Chinese Journal of Nursing

Expert consensus on the difficult cannulation of hemodialysis arteriovenous fistula guided by point-of-care ultrasound

Blood Purification Committee of Chinese Nursing Association（Writing Committee：CHEN Lin，XIA Jinghua，FU Xia，MA Zhifang，XIAO Guanghui）

2025, 60(19): 2309-2312. DOI: 10.3761/j.issn.0254-1769.2025.19.001

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Objective To formulate an expert consensus on the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound（hereinafter referred to as the consensus）. To standardize the clinical practice of ultrasound-guided puncture of difficult autologous arteriovenous fistula. Methods We conducted a comprehensive literature review of domestic and international publications，integrated clinical nursing experts’ practical experience，and followed evidence-based nursing principles to identify the best available evidence. Through expert panel discussions and 3 rounds of Delphi expert consultation，we systematically revised，refined and improved the initial draft of the consensus，ultimately developing the finalized version. Results The response rates of the 3 rounds of Delphi expert correspondence inquiries were all 100%；the authority coefficient of expert correspondence inquiries was 0.97；the mean importance assignment of the 3 rounds of correspondence inquiries was more than 3.50. The Kendall coordination coefficients of the 3 rounds of expert consultation were 0.127，0.120，and 0.201，respectively （P<0.05），and the degree of coordination of expert opinions was good and the expert opinions were consistent. The consensus summarized 5 aspects，including relevant terms and definitions，indications for real-time ultrasound-guided arteriovenous fistula puncture，personnel qualifications and training，difficult arteriovenous fistula puncture procedures under real-time ultrasound-guided，and nursing quality control. Conclusion The consensus is scientific，which can provide a basis for hemodialysis practitioners to practice the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound.

Development and validation of a risk prediction model for non-cuffed catheter dysfunction in hemodialysis patients

JIANG Haiqiang, GONG Juan, WU Shuang, PENG Jia, WU Chuanfang

2025, 60(19): 2313-2320. DOI: 10.3761/j.issn.0254-1769.2025.19.002

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Objective To develop and validate a risk prediction model for non-cuffed catheter（NCC） dysfunction in hemodialysis patients，aiming to provide a reference for early clinical identification and warning. Methods A prospective study design was adopted. A total of 569 patients with indwelling NCC from the hemodialysis center of a tertiary hospital in Nanchang between December 1，2023 to May 20，2024，were included as a modeling cohort. An additional 172 patients from the hemodialysis center of a tertiary hospital in Changsha，enrolled between May 30 to October 20，2024，formed a validation cohort. Data were collected on general patient characteristics，dialysis information，catheterization details，and clinical parameters. The risk prediction model was constructed using a combination of variables identified through univariate analysis，Lasso regression，logistic regression，and the Boruta algorithm. Model performance was evaluated accordingly. Results The incidence of NCC dysfunction in hemodialysis patients was 44.94%. A total of 5 common predictors were identified by both algorithms，including age，ultrafiltration volume，catheter insertion site，catheter indwelling time，and C-reactive protein. The area under the receiver operating characteristic curve（AUC） was 0.720 for internal validation and 0.766 for external validation. The Brier scores for curve calibration were 0.213 and 0.203，respectively. The decision curve analysis showed clinical benefit within risk threshold ranges of 22%~82% and 22%~96%，respectively. Conclusion The risk prediction model developed in this study demonstrates good predictive performance and can serve as a screening and assessment tool for identifying the risk of NCC dysfunction in hemodialysis patients.

Research on the current status and influencing factors of the multidimensional symptom network in maintenance hemodialysis patients

CHENG Li, ZOU Yujiao, HU Tiantian, JI Chumin, QIU Yiyang, ZHU Zheng, ZHANG Yongmei, WU Yan

