Objective To systematically evaluate the factors that promote and hinder exercise in frail older adults,and to provide references for the formulation of exercise intervention programs.Methods We searched PubMed,Web of Science,Embase,CINAHL,Cochrane library,CNKI,Wanfang,VIP database,and China Biomedical Literature Database for qualitative studies on exercise facilitators and hindrances in frail older adults,and the search time period was from the establishment of the databases to September 1,2024.The quality of the literature was evaluated using the Joanna Brigg Institute Australian Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research(2016),and the results were integrated by integrating methods.Results A total of 18 studies were included,and 72 research results were extracted,and 10 categories were summarized.The final synthesis included 2 integrated results:the facilitators included personal exercise motivation,physical and psychological benefits,positive interpersonal interactions,multiple social support systems and person-centred exercise programme;the impediments included underlying diseases and somatic functional limitations,negative psychological status,low health literacy,family role conflicts and limits of the environment.Conclusion Exercise for frail older adults is affected by a variety of factors.Healthcare professionals should improve the positive perception of exercise for frail older people and help them overcome psychological barriers;establish an all-round support system to enhance the sense of social contact of the frail elderly;formulate a personalised exercise programme with a human-centred approach to enhance the motivation of the frail elderly.
目的 系统评价基于"互联网+"的护理干预对癌症患者疼痛的干预效果并探索最佳的干预形式.方法 计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、维普数据库、万方数据库和中国生物医学文献数据库中关于基于"互联网+"的护理干预对癌症患者疼痛效果的随机对照试验,检索时限为建库至2022年5月.由2名研究者独立进行文献筛选、资料提取、文献质量评价,采用RevMan 5.4软件进行Meta分析.结果 共纳入9篇文献,包括1 049例患者.Meta分析结果显示,与常规护理相比,基于"互联网+"的护理干预能够有效降低癌症患者的疼痛强度[MD=-0.70,95％CI(-1.29,-0.11),P=0.03]、减少疼痛干扰[MD=-0.71,95％CI(-1.08,-0.33),P=0.04];干预形式中,互动式健康教育组疼痛强度最低,差异具有统计学意义[MD=-0.23,95％CI(-0.43,-0.02),I2=0,P=0.03].此外,基于"互联网+"的护理干预对50～＜60岁癌症患者的疼痛强度改善效果更明显[MD=-0.26,95％CI(-0.46,-0.06),I2=0,P=0.01].结论 实施基于"互联网+"的护理干预能有效改善癌症患者的疼痛强度与疼痛干扰;互动式健康教育是最佳的干预形式.
总结1例肾移植术后合并急性抗体介导排斥反应患者的护理经验.护理要点:及早识别消化道出血,积极预防低血容量性休克;严密观察输血并发症;预防深静脉血栓及颈内静脉血栓;提供分阶段营养支持,维持内环境稳定;及早识别急性抗体介导排斥反应,启动应急预案;血浆置换的管理;免疫抑制药物精准化护理;全程心理疏导,缓解患者负性情绪.经过81d积极治疗与精心护理,患者康复出院.
目的 落实以波特兰草案为依据的微量泵持续静脉输注胰岛素优化方案,改善急性心肌梗死合并2型糖尿病患者行经皮冠状动脉介入术后血糖水平.方法 2021年3月—2022年2月将122例急性心肌梗死合并2型糖尿病行经皮冠状动脉介入术患者随机分为试验组和对照组,试验组采取静脉微量泵持续输注胰岛素优化方案,对照组依据波特兰草案调控血糖.采用平均血糖值、血糖标准差、平均血糖波动幅度、餐后血糖波动幅度及葡萄糖目标范围内时间评价患者在住院期间的血糖控制水平.结果 两组的平均血糖值、血糖标准差及平均血糖波动幅度均降低,差异均具有统计学意义(P<0.05),餐后血糖波动幅度差异无统计学意义(P=0.154);两组住院期间葡萄糖目标范围内时间比较,差异均具有统计学意义(P<0.05).结论 护士通过实施微量泵持续静脉输注胰岛素优化方案可减小患者血糖波动幅度,提高葡萄糖目标范围内时间.
