Table of Content

10 September 2023, Volume 58 Issue 17

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Research Paper

Construction and application of standardized process for regional transport of mobile extracorporeal membrane oxygenation patients led by nurses

LI Lian, WANG Jinning, CHEN Chenkan, JIN Jiajia, PAN Xiangying

2023, 58(17):  2053-2058.  DOI: 10.3761/j.issn.0254-1769.2023.17.001

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Objective A nurse-led standardized process for regional transport of mobile extracorporeal membrane oxygenation（ECMO） patients was constructed and applied，and its application effect was analyzed. Methods Based on the opinions of extracorporeal life support organization ECMO transport guidelines，a nurse-led standardized process for the regional transport of mobile ECMO patients was constructed through literature search，expert consultation and exercise testing. A convenient sampling method was used to continuously select 82 patients who applied mobile ECMO out-of-hospital treatment in the general care unit of a tertiary hospital in Zhejiang Province from August 2020 to July 2022 as the study subjects，including 47 cases admitted in August 2021 to July 2022 as the experimental group，and 35 cases admitted from August 2020 to July 2021 as the control group. The experimental group was implemented by a nurse-led standardized transport process for mobile ECMO patients，and the control group was implemented by a routine mobile ECMO patient transport process，and the differences in material preparation time，departure time of personnel，time from towel laying to transferring，and transport adverse event rate were compared between the 2 groups. Results There were no significant differences in gender，age，and disease type between the 2 groups. Compared with the control group，the material preparation time（10.09±2.96）minutes, the departure time of personnel arrival （12.74±4.61） minutes and the time from towel laying to transferring（31.40±6.44） minutes were significantly shortened, and the incidence of adverse events in the experimental group decreased significantly. The differences were statistically significant（P<0.05）. Conclusion The application of the nurse-led standardized process for regional transport of mobile ECMO patients can shorten the time related to transport and reduce the incidence of adverse events during transport，and the nurse-led transport can improve its efficiency and reduce the transport risk of ECMO patients.

The construction and evaluation of an evidence-based decision support system for the nutrition risk screening of congenital heart disease children

FU Weijia, GU Ying, YANG Yuxia, WANG Yingwen, MI Yaping, WANG Zhenxu, GONG Weijuan, REN Yuehong

2023, 58(17):  2059-2066.  DOI: 10.3761/j.issn.0254-1769.2023.17.002

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Objective To develop an evidence-based decision support system for nutritional risk screening and assessment in children with congenital heart disease（CHD），and to evaluate its clinical effect. Methods The best evidence for nutritional risk screening and assessment in CHD children was summarized，and an evidence-based decision support system was developed. A before-and-after study design was adopted，and the medical staff and children with CHD admitted to the Cardiac Intensive Care Unit of a tertiary A-level hospital for children in Shanghai were selected as the research subjects. The data of the experimental group was collected from September to December 2021，while the data of the control group was collected from September to December 2020. The outcome measurement were the consistency of nutritional risk screening results of the responsible nurses and nutrition specialist nurses，the time-consuming of nutritional risk screening，the proportion of children receiving nutritional assessment and intervention，the response time of high-risk warning value of nutritional screening，and the satisfaction of medical staff with the use of information system. Results 191 children were included in the experimental group，and 193 were in the control group. The consistency coefficient of the nutritional risk screening results was 0.890 in the experimental group，and it was 0.689 in the control group. The nutritional risk screening time was（2.97±1.05） min in the experimental group，and it was（4.05±1.01） min in the control group. The proportion of infants who received nutritional assessment in the experimental group was 95.29%，compared with 89.64% in the control group；the proportion of infants receiving nutritional intervention was 69.11% in the experimental group，and 54.92% in the control group. The response time of the high-risk warning value of nutritional screening in the experimental group was（4.73±2.31） min，while the control group was（41.53±9.13） min. The satisfaction score of medical staff on the use of the clinical nursing information system was（108.04±11.31） points，and it was（92.89±9.37） points in the control group. The above data were compared between the 2 groups，and all the difference were statistically significant（P<0.05）. Conclusion Using the evidence-based decision support system for nutritional risk screening and assessment of CHD children can improve the consistency of nutritional risk screening results，shorten the time-consuming of nutritional risk screening，promote nutritional assessment and nutritional intervention by medical staff，and improve satisfaction with the use of information system.

