PurposeWe aimed to systematically review studies that used a group-based trajectory modeling approach to explore the categories of fear of cancer recurrence (FCR) trajectories and their predictors in cancer survivors.MethodsMEDLINE, EMBASE, CINAHL, Scopus, and Web of Science were searched. Three authors independently reviewed the literature for predefined eligibility criteria. The Joanna Briggs Institute critical appraisal tools for Cohort Studies and the Guidelines for Reporting on Latent Trajectory Studies were used to assess the quality of included studies. A qualitative synthesis of the included studies was performed.ResultsNinety-eight studies were retrieved after removing duplicates, and 11 studies met the criteria for inclusion. There are four types of FCR trajectories: stable, decreasing, increasing, and stable-then-decreasing-then-increasing. The following factors were considered significant predictors of FCR trajectory category in at least one of the included studies: age, race, income, education, employment, cancer stage, physical symptoms, depression, anxiety, satisfaction with medical care, and selected cognitive and behavioral factors.ConclusionsThere was considerable heterogeneity among the studies included in study design and FCR trajectory results. Factors that significantly predicted FCR trajectory categories mostly focused on psychological characteristics. The correlation of sociodemographic and disease-related predictors with FCR trajectory categories was not consistent among the included studies.Implications for cancer survivorsWe suggest that future scholars should incorporate more psychological factors when identifying cancer survivors who persistently maintain a high level of FCR and developing FCR mitigation measures.

目的 通过概念分析法界定跌倒恐惧的概念内涵,为今后科学准确地评估老年人跌倒恐惧以及制订针对性的护理干预计划提供参考.方法 系统检索中国知网、万方、维普、PubMed、Web of Science等数据库从建库至2022年1月12日收录的有关跌倒恐惧的相关文献,共纳入41篇文献.采用Walker等提出的经典概念分析法对文献中关于跌倒恐惧的概念内涵进行分析.结果 老年人跌倒恐惧的定义属性包括以下3个方面.①情绪状态:焦虑、担忧;②认知机制:对潜在威胁的主观估计和避免跌倒能力的现实评估;③行为元素:活动回避.结论 鉴于跌倒恐惧的高发生率和不良后果,临床医护人员应认识到跌倒恐惧的存在及其重要性,通过早期识别高风险人群构建并开展针对性的护理措施,以期降低老年人跌倒恐惧.

Abstract Purpose This study aimed to explore psychological resilience subgroups of colorectal cancer inpatients with an enterostomy through latent profile analyses and to identify the sociodemographic, clinical and psychological characteristics among resilience subgroup members. Methods A cross-sectional study was conducted. 226 colorectal cancer patients after enterostomy were recruited in the study. Data were collected with a general information questionnaire, Conner Davidson Resilience Scale, Medical Coping Modes Questionnaire, Stoma Self-Efficacy Scaleand Social Support Rating Scale. Results Three distinct subgroups of resilience were identified: “adaptation difficulty group” (33.6%), “moderate adaptation group” (29.2%) and “complete adaptation group” (37.2%). Monthly per capita family income, social support, and self-efficacy were predictors of resilience subgroups. Conclusion The resilience of colorectal cancer patients after enterostomy can be divided into several subgroups. The decrease in family income per month, self-efficacy and social support will increase the risk of patients belonging to the adaptation difficulty group or moderate adaptation group. Clinical nurses should develop targeted intervention programmes based on the characteristics of subgroups at high risk of resilience to further improve patient resilience.

目的 了解老年患者家属对日间手术流程的真实体验与需求,为临床适老化日间手术流程的构建提供参考.方法 采用质性研究中的现象学研究方法,于2021年10-12月对10名老年日间手术患者家属进行面对面半结构性访谈,并以Giorgi六步法对访谈资料进行整理和分析.结果 老年患者家属对日间手术流程整体体验的感知包括术前等候时间长、术中易产生焦虑情绪、围术期渴望得到健康指导.老年患者家属对日间手术流程的需求包括术前对手术相关信息需求大、术后对疾病康复护理内容需求多、围手术期对人文关怀有一定需求.结论 适老化日间手术流程的构建可以从加强人文关怀、完善信息支持系统和延续性护理服务着手,降低老年患者家属的焦虑,促进适老化日间手术流程的优化与老年友好型医疗护理环境的发展.