目的 汉化减重代谢术后患者自我管理量表(Bariatric Surgery Self-management Questionnaire,BSSQ),并检验其信效度.方法 获取原量表作者授权后对原量表进行正译、综合、回译,经文化调适后形成中文版BSSQ.采用便利抽样法,选取2022年5月—8月于沈阳市某三级甲等综合医院减重代谢外科门诊随访的227例减重代谢术后患者作为调查对象,进行问卷调查,并便利选取30例调查对象于2周后重测,以评价量表的信效度.结果 中文版BSSQ包括9个维度、32个条目.条目水平的内容效度指数为0.833～1.000,量表水平的内容效度指数为0.970.探索性因子分析提取9个因子,累计方差贡献率为60.314％.中文版BSSQ得分与一般自我效能感量表得分呈正相关(r=0.329,P＜0.001)与病人健康问卷抑郁量表得分呈负相关(r=-0.141,P=0.034).中文版BSSQ量表总的Cronbach's α系数为0.867,各维度的Cronbach's α系数为0.420～0.813;中文版BSSQ量表总的重测信度为0.885,各维度的重测信度为0.766～0.982.结论 中文版BSSQ具有良好的信效度,可作为减重代谢术后患者自我管理能力的评价工具.
Objective To develop and evaluate a risk predictive model for high level of self-reported symptom cluster distress in breast cancer patients undergoing chemotherapy. Methods 647 patients who received chemotherapy and met the inclusion and exclusion criteria were selected at 4 tertiary hospitals in Shanghai,Shandong,Jiangsu,and Zhejiang from October 2019 to May 2021. Cases were randomly assigned to a modeling group and a validation group based on 5-fold cross-validation method at a ratio of 8:2. The random forest algorithm was used to develop the risk predictive model in the modeling group. The receiver operating characteristic curve,Hosmer-Lemeshow goodness-of-fit test,calibration curve,and decision curve were used to comprehensively evaluate the prediction performance of the model in the validation group. Risk factors were identified based on the order of the importance of each influencing factors. Results The incidence of high symptom cluster distress was 33.27% in the modeling group and 29.23% in the validation group. The area under the receiver operating characteristic curve of the prediction model was 0.91;the sensitivity was 65.8%;the specificity was 93.5%;Hosmer-Lemeshow goodness-of-fit test was insignificant（P =0.1365）;the decision curve was above the reference line. Body image,self-efficacy,and financial burden were the most important predictors.Conclusion The risk predictive model based on random forest algorithm has good predictive performance,which is of great significance to help identify breast cancer subgroups at high risk of symptom cluster distress,and will potentially promote symptom management.
Objective To explore potential classes characteristics of cancer patients’ fear of recurrence,and to analyze differences in characteristics of cancer patients across classes. Methods A cross-sectional study design with proportional allocation continuous sampling was used to select cancer patients of lung cancer,gastrointestinal cancer,breast cancer and gynecologic tumors who were hospitalized and treated in a tertiary hospital in Shenyang from February 2021 to October 2021 as the survey population. The study instruments included the General Information Questionnaire,the Illness Uncertainty Scale,the Hospital Anxiety and Depression Scale,the Perceived Social Support Scale and the short version of the Fear of Cancer Recurrence Scale. Results A total of 390 cancer patients were investigated,and 76.7% of them had fear of recurrence. Fear of recurrence was demonstrated in 3different potential classes,named as “low fear of recurrence-extroverted”, “medium fear of recurrence-regular”,and“high fear of recurrence-neurotic”.The percentages were 19.5%,59.7%,and 20.8%,respectively.Compared with the type of “low fear of recurrence-extroverted”,cancer patients with higher anxiety levels were more likely to be classified as “medium fear of recurrence-regular” and “high fear of recurrence-neurotic”（OR=1.282,P=0.016;OR=1.378,P=0.010）. Cancer patients with lower levels of social support were more likely to be classified as “medium fear of recurrence-regular” and “high fear of recurrence-neurotic”（OR=0.948,P=0.010;OR=0.900,P＜0.001）. Cancer patients with higher levels of illness uncertainty were more likely to be classified as “high fear of recurrenceneurotic”（OR =1.078,P =0.012）. Conclusion The incidence of fear of recurrence in cancer patients is at a high level with distinct characteristics of classification. It is suggested that health care professionals can adopt targeted nursing interventions according to the personality characteristics of different classes of cancer patients to avoid fear of recurrence.
