BackgroundThe incidence rate of colorectal cancer (CRC) is rising among adults under the age of 50 (early-onset colorectal cancer, EOCRC). Post-ostomy dysfunction, along with negative perceptions due to incorrect public views and a decline in quality of life, has a significant impact on these individuals, their families, and social relationships.ObjectiveBy understanding the adaptation process of post-ostomy EOCRC(POEOCRC) patients, this study aims to provide information for developing targeted nursing interventions for this population.MethodsBased on the social-ecological theory, semi-structured, in-depth interviews were conducted with 16 POEOCRC patients in China between May 2023 and January 2024.Colaizzi’s method of phenomenology was employed for data analysis.ResultsThis study found two aspects of adaptation experience in POEOCRC patients. For resilience, three themes emerged:(1) Micro-Positive individual psychological experiences, (2) Meso-Positive adjustment within the family and (3) Macro-Social resource integration and utilization. In terms of vulnerability, three themes were as follows:(1) Micro-Persistent negative experiences, (2) Meso-Family crisis caused by the ostomy and (3) Macro-Urgency and fragility of social support.ConclusionThis study based on the social-ecological theory and highlights different dimensions of resilience and vulnerability experienced by POEOCRC patients. Early and targeted interventions to promote patients’ coping skills and their ability to adapt to family and society.

PurposeWith the prolonged survival time of patients with permanent colostomy for colorectal cancer, they and their spouses face tremendous pressure and development dilemmas that can easily lead to family adaptation crises. This qualitative study amid to explore the dyadic experiences of family resilience among Chinese patients with permanent colostomy and their spouses.MethodsA phenomenological research method was adopted. Semi-structured, in-depth, face-to-face interviews with 10 dyads of patients with permanent colostomy and their spouses were recruited through purposive sampling from a public tertiary hospital in China from March 2023 to July 2023.The Dyadic interview analysis and Colaizzi methods were used to analyze the interview data.ResultsThree themes and nine subthemes were developed. (1) family crisis and dichotomous coping with stress-family crisis and coping pressure caused by enterostomy;(2) Adjustment and adaptation within the family-Joint adjustment and adaptation within the couple's family; and (3) integration and utilization of multi-dimensional social external resources (micro-level, meso-level, and macro-level).ConclusionsCouples living with permanent colostomy often undergo a complex emotional journey, experiencing varied levels of individual stress as they navigate social interactions and daily activities, which can contribute to a decline in family adaptation. With the help of the perspective of family advantage, health practitioners should pay attention to the evaluation of individual factors and family environmental resources , to fully mobilize advantage resources and give effective interventions to improve the family and social adaptation level of patients and their spouses.

Background To understand the current state of financial toxicity and suicide risk in head and neck cancer patients,to investigate the correlation between the level of financial toxicity and suicide risk in head and neck cancer patients,and to provide a basis for reducing the level of financial toxicity and the risk of suicide in head and neck cancer patients. Methods A cross-sectional survey was conducted,from March 1 to July 31,2022,150 head and neck cancer patients were selected from Oncology Department of East Hospital Affiliated to Tongji University by convenient sampling method.The survey was carried out by means of the general questionnaire,Comprehensive Score for Financial Toxicity based on the Patient-Report Outcome Measures(COST-PROM),Cancer Suicide Risk Scale(CSRS),and then analysis the datum. Results The score of COST-FROM of 150 head and neck cancer patients was (18.00±6.12) points,and the score of CSRS of head and neck cancer patients was (36.31±8.51) points.The total score of economic toxicity was significantly negatively correlated with the total score of suicide risk and its dimensions (r values were − 0.446 to 0.235,all P<0.05).The total score of suicide risk was negatively correlated with the total score of economic toxicity and the scores of each dimension (r values were − 0.446 to -0.251,all P<0.05). Conclusion Patients with head and neck cancer were at higher risk of suicide,and financial toxicity was a significant contributing factor to suicide risk,with higher levels of financial toxicity associated with a higher risk of suicide.Reducing the level of financial toxicity in patients with head and neck cancer has important implications for reducing their risk of suicide.

