Table of Content

10 May 2024, Volume 59 Issue 9

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Research Paper

A mixed method study on the relationship between health promotion behavior and health locus of control among patients living with pulmonary tuberculosis

HAN Dongfang, TIAN Tian, GAO Chang, ZHANG Jingjun, LI Xiaomei

2024, 59(9):  1029-1036.  DOI: 10.3761/j.issn.0254-1769.2024.09.001

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Objective To explore the health promotion behaviors among patients with pulmonary tuberculosis （TB），and to analyze its relationship with health locus of control，in order to provide scientific references for improving TB patients’ health-promotion behaviors in clinical nursing care. Methods The interpretive sequence mixed method design was utilized. A convenient sampling was used to enroll 300 TB patients from 2 TB specialized tertiary hospitals in Xi’an as research subjects from January to April 2023. General information questionnaire，Health promoting lifestyle profile-Ⅱ，and Multidimensional health locus of control scale were used to collect data，and single-factor analysis and multiple linear regression analysis were conducted. Purposeful sampling was used to select 11 TB patients for a semi-structured interview，and the Colaizzi 7-step method was used to extract themes. Results In the quantitative study，the total score of health promoting behaviors in 294 TB patients was（110.26±15.74）. Patients’ internal health locus of control，chance health locus of control，and occupational status significantly influenced their health-promotion behaviors（P<0.05）. In the qualitative study，4 themes were extracted，including awakening self-awareness of health，the desire to establish a normal life，the distress of multiple uncertainties，and the immediate effect of authoritative guidance. The qualitative and quantitative studies complemented each other and further verified the relationship between health promotion behaviors and health locus of control of TB patients. Conclusion The level of health-promotion behaviors in TB patients needs to be further improved. Nurses need to take systematic health education as an opportunity by the catalytic effect of individual health awareness，to improve their internal locus of control，reduce their opportunity control tendency due to multiple uncertainties，with the ultimate purpose of helping TB patients form and maintain health promotion behaviors.

Construction and application of early phase Ⅰ cardiopulmonary rehabilitation program for patients with Type A aortic dissection

SI Qianqian, WANG Ying, ZHAO Fuyun, MA Xiaoxiao, LIU June

2024, 59(9):  1037-1042.  DOI: 10.3761/j.issn.0254-1769.2024.09.002

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Objective To construct early phase Ⅰ cardiopulmonary rehabilitation program for patients with Type A aortic dissection and to evaluate its clinical effects. Methods From January 2021 to October 2022，type A aortic dissection patients of a tertiary hospital in Beijing was selected by the destination sampling. They were divided into a control group and an intervention group. The intervention group was given early phase Ⅰcardiopulmonary rehabilitation program for patients with type A aortic dissection and the control group was given routine care. The 6-minute walking experiment（6MWT），Borg subjective fatigue score，the first time out of bed，the incidence of hypoxemia and related complications，and the incidence of adverse events related to rehabilitation nursing were compared between the 2 groups. Results A total of 130 cases were selected，among which 20 cases were excluded because of surgical complications and self-withdrawal. A total of 110 cases were finally included，with 57 cases in the intervention group and 53 cases in the control group. The results of walking distance of 6MWT，Borg subjective fatigue score and incidence of hypoxemia had statistical significance between the 2 groups（P<0.05）. The results of the time of the first time out of bed and the incidence of complications and the incidence of adverse events related to rehabilitation nursing had no statistical significance between the 2 groups（P>0.05）. Conclusion Early phase Ⅰ cardiopulmonary rehabilitation program for patients with type A aortic dissection benefits the improvement of the motor function，the reduction of incidence of hypoxemia.