To summarize the nursing experience of a child with pulmonary rejection after hematopoietic stem cell transplantation who underwent double lung transplantation and was complicated with bronchiolitis obliterans after lung transplantation and underwent second lung transplantation.The key points of nursing included:the implementation of step-wise lateral position and prone position alternate non-invasive mechanical ventilation to improve lung function;sequential airway clearance was used to control pulmonary infection;precise volume management to prevent pulmonary edema;to strengthen the observation and medication management,prevent hospital infection and rejection;to provide goal-oriented personalized nutritional support to improve nutritional status;psychological nursing measures were implemented to improve the treatment confidence and compliance of children;health education and follow-up management should be strengthened to improve the long-term quality of life.After active treatment and careful nursing,the child recovered and was discharged 26 days after surgery.
Objective To describe the status of the post-discharge coping difficulties in women with hypertensive disorders of pregnancy(HDP),and to explore its influencing factors.Methods A total of 280 women with HDP from a tertiary A maternity hospital in Nanjing City were investigated with the general information questionnaire,the post-discharge coping difficulty scale-new mother form,the readiness for hospital discharge study-new mother form,the family APGAR index.The factors influencing post-discharge coping difficulties in women with HDP were analyzed using univariate analysis and multiple linear regression.Results 238 valid questionnaires were collected,with a response rate of 85.0%.The score of the post-discharge coping difficulties in women with HDP was 5.07±1.69,which is at a middle level.The results of multiple linear regression analysis showed that parity,primary caregiver during the postpartum period,HDP type,readiness for hospital discharge,family APGAR index were influencing factors of post-discharge coping difficulties in women with HDP(P＜0.05).Conclusion Post-discharge coping difficulties in women with HDP remains to be further improved,and it is affected by many factors.Medical staff should pay more attention to post-discharge coping difficulties of such parturients,formulate targeted continuation care programs according to relevant influencing factors,comprehensively improve their coping ability,and reduce their coping difficulties after discharge.
Incontinence-associated dermatitis is one of the common complications in critically ill patients.This paper reviews the research progress of risk prediction models for incontinence-associated dermatitis in critically ill patients,introduces and compares the characteristics and application effects of different risk prediction models.The purpose is to provide ideas for constructing a localized risk prediction model and provide evidence for medical staff to identify risk factors of incontinence-associated dermatitis at an early stage and take preventive measures.
To summarize the emergency nursing experience of a patient with extremely severe burns and inhalation injury who developed laryngospasm when establishing an artificial airway.Nursing points include:identification and treatment of complications during artificial airway establishment for high-risk airway patients,and elimination of the risk factors of airway spasm in patients.Conduction of early sedation and awakening,the use of simple communication methods,and the conduction of off-line respiratory assessment and training.The use of active warming measures,and paying attention to fluid resuscitation and body temperature management of burn patients.Trauma team manages the whole process to shorten the emergency stay time of extremely severe burn patients.After 44 days of active treatment and meticulous nursing care,the patient was successfully treated and discharged from the hospital.
Objective To evaluate the methodological quality and measurement characteristics of health literacy assessment tools for diabetic patients and to provide references for medical staff to select the best assessment tools.Methods The PubMed,Embase,CINAHL,Web of Science,CNKI,VIP database,Wanfang Data,and Chinese Biomedical Database were searched from inception to December 31,2022.Data were screened and extracted independently by 2 researchers.The consensus-based standards for the selection of health measurement instruments(COSMIN)system evaluation guidelines were spontaneously used to evaluate the included assessment tools.Finally,recommendations were made.Results A total of 15 studies were included,involving 12 health literacy assessment tools for diabetic patients.Among them,KHLS-DM and DNT-15 have satisfactory content validity and internal consistency and are recommended as Grade A.HLSQ-3 has high-quality evidence to suggest that its internal consistency is"inadequate"and recommended as Grade C,while the other 9 scales are recommended as Grade B for content validity or internal consistency of uncertain/inadequate evidence at or above the intermediate level.Conclusion KHLS-DM can evaluate written literacy,numeracy,and critical literacy of patients,and each measurement characteristic has been comprehensively evaluated with high reliability and validity,so it is recommended to be applied first.DNT-15 focuses on evaluating the numeracy of patients,which can be used in combination with other scales to evaluate health literacy of patients more comprehensively.