Objective:To understand the current state of financial toxicity and suicide risk in head and neck cancer patients, to investigate the correlation between the level of financial toxicity and suicide risk in head and neck cancer patients, and to provide a basis for reducing the level of financial toxicity and the risk of suicide in head and neck cancer patients.Methods:A cross-sectional survey was conducted, from March 1 to July 31, 2022, 150 head and neck cancer patients were selected from Oncology Department of East Hospital Affiliated to Tongji Universityby by convenient sampling method. The survey was carried out by means of the general questionnaire, Comprehensive Score for Financial Toxicity based on the Patient-Reported Outcome Measures (COST-PROM), Cancer Suicide Risk Scale (CSRS), and then analysis the datum.Results:The score of COST-PROM of 150 head and neck cancer patients was (18.00 ± 6.12) points, and the score of CSRS of head and neck cancer patients was (36.31 ± 8.51) points. The total score of economic toxicity was significantly negatively correlated with the total score of suicide risk and its dimensions ( r values were -0.446 to 0.235, all P<0.05). The total score of suicide risk was negatively correlated with the total score of economic toxicity and the scores of each dimension ( r values were -0.446 to -0.251, all P<0.05). Conclusions:Patients with head and neck cancer were at higher risk of suicide, and financial toxicity was a significant contributing factor to suicide risk, with higher levels of financial toxicity associated with a higher risk of suicide. Reducing the level of financial toxicity in patients with head and neck cancer has important implications for reducing their risk of suicide.

Objective:To describe the family resilience experience of colorectal cancer patients′ spouses in the process of care, and to provide reference for making effective clinical nursing interventions.Methods:Objective sampling method was used to select the spouses of colorectal cancer patients who were hospitalized in Shanghai East Hospital from March to April 2023. A phenomenological research was used. Semi-structured, in-depth interviews were conducted with 10 spouses of colorectal cancer patients undergoing colostomy. Data was transcribed and analyzed using Colaizzi′s method.Results:Three themes were extracted: family crisis and coping pressure including increased burden of care, accompanying emotional internal friction, heavy economic pressure; internal adjustment and adaptation within the family including positive family beliefs, timely adjustment of family roles, clear and effective communication and interaction; integration and utilization of external resources including active access to information, medical professional support, social external support.Conclusions:With the help of the perspective of family advantage, medical staff should pay attention to the evaluation of care needs and family resilience of colorectal cancer patients′ spouses, to fully mobilize advantage resources and give effective intervention measures to improve the family and social adaptation level of patients and their spouses.

综述营养风险的概念、常用营养评估工具、营养风险与营养支持现状、影响因素研究及常用营养支持方法,提出营养筛查量表专一性不足、我国肿瘤病人营养支持率低、营养支持方式不合理等问题,以期对肿瘤病人的营养风险筛查、营养支持研究提供参考和借鉴.

文章介绍比较了6个用于指导临床安宁疗护工作的理论框架及其应用实践,包括症状管理理论、二元应对理论、叙事护理理论、舒适护理理论、和谐护理理论和华生关怀理论,以期为临床安宁疗护工作人员开展多样化干预策略提供借鉴选择,并为临床开展相关理论及实践研究提供参考.

目的 探讨新型冠状病毒肺炎患者在入住隔离病房后的真实想法和体验,为制订针对性护理策略提供参考.方法 采用质性研究中的现象学研究方法,于2020年3月对7例入住武汉雷神山医院的新型冠状病毒肺炎患者进行面对面半结构性访谈,并以Colaizzi七步分析法对访谈资料进行整理分析.结果 针对7例患者的真实住院体验,提炼出6个主题:初入病房时内心充满矛盾、住院期间感到压抑和孤独、体验到疾病及治疗的诸多不确定感、能更好地尊重和体谅医护人员、渴望得到更多支持、积极尝试各种自我应对策略.结论 了解新型冠状病毒肺炎住院患者的心理变化有利于护士开展针对性的健康宣教和心理支持,有利于加强护患合作、增强患者战胜疾病的信心.

