Table of Content

10 August 2026, Volume 61 Issue 15

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Original article

Comparison study on the consistency between multidimensional nursing levels and physician-ordered nursing levels in patients with ischemic stroke

WANG Zhiyi, LI Bo, WEI Lingling, ZHENG Jianhua, ZHAI Mengcui, QU Hui, YU Yanjuan, LU Ming

2026, 61(15):  2021-2027.  DOI: 10.3761/j.issn.0254-1769.2026.15.001

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Objective To develop multidimensional nursing level determination rules for patients with ischemic stroke，analyze their consistency with physician-ordered nursing levels，and provide a quantitative reference for nurses to participate in dynamic nursing level assessment. Methods The multidimensional nursing level determination rules were developed through literature review，expert group discussion and expert consultation. A retrospective study was conducted among 458 patients with ischemic stroke in the neurology department of a tertiary hospital from October 2024 to June 2025. Taking the first change in physician-ordered nursing level as the study context，6 assessment indicators were extracted to generate multidimensional nursing levels. Using physician-ordered nursing levels as the reference，the consistency rate，linear weighted Kappa coefficient，between-group comparison and classification and regression tree were used to analyze the determination effect. Results A total of 447 patients were ultimately enrolled in this study. The multidimensional nursing levels were consistent with physician-ordered nursing levels in 360 cases，with a consistency rate of 80.54% and a linear weighted Kappa coefficient of 0.674. The correct recognition rates for special，first-level and second-level nursing were 100%，94.12% and 68.20%，respectively. Inconsistent cases were mainly physician-ordered second-level nursing classified as first-level nursing. Differences in all assessment indicators between the 2 groups were statistically significant. Classification and regression tree analysis showed that the National Institutes of Health Stroke Scale score was the first splitting variable，while the Barthel Index，Modified Early Warning Score and Patient Health Questionnaire-9 score participated in the determination of nursing level. Conclusion Multidimensional nursing levels have moderate consistency with physician-ordered nursing levels and may provide a quantitative reference for nurses to conduct dynamic nursing level assessment in patients with ischemic stroke.

Construction and preliminary validation of a standard operating procedure for active rehabilitation nursing in patients with paralysis guided by motor imagery-based brain-computer interface

LI Liqun, LIU Juan, SHAO Xiuqin, YE Jun, ZHU Ye’an, DONG Xiaoyang, YAN Yin

2026, 61(15):  2028-2034.  DOI: 10.3761/j.issn.0254-1769.2026.15.002

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Objective To construct and preliminarily validate a standard operating procedure（SOP） for active rehabilitation nursing in patients with paralysis guided by motor imagery-based brain-computer interface（MI-BCI），providing a reference for the standardized application of brain-computer interfaces in rehabilitation nursing. Methods An initial draft of the nursing SOP was developed through literature review，clinical field observation，and expert panel discussion. From February to March 2026，16 experts were consulted using the Delphi method in 2 rounds to revise and optimize the SOP. A prospective single-arm pilot study was subsequently conducted，and 5 paralysis patients from the rehabilitation medicine department of a tertiary A hospital in Nanchang，Jiangxi Province，were selected for preliminary clinical application validation. Results The effective response rates of the 2 rounds of expert consultation questionnaires were both 100%，and the expert authority coefficients were 0.897 and 0.906，respectively. In the second round of expert consultation，the coefficients of variation of item importance scores ranged from 0 to 0.142，and Kendall’s coefficients of concordance ranged from 0.183 to 0.396，all showing statistical significance（P<0.001）. The final SOP consisted of 5 first-level items，11 second-level items，and 16 third-level items. Preliminary validation results showed that the SOP implementation rate was 95.6%，the training completion rate was 100%，and no serious adverse events occurred. Patients，family caregivers，and nurses all reported high satisfaction，and patients demonstrated good participation in motor imagery training. Conclusion The constructed SOP for MI-BCI-guided active rehabilitation nursing in patients with paralysis is scientific，comprehensive，and highly specialized，and it may provide a reference for the standardized application of brain-computer interface technology in rehabilitation nursing.