Objective To understand the barriers of surrogate decision-makers participating in the advanced care planning(ACP)for patients with advanced cancer,and to provide references for the construction and intervention of educational programs.Methods Under the guidance of ternary reciprocal determinism,qualitative research method was used to conduct semi-structured interviews with 12 surrogate decision makers of advanced cancer patients in 2 tertiary hospitals of Zhejiang Province,and the data was analyzed using targeted content analysis.Results Based on the theory,the influencing factors of participating in ACP of the surrogate decision-makers of patients with advanced cancer were summarized into 3 themes:individual level-dual restriction of subjective thought and objective ability(value restriction,cognitive understanding deviation,economic condition restriction,patient's situation control),environment level-synergistic influence of medical environment and social environment(limited medical conditions,pressure from public moral opinion,insufficient policy guarantee,lack of family consensus),behavior level-interaction of external guidance and internal feedback(lack of guidance of medical staff,experience support of medical decision-making).Conclusion Surrogate decision-makers of patients with advanced cancer face many pressures before participating in the ACP.Under the guidance of the theory of knowledge,belief and practice,medical staff can give them pre-established medical care knowledge to correct their cognitive bias.Medical staff can guide the realization of"family-centered"decision-making mode to strengthen the family support of surrogate decision-makers.Medical staff also can lead the establishment of a surrogate decision-makers support group to share decision-making experience and provide medical decision-making assistance.
Objective To gain an in-depth understanding of the real experiences,feelings and needs of fathers of premature infants in NICU regarding hospital discharge preparation,and to provide a basis for medical institutions on the development of personalized health education plans and continuous nursing care plans for discharged premature infants.Methods By the purposive sampling method,15 fathers of premature infants in NICU of a tertiary obstetrics and gynecology hospital in Zhejiang Province from April 2022 to July 2022 on the day of discharge and 6 weeks after discharge were selected for semi-structured interviews,and the interview data were analyzed using the Colazzi's phenomenological 7-step analysis.Results The experiences and needs of NICU premature fathers in discharge preparation are divided into 4 themes.1.The father's problems coexist with the growth of premature infants,such as expecting to see premature infants on the day of discharge and having confidence in discharge care,experiencing various negative emotions after discharge,and increasing empathy and sense of responsibility after discharge.2.Inadequate ability to care for oneself,including a lack of access to professional care knowledge,a need to improve nursing skills,and an overreliance on premature mothers.3.Social role conflict in the family.4.Longing for assistance,including professional medical advice and more family support.Conclusion Fathers of premature infants in the NICU coexist with negative emotions and growth experiences as they prepare for discharge,with various needs such as reducing role conflict,enhancing independent care ability,and obtaining psychological and multi-party support.To improve their discharge preparation level,nursing staff should develop a personalized health education plan as well as a continuous nursing plan.
Objective This study aims to explore the formation of the dilemma of"giving care"for disabled elderly people in nursing homes from the perspective of active health.Methods Purposive sampling was used to select caregivers and disabled elderly people from a nursing home in Chongqing as research subjects from July 2022 to December 2022.One-on-one in-depth interviews were conducted and Colaizzi's 7-step thematic analysis method was employed to collect and analyze the interview data.Results 4 themes were identified:①the dominance of the"giving"care concept,including the cultural thoughts of filial piety,passive acceptance of care characteristics and consumer psychology regarding paid services;②insufficient"participation"care ability,including lack of knowledge regarding active health and a weakening of skills to promote participation;③the hindrance to"transformation"of care models,including objective limitations in terms of human resources and delays in adapting aging environments;and ④the decline in"utilization"of internal abilities,including excessive avoidance of potential risks,a heavy workload of care and poor quality of individual care.Conclusion The formation of the dilemma of"giving care"for disabled elderly people in nursing homes is affected by multiple factors such as social background,service system,supply resources,and management mode.Transforming disabled elderly individuals from a state of"passive giving care"to"active participation in their health"is an important measure to realize the concept of positive aging and healthy aging.
Objective To systematically evaluate the qualitative studies on the care experience of caregivers for primary malignant bone tumors patients,in order to provide references for the construction of bone tumor support care system.Methods The Cochrane Library,PubMed,Embase,CNKI,Wanfang Database,VIP database,and China Biomedical Literature Database were searched by computer to collect qualitative studies on the care experience of caregivers of malignant bone tumors patients from the establishment of the databases to November 2022.The quality of the literature was evaluated using the Joanna Briggs Institute(JBI)Quality Evaluation Criteria for Quality Research in Evidence-Based Health Care Centers(2016),and the results were integrated by a pooled integration approach.Results A total of 12 studies were included;48 themes were extracted and summarized into 9 categories,which were combined into 3 integrated results.Integration result 1 is obvious physical and mental disturbance.Integration result 2 is multiple role maladaptation.Integration result 3 is positive growth after adjustment.Conclusion Caregivers of patients with malignant bone tumors have serious physical and mental burden and are eager for multiple support.It is suggested that medical staff pay attention to the multi-dimensional needs of patients,formulate personalized support strategies,help caregivers adapt and transform their roles,and promote the post-traumatic growth of caregivers.