Special Planning——Diabetes Care

Behavioral characteristics of patients with recurrent hypoglycemia in the degeneracy of blood glucose management：a mixed-methods study

SHEN Zhijia, CHEN Xinyu, QIAN Zhijie, YIN Limei

2024, 59(9):  1043-1050.  DOI: 10.3761/j.issn.0254-1769.2024.09.003

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Objective To explore the process and main behavior characteristics of behavioral characteristics of patients with recurrent hypoglycemia in the degeneracy of blood glucose management. Methods A mixed-method convergent design was used to collect data. From June 2022 to April 2023，382 patients with recurrent hypoglycemia were admitted to the endocrine department of a tertiary hospital in Jiangsu were recruited to score of ego depletion. K-means clustering was conducted to analyze the distribution characteristics of patients’ characteristics in blood glucose management. At the same time，19 patients who were selected from the participants of the quantitative study were recruited to attend semi-structured interviews. Results Quantitative results analysis：the average score of blood glucose management loss was（49.20±6.58），and the average scores of cognitive control，behavioral control and emotional control were（17.90±4.12），（15.49±3.64） and （15.81±3.58），respectively. The results of cluster analysis showed that behavioral characteristics could be divided into 3 groups：a cognitive depletion group，an emotional depletion group and a self-control group. Qualitative data analysis：the process of deterioration of management in patients included 3 major themes，including the antecedents of ego depletion，the process of ego depletion and the aftereffects of ego depletion. Analysis of the mixed results showed that the status of ego depletion is serious；patients ignore the behavioral elements of active participation in blood glucose management，show many irrational decision-making behaviors，and the degradation behavior characteristics of patients’ blood glucose management are different. Conclusion The degeneration behavior of blood glucose management was serious and affected by single or multiple factors，continuously consuming self-control energy and causing ego depletion. To promote the long-term maintenance of blood glucose management，priority should be given to take actions to enhance patients’ perceptions，emotion and behaviors，help them learn about the possible blood glucose changes，improve their understanding and recognition of the value of scientific management.

The status and influencing factors of kinesiophobia in patients with diabetic peripheral neuropathic pain

WANG Limei, LI Lu, LI Yuxia, YU Peng, LUO Qian, ZHANG Chongni

2024, 59(9):  1051-1056.  DOI: 10.3761/j.issn.0254-1769.2024.09.004

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Objective To understand the status and influencing factors of kinesiophobia in patients with diabetic peripheral neuropathic pain（DPNP）. Methods From February to June 2023，192 patients with DPNP in a tertiary general hospital in Nanchang City，Jiangxi Province were selected by convenience sampling method. The patients were investigated by the demographic information questionnaire，Tampa Scale for Kinesiophobia，Numerical Rating Scale，Medical Coping Modes Questionnaire，Diabetes Distress Scale，and Summary of Diabetes Self-care Activities.Multiple linear regression were used to analyze the influencing factors of kinesiophobia in patients with DPNP. Results The score of kinesiophobia in patients with DPNP was（36.68±3.88），and the incidence of kinesiophobia was 38.5%. Multiple linear regression analysis showed that marital status，pain level，coping style，diabetic distress and self-management behavior were influential factors for kinesiophobia in patients with DPNP（all P<0.05）. Conclusion Patients with DPNP have a moderate level of kinesiophobia. Nursing staff should pay attention to the early assessment of patients’ kinesiophobia，promptly identify and take effective measures to reduce the level of patients’ kinesiophobia，increase their motivation to exercise，and improve their prognosis and quality of life.

Potential profile analysis and influencing factors of self-management in prediabetic patients

DING Huimin, DAI Limin, CAI Dongqing, YANG Qun

2024, 59(9):  1057-1064.  DOI: 10.3761/j.issn.0254-1769.2024.09.005

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Objective To explore the potential categories of self-management behavior in prediabetes patients and analyze the influencing factors of different potential categories. Methods A convenient sampling method was used to select pre-diabetic patients treated in physical examination centers and endocrinology outpatient clinics in 2 tertiary A hospitals in Jiangsu Province from September 2022 to June 2023. General data questionnaire，Prediabetic Disease Knowledge Questionnaire，Prediabetes Self-management Scale，Diabetes Self-efficacy Scale and Social Support Rating Scale were used for investigation. Results A total of 445 subjects were included in this study，with an average age of（44.92±4.98） years. 4 potential categories of self-management behavior were identified，namely low self-management（16.4%），static self-management（19.1%），dynamic self-management（25.6%） and high self-management（38.9%）. Occupational status，marital status，family per capita monthly income，family history of diabetes，disease knowledge，self-efficacy and social support were the influencing factors of self-management behavior in prediabetes patients（P<0.05）. Conclusion There are significant category characteristics of self-management behavior in patients with prediabetes. Medical staff can identify the category characteristics and influencing factors early，and provide bases for medical staff to formulate targeted clinical intervention measures to help patients improve their self-management level.