Chinese version of the Dysphagia Handicap Index-Companion for stroke patients and its reliability and validity test

XU Dacai, DING Yao, WANG Lu, WANG Yueqin

2026, 61(15):  2035-2040.  DOI: 10.3761/j.issn.0254-1769.2026.15.003

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Objective To translate the Dysphagia Handicap Index-Companion（DHI-C） into Chinese and to test its reliability and validity，thereby providing a reliable and scientific assessment tool for evaluating the care burden and physical and mental status of companions of stroke patients with dysphagia in China. Methods The Chinese version of the DHI-C was developed through translation，back-translation，cultural adaptation，and pilot testing. A survey was conducted among 350 caregivers of stroke patients with dysphagia who visited a tertiary Grade A hospital in Jiangsu Province using the Chinese version of the DHI-C from October 2025 to February 2026. The Chinese version of the Dysphagia Handicap Index（DHI） was used as the reference tool for convergent validity. Reliability and validity were analyzed using SPSS 24.0 and R 4.4.2. Results A total of 338 valid questionnaires were collected, yielding a validity rate of 96.57%. The Cronbach’s α coefficient of the Chinese version of the DHI-C was 0.942，and the Cronbach’s α coefficients for the physical，emotional，and functional subscales were 0.861，0.908，and 0.843，respectively. The test-retest reliability of the total scale was 0.883，and the test-retest reliabilities for the 3 subscales were 0.833，0.881，and 0.812，respectively. The item-level content validity index（I-CVI） ranged from 0.800 to 1.000，and the scale-level content validity index average（S-CVI/Ave） was 0.936. Exploratory factor analysis extracted 3 common factors with eigenvalues greater than 1，which together accounted for 70.58% of the total variance. Confirmatory factor analysis indicated a good model fit. The total score of the Chinese version of the DHI-C was positively correlated with that of the Chinese version of the DHI（r=0.772，P<0.05）. Conclusion The Chinese version of the DHI-C has good reliability and validity and can be used to assess caregivers of stroke patients with dysphagia in China.

The role function and influence of non-relative witnesses in pre-hospital health-seeking delay of stroke patients：a scoping review

LI Ruolin, JIN Yujia, WANG Xiaoxuan, WANG Wenna, WANG Shanshan, QIU Yunjing, CHEN Ruofei, MEI Yongxia, ZHANG Zhenxiang, LIN Beilei

2026, 61(15):  2041-2047.  DOI: 10.3761/j.issn.0254-1769.2026.15.004

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Objective To conduct a scoping review of the role functions and potential impacts of non-relative witnesses in pre-hospital delay among stroke patients，providing a reference of future public science education in stroke. Methods A systematic search was conducted in Chinese and English databases（CINAHL，Cochrane Library，Embase，PubMed，Web of Science，Wanfang Data，CNKI，and CBM）. The search time limit was updating from the establishment of the databases to March 19，2026. Results A total of 11 studies were included，of which 1 focused solely on decision delay；there were 8 quantitative studies and 3 qualitative studies. Non-relative witnesses mainly included friends，neighbors，acquaintances，colleagues，and residential staff. Their roles included symptom identification and risk assessment，information support and auxiliary decision-making，and emergency response and transfer assistance. Among them，9 studies mentioned that non-relative witnesses could promote timely medical treatment through correct responses，whereas incorrect handling could lead to delayed medical treatment. Conclusion Non-relative witnesses play a crucial role at the time of stroke onset，and they can act on all links of pre-hospital medical treatment. Improving their ability to identify stroke and respond appropriately can promote patients’ medical treatment. However，the current evidence is mainly based on observational studies，and there is a lack of intervention studies targeting non-relative witnesses. In the future，it is necessary to rely on new technologies such as simulation experiments to explore intelligent intervention strategies and effectiveness of public science popularization education，so as to provide new intervention focuses for reducing stroke-related mortality and disability.