2025, 60(19): 2321-2327. DOI: 10.3761/j.issn.0254-1769.2025.19.003

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Objective To investigate the current symptom status of maintenance hemodialysis（MHD） patients，analyze the influencing factors from the perspective of multidimensional symptom burden，extract symptom groups，and construct a symptom network. Methods A total of 490 patients who received MHD at the blood purification center of a tertiary hospital in Shanghai from March to April 2025 were selected using a convenience sampling method. 30 symptoms of MHD patients were investigated using a modified dialysis symptom index table. SPSS and R software were utilized to analyze the influencing factors，extract symptom groups，and construct a multidimensional symptom network. Results A total of 488 valid questionnaires were collected, with a valid questionnaire recovery rate of 99.59%. The median number of symptoms experienced by patients was 6（interquartile range：4，8），with the top 5 symptoms being dry skin（69.88%），fatigue or tiredness（56.97%），itching（56.97%），worry（50.20%），and dry mouth（46.31%）. Multidimensional analysis indicated that age，duration of dialysis，education level，and complications were influencing factors of symptom burden scores across different dimensions. 6 stable symptom groups were extracted，namely skin discomfort，fatigue and pain，gastrointestinal tract，sleep disorders，water-electrolyte imbalance，and uremia. The results of the symptom network analysis revealed that difficulty of falling asleep had the highest intensity centrality（r_s=2.18，2.25，2.12）. Conclusion The symptom association is relatively stable，and difficulty of falling asleep is the core symptom. This finding can assist clinical medical staff in achieving efficiency and precision in symptom group management.

A qualitative study on needle-related distress of arteriovenous fistula experiences in hemodialysis patients

WANG Wenqian, NIU Hongyan, LI Qingzhi, HU Lulu

2025, 60(19): 2328-2332. DOI: 10.3761/j.issn.0254-1769.2025.19.004

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Objective To explore the authentic experiences of needle-related distress during arteriovenous fistula cannulation in hemodialysis patients and provide a basis for developing targeted assessment tools and intervention plans in clinical practice. Methods This study adopted a descriptive phenomenological research method. Using purposive sampling，13 hemodialysis patients with arteriovenous fistula from the blood purification center of a tertiary hospital in Changzhou were recruited for semi-structured interviews between November 2024 and January 2025. Data were analyzed using Colaizzi’s 7-step method. Results Totally 4 themes and 10 sub-themes were extracted，namely dynamic evolution of distressing experiences（cognitive gaps and unfamiliar environments triggering distress，familiarity with procedures and self-management alleviating distress，sudden medical events reawakening distress），embodied cognition of distressing experiences（somatic distress，cognitive distress，mind-body dualistic interaction），subjective interaction in distress perception（subjective perceptions of differences in puncture skills，positive regulation through good communication attitudes），coping strategies for distressing experiences （empowerment-based coping，adaptive compromise）. Conclusion The needle-related distress associated with arteriovenous fistula puncture in hemodialysis patients is not a single physical feeling，but a complex experience involving physical and mental interaction，nurse-patient interaction and coping strategies. Clinically，a dynamic assessment and precise intervention system should be constructed to improve patients’ puncture experience and quality of life.

The influence of social support on depressive symptoms among elderly maintenance hemodialysis patients

LU Qinyi, JIN Xueqin

2025, 60(19): 2333-2339. DOI: 10.3761/j.issn.0254-1769.2025.19.005

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Objective This study aims to explore the influence of social support on depressive symptoms and its threshold effect in elderly patients undergoing maintenance hemodialysis（MHD），thereby providing a basis for improving patients’ depressive conditions. Methods A convenience sample of 440 elderly MHD patients was recruited from the hemodialysis centers of 3 general hospitals in Kunshan between October 2024 and February 2025. Data collection involved the use of a general information questionnaire，the Social Support Rating Scale（SSRS），and the Short Form Geriatric Depression Scale（GDS-15）. Logistic regression and threshold effect analyses were conducted to identify influencing factors and assess their impact. Results A total of 432 valid questionnaires were recovered，yielding a response rate of 98.18%. The prevalence of depressive symptoms among elderly MHD patients was 27.8%，with an average social support score of 32.53 ± 5.58，indicating a moderate level of social support. Logistic regression analysis revealed that the use of assistive devices，dialysis modality，marital status，social support，and type of vascular access were significant factors influencing depressive symptoms（P<0.05）. Restricted cubic spline analysis indicated a non-linear relationship between social support and depressive symptoms（P<0.001）. Threshold effect analysis showed that when the social support score was ≥23，depressive symptoms decreased as the social support score increased（P<0.05）. Conclusion The impact of social support on depressive symptoms in elderly MHD patients has a critical threshold. This finding suggests that clinical healthcare providers should prioritize interventions for patients with low social support to improve their physical and mental health and quality of life by enhancing social support levels.