Development and reliability and validity test of a Self-Assessment Scale for Medication Literacy in Patients with Coronary Heart Disease Comorbidity Diabetes

LIU Haiting, WANG Yongmei, ZHENG Beibei, CAI Lili, YE Linbin, WU Jiayun, NING Li, LI Yimin, CHEN Weixia

2024, 59(9):  1065-1071.  DOI: 10.3761/j.issn.0254-1769.2024.09.006

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Objective To develop a self-assessment scale for medication literacy in patients with coronary heart disease comorbidity diabetes and to test its reliability and validity. Methods According to medication literacy theory model，the initial scale was formed through literature review，the qualitative interview and expert inquiry. Cognitive interview was used to optimize the expression of item text. 421 patients with coronary heart disease comorbidity diabetes in a tertiary hospital in Zhejiang province from November 2022 to April 2023 were selected to investigate the reliability and validity of the scale by convenience sampling. Results The self-assessment scale of drug literacy for coronary heart disease comorbidity diabetes mellitus included 23 items in 5 dimensions including acquisition，understanding，communication，evaluation and calculation. The total Cronbach’s α coefficient of the scale was 0.911；the retest reliability was 0.948；the average content validity index was 0.997；the correlation coefficients between each dimension and total score of the scale and the calibration scale ranged from 0.485 to 0.926. The exploratory factor analysis was employed to extract 5 common factors，and the cumulative variance contribution rate was 73.753%. Confirmatory factor analysis showed that the scale factor structure was stable. Conclusion The scale has good reliability and validity，and it can be used as an effective tool to evaluate the self-rated medication literacy level of patients with coronary heart disease comorbidity diabetes.

Quality appraisal of hypoglycemia fear assessment tools for adults

CHEN Lixia, SHI Hui, ZHU Dezheng, ZENG Ying

2024, 59(9):  1072-1079.  DOI: 10.3761/j.issn.0254-1769.2024.09.007

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Objective To evaluate the quality of hypoglycemia fear assessment tools for adults，so as to provide references for the selection of high-quality research tools. Methods PubMed，Embase，Web of Science，CNKI，VIP，Wanfang，CBM were retrieved to collect the literature on the measurement properties of hypoglycemic fear. There were 2 researchers who screened the literature and extracted data，independently. Based on the consensus-based standards for the selection of health measurement instruments（COSMIN） guideline，the methodological and measure-ment properties quality of the included assessment tools were evaluated by the COSMIN risk of bias checklist and quality criteria. Results A total of 17 studies involving 6 hypoglycemia fear assessment tools for adults were included，none of which reported cross-cultural validity，measurement error，and responsiveness. All assessment tools were recommended by grade B. Conclusion The 15-item Fear of Hypoglycemia Scale（FH-15） has the most comprehensive measurement properties in its evaluation，and can be provisionally recommended for use，but it needs further testing.

Standards

Nursing expert consensus on subcutaneous injection for allergen-specific immunotherapy

Allergy and Clinical Immunology Committee of Chinese Research Hospital Association, Allergy Care Group, Chinese Society of Allergology, Chinese Medical Association, Allergy Prevention and Control Committee of Chinese Preventive Medicine Association, （Writing Committee：WANG Qing, LIU Jun, ZHI Fan, WAN Wenjin, TIAN Fengying, HUO Xiaopeng, ZHOU Wenhua YANG Yongshi, WANG Tiantian, SUN Jinlü）

2024, 59(9):  1080-1083.  DOI: 10.3761/j.issn.0254-1769.2024.09.008

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Objective To develop an expert consensus on subcutaneous injection for allergen-specific immunotherapy. Methods Relevant domestic and international literature was reviewed，and nursing experts who had experiences in subcutaneous injection of allergen-specific immunotherapy were interviewed to form the initial draft of the consensus. A total of 85 experts from 42 hospitals nationwide were invited to participate in discussions. 2 rounds of expert consultations，adjustments，revisions，and improvements were made to the initial draft，and an online meeting was held to form the final version of the consensus. The content approved by more than 75% of the expert group is adopted，or it will be discussed or deleted. Results The expert consensus includes operational standards for subcutaneous injection of allergen-specific immunotherapy，identification and management of adverse reactions，and health education. Conclusion The consensus demonstrates strong scientific rigor and practicality，providing guidance for nursing practices in the field of clinical allergology.