Special Planning-TCM Nursing

Investigation on status of Traditional Chinese Medicine nursing service in general hospitals in Zhejiang Province

XU Min, LI Xiaohong, YE Menghua, CHEN Xiaojie, WANG Yongjian, SUN Qiuhua

2023, 58(17):  2067-2073.  DOI: 10.3761/j.issn.0254-1769.2023.17.003

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Objective To understand the status of Traditional Chinese Medicine（TCM） nursing service in general hospitals in Zhejiang province，and to provide reliable data for relevant departments to formulate supporting policies，so as to promote the sustainable development of TCM nursing service in Zhejiang province. Methods From August to November 2022，a whole-group sampling method was used to survey 103 general hospitals in Zhejiang Province using a self-designed questionnaire on the current status of TCM nursing services in general hospitals in the province. The questionnaire included 3 aspects：basic information of the hospital，current status of TCM nursing services and supportive needs for the development of TCM nursing services. Results A total of 103 valid questionnaires were collected，and the effective questionnaire recovery rate was 100%. Among the 103 hospitals，54（52.43%） are tertiary hospitals and 42（40.78%） are secondary hospitals，and 7（6.80%） are other hospitals. 91（88.35%） hospitals carried out TCM nursing services；73（80.22%） hospitals carried out no less than 5 TCM nursing technical items；34（37.36%） hospitals carried out no less than 4 TCM nursing technical categories；29（31.87%） hospitals served no less than 10，000 cases of patients per year with TCM care technology，and 24（26.37%） hospitals opened TCM nursing care clinics. The demand for support in the development of TCM nursing services is mainly related to the demand for policies，hospitals and training. Conclusion TCM nursing services in general hospitals in Zhejiang Province are well developed. However，there are still problems such as the insufficient development of TCM nursing clinics，unbalanced previous development of different levels of hospitals，shortage of TCM nursing talents，and imperfect quality supervision system，etc. In the future，TCM nursing support，talent training and standardized management should be further strengthened to promote the sustainable and steady development of TCM nursing in general hospitals.

Application of Xiaoyu Tongluo fumigation moxibustion in preventing deep vein thrombosis after major orthopedic surgery