Application progress of intelligent rehabilitation robots in stroke patients and nursing implication

YANG Jiayuan, LI Jing, JIANG Hua

2026, 61(15):  2048-2053.  DOI: 10.3761/j.issn.0254-1769.2026.15.005

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Intelligent rehabilitation robots can effectively enhance rehabilitation compliance and improve functional outcomes in stroke patients，representing an important innovative direction in the field of stroke rehabilitation and demonstrating unique advantages in stroke rehabilitation training. This article reviews the rehabilitation training methods and application effects of intelligent rehabilitation robots in stroke patients，including intelligent control technology robots，brain-computer interface-driven rehabilitation robots，multimodal fusion robots，and virtual reality and augmented reality technology-integrated rehabilitation robots. It identifies current challenges in the application of intelligent rehabilitation robots，such as insufficient age-friendly design，inadequate clinical efficacy validation，lack of multidisciplinary collaboration，and lagging healthcare insurance policies. Corresponding recommendations for application development and nursing implications are proposed to promote the standardized and sustainable application of intelligent rehabilitation robots in stroke rehabilitation.

Clinical practice guidelines for nursing management of iodinated contrast media extravasation（2026 updated version）

Radioactive Interventional Nursing Professional Committee of Chinese Nursing Association (Writing Committee: ZHANG Hongmei, ZHANG Su, LIU Yu)

2026, 61(15):  2054-2060.  DOI: 10.3761/j.issn.0254-1769.2026.15.006

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Objective To update and supplement the clinical practice guidelines for nursing management of iodinated contrast media extravasation（hereinafter referred to as the Guidelines） developed in 2021. Methods Systematic searches were performed for relevant literature published from May 12，2019 to July 22，2025 on domestic and international guideline websites，professional association websites and databases to collect the latest evidence-based evidence related to iodinated contrast media extravasation. Standardized procedures of literature quality appraisal，data extraction and evidence synthesis were implemented to integrate relevant research findings and develop the draft Guidelines. The Delphi method was used to conduct 2 rounds of expert consultation. After revision and improvement through expert argumentation and external review，the consensus on recommendations and strength of recommendations was reached，and the final version of the Guidelines was established. Results The updated Guidelines add 22 new recommendations and revise 4 existing ones，covering 9 domains：risk factors for iodinated contrast medium extravasation，informed consent，individualized injection protocols，preventive strategies for extravasation，pre-injection preparation，monitoring during injection，emergency management of extravasation，post-extravasation precautions，and quality improvement related to iodinated contrast medium extravasation. Conclusion This study completes the update of the original Guidelines. It offers evidence-based support for clinical nurses’ decision-making and facilitates standardized management for the prevention and response to iodinated contrast media extravasation.

Expert consensus on home-based self-management guidance for patients undergoing ambulatory chemotherapy

Oncology Nursing Committee of Chinese Nursing Association (Writing Committee: LIN Xiling, WANG Liying, WANG Haiyan, QIN Huiying, SHI Simei, LI Jia)

2026, 61(15):  2061-2068.  DOI: 10.3761/j.issn.0254-1769.2026.15.007

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Objective To develop an expert consensus on home-based self-management guidance for patients undergoing daytime chemotherapy（hereinafter referred to as the“Consensus”），in order to standardize health education and improve patients’ self-management ability. Methods A preliminary draft of the “Consensus” was formulated based on a comprehensive review of domestic and international literature and integration of relevant evidence. From June to October 2025，2 rounds of Delphi expert consultation and 2 rounds of expert panel discussions were conducted to revise the “Consensus”，resulting in the final version. Results The effective response rates for both rounds of expert consultation were 100%. The expert authority coefficient was 0.90，and Kendall’s coefficients of concordance were 0.157 and 0.114，respectively （both P<0.001）. The final consensus consists of 5 sections：basic knowledge of self-management， management of daily life，management of home-based oral chemotherapy，management of a central venous catheter，and identifying adverse reactions and management. Conclusion The “Consensus” is scientific and rigorous，and can serve as a reference for clinical nurses in providing guidance on home-based self-management for patients receiving daytime chemotherapy.