Specialist Practice and Research

A study on the trajectory and influencing factors of joint awareness in patients with total knee arthroplasty

LI Qi, SU Qingqing, ZHANG Yaoyao, WANG Tiantian, LÜ Jing, LI Yake, LI Haiyan

2024, 59(9):  1084-1090.  DOI: 10.3761/j.issn.0254-1769.2024.09.009

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Objective To explore the trajectory and influencing factors of joint awareness after total knee arthroplasty. Methods With the method for convenience sampling，patients who met the standards for total knee arthroplasty from July 2021 to March 2022 were selected. General information，severity of osteoarthritis，anxiety and depression，and self-efficacy were investigated before surgery（T0）. Joint awareness was investigated at 1 month （T1），3 months（T2），and 6 months（T3） after surgery，respectively. Latent growth curve model was used to describe the overall trend of joint awareness；latent class growth model was used to analyze latent subgroups；logistic regression analysis was used to determine the impact of related variables on the trajectory of joint awareness. Results The scores of joint awareness were（32.70±5.80），（47.67±4.67） and （61.53±7.81） respectively at T1 to T3，and joint awareness showed an increasing trend（P<0.001）. The trajectory of joint awareness was divided into 2 potential subgroups：the rapid growth group（61.83%） and the slow growth group（38.17%）. Age，BMI，other chronic diseases or not，years of osteoarthritis，severity of osteoarthritis，anxiety，depression，and self-efficacy affected the trend of joint awareness（all P<0.05）. Conclusion Joint awareness showed a linear growth trend with the postoperative time，and there were 2 potential subgroups in the trajectory. Medical workers could develop corresponding interventions based on the influencing factors to improve patients’ postoperative awareness of artificial joints.

Construction and validation of a risk predictive model for the bowel preparation failure in colonoscopy patients

LIU Ya, LIU Xiaoqing, YANG Xuening, WANG Ping, LIU Xuekui, LUO Dan

2024, 59(9):  1091-1098.  DOI: 10.3761/j.issn.0254-1769.2024.09.010

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Objective To analyze the predictive value of fecal form for the quality of bowel preparation in patients scheduled for colonoscopy，identify risk factors for bowel preparation failure，and develop and validate a risk prediction model. Methods This was a prospective cohort study using convenience sampling. Patients scheduled for colonoscopy in the Digestive Department of a tertiary A hospital in Jiangsu Province from June to December 2022 were included in the modeling cohort. General information sheet and the Bristol Stool Form Scale（BSFS） were used for data collection. Patients were categorized into a successful bowel preparation group and a bowel preparation failure group based on the quality of bowel preparation. The optimal cutoff value for BSFS was determined using the best cutoff value method. Logistic regression analysis was employed to identify risk factors for bowel preparation failure，and a nomogram risk prediction model was constructed. Patients undergoing colonoscopy in the same hospital from January to February 2023 were served as the validation cohort. Results The modeling cohort included 569 patients，and the validation cohort included 212 patients，with bowel preparation failure rates of 19.0% and 19.8%，respectively. The risk prediction model formula derived from logistic regression analysis was P=-2.209+0.619 × hospitalized patients+0.635 × age≥65 years-0.710 × previous colonoscopy history+2.031 × BSFS type 1~2. The area under the receiver operating characteristic curve for the model was 0.751，with a sensitivity of 54.6%，a specificity of 85.9%，and the optimal cutoff value was 0.225，corresponding to a risk score of 80 for bowel preparation failure. The Hosmer-Lemeshow test showed χ²=4.429，P=0.351. External validation demonstrated an area under the receiver operating characteristic curve of 0.775，indicating good model fit and high predictive value. Conclusion The incidence of bowel preparation failure in colonoscopy patients is relatively high. Patients aged≥65 years，hospitalized patients，those with no history of colonoscopy，and those with BSFS type 1~2 are more likely to experience bowel preparation failure. The risk prediction model developed in this study has good predictive performance and can provide a basis for clinical nurses to quickly assess the risk of bowel preparation failure in patients.