YANG Jiaojiao, ZHANG Li, XU Qiuqun, QIN Danxia, WANG Li, DONG Xiaoxiao, NING Li

2023, 58(17):  2074-2081.  DOI: 10.3761/j.issn.0254-1769.2023.17.004

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Objective To investigate the effect of Xiaoyu Tongluo fumigation moxibustion on the prevention of lower extremity DVT in patients with qi stagnation and blood stasis syndrome after major orthopedic surgery. Methods On the basis of literature review and expert meeting discussion，the intervention plan was constructed. A total of 132 patients with qi stagnation and blood stasis syndrome after major orthopedic surgery who were hospitalized in the joint department of an orthopedic hospital in Zhejiang Province from November 2021 to November 2022 were selected as the research subjects by stratified sampling method. They were divided into a Xiaoyu Tongluo fumigation moxibustion group，a moxibustion group and a control group，with 44 cases in each group. On the basis of the control group，the moxibustion group was treated with Xiaoyu Tongluo fumigation moxibustion；the moxibustion group was treated with moxibustion on the basis of the interventions in the control group，and the control group was given routine nursing measures to prevent the formation of DVT. The incidence of lower extremity DVT before discharge，coagulation function indexes on the 1st and 7th day after operation and daily pain score were compared among the 3 groups，and the intervention effect was evaluated. At the same time，the safety and feasibility of the intervention program were evaluated by the occurrence and completion rate of adverse reactions. Results There was no lower extremity DVT in the Xiaoyu Tongluo fumigation moxibustion group. The incidence of lower extremity DVT was 4.65 % in the moxibustion group and 16.67 % in the control group. The difference in the incidence of lower extremity DVT between the Xiaoyu Tongluo fumigation moxibustion group and the control group was statistically significant（P<0.05）. Before and after the intervention，there were statistically significant differences in D-dimer，activated partial thromboplastin time，fibrinogen and prothrombin time among the 3 groups（P<0.05）. After the intervention，there were significant differences in D-dimer，activated partial thromboplastin time，fibrinogen and prothrombin time among the 3 groups（F=41.885，P<0.001；F=247.377，P<0.001；F=32.626，P<0.001；F=17.056，P<0.001）. The pain scores of the 3 groups were statistically significant on the 6th and 7th day after operation（P<0.05）. There was no adverse reaction during the intervention period in the moxibustion group and the moxibustion group，and the completion rate was 97.73%. Conclusion Compared with moxibustion， Xiaoyu Tongluo fumigating moxibustion can more effectively reduce the incidence of DVT in lower limbs of patients with qi stagnation and blood stasis syndrome after major orthopedic surgery，effectively improve the hypercoagulable state of patients，and continuously relieve the pain of affected limbs. The intervention program has good safety and feasibility.

Study on the effect of Fire Dragon moxibustion on dysmenorrhea based on the theory of regulating menstrual cycle

JIN Yang, FENG Ying, XU Xiuling, DONG Pingpei, CHEN Ming

2023, 58(17):  2082-2087.  DOI: 10.3761/j.issn.0254-1769.2023.17.005

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Objective To explore the effect of fire-dragon moxibustion technology on dysmenorrhea of cold-damp stagnation pattern based on the theory of regulating menstrual cycle，and to analyze the best time for intervention. Methods Convenience sampling method was adopted to select dysmenorrhea patients with cold-damp stagnation pattern，who visited the gynecological clinic of Hangzhou Hospital of Traditional Chinese Medicine from January 2020 to June 2022 as the research subjects. 2 factor and 2 level factorial design was used. SPSS 25.0 was used to generate a completely random number table for random grouping. Finally，a total of 4 groups with 30 patients in each group were obtained. The control group（group A1B1） received routine nursing；the experimental group 1 （group A2B1） received fire-dragon moxibustion technique on the 8th and 11th day after ovulation；the experimental group 2（A1B2 group） underwent fire-dragon moxibustion technique on the 1st and 4th days of menstruation；the experimental group 3（A2B2 group） received fire-dragon moxibustion technique on the 8th and 11th day after ovulation and on the 1st and 4th days of menstruation. A menstrual cycle was a course of treatment，and the experiment was conducted for a total of 3 courses. The dysmenorrhea symptom score and pain visual analog scale score before and after intervention were compared between the 4 groups. Results Univariate analysis of variance showed that after intervention，the visual analog scale score and dysmenorrhea symptom score of the 4 groups were significantly improved，with statistical difference（F=7.798，P<0.001；F=9.859，P<0.001）. According to multiple LSD comparisons，the VAS score and dysmenorrhea symptom score of experimental group 3 were significantly different from those of experimental group 2 and control group（P<0.05）. Compared with that of experimental group 3，the dysmenorrhea symptom score of experimental group 1 was significantly shorter（P<0.05）. According to the factorial analysis，the main effect of fire-dragon moxibustion technique on VAS score and symptoms score of dysmenorrhea in early menstrual period and in menstrual period is significant（P<0.05），but there was no interaction between early menstrual and menstrual fire-dragon moxibustion on VAS score and symptoms score of dysmenorrhea（P>0.05）. Conclusion The fire-dragon moxibustion technique based on the theory of regulating menstrual cycle can effectively improve the dysmenorrhea symptoms and relieve dysmenorrhea of cold-damp stagnation pattern，and the best intervention time is in the early menstrual period.