Expert consensus on nursing practice of oxygen therapy in adults with hypoxemia at high altitude

Chongqing Nursing Association，Xizang Nursing Association (Writing Committee: REN Hongyan, PAN Longfang, TANG Ping, FENG Jiayao, LIN Ling, LIANG Yi, GA Duo, SE Jina, GESANG Luobu)

2026, 61(15):  2069-2075.  DOI: 10.3761/j.issn.0254-1769.2026.15.008

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Objective To develop an expert consensus on nursing care for oxygen therapy in adult patients with hypoxemia in high-altitude regions（hereinafter referred to as the “Consensus”），aiming to guide nurses in high-altitude regions in standardizing relevant nursing practices. Methods Using an evidence-based approach，we systematically searched for，evaluated，and synthesized relevant evidence，classified the evidence levels，and drafted the initial version of the “Consensus”. From March to November 2025，21 medical or nursing experts from 6 provinces and municipalities were invited to participate in 2 rounds of expert consultation via mail，and 8 experts conducted 2 rounds of expert panel discussions to finalize the “Consensus”. Results The response rate for valid questionnaires in both rounds of expert consultation was 100%. The experts’ agreement coefficient was 0.90；the familiarity coefficient was 0.73；the authority coefficient was 0.82. The mean importance scores for each item ranged from 3.80 to 4.80 points；the coefficients of variation ranged from 0.11 to 0.24；the Kendall’s coefficients of concordance were 0.125 and 0.123，respectively（P<0.001）. The “Consensus” covers 4 aspects：nursing assessment，selection of oxygen therapy equipment and methods，nursing implementation，and safety management. Conclusion This “Consensus” is scientifically sound and clinically applicable，and can provide guidance for nurses in high-altitude regions to standardize the implementation of oxygen inhalation therapy.

Analysis of the characteristics and influencing factors of post-intensive care syndrome risk trajectory in critically ill patients

LIU Yan, YAO Li, WANG Yinhua, WANG Tingrui, LI Qinqin

2026, 61(15):  2076-2084.  DOI: 10.3761/j.issn.0254-1769.2026.15.009

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Objective To explore the course of post-intensive care syndrome in critically ill patients，analyze the influencing factors，and provide theoretical bases for clinical implementation of precise management. Methods By using the convenience sampling method，357 patients who were transferred out of the ICU of a tertiary grade A hospital in Guizhou Province from December 2024 to July 2025 were selected for the questionnaire survey. The baseline survey was conducted using the general information questionnaire，Richards-Campbell sleep questionnaire，and Barthel Index. The Health Aging Brain Care Monitoring Questionnaire（Mixed Version） was used to assess the risk level of ICU post-syndrome at 3 time points：1 week（T1），1 month（T2），and 3 months（T3） after the pa-tients were transferred out of the ICU. The latent class growth model was used to identify the potential classes of post-intensive care syndrome risk in critically ill patients，and the multivariate Logistic regression was used to ana-lyze the influencing factors of the potential classes. Results A total of 301 patients completed all 3 follow-ups. The development trajectory of post-intensive care syndrome presented 4 types，including slow recovery trajectory（24.25%），rapid recovery trajectory（44.19%），risk increasing trajectory（6.64%），and persistent high-risk trajectory（24.92%）. Logistic regression analysis showed that the length of ICU post-hospitalization，personality traits，marital status，Barthel Index score，Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ） score，presence of infection，presence of internal environment disorder，and early activities were independent influencing factors for the potential categories of post-intensive care syndrome risk trajectory in critically ill patients（P<0.05）. Conclusion The post-intensive care syndrome in critically ill patients shows different change trajectories. Healthcare professionals should pay attention to the risk assessment of the post-intensive care syndrome in patients who have a longer ICU stay，a higher APACHE Ⅱ score，an Barthel Index score of 21~59，introverted personality，being unmarried/divorced/widowed，presence of infections and internal environment disorders，and lack of early activities. They should also implement precise interventions as early as possible based on the possible influencing factors.

Current condition and influencing factors of barriers to physical activity among pregnant women with prepregnancy overweight or obesity