Development and reliability and validity test of the Psychological Birth Trauma Assessment Scale

SUN Xiaoqing, ZHANG Aixia, ZHU Zhu, FAN Xuemei, MEI Shijuan, HUANG Xinxin, CONG Shengnan, XIE Hongyan

2024, 59(9):  1099-1105.  DOI: 10.3761/j.issn.0254-1769.2024.09.011

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Objective To develop a Psychological Birth Trauma Assessment Scale and to test its reliability and validity. Methods Through literature review，semi-structured interview，expert conference，Delphi expert enquiry and preliminary investigation，a pre-test scale was formed. From March to May 2023，postpartum women from 38 hospitals of different levels in 15 provinces（Jiangsu，Anhui，Zhejiang，Fujian，Tibet，and Shanghai，etc.） were conveniently selected for investigation. The sample size of the first-round survey was 547，which was used for reliability and validity test. The sample size of the second-round survey was 550，which was used for confirmatory factor analysis. Results The psychological birth trauma assessment scale consisted of 2 parts，with a total of 29 items in 6 dimensions. The intrapartum feeling part included 4 dimensions，with a cumulative variance contribution rate of 63.992%，and the postpartum effect part included 2 dimensions，with a cumulative variance contribution rate of 68.208%. The content validity index of the scale was 0.947，and the content validity index of each item was 0.809~1.000. The total score of the scale and the scores of each dimension were significantly negatively correlated with the total score of the calibration scale（r=-0.784~-0.533，P<0.001）. The total Cronbach’s α coefficient was 0.941，and the split-half reliability coefficient was 0.883. Confirmatory factor analysis showed that the main evaluation indicators were all within the acceptable range. Conclusion The Psychological Birth Trauma Assessment Scale has good reliability and validity，and it can be used as an assessment tool for the degree of maternal psychological birth trauma.

Enteral and Parenteral Nutrition

Evidence summary of enteral and parenteral nutrition support in adult patients with severe burns

XIE Yusheng, HUANG Rongrong, ZHAO Xue, MA Lei, HU Yan, YANG Qian, WANG Qiansha, MING Yue

2024, 59(9):  1106-1113.  DOI: 10.3761/j.issn.0254-1769.2024.09.012

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Objective To systematically retrieve and integrate the best evidence of enteral and parenteral nutrition support in adult patients with severe burns. Methods 2 nursing master students who had studied evidence-based nursing systematically searched the clinical decisions，recommended practices，guidelines，expert consensuses，systematic reviews，evidence summaries and other evidences on enteral and parenteral nutrition support for adult patients with severe burns in domestic and foreign guideline networks，relevant institutional websites and databases. The retrieval time was from the establishment of the databases to April 2023. 2 researchers who had obtained master’s degrees and undergone systematic evidence-based training in Fudan University used the appraisal of guidelines for research and evaluation Ⅱ and JBI critical appraisal tools to evaluate the methodological quality，and extracted and summarized the evidence according to the theme. Results A total of 28 articles were included，including 1 clinical decision，9 guidelines，3 expert consensuses，9 systematic reviews，and 6 evidence summaries. A total of 20 pieces of evidence were summarized from 6 aspects：nutritional risk screening and assessment，energy requirement calculation，timing and route of nutritional support，nutrient intake，nutritional support monitoring and effect evaluation. Conclusion The best evidence of enteral and parenteral nutrition support for adult patients with severe burns summarized in this study is more comprehensive and scientific. It is suggested that in clinical application，targeted screening should be carried out according to the promotion and hindering factors of evidence，so as to scientifically carry out nutritional support for adult patients with severe burns.

