Chinese Journal of Nursing

Development and implementation of an interdisciplinary collaborative care model led by specialty nurses

FENG Jiehui, YIN Yu, WU Yinü, ZHANG Lusha, WANG Huafen

2025, 60(23): 2821-2827. DOI: 10.3761/j.issn.0254-1769.2025.23.001

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Objective To construct an interdisciplinary collaborative care model led by specialty nurses under the hospital-wide bed-sharing model，and to explore its application effects，aiming to improve nursing efficiency and enhance nursing quality. Methods Based on collaborative nursing theory，combined with the healthy work environment framework，an interdisciplinary collaborative care model led by specialty nurses was constructed through literature review and expert meetings，including 6 dimensions：communication，collaboration，decision-making，human resources，value，and leadership. Using purposeful sampling，specialty nurses and interdisciplinary admitted patients from a tertiary general hospital in Zhejiang Province in 2024 were selected as the application subjects. The proportion of interdisciplinary admitted patients，incidence of adverse events，patient satisfaction，average patient hospitalization days，specialty nursing consultation rate，and the collaborative ability and healthy work environment perception level of specialty nurses before（2023） and after（2024） the application of the model were described and compared. Results After implementation of the model，the proportions of interdisciplinary admitted patients，specialty nurses consultation rates，collaborative competence of specialty nurses，and perceived levels of a healthy work environment were significantly higher than those before implementation，with statistically significant differences（P<0.001）. The comparison of adverse event incidence rates before and after the model implementation showed no statistically significant difference（P>0.05）. Patient satisfaction scores were 97.94 points after implementation of the model and 98.48 points before implementation；the average length of hospital stay was 5.00 days post-implementation and 4.87 days pre-implementation. Conclusion The application of the interdisciplinary collaborative care model led by specialty nurses helps to integrate specialty nursing resources，enhances the collaborative ability and healthy work environment perception level of specialty nurses，and can provide a practical pathway for interdisciplinary collaborative care under the hospital-wide bed-sharing model.

Innovative approaches and outcome evaluation of an in-service training model for nurses in a public hospital

FENG Mei, WANG Lei, JIANG Yan, GONG Shu

2025, 60(23): 2828-2834. DOI: 10.3761/j.issn.0254-1769.2025.23.002

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Objective To explore the optimization strategies and implementation outcomes of an in-service training model for nurses in a public hospital，so as to provide references for improving training quality and efficiency. Methods Beginning in 2020，a systematic and continuous refinements were introduced to the in-service nurse training program at a tertiary general hospital in Sichuan Province，focusing on enhancing nurses’ job competency. This optimized training model encompassed 6 core elements，including systematized training content，talented training instructors，flexible training mechanisms，information-based training platforms，diversified training methods，and extensive training evaluations. Data on training participation，satisfaction，and clinical quality indicators （2019—2024） were collected and supplemented by assessment scores and competency evaluations（2021—2024） for comparative analysis. Results From 2019 to 2024，the annual training attendance，average training hours per nurse，and training satisfaction rates increased annually. In 2024，the total annual training attendance reached 258 191；the average training hours per nurse were 17.1，and training satisfaction rate was 97.3%. Theoretical knowledge，clinical practical skills，and job competency assessment scores from 2021 to 2024 showed a significant upward trend（P<0.001），with scores in 2024 being significantly higher than those in the previous 3 years（P<0.05）. The incidence of hospital-acquired pressure injuries （stage 2 or above） and the rate of fall-related injuries in 2024 were significantly lower than those in 2023（P<0.001）. Conclusion The optimized in-service training model for nurses in the public hospital effectively improved the utilization efficiency of training resources，enhanced the comprehensive professional competence of nurses，and contributed to the improvement of clinical nursing quality.