YANG Yiyun, PU Congshan, DING Yajie, ZHANG Yingying, WANG Yiting, QU Lijie

2026, 61(15):  2085-2092.  DOI: 10.3761/j.issn.0254-1769.2026.15.010

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Objective To explore the potential profile of barriers to physical activity and its influencing factors among pregnant women with prepregnancy overweight or obesity，so as to provide evidence for developing precise physical activity interventions during pregnancy. Methods Convenience sampling was employed to investigate 430 pregnant women with prepregnancy overweight or obesity admitted to a tertiary A-level maternity hospital in Nanjing City from August to December 2024. Data was collected using the pregnant women’s general information questionnaire，Barriers to Physical Activity during Pregnancy Scale，Pregnancy Exercise Self-Efficacy Scale，Body Image in Pregnancy Scale. The latent profiles of barriers to physical activity in pregnant women with prepregnancy overweight or obesity，the influencing factors of latent profiles were identified by single-factor analysis and multivariate Logistic regression. Results A total of 418 valid questionnaires were collected in this study，and 97.21% of the valid questionnaires were included. The total score of the barriers to physical activity was（100.57±17.46） points. Barriers to physical activity in pregnant women with prepregnancy overweight or obesity cancer could be divided into 3 latent profiles：low barrier-activity adaptive type （17.22%），moderate barrier-activity fluctuating type（55.02%） and high barrier-activity restricted type（27.75%）. Per capita monthly income of the family，exercise guidance from medical staff during pregnancy，exercise self-efficacy and body image were the factors influencing the barriers to physical activity in pregnant women with prepregnancy overweight or obesity（all P<0.05）. Conclusion There is heterogeneity in barriers to physical activity of pregnant women with prepregnancy overweight or obesity. According to the characteristics and influencing factors of different profile categories，medical staff can formulate precise nursing interventions to reduce the occurrence and development of barriers to physical activity and improve maternal and infant pregnancy outcomes.

Construction of a proactive health behavior model for elderly patients with chronic obstructive pulmonary disease

XUE Xiujuan, LU Ranran, TAO Junrong, WANG Shuxian, SUN Fang, XU Cuiping

2026, 61(15):  2093-2101.  DOI: 10.3761/j.issn.0254-1769.2026.15.011

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Objective To explore the connotation，formation，and maintenance mechanism of proactive health behaviors in elderly patients with chronic obstructive pulmonary disease（COPD），and to construct a proactive health behavior model for elderly COPD patients，so as to provide references for promoting their proactive health behaviors. Methods From July to September 2025，grounded theory and purpose sampling were used to select 15 elderly patients with COPD in the respiratory department of a tertiary A hospital in Jinan for semi-structured in-depth interviews. The data were analyzed via three-level coding and constant comparative analysis to extract concepts and categories，and to construct a theoretical model. Results The proactive health behaviors of elderly COPD patients mainly consisted of 3 types：treatment-related behaviors，rehabilitation exercise behaviors，and lifestyle management behaviors，with 4 core characteristics：autonomy，sustainability，adaptability，and goal-directedness. During the behavio-ral process，intrinsic driving factors such as cognitive awareness，health responsibility，self-management skills，and psychological adjustment provided impetus for the initiation of proactive health behaviors in COPD patients. External support factors including family support，medical and community support，information resources，and social support played important roles in promoting the sustainability of health behaviors. During the behavioral maintenance process，patients faced multiple barriers including physical，psychological，economic，and environmental obstacles，which they coped with through strategies of active adjustment or passive abandonment. The experiential process of proactive health behaviors could in turn influence patients’ cognition and psychological state，and further affect subsequent behavioral decisions. Conclusion The proactive health behavior model for elderly COPD patients can guide healthcare professionals from the perspective of the proactive health behavior process，help clarify its manifestations and core characteristics，systematically assess patients’ intrinsic drivers and external contexts，and thereby optimize health education and intervention strategies. It provides stratified，contextualized，and operable guidance for clinical practice.

A qualitative study on symptom experiences among hepatocellular carcinoma patients during targeted therapy combined with immunotherapy