Application of progressive upper limb exercise rehabilitation in patients with permanent pacemaker implantation

FENG Jia, ZHENG Linlin, SHAO Cuimei, ZHENG Suwei, YAO Xiaofang, PENG Dan, SONG Jianping

2025, 60(19): 2340-2347. DOI: 10.3761/j.issn.0254-1769.2025.19.006

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Objective To investigate the intervention effects of a progressive upper limb exercise rehabilitation program based on the multi-process action control theory on upper limb function，rehabilitation compliance，and quality of life in patients with permanent pacemaker implantation（PPI）. Methods A total of 130 patients scheduled for PPI from March to August 2024 were selected using a convenience sampling method. Among them，65 patients admitted from June to August were assigned to the experimental group， and 65 patients admitted from March to May formed the control group. The experimental group received the progressive upper limb exercise program in addition to routine care，while the control group received routine care only. The intervention lasted for 3 months. The differences were compared between the 2 groups in terms of primary outcome measures，including the Shoulder Pain and Disability Index（SPADI） and grip strength. The secondary outcome measures were the Quality of Life Instrument for Chinese Patients with Pacemaker（QLICPP），hospital stay and incidence of complications. Results A total of 122 patients（62 in the experimental group and 60 in the control group） completed this study. Repeated-measures analysis of variance showed significant interaction effects between time and group for the total SPADI score and its pain and disability dimensions，as well as for the physical function，psychological function，and total score of QLICPP（P<0.001）. Simple effects analysis indicated that the experimental group had better grip strength than the control group at 1 month postoperatively，and lower SPADI scores and total score than the control group at 1 and 3 months postoperatively. At 1 month postoperatively，the total QLICPP score and each dimension of the experimental group were higher than those of the control group（P<0.05）. There were no significant differences between the 2 groups in the incidence of complications and length of hospital stay（P>0.05）. Conclusion The progressive upper limb exercise rehabilitation program developed in this study effectively addressed the issue of low rehabilitation compliance in PPI patients，improved their upper limb function and quality of life，and it was safe. It provides a feasible and effective new pathway for the rehabilitation of PPI patients.

Development and validation of a risk prediction model for early postoperative delirium in lung transplant patients

KOU Wanting, CAI Yinghua, ZHOU Haiqin, WAN Xia, WU Qiong

2025, 60(19): 2348-2355. DOI: 10.3761/j.issn.0254-1769.2025.19.007

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Objective To understand the current situation and influencing factors of delirium in lung transplant patients in the early postoperative period，and to construct and verify a risk prediction model. Methods The convenience sampling method was used to select patients who were admitted to a tertiary general hospital in Jiangsu Province for lung transplantation from June 2023 to November 2024. Lasso regression was used to screen variables，and logistic regression analysis was used to explore the influencing factors of early postoperative delirium in lung transplantation patients，and the risk prediction model was constructed and nomogram was drawn. The area under the working curve（AUC） of the subjects and the Hosmer-Lemeshow test were used to evaluate the discrimination and calibration of the model. Internal validation of the model was performed by repeated sampling 1000 times using Bootstrap method. Results A total of 228 lung transplant patients were included in this study，of which 76 developed delirium in the early postoperative period，with an incidence of 33.33%. Age≥51.5 years，hypertension combined with diabetes mellitus，the Lung Allocation System（LAS） score≥75.63，the duration of mean arterial pressure less than 70 mmHg≥12.50 min，intraoperative red blood cell transfusion≥750 ml，and midazolam dosage≥102.50 mg were the independent risk factors for early postoperative delirium in lung transplantation（P<0.05）. The AUC of the model was 0.771；the optimal cut-off value was 0.334；the sensitivity and specificity were both 0.724. The results of Hosmer-Lemeshow test showed that χ²=5.677，P=0.683；the internal verification showed that the AUC of the model was 0.737，and the absolute error of the actual and predicted values of the calibration curve was 0.023，and the calibration curve was close to the ideal curve. Conclusion Age，hypertension combined with diabetes mellitus，LAS score，duration of mean arterial pressure less than 70 mmHg，amount of intraoperative red blood cell transfusion，and midazolam dosage are the influencing factors for early postoperative delirium in lung transplant patients. The risk prediction model constructed in this study has good predictive performance and can be used as a risk prediction tool for early postoperative delirium in lung transplant patients，helping to timely and accurately identify high-risk groups of delirium，helping to reduce the incidence of early postoperative delirium，and improve patient prognosis.