Cost-effectiveness analysis of quality improvement action for venous blood sampling

HUANG Chan, ZHANG Haiyan, XU Yinhuan, CHI Yanyu, WANG Linnan, LIU Yan, MIN Yudi

2025, 60(23): 2835-2842. DOI: 10.3761/j.issn.0254-1769.2025.23.003

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Objective To improve the quality of blood specimen collection among inpatients through a quality improvement（QI） action and evaluate its cost-effectiveness，provide multi-dimensional references for the QI action of high-frequency nursing processes and procedures. Methods From January 2023 to October 2024，a QI action for venous blood sampling based on the Plan-Do-Study-Act（PDSA） cycle was implemented across 74 wards in a tertiary general hospital in Beijing. By cost-effectiveness analysis（CEA），effectiveness indicators included the incidence of venous blood sampling-related errors and the diagnostic and treatment time prolonged by repeat venous blood sampling. The medical costs were calculated from repeat blood sampling due to venous blood sampling-related errors and implementation cost of each phase. The cost and effect of the action to improve the quality of venous blood collection were evaluated. Results Following the intervention，the incidence of venous blood sampling-related errors among inpatients decreased from 0.18% to 0.03%（P<0.001）. The diagnostic and treatment duration prolonged by repeat venous blood sampling was reduced from 1 853.89 minutes to 377.04 minutes per 1 000 discharged patients. The annualized medical cost due to repeat blood sampling dropped from 26 433.89 yuan to 4 160.30 yuan. The total implementation cost of the QI action was 18.36 thousand yuan. Conclusion The QI action significantly reduced venous blood sampling-related errors，shortened diagnostic and treatment delays caused by repeat blood sampling and lowered associated medical costs. Overall，it improved nursing quality，enhanced diagnostic efficiency，and reduced medical resource waste.

Application of a whole process nursing program based on the theory of Timing It Right in severe trauma patients in an emergency department

HE Shasha, PENG Yanhong, TAN Caixia, LIU Jing, JIANG Dandan, ZOU Licheng, CHEN Yingxian, WANG Zhimin

2025, 60(23): 2843-2849. DOI: 10.3761/j.issn.0254-1769.2025.23.004

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Objective To explore the application effect of a whole process nursing program based on the theory of Timing It Right in the treatment of patients with severe trauma in an emergency department，and to provide a reference for the treatment of severe trauma patients. Methods Using convenience sampling，90 patients with severe trauma admitted to a tertiary A hospital in Hengyang between June and November 2024 were selected as study participants. Among them，45 patients admitted from September to November were assigned to an experimental group and received a whole process nursing program based on the theory of Timing It Right in addition to routine care. The other 45 patients admitted from June to August were assigned to a control group and received routine care only. Timeliness indicators，body temperature，pain scores，post-traumatic stress disorder scores，and the incidence of complications during hospitalization were compared between the 2 groups. Results A total of 43 patients were eventually included in each group，respectively. After the intervention，the experimental group showed significantly shorter time in establishing intravenous access，implementing warming measures，completing preoperative preparations，emergency department stay，postoperative handover，and ICU length of stay compared to the control group（P<0.05）. The experimental group also had higher body temperature，lower pain scores，lower post-traumatic stress disorder scores，and a lower incidence of complications than the control group（all P<0.05）. Conclusion The whole process nursing program based on the theory of Timing It Right can improve the timeliness of emergency care for patients with severe trauma，alleviate hypothermia and pain，reduce the severity of post-traumatic stress disorder，and decrease the incidence of complications.

Development and application of a disease severity graded nursing information system for ICU patients

HOU Jin, PAN Wenyan, LI Jingjing, ZHAO Yangyang, LIU Xiao, YE Jiajing, LI Gaile, ZHANG Yuxia