Summary of the evidence on Traditional Chinese Medicine nursing for breast cancer-related lymphedema patients

ZHOU Xu, HUANG Zheng, ZHU Weikang

2023, 58(17):  2088-2094.  DOI: 10.3761/j.issn.0254-1769.2023.17.006

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Objective To retrieve，evaluate and summarize the best-quality evidence on traditional Chinese medicine nursing for patients with breast cancer-related lymphedema. Methods According to the “6S” model，we used an evidence-based nursing method to retrieve relevant literature. The literature included guidelines，expert consensuses，evidence summaries，clinical decisions，systematic reviews，meta-analyses and original researches. Selected publications were from the earliest date in the database to April 30，2023. There were 2 researchers who evaluated the quality of literature and extracted and integrated evidence from the included articles. Results In total，13 publications were included，involving 3 sets of guidelines，3 expert consensuses，3 evidence summaries，4 systematic reviews. Ultimately，we summarized 16 pieces of the best-quality evidence on the etiology and evaluation of edema，external application of traditional Chinese medicine，traditional Chinese medicine fumigation and washing，moxibustion，acupressure point massage，traditional Chinese medicine diet nursing，and sports guidance. Conclusion Traditional Chinese medicine nursing is an effective treatment for patients with breast cancer-related lymphedema and does not have adverse reactions. However，as the quality of methodology in this study might be not too high，this conclusion may need to be further confirmed by high-quality randomized controlled trials.

Nursing intervention of Traditional Chinese Medicine in gynecological malignant tumor patients with cancer-related fatigue：a best evidence summary

WANG Tingting, DUAN Xia

2023, 58(17):  2095-2102.  DOI: 10.3761/j.issn.0254-1769.2023.17.007

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Objective Through searching，evaluating and summarizing the best evidence of non-drug nursing intervention in traditional Chinese medicine for the gynecological malignant tumor patients with cancer-related fatigue（CRF），it provides theoretical bases for clinical practice. Methods According to the principle of 6S Hierarchy of Evidence-Based Resources，relevant evidence of non-drug nursing intervention in traditional Chinese medicine for the gynecological malignant tumor patients with CRF was searched from domestic and foreign databases，guideline websites and professional society websites，including systematic review，guideline，evidence summary，meta-analysis，clinical decision，expert consensus，etc. The retrieval time is from the establishment time of databases to December 2022. The quality of the incorporated literature is evaluated by 2 researchers. Then they extracted data and summarized the evidence from the literature that meets the classification standards. Results A total of 18 pieces of the literature were included，including 13 meta-analyses，1 evidence summary，3 clinical guidelines and 1 consensus of experts，and 27 pieces of best evidence were summarized from 5 aspects of moxibustion therapy，acupoint massage therapy，music therapy，Daoyin and auricular point therapy. Conclusion The study summarizes the best evidence of non-drug nursing intervention in traditional Chinese medicine for the gynecological malignant tumor patients with cancer-related fatigue. Clinical healthcare professionals can combine the needs and wishes of patients，fully consider the clinical situation，optimize the intervention measures for the gynecological malignant tumor patients with cancer-related fatigue.