Intractable Diseases Care

Nursing care of a patient before operation with mechanical circulation-assisted bridging heart transplantation

LI Xuqin, FENG Jiehui, HUANG Fangfang, YU Chao, LIANG Shiyu, WANG Xiao, LI Xufang, ZHU Han

2024, 59(9):  1114-1117.  DOI: 10.3761/j.issn.0254-1769.2024.09.013

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To summarize the nursing care of a patient with acute myocardial infarction complicated with cardiogenic shock before operation. The main nursing points are as follows：in the acute stage，the integrated rescue was implemented with rapid on-machine coordination of external cardiopulmonary resuscitation，multidisciplinary collaboration to ensure safe patient transport；during the bridging period，the combined operation care of extracorporeal membrane oxygenation，intra-aortic balloon counter pulsation and continuous kidney replacement therapy was carried out with goal-oriented anticoagulation care，prevention of catheter-related infection with the assistance of mechanical circulation，and neurological function monitoring. The patient successfully passed the waiting period for heart transplantation and underwent heart transplantation 21 days after admission. With the follow-up for 1 year，the patient recovered well.

Nursing care of a patient with acute myocardial infarction after double knee joint replacement due to alkaptonuria

JIA Xiaojing, CHEN Yizhu, XU Zhiying, HE Xia, GENG Chao

2024, 59(9):  1118-1121.  DOI: 10.3761/j.issn.0254-1769.2024.09.014

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To summarize the nursing care of a patient with acute myocardial infarction after double knee joint replacement due to alkaptonuria. The main nursing points were as follows：strict condition monitoring，being alert to the occurrence of cardiac complications；strengthening thrombus and bleeding management to prevent related complications；early progressive rehabilitation exercise to promote functional rehabilitation of the affected limb；implementing analgesic management to improve pain symptoms；carrying out nutrition assessment and personalized nutrition support；paying attention to humanistic care，targeted psychological nursing. After careful treatment and nursing care，the patient was discharged from the hospital. After 3 months of telephone follow-up，the patient recovered well.

Evidence Synthesis Research

Influencing factors of frailty in lung transplant patients：a Meta-analysis

GU Peipei, ZENG Fei, LAN Meijuan, LIANG Jiangshuyuan, GUO Luyao, CAI Lingyun, ZHU Yan, GUO Ge

2024, 59(9):  1122-1129.  DOI: 10.3761/j.issn.0254-1769.2024.09.015

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Objective To identify the factors associated with frailty in lung transplant patients by a meta-analysis. Methods Computerized search was performed for studies on the influencing factors of frailty in lung transplant patients in the CNKI， WanFangData， VIP， CBM， PubMed， Web of Science， Embase， Elsevier ScienceDirect and CINAHL databases. The search was conducted from the time of database construction to November 2023. Literature screening， quality assessment， and data extraction were performed independently by 2 investigators， and Meta-analysis was performed using Stata 17.0 software. Results 10 cohort studies， including 1 999 patients， were finally included， and 13 influencing factors were extracted， including advanced age （OR=1.05）， female （OR=2.50）， BMI （OR=0.38）， diagnosis of primary pulmonary disease （OR=2.90）， 6MWD （OR=0.34）， and lung allocation score （OR=0.69）， FVC （OR=0.60）， pre-transplant frailty （OR=0.81）， hypoproteinemia （OR=4.12）， hemoglobin （OR=0.50）， anemia （OR=4.37）， length of ICU stay （OR=1.24）， and total length of stay （OR=1.05）. Short Physical Performance Battery is an assessment tool for frailty in lung transplant patients， with an incidence of frailty in 24% before transplantation and 50% in post-transplantation. Fried Frailty Phenotype is an assessment tool for frailty in lung transplant patients， with a pre-transplant frailty incidence of 30%. Conclusion There are many factors involved in the incidence of frailty in lung transplant patients， and nursing staff should dynamically evaluate the frailty of lung transplant patients， and give individualized and precise interventions in combination with a multidisciplinary model to improve or delay the progression of frailty.

Experience of virtual reality rehabilitation of stroke patients：a Meta-synthesis of qualitative study