2025, 60(23): 2850-2855. DOI: 10.3761/j.issn.0254-1769.2025.23.005

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Objective To develop an ICU patient disease severity grading nursing information system and evaluate its application effect，with the aim of optimizing human resources allocation and improving the quality of care for critically ill patients. Methods A research team was established to construct an ICU patient disease severity grading nursing information system through methods such as literature review，clinical investigation and expert consultation. The system consists of 3 modules，including disease severity grading，disease severity early warning and auxiliary decision-making. This system was officially applied in the ICU of a tertiary grade-A hospital in Shanghai in October 2023. The patients admitted in November 2023 were assigned to an experimental group，and those admitted in August 2023 were assigned to a control group. The correlation between the disease severity grading and Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ） score was evaluated in the experimental group. Indicators including ICU nursing quality scores，the success rate of patient rescue，and length of ICU stay were compared between the 2 groups. Results The experimental group included 324 patients and the control group included 285 patients. In the experimental group，a positive correlation was observed between the disease severity grading result and the APACHE Ⅱ score（P<0.001）. Compared with the control group，the experimental group had higher ICU nursing quality score and the success rate of patient rescue，as well as a significantly shorter length of ICU stay（P<0.05）. Conclusion The use of the ICU patient condition grading nursing information system enables the classification of patient disease severity and the early warning of disease severity，which contributes to improve the quality of care，increase the success rate of patient rescue，and shorten the length of ICU stay for patients.

Construction and application of an intelligent tracking module for emergency items in a central sterile supply department

ZHANG Dongfang, WANG Xiuli, ZHANG Shuli, CAI Libai, WANG Yonghua, MA Xue, QIAO Panpan

2025, 60(23): 2856-2863. DOI: 10.3761/j.issn.0254-1769.2025.23.006

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Objective The intelligent tracking module of emergency items in a central sterile supply department was constructed and preliminarily applied，aiming to evaluate the timeliness and accuracy of its supply in the process of emergency items management. Methods A research team was set up to develop an intelligent tracking module for emergency items under the existing traceability system of a central sterile supply department. The module can monitor the surgical status，the number and stock of sterile packages in real time，intelligently identify emergency items and their required quantity according to the functional relationship between them，and make early warning according to the emergency level of emergency items. The module was formally applied in a central sterile supply department of a tertiary hospital in Henan Province in July 2024. The application effect was evaluated by comparing the false alarm rate，delay rate，reprocessing time，quality qualification rate and the system’s usability，satisfaction of medical staff after the application of the module（July to September 2024） and before the application （July to September 2023）. Results The number of emergency items before and after the application of the module was 2 452 and 1 020，respectively. The false alarm rates were 36.54% and 0.49%，respectively. The delay rates were 8.56% and 0.29%，respectively. The reprocessing time of a single emergency item decreased from（190.03±3.32） mins to（135.05±3.46） mins，and the satisfaction of medical staff increased from（2.33±0.22） scores to（4.12±0.19） scores. The differences were statistically significant（P<0.001）. The system usability score was（43.30±4.75），which was at a high level. The qualified rate of emergency items increased from 99.31% to 99.80%，and the difference was not statistically significant（P=0.070）. Conclusion The construction and application of the intelligent tracking module of emergency items in the central sterile supply department can reduce the false alarm rate and delay rate of emergency items，shorten the processing time，effectively standardize the processing flow of emergency items，reduce resource consumption，improve the working efficiency and satisfaction of the staff in the operating room and central sterile supply department，and ensure the quality of work.

Application of nurse-led early pulmonary rehabilitation strategies in elderly postoperative lung cancer patients

ZHAO Yingnan, ZHENG Xintong, ZHENG Qiugang, LIU Junling, WU Hongyue, WEN Xiaoyan, WEI Xiaoqian, LI Jing, YANG Chuanchuan, LI Yan