目的:对消化道癌症病人化疗期间不同症状体验进行症状群的研究,为进一步采取症状群联合干预方案提供指导.方法:采用便利抽样法选取某三级甲等综合医院肿瘤科化疗的207例消化道癌症病人,运用一般资料调查表、安德森症状调查量表进行问卷调查,获取病人的症状体验,进行分析和分类;并分别根据症状发生率和严重度进行探索性因子分析,提取症状群,比较和分析症状群的稳定性.结果:消化道癌症病人化疗期间存在多种症状,发生率最高的症状为疲乏,其次为食欲下降、口干;相对较严重的症状为食欲下降,其次为疲乏、恶心;症状造成的困扰依次为对一般活动、情绪、走路等的影响.经四象限分析得出发生率高、严重度也高的症状包括疲乏、嗜睡/困倦、恶心、食欲下降、口干,建议作为干预方案需要考虑的关键性症状.根据症状发生率和严重度进行探索性因子分析均得出4个症状群:胃肠道症状群、疲乏症状群或疲乏-疼痛症状群、心理症状群或疼痛-心理症状群、神经毒性症状群.其中根据严重度维度得出的症状群累积可解释86.40％的变异,根据发生率维度得出的症状群累积可解释60.89％的变异,两种方法获得的症状群结果一致性为84.6％.结论:采用症状的发生率、严重度以及四象限分类法可以获得最需要关注的重要症状;采用不同的维度提取症状群一致性较好.特别是采用严重度提取的症状群,与最需要关注的重要症状作为指引,形成重点,或可作为症状群联合干预的重要依据,提高症状管理的效率.

目的 调查消化道癌症患者化疗期间症状群构成,分析各症状群严重程度的影响因素,为实现针对性症状群管理提供参考.方法 便利抽样选取2018年1-12月在某三级甲等医院肿瘤专科诊治的消化道癌症患者207例为研究对象,采用一般人口学资料、疾病资料和心理状况调查表(心理一致感量表)、安德森症状调查量表对其进行调查;通过探索性因子分析提取症状群,采用多元逐步回归分析影响因素.结果 患者化疗期间存在4个症状群,即胃肠道症状群、疲乏-疼痛症状群、心理症状群和神经毒性症状群,累积可解释86.40％的变异;职业状态、文化程度、病程、疾病分期、化疗方案、化疗次数、心理一致感等分别是各症状群严重程度的影响因素(均P<0.05),其中心理一致感对4个症状群的严重程度均有影响.结论 医护人员应从症状群角度对患者进行症状管理,并可根据影响因素,对患者实施针对性干预,以实现症状困扰最小化、生活质量最优化.

Objective: To analyze the effects of gradual and early rehabilitation exercises in bed on promoting postoperative bowel recovery in patients with colorectal cancer. Methods: Eighty colorectal cancer patients having radical surgery were randomly divided into experimental group and control group, with 40 cases in each group. The patients in experimental group began to do rehabilitation exercise in bed gradually 6 hours after the operation under nurses' direction, and the control group received routine care after the operation. Patients' recovery situation of intestinal function was compared between two groups. Results: The recovery time of bowel sounds, the first flatus time, first defecation time, first time of eating liquid and time of meeting the discharge standards were all earlier than those of the control group (P<0.05).Conclusion: The gradual and early rehabilitation exercises in bed are safe and feasible, which can effectively promote the early bowel recovery of patients with colorectal cancer after surgery.

Objective To understand the situation of nursing teamwork against a background of high-quality nursing service and to explore the influencing factors of nursing teamwork so as to find out practical solutions to improve the level of nursing teamwork.Methods A total of 380 nurses of a classⅢ grade A general hospital in Shanghai Municipality were investigated with the nursing teamwork survey (NTS) by cluster sampling in June 2016. The data were analyzed with SPSS 20.0.Results The median of the total score of NTS among nurses was 4.31 (the full marks are 5). The scores of four dimensions from the highest to the lowest were: team leader (4.75), shared mental models (4.50), trust and support (4.38), team-oriented (4.00). The influencing factors of nursing teamwork included departments, weekly working hours, overtime hours and most often shift nearly three months, whether planed to leave current operating post and departments human resource allocation with significant differences (P<0.05).Conclusions There is still room for improvement in nursing teamwork. Promot teamwork among nurses through reasonably allocating nursing human resources, scientifically scheduling, strengthening humanistic concern and reducing negative effects.