Research on the current status and influencing factors of post ICU syndrome in severe patients

WANG Tingshu, YAO Li, LIU Yan, JING Bei, LI Qinqin, WANG Tingrui

2025, 60(19): 2356-2363. DOI: 10.3761/j.issn.0254-1769.2025.19.008

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Objective To explore the current situation and influencing factors of post-intensive care syndrome （PICS） in critically ill patients a month after their transfer out，and to provide a basis for formulating individualized intervention measures. Methods By the convenience sampling method，550 patients who were transferred out of the ICU of a tertiary A hospital in Guizhou Province for a month from April to November 2024 were selected as the survey subjects. The general information of the patients was collected and sorted out. During their stay in the ICU，the Barthel Index，the Richards Campbell Sleep Scale，and the Perceived Social Support Scale were employed for evaluation. A month after the patients were transferred out of the ICU，the assessment was completed through telephone follow-up using the Chinese version of the Brain Care Monitoring Questionnaire for Healthy Aging. According to the assessment a month after the patients were transferred out，they were divided into a PICS group and a non-PICS group. Univariate analysis and binary Logistic regression analysis were completed based on the data of the 2 groups. Results A total of 550 questionnaires were distributed，and 442 valid questionnaires were ultimately collected，with a valid questionnaire collection rate of 80.3%. Among them，194 cases（43.9%） were high-risk patients with PICS. Binary logistic regression analysis showed that advanced age，pulmonary infection，total hospitalization time>15 days，and internal environment disorder were the risk factors for PICS in ICU patients（P<0.05）. Conclusion The risk of PICS is relatively high in critically ill patients a month after the transfer. Medical staff need to pay attention to patients who are older，have pulmonary infections and internal environment disorders，and formulate personalized intervention measures for different disease types to improve the long-term health prognosis of patients.

Classification prediction of exercise perception in elderly hip arthroplasty patients and nursing implications

XIE Qianming, LIAO Chunyan, CHEN Guowei, PENG Yanhong, JIANG Guixiang, TANG Huihua

2025, 60(19): 2364-2370. DOI: 10.3761/j.issn.0254-1769.2025.19.009

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Objective To explore the potential categories of exercise perception in elderly hip arthroplasty（HA） patients，analyze the prediction factors of different categories，and provide references for clinical nursing. Methods A convenience sampling method was used to select elderly HA patients treated in 6 orthopedic wards of 2 tertiary A hospitals in Guilin from October 2024 to February 2025. The general data questionnaire，Exercise Benefits and Barriers Perception Scale for Hip/Knee Throplasty Patients，Tampa Scale of Kinesiophobia，the 5-Factor Modified Frailty Index，and Self-Efficacy for Rehabilitation Outcome Scale were used for investigation. Latent profile analysis was used to identify the potential categories of exercise perception of elderly HA patients，and decision tree model was used to explore the core predictive factors of different profile. Results 222 valid questionnaires were collected, with an effective response rate of 96.52%. A total of 222 elderly HA patients were divided into 3 profiles：high benefit-low barrier group（19.82%），low benefit-high barrier group（22.07%），and mild barrier group（58.11%）. Frailty，kinesophobia，rehabilitation self-efficacy，residence，educational level and daily exercise were significant predictors of latent profiles（P<0.05），and the frailty was located in the root node of the decision tree model. Conclusion The level of exercise perception in elderly HA patients needs to be improved，and shows population heterogeneity. Medical staff should prioritize interventions for low benefit-high barrier and mild-barrier groups，implementing targeted strategies based on profile characteristics and predictive factors to improve their exercise perception.