2025, 60(23): 2864-2871. DOI: 10.3761/j.issn.0254-1769.2025.23.007

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Objective To evaluate the application effect of nurse-led early pulmonary rehabilitation strategies in elderly patients after lung cancer surgery，and provide an evidence-based basis for optimizing the rehabilitation nursing plan for elderly patients after lung cancer surgery. Methods A randomized controlled trial design was adopted. Patients were recruited from the thoracic surgery department of a tertiary A tumor specialized hospital in Tianjin from September 2024 to March 2025，strictly according to the inclusion and exclusion criteria. Patients were divided into an experimental group（70 patients） and a control group（70 patients） using block randomization. The experimental group received nurse-led early pulmonary rehabilitation strategies，while the control group received conventional pulmonary rehabilitation nursing. After the intervention，the differences in pulmonary infection，forced vital capacity，6-minute walk distance，blood oxygen saturation，postoperative hospital stay，pain score，exercise self-efficacy，and pulmonary air leakage were compared between the 2 groups. Results Finally，62 patients in the experimental group and 68 patients in the control group completed the study. After the intervention，the 6-minute walk distance of the experimental group was（363.76±54.42） m，which was higher than（336.01±55.56） m in the control group；the forced vital capacity was（1.58±0.47） L，higher than（1.28±0.33） L in the control group；the exercise self-efficacy score was（56.9±12.2） points，higher than（43.0±13.0） points in the control group；repeated-measures ANOVA showed that there was an interaction effect between time and group for postoperative blood oxygen saturation and pain scores in both groups（P<0.05）. Simple effect analysis showed that the pain score of the experimental group on the third day was（1.97±0.51） points，lower than（2.20±0.55） points in the control group；the pain score on the first day after surgery and blood oxygen saturation on the 2nd to 3rd days after surgery were higher than those in the control group，and the differences were statistically significant（P<0.05）. There was no significant difference in the duration of postoperative lung infection，postoperative hospital stay，duration of lung leakage，and incidence of persistent lung leakage between the 2 groups（P>0.05）. Conclusion The nurse-led early pulmonary rehabilitation strategies are beneficial to promote postoperative pulmonary recovery，improve patients’ activity endurance，enhance oxygenation，and boost patients’ confidence in completing subsequent pulmonary rehabili-tation training.

Latent profiles of learned helplessness and its influencing factors in elderly patients on maintenance hemodialysis

LU Qinyi, LU Chengqian, NIE Yixuan, JIN Xueqin

2025, 60(23): 2872-2879. DOI: 10.3761/j.issn.0254-1769.2025.23.008

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Objective To explore the latent profiles of learned helplessness and their influencing factors in elderly patients undergoing maintenance hemodialysis（MHD），so as to provide references for clinical nursing practice. Methods A convenience sample of 440 elderly patients undergoing MHD was selected from 3 hemodialysis centers in Kunshan City between October 2024 and February 2025. Data were collected using a general information questionnaire，the Learned Helplessness Scale，the International Physical Activity Questionnaire Short Form，and the Post-Dialysis Fatigue Scale. Latent profile analysis and logistic regression were used to identify distinct profiles and their influencing factors. Results A total of 432 valid questionnaires were collected，yielding a response rate of 98.18%. The mean score for learned helplessness among the 432 elderly MHD patients was（37.34±12.76）scores. LPA revealed 3 distinct latent profiles：Low Helplessness-Low Hopelessness（59.72%），High Helplessness-Low Hopelessness（25.92%），and High Helplessness-High Hopelessness（14.35%）. Logistic regression analysis indicated that age，primary disease，sedentary behavior，and post-dialysis fatigue were significant influencing factors for profile membership（P<0.05）. Conclusion Learned helplessness exhibits heterogeneity in elderly patients on MHD. Healthcare providers may implement personalized interventions targeting profile-specific influencing factors to reduce helplessness.

Development and reliability and validity test of Hospice Care Decision-Making Participation Scale for Terminally Ill Elderly Patients

YANG Mengru, ZHAO Yue, LI Boya, HU Ningning, FU Feng, TANG Xiaogui, FAN Jingjing, LI Yinglan

