TMPS-10 following the forward translation，back translation，cultural adaptation，and pre-survey according to the Functional Assessment of Chronic Illness Therapy translation methodology（FACIT）. Evaluation of content effective-ness was conducted through 2 rounds of expert consultations. From May to August 2022，334 young HIV/AIDS patients who were admitted to an HIV specialty clinic of a tertiary A hospital in Changsha were selected to test the reliability and validity of the scale. Results The Chinese version of TMPS-10 includes 2 dimensions with a total of 10 items. The content validity index of the total scale is 0.975，and the content validity index of each item is between 0.875-1.000. Exploratory factor analysis resulted in a 2-factor structure，explaining 65.719% of the total variance. Confirmatory factor analysis showed a good model fit. The Cronbach’s α for the total TMPS-10 score was 0.832，and 0.894 for the managing the pain dimension，and 0.856 for the enduring the pain dimension. Conclusion The Chinese version of TMPS-10 has good reliability and validity，which can be used to evaluate the tolerance for mental pain of young HIV/AIDS patients in China.