LIU Chang, CHEN Dayu, HE Yanlin, ZHANG Aimei, JIANG Mingmei, REN Chunxia

2026, 61(15):  2102-2108.  DOI: 10.3761/j.issn.0254-1769.2026.15.012

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Objective To explore the real-life experience of symptoms among hepatocellular carcinoma patients during targeted therapy combined with immunotherapy，thereby providing a reference for the development of appropriate nursing strategies and protocols in clinical practice. Methods Using purposive sampling，13 patients with hepatocellular carcinoma undergoing targeted therapy combined with immunotherapy at a tertiary A hospital in Anhui Province between May and June 2025 were selected as study subjects. Semi-structured interviews were conducted based on the theory of unpleasant symptoms. Data were analyzed using Colaizzi 7-step analysis method to extract themes. Results A total of 3 themes and 8 subthemes were identified：the multidimensional manifestations of physical symptoms and their psychosomatic chain reactions（social isolation and emotional disturbances caused by skin toxicity，physical disarray and contraction of daily life caused by gastrointestinal symptoms，negative mood and existential anxiety under the onslaught of pain，and the loss of confidence in treatment and a sense of insecurity caused by serious adverse reactions，psychological burden and challenges in role adaptation in therapeutic settings（existential anxiety arising from the trade-off between therapeutic efficacy and adverse reactions，feelings of guilt and loss of self-worth resulting from the reversal of family roles），and the structural characteristics and challenges of external support systems（perception of economic pressure and coping with medical costs，the mismatch between supply and demand for continuity of care and the gap in patient experience）. Conclusion During targeted therapy combined with immunotherapy period，the symptom burden of hepatocellular carcinoma patients was typically influenced by the combined effects of physiological，psychological，and environmental factors. Therefore，it is essential to implement timely and effective comprehensive interventions to alleviate patients’ discomfort and enhance overall treatment outcomes and quality of life.

Development and clinical validation of a Perioperative Safety Self-Checklist for Elective General Anesthesia surgical patients

TANG Weirong, WU Xiaorong, YIN Yunrui, YE Huilin, ZHANG Yingjia, LI Yuerong

2026, 61(15):  2109-2116.  DOI: 10.3761/j.issn.0254-1769.2026.15.013

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Objective To construct and clinically verify a perioperative safety self-checklist for elective general anesthesia surgical patients，so as to provide a scientific and effective tool for surgical patients to participate in perioperative safety management. Methods Based on literature review and semi-structured interviews，a preliminary draft of the self-checklist was initially formulated. From March to May 2025，16 experts from the relevant field in 8 tertiary hospitals across the country were invited to conduct 2 rounds of Delphi expert consultation. The list items were revised and improved by incorporating expert opinions，and a pilot version of the checklist was formed. Using convenience sampling，patients undergoing general anesthesia for elective surgery from 6 surgical departments in a tertiary hospital in Chongqing from July to November 2025 were selected as the survey subjects. Content validity index，intra-class correlation coefficient（ICC） and Cronbach’s α analysis were conducted. Results The recovery rates of valid questionnaires in both rounds of expert consultation were 100%. The expert authority coefficients were 0.90 and 0.94，respectively. The Kendall’s coefficient of concordance was 0.356 and 0.365，respectively（P<0.001）. Finally，a self-checklist with 3 first-level indicators，7 second-level indicators，and 32 items was formed. The results of reliability and validity verification showed that the Total Scale-Content Validity Index/Average（S-CVI/Ave） was 0.886，and the mean value of ICC was 0.883，with a 95% confidence interval of （0.857~0.905），and P<0.001. The overall Cronbach’s α coefficient of the checklist was 0.894，and the Cronbach’s α coefficients for the dimensions ranged from 0.768 to 0.915. Conclusion The constructed self-checklist for perioperative safety of elective general anesthesia surgical patients is comprehensive in content，scientific and clinically practical，providing a basis for carrying out surgical patients’ participation in perioperative safety management.

Influencing factors of healthcare-seeking delay in patients with breast cancer-related lymphedema after surgery：a mixed-methods study