2025, 60(23): 2880-2886. DOI: 10.3761/j.issn.0254-1769.2025.23.009

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Objective To develop a scale for assessing the decision-making participation of elderly patients in end-of-life hospice care and evaluate its reliability and validity，with the aim of providing a reliable tool for assessing the level of decision-making participation in end-of-life hospice care for elderly patients. Methods Based on the theory of planned behavior framework，a draft of the scale was developed through literature review，Delphi expert consultation，and a pilot survey. Using convenience sampling，a survey was conducted from February to May 2025，selecting 503 elderly patients in end-of-life stages from 4 tertiary general hospitals and a cancer specialty hospital in Urumqi. The reliability and validity of the scale were tested. Results 522 questionnaires were sent out，and 503 valid questionnaires were recovered，with an effective questionnaire recovery rate of 96.36%. Exploratory factor analysis extracted 5 common factors，with a cumulative variance contribution rate of 82.107%. Confirmatory factor analysis showed that the model fit well. The item level content validity index was 0.950~1.000，and the scale level content validity index was 0.992. The Cronbach’s alpha coefficient was 0.948，and the split-half reliability coefficient was 0.865. The correlation coefficients between the total score of the questionnaire and the score of the calibration instrument were 0.599，respectively. The final formal scale consisted of 29 items in 5 dimensions：behavioral attitude，subjective norm，perceived behavioral control，behavioral intention and behavior. Conclusion The Hospice Care Decision-Making Participation Scale for Terminally Ill Elderly Patients has good reliability and validity，and can be used as an evaluation tool for hospice decision-making participation of terminally elderly patients.

Study on the relationship between sleep quality trajectories and neurological function recovery in stroke patients and its nursing implications

YANG Fanjiayi, WEI Jianing, LI Chenshuang, SUN Changqing, LIU Yanjin, DONG Xiaofang

2025, 60(23): 2887-2894. DOI: 10.3761/j.issn.0254-1769.2025.23.010

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Objective This study examined objective sleep quality trajectories in stroke patients and their impact on neurological recovery to guide targeted interventions. Methods From November 2023 to July 2024，362 stroke patients were recruited from neurology departments 5 tertiary hospitals in Henan Province using multicenter cluster sampling. Baseline data were collected via medical records and questionnaires，while objective sleep quality was longitudinally assessed with triaxial accelerometers. Neurological recovery at convalescent phase was evaluated using the modified Rankin Scale. Parallel-process latent class growth modeling identified sleep quality trajectories，and their impact on neurological recovery was analyzed via binary logistic regression. Results Among 306 stroke patients completing follow-up，4 sleep quality trajectories emerged：consistently good sleep quality group（34.31%），improving short sleep-increased efficiency-reduced fragmentation group（49.02%），sustained long sleep-reduced efficiency-worsened fragmentation group（7.84%），and consistently poor sleep quality group（8.83%）. Employment status，stroke type，comorbidities，activities of daily living，social support，fatigue，and depression significantly influenced trajectory classification（P<0.05）. Sustained long sleep-reduced efficiency-deteriorated fragmented group（OR=5.077） and consistently poor sleep quality group（OR=6.462） had significantly higher odds of poor neurological recovery versus the consistently good sleep quality group. Conclusion Stroke patients’ varied sleep recovery trajectories differentially impact neurological recovery，necessitating personalized sleep interventions to improve outcomes.

A survey of the current status of anesthesia nursing service provision and quality management in 1 382 hospitals

LI Qing, LIU Ting, LAN Xing, ZHI Hui, DUAN Na, YAN Jinxiu, DENG Manli, DING Hong, YANG Yuelai, LI Liangyu