Specialist Practice and Research

Research on the developmental trajectory of rehabilitation exercise adherence and its potential classes predictors in stroke patients

LÜ Yumei, GUO Yucheng, ZHOU Yuqiu

2023, 58(17):  2103-2111.  DOI: 10.3761/j.issn.0254-1769.2023.17.008

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Objective To explore the development trajectory of rehabilitation exercise adherence and its potential classes predictors in stroke patients. Methods By the convenience sampling method，252 stroke patients who were hospitalized in 2 tertiary hospitals in Daqing from September 2020 to May 2021 were selected.The general situation questionnaire，questionnaire of exercise adherence for stroke patients，the brief illness perception questionnaire，Herth hope index，and hospital anxiety and depression scale were used to collect the baseline data of patients，and the rehabilitation exercise adherence was assessed at 6，14 and 24 weeks after stroke. Latent growth mixed model was used to identify the development trajectory of rehabilitation exercise adherence among stroke patients，and multivariate logistic regression analysis was used to explore the predictors of different latent trajectories classes. Results A total of 4 developmental trajectories of rehabilitation exercise adherence among stroke patients were identified：low adherence-improvement group（7.5%），sustained moderate adherence group（21.4%），moderate adhere-nce-decline group（46.5%）and low adherence-decline group（24.6%）. Multivariate Logistic regression analysis showed that stroke type，number of stroke attacks，baseline hope，anxiety and depression levels were independent predictors of different developmental trajectory of rehabilitation exercise adherence among stroke patients（P<0.05）. Conclusion There is significant group heterogeneity in the developmental trajectory of rehabilitation exercise adherence in stroke patients within 24 weeks of onset. Only a small number of patients’ adherence continued to be at a high level or improved from a low level，and about 1/4 of the patients continued to be at a low level and tending to decline. Medical staff should identify patients in the low adherence-decline group early on the basis of predictive factors，and implement targeted，specific and efficient adherence interventions to improve the development trend of adherence.

Influencing factors of early activities in patients with acute ischemic stroke：a qualitative study

ZHANG Min, WANG Qing, SHI Huiling, SHENG Shaoting

2023, 58(17):  2112-2118.  DOI: 10.3761/j.issn.0254-1769.2023.17.009

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Objective To explore the influencing factors of early activities in patients with acute ischemic stroke，and to provide bases for conducting individualized interventions. Methods 15 patients with acute ischemic stroke were interviewed by behavioral event interviews，and then the data were analyzed，and themes were extracted based on the Capacity，Opportunity，Motivation-Behavior（COM-B） system and Colaizzi 7-step analysis method. Results 3 themes of capability，motivation and opportunity were identified containing 12 subthemes：capability（physical dysfunction，perception of "incapacitation"，lack of early activity knowledge）；motivation（expectation of rehabilitation outcome，value perception of early activity，rehabilitation coping style，preference for exercise rehabilitation，early activity experience，rehabilitation self-efficacy）；opportunity（prescription and guidance of early activity，environment nudging，multiple external support）. Conclusion The influencing factors of early activity in patients with acute ischemic stroke are complex and diverse. Medical staff should pay attention to patients’ rehabilitation preference，formulate personalized activity prescription，establish multi-dimensional early activity nudging strategies and multiple external support systems，so as to improve the compliance of early activity，maximize the benefit of exercise rehabilitation，and improve the disease outcome.

Analysis of environmental factors and impact path of physical activity in pregnant women

WANG Yupeng, XU Ping, FENG Suwen

2023, 58(17):  2119-2125.  DOI: 10.3761/j.issn.0254-1769.2023.17.010

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Objective To investigate the environmental factors of physical activity among pregnant women，so as to provide a basis for the formulation of targeted intervention programs. Methods Using convenient sampling method，from May to December 2021，we investigated 1200 pregnant women who were received routine prenatal examination in obstetric clinic of a tertiary hospital in Zhejiang province with the general information questionnaire，Pregnancy Physical Activity Questionnaire，Falls Efficacy Scale International，Home Falls and Accidents Screening Tool，and Social Support Rate Scale. Univariate analysis，Spearman correlation were used to analysis the data，and the structural equation model was established. Results A total of 1118 pregnant women were enrolled，and only 202（18.70%） of whom met the criteria of physical activity. Pathway analysis showed that fear of falling，residential environment and social support had a direct impact on the physical activity during pregnancy with an effect of -0.168，0.326 and 0.381，respectively. Residential environment also affected physical activity through the independent mediating effect of fear of falling with an effect of 0.074，accounting for 18.50% of the total effects. Social support also affected physical activity through the independent mediating effect of residential environment and fear of falling，and the chain mediating effect of residential environment and fear of falling，accounting for 34.20% of the total effects. Conclusion The rate of pregnant women met the criteria of physical activity is low. Medical staff should pay attention to the impact of fear of falling，residential environment and social support on physical activity during pregnancy，and take targeted measures to increase the level of activity，so as to improve the level of physical activity during pregnancy.