Development and reliability and validity test of the Ego Depletion Scale for Type 2 Diabetes Patients

YOU Jiaxin, XU Rong, XIA Tian, HUANG Haishan, LU Xiao, LIU Hong, HUANG Yan, LIU Qinghua, BIAN Xuna

2025, 60(19): 2371-2377. DOI: 10.3761/j.issn.0254-1769.2025.19.010

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Objective To develop the Ego Depletion Scale for Type 2 Diabetes Patients and evaluate its reliability and validity，and to provide a specific assessment tool for evaluating ego-depletion in self-management. Methods Guided by the self-control strength model，the initial scale was constructed through literature review，semi-structured interviews，2 rounds of expert consultation，and a pilot survey. A convenience sampling method was employed to recruit 460 patients with Type 2 Diabetes from the endocrinology department of a tertiary hospital in Wuhan，Hubei Province，between April and July 2024. They were randomly divided into 2 subsets for exploratory factor analysis and confirmatory factor analysis. Results A total of 451 valid questionnaires were collected. Exploratory factor analysis extracted 6 common factors，with a cumulative variance contribution of 73.231%. In confirmatory factor analysis，an item was deleted due to failing to meet the standardized loading value criterion. The revised Ego Depletion Scale for Type 2 Diabetes Patients comprised 6 dimensions and 22 items. The total Cronbach’s α coefficient was 0.911；split-half reliability was 0.744；the content validity index was 0.860. Correlation coefficients between the total score and scores of each dimension of the scale and the total score of the Self-Regulatory Fatigue Scale ranged from 0.558 to 0.946（P<0.001）. Conclusion The scale exhibits robust reliability and validity，serving as a scientifically instrument for assessing ego depletion in patients with Type 2 Diabetes.

A qualitative study on the experiences of nutrition impact symptoms in esophageal cancer patients

CHENG Muxi, LIAO Huiyan, LI Hui, HE Yuxin, ZHONG Lei, SONG Xinhui, LI Mei

2025, 60(19): 2378-2383. DOI: 10.3761/j.issn.0254-1769.2025.19.011

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Objective To explore the real experiences of nutrition impact symptoms in esophageal cancer patients during diagnosis and treatment，and to provide references for developing nutritional management strategies. Methods Using purposive sampling，15 esophageal cancer patients admitted to the thoracic surgery department of a tertiary grade A hospital in Guangzhou from October to December 2024 were selected for semi-structured interviews. Thematic analysis was used for data analysis. Results 4 themes and 12 sub-themes were identified：①Multiple symptom perceptions：esophageal obstruction-dysphagia，appetite-affecting symptoms，multiple symptom over-lap，and individual differences in symptom perception. ②Insufficient symptom cognition：overestimation of symptom controllability and biased symptom attribution. ③Negative emotional reactions：anxiety and fear about eating，frustration with declining eating function，and helplessness and guilt about losing control over eating. ④Di-verse symptom coping strategies：avoidance coping，adaptive coping，and active nutritional management. Conclusion The nutrition impact symptom experiences of esophageal cancer patients are complex and diverse. Healthcare professionals should promptly identify and assess nutrition impact symptoms，provide nutrition health education，strengthen psychological guidance，and develop culturally distinctive individualized nutritional management strategies.

A comparative study on the current status of disability assessment and long-term care needs assessment in 49 pilot cities of the long-term care insurance system

ZHANG Jiali, CHEN Hongxiu, WANG Yilin, LIU Ya, XU Shihao, WANG Yanyan, DONG Birong, SUN Hong, HU Xiuying

2025, 60(19): 2384-2390. DOI: 10.3761/j.issn.0254-1769.2025.19.012

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Objective To analyze the disability level and long-term care needs assessment policies issued by 49 pilot cities in China’s long-term care insurance system，providing insights for further improvement of the system. Methods Policy documents related to long-term care insurance，published between June 2016 and December 2024 on official platforms of local governments，the Ministry of Human Resources and Social Security，the National Healthcare Security Administration，and the National Public Service Platform for Standards Information，were retrieved. A comparative analysis was used to summarize and compare the content of these policy texts. Results Currently，there are 49 pilot cities implementing the long-term care insurance system in China. 47 cities have issued disability level assessment standards，with 38 cities adopting the trial standards issued by the National Healthcare Security Administration. In 42 pilot cities，the disability level assessment includes indicators such as activities of daily living，cognitive function，and sensory and communication abilities. 22 cities have issued policies related to care needs assessment. In most cities，the care needs assessment partially or fully includes indicators from the disability level assessment. Conclusion There is no national uniformity in disability level assessment standards，and the care needs assessment framework needs further improvement. It is recommended to standardize disability level assessment criteria，clearly delineate the boundaries and content of disability level and care needs assessments，and enhance the development of the care needs assessment system.