2025, 60(23): 2895-2900. DOI: 10.3761/j.issn.0254-1769.2025.23.011

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Objective To investigate the current status of anesthesia nursing service provision and quality management in secondary and tertiary hospitals in 31 provinces（municipalities/autonomous regions），so as to provide a basis for further standardizing management and promoting homogeneous development. Methods The survey was conducted from August to December，2023，using convenience sampling method and self-designed questionnaire on the current status of anesthesia nursing service provision and quality management in secondary and tertiary hospitals in 31 provinces（municipalities/autonomous regions）. Administrators at anesthesiology nursing units，departments of anesthesiology，operating theaters or nursing departments were surveyed. The questionnaires covered 3 aspects，including the basic situation of the anesthesiology departments in their hospitals，the construction of anesthesia nursing units，and the types of anesthesia nursing services provided and quality management. Results A total of 1 403 questionnaires were collected，with 1 382 valid questionnaires，and an efficiency of 98.50%. A total of 1 382 anesthesia care management-related managers of secondary and tertiary hospitals participated in the survey. Among them，only 404（29.23%） hospitals set up stand-alone anesthesia nursing units；1 208（87.41%） hospitals provided anesthesia-related nursing services，mainly containing 12 types of specialty care services such as anesthesia induction room care and intraoperative anesthesia monitoring. Among 1 208 hospitals that provided anesthesia care services，anesthesia nursing care quality control groups had been built in 499 hospitals （41.31%），and 427 hospitals （35.35%） had anesthesia nursing care quality indicators，including 8 indicators such as qualification rate of emer-gency supplies and incidence of nursing adverse events. Conclusion The scope of anesthesia nursing services in domestic secondary and above hospitals is relatively broad. However，the establishment of anesthesia nursing units is not yet widespread，and the management structure is unclear. It is recommended to unify the organizational structure of the management system of the anesthesia care units，and to clarify the division of work and duties，in order to promote their management quality and promote homogeneous development.

Analysis of the components of clinical nurses’ ability to judge early deterioration of patient condition

LIU Junling, ZHAO Yingnan, ZHENG Xintong, WEI Xiaoqian, LI Bing, WU Hongyue, WANG Zidan, LI Yan

2025, 60(23): 2901-2907. DOI: 10.3761/j.issn.0254-1769.2025.23.012

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Objective To explore the components of clinical nurses’ ability to early judge the deterioration of patients’ conditions，providing a reference for the subsequent construction of a scientific ability evaluation system and the formulation of intervention measures. Methods Based on the Clinical Judgment Model，a descriptive qualitative research method was adopted. Using purposive sampling，22 clinical nurses from 2 tertiary grade A hospitals in Tianjin were selected for semi-structured interviews between February and March 2025. Content analysis was used to summarize，analyze，and extract themes. Results A total of 4 themes and 11 sub-themes were identified.①Problem awareness ability，including information collection ability，keen insight ability，risk identification ability，and intuitive perception ability.②Disease analysis ability，including knowledge application ability and differential diagnosis ability.③Emergency response ability，including information transmission ability，organizational coordination ability，and emergency stress resistance ability.④Reflection and improvement ability，including experience summarization ability and continuous learning ability. Conclusion Clinical nurses need to possess multiple abilities to assess the deterioration of a patient’s condition at an early stage. Nursing managers should prioritize the development of these skills to enhance nurses’ ability to accurately assess the deterioration of a patient’s condition at an early stage. Additionally，they should optimize the allocation of nursing resources based on these skill requirements to improve the quality of nursing care.

Characteristics of intrinsic capacity in community-dwelling older adults with diabetes mellitus：a mixed- method study