Objective We assessed the effectiveness of a new standardized nursing cooperation workflow in patients with acute ischemic stroke (AIS) to reduce stroke thrombolysis delays. Patients and methods AIS patients receiving conventional thrombolysis treatment from March to September 2015 were included in the control group, referred to as T0. The intervention group, referred to as T1 group, consisted of AIS patients receiving a new standardized nursing cooperation workflow for intravenous thrombolysis (IVT) at the emergency department of Shanghai East Hospital (Shanghai, People’s Republic of China) from October 2015 to March 2016. Information was collected on the following therapeutic techniques used: application or not of thrombolysis, computed tomography (CT) time, and door-to-needle (DTN) time. A nursing coordinator who helped patients fulfill the medical examinations and diagnosis was appointed to T1 group. In addition, a nurse was sent immediately from the stroke unit to the emergency department to aid the thrombolysis treatment. Results The average value of the door-to-CT initiation time was 38.67±5.21 min in the T0 group, whereas it was 14.39±4.35 min in the T1 group; the average values of CT completion-to-needle time were 55.06±4.82 and 30.26±3.66 min; the average values of DTN time were 100.43±6.05 and 55.68±3.62 min, respectively; thrombolysis time was improved from 12.8% (88/689) in the T0 group to 32.5% (231/712) in the T1 group (all P<0.01). In addition, the new standardized nursing cooperation workflow decreased the National Institutes of Health Stroke Scale (NIHSS) scores at 24 h (P<0.01) (T0: prethrombolysis, 6.97±3.98; 24 h postthrombolysis, 3.33±2.09; 2 weeks postthrombolysis, 2.25±1.01 and T1: prethrombolysis, 7.00±3.89; 24 h postthrombolysis, 2.60±1.66; 2 weeks postthrombolysis, 2.21±1.02). Conclusion The new standardized nursing cooperation workflow reduced stroke thrombolysis delays in patients with AIS.

Objective: To explore the effect of the Knowledge-Skills-Support symptom management program on the gastrointestinal symptom cluster in cancer patients. Methods: The patients admitted from July to December in 2014 were selected as the control group, which accepted routine care. While the patients admitted from April to September in 2015 were selected as experimental group, which treated with the Knowledge-Skills-Support symptom management program. The MSAS, FACT-G (V4.0) and KPS were used to evaluated the differences in the gastrointestinal symptoms, quality of life and functional status of two groups patients on admission, one week after chemotherapy, one month after chemotherapy and three months after chemotherapy. Results: There were statistically significant between two groups in gastrointestinal symptoms experience (F=4.817,P=0.036), functional status (F=2.829,P=0.049) and quality of life (F=15.372,P<0.001). Conclusion: Knowledge-Skills-Support symptom management program can effectively improve the gastrointestinal symptoms, functional status and quality of life of cancer patients.

Background: The integration of self-efficacy (SE) theory within a nurse-led telephone follow-up education program (NP-FEP) has not been extensively evaluated for patients with cardiovascular disease. Objectives: The aim of this study is to determine the effectiveness of an NP-FEP in improving SE (primary outcome) and achieving goals related to cardiovascular risk (secondary outcome) for patients with cardiovascular disease. Methods: In June and July 2013, a total of 403 patients with cardiovascular disease in Shanghai were randomized into the intervention and control groups. Personalized end goals were established for improving cardiovascular risk for each patient. The control group received conventional follow-up education, whereas the intervention group was contacted by telephone 11 times over a 6-month period with staged goals developed based on SE theory. Self-efficacy scores and goals for reducing cardiovascular risk were assessed at baseline, at the end of the 6-month intervention, and 12 months after enrollment. Results: The SE scores in both groups increased at 6 months and decreased slightly at 12 months. The baseline SE scores were similar between the groups (P > .05), but the average SE scores were increased more for the intervention group than for the control group at 6 (P < .05) and 12 (P < .05) months. In addition, the final goal achievement rates for the intervention group were significantly higher than for the control group (P < .05). The difference between the 2 groups was reflected by differences in cardiac disease risk factors defined by the World Health Organization. Conclusion: The NP-FEP improved SE and facilitated achievement of goals related to risk factors in patients with cardiovascular disease for at least 1 year.

Objective To introduce and translate the English version of Team Development Measure (TDM) into Chinese one and evaluate the reliability and validity of the Chinese version for general practitioner teams to provide a basis for studying the development of the general practitioner teams.Methods According to the Guidelines for the Process of Cross-Cultural Adaptation of Self-report Measures, we completed the translation and culture debugging. Using the convenient sampling method, a total of 26 community health centers were selected which included 85 general practitioner teams for investigation and analyzing the reliability and validity of TDM. The data were statistically analyzed by SPSS 20.0 and AMOS 22.0.Results The correlation (r) between each item and total score of item analysis was 0.251-0.695 (all P<0.001). AllCR values of these items were greater than 3.0 except item 17 and item 23. By use the CFA method,KMO=0.912, and got 4 common factors finally, which could explain 54.3% of overall variance; and had a good fitness CFA confirmed. The Cronbach's α coefficients of the total scale and each dimensions were 0.925,and 0.680-0.916 respectively. The retest reliability was 0.787 (P<0.001).Conclusions The Chinese version of TDM has good reliability and validity and can be used as a tool for measuring the general practitioner team development.