DONG Lei, LIU Jia, ZHAO Qin, ZHAO Hongyu, ZHU Xiao

2024, 59(9):  1130-1137.  DOI: 10.3761/j.issn.0254-1769.2024.09.016

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Objective To systematically review qualitative studies on the experience of virtual reality（VR） rehabilitation in stroke patients，so as to provide references for the clinical practice of stroke rehabilitation. Methods The relevant qualitative studies in PubMed，Web of Science，Scopus，Embase，Cochrane Library，CINAHL，CNKI，WanFang Data，SinoMed and VIP Database were retrieved. The retrieval time was from the establishment of the database to April 2023. The quality of included studies was evaluated according to JBI Critical Appraisal Tool （2020） for qualitative studies. Meta-synthesis was used to integrate results. Finally，the quality of evidence was evaluated by the Confidence in the Qualitative Evidence（ConQual） approach. Results A total of 14 studies were included to extract 45 research results，and 3 synthesized findings were grouped from 10 categories according to their similarities，including the perceived benefits of VR rehabilitation；the perceived barriers of VR rehabilitation；the expectations and needs for VR rehabilitation in stroke patients. The ConQual score showed a moderate quality of the synthesized findings. Conclusion Stroke patients are positive about VR rehabilitation. But in the future，we should pay attention to optimizing the VR rehabilitation support system for stroke，improving the feedback mechanism of VR rehabilitation technology，innovating VR multi-functional rehabilitation form，promoting VR rehabilitation extend to the community and home，providing a reference for the application of VR rehabilitation in stroke patients.

Review

Ethical conflicts in interprofessional collaboration among nurses：a scoping review

LIU Mengyuan, TIAN Lingyun, JIANG Jing, FENG Xinyu, LI Weijuan, LUO Hui, LI Yinglan

2024, 59(9):  1138-1144.  DOI: 10.3761/j.issn.0254-1769.2024.09.017

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Objective The scope of related research on ethical conflicts in the interprofessional collaboration in nursing was reviewed，so as to summarize the obstacles and coping strategies that lead to ethical conflicts in interprofessional collaboration and provide references for promoting nurse engagement in interprofessional collaboration. Methods Based on the methodological framework of the scope review，we systematically searched domestic and foreign databases including the Cochrane Library，CINAHL，Embase，PubMed，Web of Science，CNKI，VIP，Wanfang and SinoMed. The time limit for database retrieval was from the establishment of each database to March 2023. The selected studies were summarized and analyzed. Results Totally 13 articles published between 1991 and 2022 were included. The obstacle factors that lead to ethical conflicts in nurse engagement of interprofessional collaboration can be divided into 3 categories，including personal factors（insufficient professional knowledge，differences in professional values），interprofessional factors（imbalanced power between professions，lack of respect and collaboration between cooperators） and environmental factors（insufficient resources and staffing，high-intensity workload，and high-pressure work environment）. At the same time, in view of these 3 aspects, it puts forward some countermeasures, such as enhancing professional knowledge，strengthening interprofessional education，improving understanding and cooperation among medical workers in different wards，providing medical practitioners with a team-based，ethical work environment that facilitates interprofessional collaborations and open dialogues. Conclusion It is of great significance for nurses to get involved in interprofessional collaborations，in order to ensure high-quality nursing services. Further studies are needed for the development of education and the core competency framework construction for interprofessional collaborations in nursing. More attention should be paid to develop the organizational atmosphere at the same time，so as to continuously improve nurse’ capabilities in interprofessional collaborations.

Shared decision making in acute coronary syndromes：a scoping review

CUI Yishuang, HE Xifei, WANG Zhaozhao, CHENG Jie, YANG Weimei, LU Lijuan

2024, 59(9):  1145-1152.  DOI: 10.3761/j.issn.0254-1769.2024.09.018

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Objective To review the application of shared decision making in acute coronary syndrome， so as to provide references for future research and application. Methods Based on the scoping review methodology， a systematic search was conducted in SinoMed， CNKI， Wanfang， PubMed， Embase， Cochrane Library， Web of Science， and CINAHL. The search time limit was from the establishment of the database to January 8， 2023， and the included literature was summarized and analyzed. Results A total of 17 articles were included. The application of shared decision making in acute coronary syndromes includes diagnosis， treatment， primary and secondary prevention. 5 patient decision aids were retrieved. The influencing factors include patient factors， medical staff factors and implementation process factors. The clinical application has good effectiveness and feasibility. Conclusion Shared decision making can help patients with acute coronary syndrome to increase their decision making knowledge， improve their decision-making experience and improve the quality of decision making. In the future， we should broaden the application scope of shared decision making in acute coronary syndromes， develop scientific and practical decision aids， take targeted measures， and explore the application of shared decision making in clinical diagnosis and treatment in China.