ZHENG Huan, CHEN Fang, SHAO Lewen, CAO Kai, ZHAO Xiaoyan

2026, 61(15):  2117-2125.  DOI: 10.3761/j.issn.0254-1769.2026.15.014

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Objective To investigate the current of healthcare-seeking delay among patients with breast cancer-related lymphedema（BCRL） after surgery，and to identify its influencing factors，thereby providing a theoretical basis for developing effective intervention strategies. Methods This study employed a parallel mixed-methods design. Convenience sampling was used to enroll 280 patients with postoperative BCRL who visited a tertiary hospital in Hangzhou，Zhejiang Province from November 2024 to September 2025. Multivariate logistic regression was used to analyze the factors influencing healthcare-seeking delay. For the qualitative component，purposive sampling was used to recruit 20 patients with BCRL treated during the same period for semi-structured interviews. The interview data were organized and analyzed following Colaizzi’s seven-step method. Variables showing statistical significance in the univariate analysis（P<0.05） and the influencing factors identified in the multivariate Logistic regression were mapped item-by-item against the themes and subthemes extracted from the qualitative interviews for integrated analysis. Results Quantitative results showed that 273 valid questionnaires were returned，and the healthcare-seeking delay rate among patients with postoperative BCRL was 52.01%. Higher scores for lymphedema self-management behavior support（P<0.001，OR=0.914） and social support（P=0.003，OR=0.871） were identified as key protective factors against healthcare-seeking delay. The qualitative analysis yielded 5 themes and 12 subthemes. The integrated findings showed that at the level of individual characteristics and behaviors，the qualitative results explained the underlying mechanisms of the quantitative findings；at the level of interpersonal networks，the qualitative and quantitative findings were highly consistent；at the level of living，working，and policy environments，the qualitative results provided both explanatory and complementary insights to the quantitative data. Conclusion Healthcare-seeking delay in patients with postmastectomy BCRL is influenced by multiple factors，including cognition，psychological status，social support，geo-economic conditions，and institutional policies. Future efforts should focus on establishing a multidimensional integrated support to promote timely healthcare-seeking behaviors，and improve the postoperative quality of life.

Influencing factors of psychological detachment among caregivers of patients with heart failure：a qualitative study

WU Fan, GAO Min, TAO Xiu, LU Jing, LI Yunxia, ZHU Yue, WANG Qin, SUN Guozhen

2026, 61(15):  2126-2133.  DOI: 10.3761/j.issn.0254-1769.2026.15.015

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Objective To explore factors influencing psychological detachment among caregivers of patients with heart failure and provide evidence for developing targeted intervention programs. Methods Based on the ABC-X model，a descriptive qualitative design was adopted. Using purposive sampling，semi-structured interviews were conducted with 22 caregivers of patients with heart failure who were hospitalized in the cardiology department of a tertiary A general hospital in Nanjing，China，between August and October 2025. Data were analyzed using directed content analysis. Results A total of 3 themes and 11 subthemes were identified：stressor-related factors （hypervigilance following acute events，persistent distress from negative emotions，excessive occupation of personal time，and increased psychological burden due to financial pressure），resource-related factors （psychological resilience buffering caregiving stress，enhanced coping efficacy through caregiving knowledge and experience，multidimensional support from family and relatives，and improved psychological safety through professional support），and cognitive factors （neglect of self-care，over-internalization of caregiving responsibility，and excessive linkage of caregiving value to the patient’s illness status）. Conclusion Healthcare professionals should guide caregivers to acknowledge and actively cope with multiple caregiving stressors，mobilize multidimensional supportive resources，and promote adaptive caregiving-related cognitive patterns，enabling caregivers to regard appropriate psychological detachment as an essential part of sustainable caregiving and thereby maintain good physical and mental health as well as caregiving quality during long-term caregiving.

Development and validation of a Discharge Readiness Scale for Patients with Systemic Lupus Erythema-tosus

SHEN Fengjiao, KONG Xiaoyang, JIN Jing, ZHOU Bingjuan, PEI Guoqin, DOU Yijing, OUYANG Tao

2026, 61(15):  2134-2141.  DOI: 10.3761/j.issn.0254-1769.2026.15.016

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Objective To develop and validate a discharge readiness scale for patients with Systemic Lupus Erythematosus（SLE） based on transition theory，tailored to the national context and disease-specific characteristics. This aims to provide a scientific assessment tool for formulating precise discharge intervention strategies and improving patients’ long-term rehabilitation outcomes. Methods Guided by the transition theory framework，an initial item pool was established through literature analysis，qualitative interviews，and the Delphi expert consultation method. The final scale was determined after a clinical pilot survey. The SLE patients from 12 hospitals in Jiangsu Province between December 2024 and October 2025 were enrolled. Item analysis was employed to screen entries，and the reliability and validity of the scale were tested. Results A total of 365 questionnaires were distributed，with 357 valid responses returned，yielding an effective response rate of 97.81%. The finalized SLE Discharge Readiness Scale comprises 4 dimensions（personal status，disease knowledge，coping ability，and anticipated support） and 32 items. The overall Cronbach’s α coefficient was 0.956；the split-half reliability coefficient was 0.859；the test-retest reliability was 0.898. The Cronbach’s α coefficients for individual dimensions ranged from 0.893 to 0.954；split-half reliability coefficients ranged from 0.907 to 0.973；test-retest reliability ranged from 0.794 to 0.850，indicating good reliability. The cumulative variance contribution rate was 68.311%. The scale-level content validity index（S-CVI） was 0.974（≥0.8），and the item-level content validity indices（I-CVI） ranged from 0.833 to 1.000，demonstrating good validity. Conclusion The developed Discharge Readiness Scale for SLE patients exhibits good reliability and validity，and it can serve as a scientific tool for assessing discharge readiness in this patient population.