目的 分析门诊居家老年压力性损伤患者营养状况及其影响因素.方法 采用微型营养评价精法对112例门诊居家老年压力性损伤患者进行营养评估.结果 微型营养评价精法评分平均分为(6.33±2.88)分,73.2％患者营养不良,22.3％患者有营养不良的风险,仅4.5％患者营养状况正常,消化道功能是否异常、不同饮食类型、是否有吞咽障碍、是否有自行进食困难及压力性损伤创面个数将影响患者的营养状况.结论 门诊居家老年压力性损伤患者营养状况较差,不同压力性损伤创面个数将影响患者营养状况,建议联合营养师,加强门诊患者的营养评估,给予针对性营养教育,必要时给予合适的营养支持,以改善患者营养状况,促进压力性损伤创面愈合.

目的 探讨老年跌倒骨折患者跌倒恐惧体验的变化,为制订有效的针对性护理干预措施提供参考.方法 采用纵向质性研究方法,以目的抽样法选取骨科病房16例老年跌倒骨折患者进行半结构式访谈,并对资料进行横断面和纵向分析.结果 共提炼出3个主题及8个亚主题:跌倒恐惧情绪体验的变化(负向情绪发展,正向情绪调节),跌倒恐惧认知体验的变化(成因多元化,自我效能降低),跌倒恐惧应对体验的变化(保持谨慎态度,树立康复信心,提升知识储备,寻求外部支持).结论 老年人跌倒恐惧体验是一个复杂的现象,呈现动态的变化过程,临床医护人员在跌倒预防计划中应早期识别存在跌倒恐惧的老年人,并通过多学科团队实施预防性护理干预.

ObjectiveTo evaluate the quality of clinical practice guidelines related to the follow-up of prostate cancer patients and to analyze the contents of their recommendations.MethodsClinical practice guidelines related to follow⁃up of prostate cancer were searched in PubMed，EMbase，CINAHL，CNKI，CBM，Wanfang Data and related guideline websites.AGREE Ⅱ was used to evaluate the quality of the included guidelines，and literature content analysis was used to analyze the recommendations.ResultsA total of five clinical practice guidelines were included，of which two were grade A and three were grade B.In descending order of average score，the six domains in AGREE Ⅱ were scope and purpose（90.28%），editorial independence（87.08%），clarity（84.72%），development eligibility（75.83%），participants（73.89%），and applicability（50.83%）.Based on content analysis，19 items were extracted，including four aspects of collaborative nursing，side effects management，health promotion，monitoring and follow⁃up.ConclusionThe quality of the included guidelines was good and the recommended contents were comprehensive，but the application of guidelines needs to be improved.

The number of hernia surgery is huge, but the surgical effects are totally different. The cooperation between clinical nurses and doctors in the perioperative period of hernia surgery and nursing in enhanced recovery after surgery are very important. According to the different characteristics of inguinal hernia, abdominal incisional hernia and parastomal hernia, different medical and nursing joint modes are needed for cooperation and clinical intervention, especially in the prevention and treatment of venous thromboembolism. Real-time monitoring and guidance shall be given, so as to promote patients and medical staff to actively participate in the formulation and implementation of clinical diagnosis and treatment plan, to help surgical patients achieve enhanced recovery after surgery.

目的 探讨加速康复外科(ERAS)护理在胰十二指肠切除术患者围手术期的应用价值.方法 选取2016年9月—2019年8月在华东医院接受胰十二指肠切除术的46例胰腺癌患者,随机分为对照组(n=23)和观察组(n=23).对照组予常规护理,观察组在对照组的基础上行ERAS护理.比较两组患者的首次肛门排气时间、首次离床时间、住院时间和腹腔引流拔管时间以及并发症发生率.结果 观察组患者的首次肛门排气时间、首次离床时间、住院天数和腹腔引流拔管时间分别为2.63天、4.01天、18.56天和9.19天,少于对照组的3.12天、6.22天、26.59天和13.02天(P<0.01);观察组并发症发生率(30.43％)低于对照组(65.22％,P=0.023).结论 ERAS护理可以一定程度上加速胰十二指肠切除术患者围手术期的术后康复.

BACKGROUNDPatients following radical prostatectomy will encounter various symptoms that may vary depending on the recovery of surgery and the use of adjuvant treatments. However, few studies have used the scale developed for prostate cancer to longitudinally assess the course of symptoms in Chinese patients. This study aimed to identify the symptom trajectories and the influencing factors in the prostate cancer patients of our area.METHODSA prospective observational study was conducted, and 155 patients with prostate cancer from 3 hospitals in Shanghai were recruited. Demographic and disease-related information was collected during the hospitalization. Further information on symptoms, adjuvant treatment, and functional exercise was collected across 4 time points. Growth mixture modeling was used to identify the trajectory patterns of symptoms, and logistic regression was used to determine the predictors.RESULTSA total of 143 patients completed the investigation of all points, with a lost-to-follow-up rate of 7.7%. Urinary incontinence, urinary tract irritation, sexual dysfunction, pelvic pain, and hormone related symptoms all had group heterogeneity, and the number of latent category trajectories obtained was 4, 3, 3, 4, and 3 respectively. There were differences in demographic, disease, and treatment-related information between the groups.CONCLUSIONSPatients with prostate cancer have different symptom levels across different periods after radical prostatectomy. Medical staff can predict these changes based on the initial level of symptoms and related factors such as age, prostate volume, medical comorbidities, drug of adjuvant treatment to clarify the critical points, populations, and symptoms that require monitoring during follow-up.