Objective To design the specific,operational bedside teaching program for critical nursing,in order to provide references for the curriculum setting of emergent and critical care for nursing students upgraded from junior college.Methods According to the Taylor program framework,combined with criti-cal nursing practice requirements,the program was set based on literature review and focus group interview with experts.Two rounds of expert consultation were conducted using Delphi method.Results The positive coefficients in the two rounds of expert consultation were 83.33% and 92.00%,respectively.The authorita-tive coefficient was 0.903 and coefficient of concordance was 0.401 (P <0.001 ).Five first-level indicators and 1 9 second-level indicators and 57 third level indicators were determined.Conclusions The curriculum of emergent and critical care for nursing students upgraded from junior college through bedside teaching is practical and operational,and it could be used as reference for other subjects in nursing students upgraded from junior college.

目的 运用动态血糖监测系统,评价睡前饮食对老年2型糖尿病患者夜间低血糖发生率的干预效果.方法 选择佩戴动态血糖监测系统且睡前(22:00监测)指尖血糖在5.0～5.6 mmol/L之间的老年2型糖尿病患者100例,随机分为观察组和对照组,观察组给予饮食干预,对照组进行常规护理,比较两组患者夜间低血糖、高血糖发生率及血糖波动幅度.结果 观察组夜间低血糖发生5人次,对照组发生44人次,差异有统计学意义(P＜0.01);观察组夜间高血糖发生4人次,对照组发生2人次,差异无统计学意义(P＞0.05);两组血糖波动幅度比较:观察组血糖范围在3.9～5.6 mmol/L时各时间段持续时间比较差异有统计学意义(P＜0.05);对照组血糖范围在≤3.9、3.9～5.6、5.7～10 mmol/L时各时间段持续时间比较差异有统计学意义(P＜0.05).结论 老年2型糖尿病患者22:00血糖若低于5.6 mmol/L时,应给予饮食干预,可有效预防夜间低血糖的发生,同时不增加高血糖风险,而且降低了血糖波动幅度.

Objective To investigate the status of self-efficacy in cardiac disease patients when discharged, and to explore the influencing factors .Methods A total of 403 patients were selected from Cardiology and Cardiothoracic Surgery Department in a three-A hospital during March to August in 2013 .The chronic disease self-efficacy scale and the basic information questionnaire of cardiac disease patients ( self-designed) were administered to these patients when discharged .Differences of self-efficacy between medical and surgical patients were compared , and the influencing factors were analyzed .Results The average score of self-efficacy for these patients was (6.63 ±1.90), which belonged to the medium level.There was a significant difference between medical and surgical patients in self-efficacy (7.27 ±1.83 vs 6.01 ±1.75;t=-7.080,P<0.01).Univariate analysis showed that the influencing factors of self-efficacy in patients including age, education background , heart function level , and the number of hospital admissions and length of hospital stay . Conclusions The self-efficacy in cardiac disease patients is in the medium level , and the self-efficacy of surgical patient is lower than that in the medical patients .

目的 采用加权秩和比法评价浦东新区44所社区卫生中心社区护理相关政策的落实情况.方法 采用德尔菲法确定“十二五”规划中提出的社区卫生护理工作相关的6个政策维度,即“护理内涵拓展(六位一体)”、“家庭责任制实行”、“人员素质能力提升”、“培训教育增加”、“专科技术和学科建设”、“考核和薪酬合理”,确定了各政策评价指标的计分标准及权重.通过对浦东新区44家社区卫生服务中心分批进行焦点小组访谈和后续补充收集数据.数据采用加权秩和比法进行统计分析.结果 根据行为、价值/导向性、效率、可行性/可操作性四方面进行评价.结果显示,6个维度间存在差异(F=42.423,P＜0.01),两两比较,“家庭责任制实行”相关政策落实情况最好,2项“护理内涵拓展”次之,“专科技术和学科建设”及“考核和薪酬合理”2项相关政策落实最差.结论 浦东新区社区卫生服务中心对社区护理相关政策的落实情况存在差异,应对社区普遍落实不良的具体政策应该进行更深入的探讨和分析,以便能够为社区护理工作的改善提供科学建议.