Nursing Management

Application of cognitive interview in the construction of Workplace Violence Management Ability Scale for Psychiatric Nurses

WANG Haoyun, GAO Yun, YE Junrong, XIAO Aixiang

2023, 58(17):  2126-2133.  DOI: 10.3761/j.issn.0254-1769.2023.17.011

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Objective To explore the application of cognitive interviews in the development of Workplace Violence Management Ability Scale for Psychiatric Nurses. Methods The first version of the Workplace Violence Management Ability Scale for Psychiatric Nurses was formed based on 4R crisis management theory，semi-structured interviews and expert consultation. From April to June 2022，a total of 24 psychiatric nurses from a psychiatric hospital in Guangzhou were selected as interviewees by the purposive sampling method. A total of 3 rounds of cognitive interviews were conducted to understand the target population’s understanding of the scale and suggestions，and the research team discussed and revised it. After the revision，a total of 453 psychiatric nurses in Guangzhou Psychiatric Hospital from July to September 2022 were selected by convenience sampling for scale measurement test and the final version of the scale was formed. Results In the first round of cognitive interview，8 items with doubts were discussed and revised. After the second round of interview，a suspicious item was revised. In the third round of cognitive interview，all the interviewees could understand the items correctly and clearly. The final version of the scale included 44 items and 6 dimensions. The Cronbach’s α coefficient of the scale was 0.983，and the average content validity index of the total scale was 0.969. The scale had good reliability and validity. Conclusion Through the use of cognitive interview，we understood the psychiatric nurses’ understanding of the scale，modified the incomprehensible，uncomfortable and irrelevant expressions in the scale，and greatly improved the scientific nature and accuracy of the scale.

Current situation of the emotional labor in pediatric nurses and its influencing factors analysis

GUO Hongqing, YAN Mengwei, LI Jing, SUN Lihua, XIE Anwei

2023, 58(17):  2134-2141.  DOI: 10.3761/j.issn.0254-1769.2023.17.012

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Objective To investigate the status and influencing factors of the emotional labor of pediatric nurses，so as to provide references for improving their emotional labor. Methods Totally 520 pediatric nurses were selected from 8 hospitals in Suzhou in July 2022. Under the guidance of the Conservation of Resources Theory，they were investigated with the general information questionnaire，Emotional Labor Scale for Nurses，Spiritual Climate Scale and Nursing Work Environment Scale. Multiple linear regression was performed to analyze the factors affecting the emotional labor. Results 443 valid questionnaires were collected. The score of the Emotional Labor Scale was[64.00（60.00，68.00）]，and the scores for emotional control effort in profession，patient-focused emotional suppression and emotional pretense by norms were[30.00（28.00，34.00）]，[20.00（18.00，21.00）] and [14.00（12.00， 15.00）]. The results of multiple linear regression analysis showed that total working time，work title，nursing work environment and spiritual climate were the main influencing factors of each dimension of the emotional labor（P<0.001）. Conclusion The emotional labor of pediatric nurses is at an upper-middle level. The nursing managers should pay attention to the emotional labor of pediatric nurses，optimize the nursing work environment and create good working atmosphere.