压力性损伤是指皮肤和(或)皮下组织的局限性损伤,通常发生在骨隆突处,一般由压力或压力联合剪切力造成[1].压力性损伤是一个突出的全球性健康问题,随着人口老龄化、心血管疾病以及晚期癌症的增多,卧床患者以及重症患者不断增加,家庭护理的范围越来越广,压力性损伤的发生率居高不下[2].据国外的文献报道压力性损伤的发病率为4.3％～22.9％[3-6].

目的 将经尿道前列腺切除术后膀胱冲洗的最佳证据应用于临床,并评价其效果.方法 采用JBI循证保健中心的临床实践应用模式,通过基线审查、证据应用、证据应用后再审查三个阶段,比较应用证据前后各项指标的变化.结果 证据应用前后,经尿道前列腺切除术后患者膀胱冲洗时间由(49.40±12.95)h缩短至(31.30±17.37)h,差异有统计学意义(P<0.05);经尿道前列腺切除术后患者导尿管堵管发生率由13％下降至3％,但差异无统计学意义(P>0.05);证据应用后经尿道前列腺切除术后患者满意度得分高于证据应用前(P<0.05).证据应用后,护士对最佳证据的执行率得到提高.结论 对经尿道前列腺切除术后膀胱冲洗患者开展基于循证的最佳证据应用,可缩短经尿道前列腺切除术后患者膀胱冲洗的时间,提高患者的满意度,提高临床护理质量,促进护理持续质量改进.

Objective To explore the experience of nutritional care provided by the main caregivers of elderly patients with pressure injury in outpatients. Methods Semi-structured, in-depth interviews were conducted on 15 main caregivers of elderly patients with pressure injury in outpatient by the purposive sampling method. Data was analyzed by Colaizzi content analysis. Results Seven themes were identified, including multiple troubles in nutritional care, lack of awareness of the relationship between nutrition and pressure injury, poor knowledge of nutritional care, unreliable ways to obtain the knowledge, poor attitude towards nutritional care, poor nutritional care behaviors, and differences in nutritional care needs. Conclusion Health care providers should value the evaluation of patients'eating ability and behavior, provide more learning approaches, change their attitude, improve the nutritional care behavior, and, if necessary, cooperate with nutritionists to provide targeted nutrition education, and establish effective family and social support systems.

Objective To investigate the current status of the knowledge about the pressure injury and caring behaviors among nursing assistants of the bedridden elderly in long-term care (LTC) facilities and to analyze its influencing factors.Methods From April to October 2017, 155 nursing assistants in seven LTC facilities in Shanghai were recruited by convenience sampling method and investigated with general information questionnaire, the Caregivers' Knowledge Questionnaire (CKQ) and the Caring Behaviors Questionnaire (CBQ).The knowledge, behavior status and influencing factors of stress injury among nursing assistents were analyzed. Results The scores of CKQ and CBQ questionnaires were 12.06±2.04 and 58.10±5.27, respectively;and the score indices were 70.94％ and 80.69％, respectively.The lowest dimensions of the score indices were "the definition of the basic concept of stress injury" and "the application of decompression devices".There were significant differences in the scores of stress injury CKQ questionnaires among caregivers with different levels of license certification, the years of working experience, the rule of being manager or nursing leader and the frequency of training (all P<0.05). The differences in the scores of behavior of caregivers with or without experience of caring for stress ulcer patients in different pension institutions were statistically significant (all P<0.05).There were some deficiencies in the knowledge of stress injury risk among caregivers for the elderly patients; and there were some misunderstandings in the preventive measures for high-risk groups.Conclusions Nursing assistents in LTC facilities have a low level of knowledge about stress injury-related care and many misunderstandings about care behavior.Therefore, it is necessary to strengthen the training.

Objective To identify barriers to pressure injury assessment among nurses working in senior-care institutions,and to provide references for targeted management.Methods Semi-structured,in depth interviews were conducted on 10 nurses selected from 5 senior care institutions in Shanghai.Data were analyzed to identify the themes.Results Seven themes were identified,including in sufficient nurses,lack of knowledge and facilities,inaccurate assessment information,poor combination between assessment and clinical practice,lack of assessment awareness or profit-driven,insufficient support,and doubts of the Braden scale.Conclusion Targeting factors that affected nurses' pressure injury assessment in senior-care institutions,such measures as management with specific teams,intensive training,improvement of information technology and nursing regulations should be taken to standardize pressure injury assessment,thus to prevent pressure injuries in the elderly.