Objective To construct a perioperative management program for breast reconstruction with deep inferior epigastric perforator flap with breast cancer,and to provide references for clinical practice.Methods The databases at home and abroad were searched to obtain the relevant literature,and the perioperative management program of breast reconstruction with inferior epigastric artery perforator flap for breast cancer was preliminarily constructed.3 rounds of expert inquiries were conducted by Delphi method from October 2022 to January 2023 to determine the final content of the program.14 patients who received breast reconstruction with deep inferior epigastric perforator flap in a tertiary hospital in Zhejiang Province from January to May in 2023 were selected as application subjects to implement the modified program and evaluate the clinical effect.Results A total of 15 experts completed 3 rounds of consultation.In the third round of consultation,the Kendall's concordance coefficient of the importance of the first-level indicators was 0.347(P<0.05);the Kendall's concordance coefficients of the importance of the second and third-level indicators were 0.388 and 0.200(P<0.001);the coefficient of variation of each indicator was 0～0.224.The final program included 3 first-level indicators,18 second-level indicators and 67 third-level indicators.The incidence of flap complications in 14 patients decreased by 11.9%.Conclusion The perioperative management program of breast reconstruction with deep inferior epigastric perforator flap for breast cancer is preliminarily applied in clinical practice,which is scientific,reliable and practical,and it can provide references for clinical nursing.
Reducing the level of emotional expression conflict of patients is of great significance to promote the functional recovery of breast cancer patients,improve their prognosis and improve their quality of life.We introduce the research progress of ambivalence over emotional expression in breast cancer patients in terms of the connotation,measurement tools,influencing factors,and intervention methods.There is still a lack of research on measuring the emotional expression conflict of breast cancer patients in China,and it is still necessary to develop a measurement tool with cultural characteristics to obtain the true level of emotional expression conflict of patients.In clinical practice,complementary and alternative medicine,cognitive behavioral intervention,mindfulness training,expressive writing intervention,and other intervention strategies have achieved certain results in improving patients'negative emotions,but personalized intervention strategies still need further exploration.
Objective To investigate the application effect of a graded management program of hand-foot syndrome(HFS)in patients with breast cancer who received chemotherapy.Methods Convenience sampling method was adopted to select breast cancer patients who received chemotherapy in the breast surgery department of a tertiary A hospital in Wuhan.According to the time of admission,55 patients admitted from April 2022 to September 2022 were included in the experimental group,in which the graded management program was carried out according to the occurrence of HFS.55 patients admitted from October 2021 to March 2022 were included in the control group,in which the routine chemotherapy care was carried out.Interventions in both groups lasted until 3 days after the last chemotherapy.The incidence of HFS and its impact on quality of life 3 days after the final chemotherapy were compared between the 2 groups.Results The incidence of HFS was 34.55%in the experimental group and 58.18%in the control group,and there were significant differences in the incidence and grade of HFS between the 2 groups(P<0.05).The total score of life quality scale in the experimental group was 15.00(13.00,17.00)and 19.00(17.00,22.00)in the control group.The life quality of patients in the experimental group was significantly higher than that in the control group(P<0.001).Conclusion The graded management program for breast cancer patients with HFS can reduce the incidence and grade of HFS,and can help to improve the quality of life in breast cancer patients who received chemotherapy.
Objective To gain insights into the supportive care needs of liver transplant recipients,in order to provide references for the formulation of effective and targeted intervention strategies.Methods Phenomenological research method was employed to conduct semi-structural in-depth interviews with 16 liver transplant recipients in the liver transplant center of a tertiary hospital in Shanghai from November 2021 to April 2022.Colaizzi 7-step analysis method and Nvivo software were used to analyze and extract the themes.Results 5 themes were extracted,including symptom management needs,longing for the perception and avoidance of recurrence risk,disease information management needs,emotional and psychological support and the return to social roles.Conclusion The physical distress and burden of liver transplantation recipients coexist.Although the initiative to seek medical treatment is high,the perception level of disease recurrence risk is not high.In order to meet the needs of liver transplant recipients and improve their quality of life,it is necessary to strengthen the health education of disease symptom management and related risk factors,pay attention to psychological counseling and strengthen social support,and provide targeted treatment care.