The relationship between task load, stress cognition and psychological disengagement among midwives in Jiangsu

JIANG Weiwei, PU Congshan, ZHU Zhu, ZHOU Chunxiu, LI Liulan, GU Xiaoxia, JIANG Panhua, WANG Jianfang, LI Lin, ZHANG Jiahua, SHAN Chunjian

2023, 58(17):  2142-2148.  DOI: 10.3761/j.issn.0254-1769.2023.17.013

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Objective To investigate the current situation of psychological detachment（PD） of midwives in Jiangsu，and to analyze its influencing factors，with the aim of providing a theoretical basis for managers to take appropriate interventions to improve the level of PD of midwives. Methods Using a convenience sampling method，614 midwives from 13 cities and 42 hospitals of different levels in Jiangsu from August 2022 to September 2022 were investigated by this cross-sectional survey. A self-developed questionnaire，Psychological Detachment Scale，the Traumatic Stress Scale for Midwives，the Jefferson Empathy Scale and National Aeronautics and Space Administration-Task Load Index were adopted to collect data. Results A total of 590 valid questionnaires were collected. The mean total score of the Psychological Detachment Scale was（9.24±3.45）. The marital status，quality of sleep，frequency of after-work use of electronic devices for work，traumatic stress，empathy，and task load were the influencing factors of PD（P<0.05）. Conclusion The low level of PD of midwives is influenced by a variety of factors. Managers，therefore，need to attach importance to the PD of midwives and formulate targeted interventions to improve the level of PD and work recovery experience with a view to promote their work engagement and quality of care.

Evidence Synthesis Research

The effectiveness and safety of internet-based tele-exercise rehabilitation in COPD patients：a systematic review

TANG Huan, CHEN Guihua, LI Qin, ZHOU Xixin, LIU Xiaoshuang

2023, 58(17):  2149-2157.  DOI: 10.3761/j.issn.0254-1769.2023.17.014

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Objective To systematically evaluate the effectiveness and safety of internet-based tele-exercise rehabilitation in COPD patients. Methods 12 electronic databases，such as Cochrane Library，PubMed，Web of Science，EBSCO etc，and clinical trials registry platforms were searched from their inception to December 2022，by computer and manual search. Literature search，study selection，data extraction and methodological quality evaluation were conducted by 2 researchers independently. Meta-analysis was performed by RevMan 5.4. Results 25 studies involving 2 359 patients were included. Meta-analysis indicated that compared to traditional exercise rehabilitation，internet-based tele-exercise rehabilitation contributed to an increase in 6MWD[MD=42.80，95%CI（29.53，56.07），P<0.001] and a decrease in COPD assessment test score[MD=-2.22，95%CI（-3.68，-0.76），P=0.003]；compared to remote rehabilitation without internet-based technology，internet-based tele-exercise rehabilitation increased patients 6MWD[MD=21.07，95%CI（13.29，28.84），P<0.001]，but its long-term maintenance effect was uncertain；it improved the level of exercise behavior，including daily walking steps[MD=805.83，95%CI（435.08，1176.58），P<0.001]，daily exercise time[MD=5.61，95%CI（3.11，8.10），P<0.001]，and moderate to high intensity exercise time[MD=2.32，95%CI（0.77，3.87），P=0.003]；internet-based tele-exercise rehabilitation also improved quality of life，by St. George’s Respiratory Questionnaire[MD=-3.12，95%CI（-5.87，-0.36），P=0.030] and Chronic Respiratory Disease Questionnaire[MD=9.18，95%CI（0.97，17.40），P=0.030]. In terms of safety，there was no significant difference in acute exacer-bations of COPD compared to the control group，but there was a higher risk of adverse events. Conclusion The implementation of internet-based tele-exercise rehabilitation can help improve motor function，exercise behavior level and quality of life in COPD patients，but the outcome evaluation indexes need to be standardized，and the long-term effects and safety of rehabilitation still need to be verified by numerous high-quality studies.