Objective To investigate the current situation of the knowledge about the pressure injury among family main caregivers of the elderly patients with pressure injury and to analyze its influencing factors,in order to provide clinical evidence of corresponding nursing countermeasures.Methods A total of 124 family main caregivers of the elderly patients with pressure injury were recruited by convenience sampling method.They were investigated with caregivers general information questionnaire,patients general information questionnaire and caregivers' knowledge about pressure injury questionnaire.Results Among 124 cases,most of the caregivers were female,and 38.7％ of the main caregivers were aged more than 60.The 124 patients had 196 wound surface in total.The total score of the caregivers' knowledge about pressure injury questionnaire was (14.52±3.024).For each dimension of caregivers' knowledge about pressure injury questionnaire,wound care exhibited the lowest score,followed by preventive measures,the basic concept of the pressure injury,the pressure injury risk population and predilection sites.Multiple regression analysis showed that caregivers' degree of education,whether had attended training,caregivers' age and economic level were the influencing factors,and accounted for 27.6 ％ of the variance in the level of the knowledge (R2=0.276)(F=12.751,P＜0.001).Conclusion The level of the knowledge about the pressure injury among family main caregivers of the elderly patients with pressure injury should be improved.It is necessary to strengthen the health education for family main caregivers to improve the knowledge level of caregivers and to reduce pressure injury's recurrence rate of patients.

(HFCWO) in elderly patients underwent abdominal surgery.Methods By convenience sampling,80 cases were select-ed and divided into control group and observation group,with 40 cases in each group.The control group re-ceived routine care,while the observation group received HFCWO treatment on the basis of routine care. The respiration related indexes,pain level,tolerated percussion on back time,HFCWO duration time and actual nursing time before and after intervention were compared.Results Before intervention,there was no statistical significance of PaO 2 ,SaO 2 ,PaCO 2 and OI found between two groups (all P >0.05).Three days after surgery,the PaO 2 ,SaO 2 and OI in observation group were better than that of control group (all P <0.05).Five days after surgery,the SaO 2 in observation group were better than that of control group (P <0.05).Between day 2 to day 5,the pain level in observation group was significantly lower than that of con-trol group (all P <0.05).One to five days after surgery,the tolerated percussion on back time and HFC-WO duration time in the observation group were longer than that of control group,the actual nursing time was less than that of control group (all P <0.05).Conclusion Compared to conventional chest physiother-apy,HFCWO could improve the respiration function of elderly abdominal post-operative patients in a short-term,as well as release the pain,prolong the tolerance time,and shorten the nursing time.

目的 分析门诊老年压力性损伤患者创面感染发生情况及相关危险因素.方法 对110例门诊老年压力性损伤患者创面感染情况进行调查,并收集患者的一般资料及压力性损伤创面的基本情况,分析压力性损伤创面感染发生的危险因素.结果 门诊老年压力性损伤患者创面感染的发生率为27.3%.回归分析结果表明糖尿病、水肿、创面持续时间是压力性损伤患者创面感染发生的危险因素,而之前经过正规治疗是其保护性因素.结论 创面感染是压力性损伤患者常见的并发症.既往有糖尿病、存在水肿情况及创面持续时间长(≥1个月)的压力性损伤患者是创面发生感染的高危人群.

Objective To investigate the caring behaviors among family main caregivers of the elderly patients with pressure injury and to analyze its influencing factors. Methods A total of 124 family main caregivers of the elderly patients with pressure injury were recruited by convenience sampling method. They were investigated with caregivers general information questionnaire, patients general information questionnaire and the self-designed pressure injury caring behaviors questionnaire. Results The total score of the pressure injury caring behaviors questionnaire was (66.22 ± 13.16). For each dimension of pressure injury caring behaviors questionnaire, the application of pressure-relief devices exhibited the lowest score(2.27), followed by wound care(2.33), position care(2.53), nutritional support (2.95) and skin care(3.03). Multiple regression analysis showed that caregiver′s economic level and whether have been attend training, the duration of the patients lie in bed and whether using air cushion bed accounted for 45.9 percent of the variance in caring behaviors. Conclusions There are many shortcomings and errors in caring behaviors among family main caregivers of the elderly patients with pressure injury.It is necessary to strengthen the health education of family main caregivers of patients with pressure injury to improve the level of caring behaviors and to reduce pressure injury′s recurrence rate of patients.