SHEN Zhijia, QIAN Zhijie, YIN Limei, NI Weiju

2025, 60(23): 2908-2915. DOI: 10.3761/j.issn.0254-1769.2025.23.013

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Objective To identify user personas of intrinsic capacity in community-dwelling older adults with type 2 diabetes mellitus（T2DM），offering evidence for the promotion and implementation of intrinsic capacity in clinical practice. Methods An interpretive sequential mixed design was used to collect quantitative and qualitative data from 6 medical community units radiated by a tertiary A Traditional Chinese Medicine hospital in Changshu city，Jiangsu province. A convenience sample of 693 older adults with T2DM in the community completed general information questionnaire and intrinsic capacity assessment scale from February 2024 to February 2025，and K-means clustering was conducted to analyze the distribution characteristics of intrinsic capacity in community-dwelling older adults with T2DM. In the qualitative phase，a purposive sampling method was used to conduct semi-structured interviews with 22 patients across different clusters by thematic analysis. The findings from both phases were integrated during the interpretation phase to conduct user persona. Results In all，664 of participants who returned responsive questionnaires were included for analysis，and 76.81% of community-dwelling older adults with T2DM showed a decline in intrinsic capacity. K-means clustering analysis outputs identify 3 groups. In qualitative data analysis，3 categories of intrinsic capacity characteristics among older adults with T2DM were refined，each encompassing 6 dimensions：cognitive，locomotion，vitality，psychological status，sensory perception，and promoting healthy behaviors dimensions. Totally 3 user personas were constructed，namely conflict-coping type dominated by psychological depletion，self-optimizing type dominated by sensory impairment，and support-dependent type dominated by cognitive decline. Conclusion The characteristic of intrinsic capacity in community-dwelling older adults with T2DM is diverse. Healthcare providers can implement categorized and personalized management by incorporating intrinsic capacity-based typologies among community-dwelling older adults with T2DM，enabling precise stabilization and optimization of intrinsic capacity to promote healthy aging.

Analysis of the correlation on social support，oral frailty，and oral health-related self-efficacy in the community-dwelling elderly adults

QIN Meirong, SHEN Fang, XIAO Wei, YANG Dan, CHEN Bining, CHEN Jinsu

2025, 60(23): 2916-2921. DOI: 10.3761/j.issn.0254-1769.2025.23.014

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Objective To investigate the relationship between oral frailty and oral health-related self-efficacy in the elderly，as well as the mediating role of social support，aiming to provide a reference for clinical workers to develop safe and effective interventions. Methods Convenience sampling was employed from December 2024 to June 2025，using a combination of online and offline methods to select elderly individuals from communities in Guangzhou，Jingzhou，and Tianmen as study participants. Data was collected using a general information questionnaire，the Chinese version of the Oral Frailty Screening Tool for Older Adults，the Chinese version of the Oral Health-Related Self-Efficacy Scale for Older Adults，and the Social Support Rating Scale. The mediating effect of social support between oral frailty and oral health-related self-efficacy was examined using structural equation modeling. Results A total of 350 questionnaires were collected，of which 331 were valid，giving a valid response rate of 94.57%. The oral frailty score for the elderly population was （4.52±1.86）；the oral health-related self-efficacy score was （51.40±11.84）；the social support score was （39.92±10.46）. Social support partially mediated the relationship between oral frailty and oral health-related self-efficacy，with a mediating effect of 28.97%. Conclusion The incidence of oral frailty in the elderly is high. Social support is a mediating variable between oral frailty and oral health-related self-efficacy. Nursing staff and community managers should pay close attention to the social status of the elderly and actively encourage them to participate in social activities to improve their self-efficacy and，consequently，improve their oral health.

Meta-analyses of the relationship between malnutrition or presence of malnutrition risk and depression in older adults

MENG Han, ZHANG Hongmei, TAO Lin, YI Yinping

2025, 60(23): 2922-2928. DOI: 10.3761/j.issn.0254-1769.2025.23.015

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Objective To explore the correlation between malnutrition and malnutrition risk and depression in the elderly，and to provide a reference for preventing and delaying the occurrence and development of depression in the elderly. Methods CNKI，China Biomedical Literature Database，VIP，Wanfang，PubMed，Cochrane Library，Web of Science，and Embase were systematically searched from inception to February 2025. The studies were screened for inclusion and quality assessment，and the extracted data were analysed using RevMan software. Results A total of 17 articles were included. Meta-analysis showed that malnutrition[OR=2.58，95%CI（1.84，3.60），P<0.001] and risks of malnutrition[OR=2.31，95%CI（1.56，3.41），P<0.001] increased the risk of depression in older adults. Subgroup analysis of study design，study region，source of study subjects，and nutritional status assessment methods showed that the use of different methods to assess malnutrition may be the source of heterogeneity in the association between malnutrition and depression in the elderly. Among the subgroups with the association between malnutrition risk and geriatric depression，there was no significant difference in the correlation between malnutrition risk and depression in the elderly when the GNRI scale was used（P>0.05），and the presence of malnutrition risk increased the risk of depression in the elderly in the other subgroups（P<0.05）. Conclusion Malnutrition or the presence of malnutrition risk can increase the risk of depression in the elderly，and early nutritional intervention is of great significance to delay the occurrence and development of depression in the elderly.