Effects of fully immersive virtual reality on extremity function of stroke patients：a meta analysis

ZHOU Wenlu, YU Jiangxuan, WANG Junjie, SHAN Xueqi, XU Yawen

2023, 58(17):  2158-2165.  DOI: 10.3761/j.issn.0254-1769.2023.17.015

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Objective To evaluate the effect of fully immersive virtual reality technology on limb function of stroke patients. Methods We searched Chinese and English databases including PubMed，Embase，Cochrane Library，CINAHL，Web of Science，CNKI etc.，and clinical trials registry platforms from inception until October 2020. Randomized controlled trials that reported the effects of fully immersive virtual reality technology for limb function in stroke patients were retrieved. The references and grey literature included in the study were also retrieved. There were 2 researchers who independently retrieved articles，evaluated quality and extracted data. RevMan 5.4 software was used for Meta-analysis. Results A total of 9 studies involving 252 patients were finally included. Meta-analysis indicated that fully immersive virtual reality technology could improve upper limb motor function[MD=5.35，95%CI（3.04，7.67），P<0.01]，dexterity[MD=8.26，95%CI（5.09，11.43），P<0.01]，enhance lower limb balance function[MD=6.30，95%CI（3.14，9.46），P<0.01]，gait coordination[MD=-4.97，95%CI（-6.76，-3.18），P<0.01]. But there was no statistically significant difference in gait velocity[MD=10.29，95%CI（-4.03，24.62），P=0.16]. Descriptive analysis indicated that fully immersive virtual reality technology could significantly improve exercise endurance. Subgroup analysis according to intervention time found that when intervention time≥4 weeks，the experimental group had statistically significant differences on the upper limb dexterity[MD=9.06，95%CI（5.69，12.43），P<0.01] and lower limb gait coordination[MD=-5.25，95%CI（-7.24，-3.26），P<0.01]. Conclusion Fully immersive virtual reality technology can improve the limb function of stroke patients，but the effect on gait velocity was not significant. The subgroup analysis of evaluation indicators suggests that sufficient intervention time should be guaranteed. More and higher quality studies are needed to further verify this in the future.

Review

Application progress of safety planning intervention in preventing patients’ suicide

MIAO Yingying, XU Hui, LI Minyue

2023, 58(17):  2166-2170.  DOI: 10.3761/j.issn.0254-1769.2023.17.016

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Safety planning intervention can provide patients with personalized coping strategies during suicidal ideation and suicide-related behaviors，thus preventing patients from committing suicide. This paper summarizes the concept，development，implementation content，advantages and application effect of safety plan intervention，in order to provide references for constructing and perfecting the suicide prevention training program for patients in China.

Concept analysis and research progress of de-implementation

LI Jiamin, LI Xuejing, ZHANG Xiaoyan, SUN Xiangyu, BAI Yunfeng, HAO Yufang, WU Xinjuan

2023, 58(17):  2171-2176.  DOI: 10.3761/j.issn.0254-1769.2023.17.017

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Objective To analyze the definition of de-implementation，and provide a theoretical basis for research and clinical practice. Methods Pubmed，ProQuest，CINAHL，CNKI，Wanfang，VIP，and China Biomedical Literature Service System databases were searched. The search time limit was from the establishment of the database to July 2022. As a result，40 articles were selected for analysis. Walker and Avant′s methods were used to perform concept analysis of de-implementation in terms of its definition，pre-factors，post-results. Results De-implementation can be classified into 4 defined attributes：low-value care as the subjects；strategies to apply；4 types of removing，replacing，reducing，restricting；complicated process. The pre-factors can be discussed from the aspects of low-value care，health care systems，patients，ethical and social factors. De-implementation can impact to patients and health care systems. Conclusions The research on de-implementation is still at an early stage. There is a lack of relevant measurement tools for the accurate determination of de-implementation. In the future，research and clinical practice should be carried out based on the concept of de-implementation.