Evaluation of implementation effect of promoting excellence and reflective learning in simulated training of nurses’ team collaboration in emergency departments

WU Zuojia, WANG Yuwei, YAN Danping, DING Youya, WANG Sa

2025, 60(19): 2391-2396. DOI: 10.3761/j.issn.0254-1769.2025.19.013

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Objective To explore the application effect of promoting excellence and reflective learning in the full-process situational simulation training of team collaboration in the emergency departments，and to provide a reference for cultivating clinical nursing talents. Methods Stratified random sampling combined with sequential substitution method was adopted to conduct situational simulation training for 56 nurses in the emergency department from October to December 2024. The method of promoting excellence and reflective learning was used for guiding feedback，including 5 steps：pre-feedback，response，description，analysis，and summary. The clinical reasoning and reflection ability，clinical practice ability and teamwork ability of nurses were compared before and after the training. Results After the training，nurses improved in all dimensions of clinical reasoning and self-assessment ability of reflection（P<0.001）. The theoretical examination and team operation assessment scores of nurses were improved compared with those before the training（P<0.001）. The leadership，teamwork ability，overall evaluation and total score of nurses were all improved compared with those before the training（P<0.05）. Conclusion The use of promoting excellence and reflective learning for training in the scenario simulation of team collaboration in the emergency departments is helpful to improve nurses’ clinical reasoning and reflection ability，clinical practice ability and teamwork ability

A path analysis study on the relationship between the nursing organizational climate and work alienation among psychiatric nurses

WANG Lan, LIU Cuicui, ZHAO Zhijiao, PANG Li, LI Wenfu, MA Qun, SHI Zhongli

2025, 60(19): 2397-2403. DOI: 10.3761/j.issn.0254-1769.2025.19.014

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Objective To explore the effect of organizational climate on work alienation in psychiatric nurses，and the mediating role of psychological capital and positive coping styles between organizational climate and work alienation，in order to provide a reference for reducing work alienation among psychiatric nurses. Methods Convenience sampling method was used to select nurses working in 6 tertiary A psychiatric hospitals in Shandong Province from January to July 2024，and the general questionnaire，Nurses’ Work Alienation Questionnaire，Organizational Climate Scale for Nursing，Psychological Capital Questionnaire，and Simple Coping Style Scale were used to conduct the survey and the mediation effect test. Results A total of 606 questionnaires were recovered，of which 572 were valid，and the validity rate of the questionnaires was 94.39%. Psychiatric nurses scored（89.58±13.69） for nursing organizational climate，（32.48±11.31） for work alienation，（97.28±19.12） for psychological capital，and（23.93±7.22） for positive coping styles. There was a direct effect of nursing organizational climate on work alienation（β=-0.681，95%CI=-0.824~-0.539）. Psychological capital and positive coping styles acted as separate mediators and chain mediators in the effect of nursing organizational climate on work alienation（β=-0.116， -0.048，-0.019，95%CI=-0.182~-0.034，-0.086~-0.006，-0.042~-0.002）. Conclusion There are multiple mediating effects of psychiatric nurses’ psychological capital，positive coping styles between nursing organizational climate and work alienation. Nursing managers can enhance psychiatric nurses’ psychological capital by creating a positive and healthy organizational climate，encouraging them to adopt positive coping styles to solve problems，and reducing work alienation.

Perioperative nursing care of a child with hypoplastic left heart syndrome undergoing modified total vena cava pulmonary artery anastomosis operation

ZHOU Jun, CHEN Ruan, ZHU Jihua

2025, 60(19): 2404-2407. DOI: 10.3761/j.issn.0254-1769.2025.19.015

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To summarize the nursing experience of a child with hypoplastic left heart syndrome undergoing modified total vena cava pulmonary artery anastomosis operation. Preoperative nursing points：to establish a multidisciplinary team to formulate the best surgical plan；implementation of pre-rehabilitation nursing to reduce the risk of surgery. Postoperative nursing points：precise volume management to ensure effective pulmonary circulation perfusion；to reduce pulmonary artery pressure and maintain effective cardiac output；early warning of high risk to prevent thrombosis；nutritional support should be strengthened and protein-losing enteropathy should be alert for its incidence. Phase I cardiac rehabilitation training should be strengthened to improve cardiopulmonary function. After careful treatment and nursing care，the child recovered and was discharged on the 28 th day after surgery.