Emergency treatment and nursing care for a patient with sympathetic storm after intracranial aneurysm rupture surgery

LU Yanhua, ZHAI Yifan, HUANG Xiaoyan, DING Haiyan, TANG Weijie, XU Zhijian, SHI Tian

2025, 60(23): 2929-2932. DOI: 10.3761/j.issn.0254-1769.2025.23.016

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This paper describes the emergency treatment and nursing care for a patient with sympathetic storm after intracranial aneurysm rupture surgery. Nursing points included：implementing effective airway management，administering sequential high-flow nasal oxygen therapy after weaning，ensuring oxygenation；strengthening hemodynamic monitoring and implementing goal-directed fluid management；conducting accurate medication，optimizing analgesic and sedative strategies，and protection of myocardial cells；implementing gradual enteral feeding to ensure energy supply；establishing a transitional nursing liaison group，applying dual psychological support，reducing negative emotions，and promoting early recovery. After comprehensive treatment and nursing care，the patient was transferred to a general ward for further treatment on the 21st day. After follow-up，the patient recovered and was discharged from the hospital with a favorable outcome.

Application of artificial intelligence-based clinical decision support systems in ICU：a scoping review

GUO Xiaofan, LIU Jinlong, YU Yili, XU Yunjia, HU Xiaomeng, XIE Yuxi, HOU Binbin, LOU Yan

2025, 60(23): 2933-2939. DOI: 10.3761/j.issn.0254-1769.2025.23.017

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Objective To conduct a scoping review of studies on the application of artificial intelligence-based clinical decision support systems（AI-CDSS） in the ICU domestically and internationally，providing references for future clinical nursing applications and research directions. Methods Computerized searches were performed across 9 Chinese and English databases，with the search period spanning from the inception of each database to May 2025. Studies related to the application of AI-CDSS in the ICU were screened，and the included literature was summarized and analyzed based on the scoping review framework. Results A total of 14 articles from 6 countries were included. AI-CDSS in the ICU primarily utilized machine learning，deep learning，and natural language processing technologies，extracting information from both structured and unstructured ICU data. These systems were mainly applied to patient groups such as those with infection risks，mechanical ventilation，comorbid coronary heart disease，and orthopedic trauma. Core functions included prediction of complications and disease outcomes，mortality risk prediction，decision recommendations，and user interaction. The systems demonstrated high recognition accuracy and strong transfer generalization capabilities in the ICU. Nurses reported high execution，adoption，satisfaction，and acceptance rates. Conclusion AI-CDSS can enhance the prediction of mortality and complication risks，improve predictive nursing levels，elevate the quality of care，and optimize patient outcomes in the ICU. Future efforts should focus on developing integrated AI-CDSS that incorporate multi-device data integration and strengthen human-machine collaboration to promote more efficient and reliable application in diverse ICU scenarios.

The application progress and implications of nutrition integration strategies in cancer survivors

GUO Yinning, XU Xinyi, DING Lingyu, MIAO Xueyi, CHEN Yimeng, FU Zhongmin, CHEN Li, XU Qin

2025, 60(23): 2940-2944. DOI: 10.3761/j.issn.0254-1769.2025.23.018

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Cancer is one of the major causes affecting public health in our country，and malnutrition is a common problem among cancer patients. Food is Medicine（FIM） and Precision Nutrition（PN） have been recognized as promising nutritional intervention strategies. This paper reviews the conceptual connotation of FIM and PN，and further explains the necessity of the integration of FIM and PN intervention strategies，the steps，and the path to implement the integration，the application progress and revelations，as well as the precautions to be taken in applying them，which can in turn provide guidance for the nutritional improvement and oncological rehabilitation of cancer patients.

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