Nursing care of a patient with chest wall defect and right lung exposure caused by high temperature aluminum water burn：a case study

GAO Mengke, HUANG Xiaoxia, TANG Jiaying, YU Anqi

2026, 61(15):  2142-2146.  DOI: 10.3761/j.issn.0254-1769.2026.15.017

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This paper summarizes the nursing experience of a patient with chest wall defect and right lung exposure caused by high-temperature molten aluminum burn. The key nursing points included：precision fluid management to balance tissue perfusion with pulmonary edema risk；implementing comprehensive protective strategies for exposed lung care；actively controlling infection to prevent septic shock；monitoring coagulation function to prevent deep vein thrombosis；implementing multimodal pain management to enhance comfort. After undergoing 2 hospitalizations for treatment and care，the patient was discharged in a recovered state.

Independent living ability among older adults in the context of digitalization：a hybrid concept analysis

LIU Jingyi, SUN Mingyao, LUO Huanhuan, LI Ziyan, WANG Zhiwen

2026, 61(15):  2147-2154.  DOI: 10.3761/j.issn.0254-1769.2026.15.018

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Objective To explore the concept of the independent living ability for older adults in the context of digitalization，so as to provide references for conducting relevant nursing research. Methods This study employed the hybrid concept analysis method proposed by Schwartz-Barcott and Kim. The theoretical phase was conducted from August to October 2025，followed by the fieldwork phase in December 2025. The analytical phase was carried out in January 2026. Findings from the theoretical and fieldwork phases were compared and integrated to clarify the definition，attributes，antecedents，and consequences of the concept. Results The independent living ability among older adults was redefined as a multidimensional and complex concept in the context of digitalization. Its core attributes encompass 4 aspects，including functional independence，psychosocial independence，technological adaptation and utilization，and economic independence. The antecedents include individual factors（sociodemographic，physiological，psychological，and behavioral factors），environmental factors，and technological factors. The consequences of independent living ability include improved physical functioning，greater psychosocial well-being，quality of life，and enhanced subjective autonomy and sense of freedom，as well as reduced family strain and caregiving burden. Conclusion The independent living ability among older adults is a complex concept that relies heavily on individual functioning，intelligent environments，and technical equipment support.

Progress in the application of multimodal artificial intelligence in early identification and nursing of pressure injuries in dark-skinned populations

LOU Jie, HUANG Rongrong, XIE Yusheng, LIU Zhaoqing, NIE Pu, HE Kehuan, WANG Langxun

2026, 61(15):  2155-2160.  DOI: 10.3761/j.issn.0254-1769.2026.15.019

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Affected by congenital genetic factors，individuals with dark skin exhibit high epidermal melanin deposition，which easily obscures early erythema signs of pressure injuries. Multimodal artificial intelligence integrates multi-source data，including medical images，physiological signals and clinical texts. It adopts data fusion algorithms to extract multidimensional complementary information，thereby breaking through the limitations of conventional single visual assessment. It provides objective and innovative insights for the early accurate identification，dynamic risk early warning，and personalized nursing decision-making of pressure injuries in dark-skinned populations. This article reviews the clinical assessment dilemmas of pressure injuries in dark-skinned groups，elaborates on the data fusion principles and application strategies of multimodal artificial intelligence，and summarizes its research progress in nursing practice. Meanwhile，it thoroughly analyzes key challenges in the clinical translation of this technology，such as data bias，insufficient clinical adaptability，and privacy and ethical constraints. The study aims to offer theoretical references for establishing a safe and efficient human-machine collaborative nursing model，optimizing the prevention and control system of pressure injuries，and improving the quality of specialized nursing.