Nursing care of a patient with spinal shock following combined mechanical circulatory support after heart valve surgery

TAO Jian, LEI Liming, SONG Yamin

2025, 60(19): 2408-2412. DOI: 10.3761/j.issn.0254-1769.2025.19.016

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To summarize the nursing care of a patient with spinal shock following combined mechanical circulatory support after heart valve surgery. The mainly nursing points are as follows. In the acute stage，hemodynamic and internal environment stability were maintained，and extracorporeal cardiopulmonary resuscitation was implemented by a multidisciplinary rapid response team. In the period of mechanical circulatory support，related complications were closely monitored，and a protocolized weaning strategy was implemented. During the spinal shock period，the focus was on maintaining spinal cord，lung and bowel function. During the recovery period，phased enhancement of early rehabilitation and intervention in negative psychological emotions were conducted. The patient successfully removed the mechanical circulatory device on the 9th day postoperatively，achieved grade 4 muscle strength in the left upper and grade 3 in other limbs after 32 days of hospitalization，ultimately discharged successfully from the hospital.

Research progress and nursing implications on the dose of early mobilization in ICU

CAI Shengyuan, CHU Junqing, QIAO Wenbo, REN Yayu, WENG Meiling, DONG Zhenyuan, ZHOU Feifei, GAO Chunhua

2025, 60(19): 2413-2418. DOI: 10.3761/j.issn.0254-1769.2025.19.017

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Precise management of the activity dose is a core component of the（early mobilization，EM） plan for ICU patients. However，the lack of clinical practice guidelines related to EM dose of existing programs hinders the implementation and development of EM in ICU patients to some extent. Therefore，this review focuses on 4 aspects，covering the definition of activity dose，assessment tools，the current clinical implementation status，and implications for future nursing. The aim is to systematically review the assessment tools and intervention strategies for the activity dose of EM in ICU patients，providing a reference for optimization of EM programs.

Research progress on kinesiophobia in school-aged children with asthma and nursing enlightenment

SUN Zhixiang, FU Jing, WEN Pingpin, ZHANG Xiaoli, YANG Xinyu, LIU Chunyan, XIAO Yu

2025, 60(19): 2419-2425. DOI: 10.3761/j.issn.0254-1769.2025.19.018

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Kinesiophobia is prevalent among school-aged children with asthma，and severe kinesiophobia can hinder their participation in physical activities and disease control，adversely affecting their physical and mental health. This paper reviews the concept，development，assessment tools，influencing factors，and intervention strategies of kinesiophobia in school-aged children with asthma，analyzes existing challenges，and proposes directions for future research. It aims to provide insights for developing scientific and personalized intervention plans to enhance children’s exercise levels and improve their quality of life.

Application of telemedicine in the continuous care of patients with rheumatoid arthritis：a scoping review

GUO Yifan, REN Hua, BAI Jing, LIU Sanjiao

2025, 60(19): 2426-2432. DOI: 10.3761/j.issn.0254-1769.2025.19.019

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Objective This paper reviews the application of telemedicine in the continuous care for patients with rheumatoid arthritis and provides a reference for relevant research. Methods Guided by the methodological framework of scoping review，we systematically searched a total of 8 databases including PubMed，Embase，Web of Science，Cochrane Library，CNKI，Wanfang Database，VIP Database，and China Biomedical Literature Database，and the search time period was from the establishment of the database to March 18，2025，and the included literature were analyzed for comprehensive analysis. Results A total of 26 articles were included. The main carrier forms of telemedicine include applications，network communication software，remote management platforms，and portable electronic devices. The content elements include remote follow-up，remote monitoring，remote medical consultation，remote education，and remote psychological intervention. The evaluation indicators included clinical indicators，self-management indicators，health-related quality of life，satisfaction，feasibility indicators and other indicators. Conclusion Telemedicine can be used as an emerging method to be applied to the continuous care of patients with rheumatoid arthritis，and it is suggested that the relevant fields can optimize the application function of telemedicine，enrich the content elements and improve the evaluation index，in order to improve the quality of continuous care for patients.

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