目的:探讨维持性血液透析患者应用小组式正念减压干预的效果.方法:选取郑州大学第一附属医院 2020年3月至 2021 年 3 月收治的 112 例维持性血液透析患者,按简单随机化法分为两组.对照组(56 例)接受常规护理干预,研究组(56 例)接受小组式正念减压干预.对比两组干预前后心理韧性量表(CD-RISC)评分、心理状态[汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分]、病耻感[社会影响量表(SIS)评分]及生活质量量表(KDQ)评分,统计两组并发症发生情况.结果:两组干预后CD-RISC、KDQ各项评分较干预前提高,HAMA、HAMD及SIS各项评分较干预前降低,且研究组干预后CD-RISC、KDQ各项评分高于对照组,HAMA、HAMD及SIS各项评分低于对照组(P＜0.05).研究组并发症发生率(3.57%)比对照组(14.29%)低(P＜0.05).结论:小组式正念减压干预应用于维持性血液透析患者中可改善患者心理弹性及负性情绪,减少病耻感,降低并发症发生率,提高患者生活质量.

Objective To investigate the status of caregivers’ acceptance of enhanced recovery after surgery（ERAS） and analyse the influencing factors from the perspective of patient caregivers themselves and to provide a reference for medical staff to carry out targeted intervention. Methods Data were collected from 165 patient caregivers in a tertiary first-class hospital, and a self-designed questionnaire was used to measure the acceptance of ERAS among them. Total 160 valid questionnaires were collected. Multiple linear regression was used to analyse the influencing factors. Results The total scores of acceptances of ERAS, preoperative preparation, intraoperative treatment and postoperative management of 160 caregivers were（53.16±11.50）points,（17.73±4.42） points,（14.66±2.82） points and（20.77±4.92） points, respectively. The results of multivariate linear stepwise regression analysis showed that age, habitat, culture level, average monthly income and operation history were the main influencing factors of caregivers’ acceptance of ERAS concept（B values were-4.074,-2.058, 2.289, 2.922 and-3.020, respectively, all P＜0.05）. Age, habitat and operation history were negatively correlated with the acceptance of ERAS, whereas culture level and average monthly incomes were positively correlated with it. Conclusion The acceptance of ERAS among caregivers is at mid-level, but a large difference is observed. The medical staff should be educated on the concept of ERAS according to the characteristics of different caregivers, and take targeted interventions to improve the acceptance of the concept of ERAS by caregivers, so as to select the best treatment scheme for patients and promote their postoperative recovery.

目的 调查新冠疫情后护理人员创伤性应激障碍的现状,为进一步增强护理人员的身心健康提供参考依据.方法 2023年2-3月,以郑州大学第一附属医院急诊、内科、外科等科室新冠疫情期间在岗的278名护理人员为研究对象,采用自制的一般资料调查表、创伤后应激障碍量表-民用版(PCL-C)收集临床资料进行调查.结果 护理人员PCL-C总分为(33.92±15.01)分;创伤后应激障碍阳性检出率为33.1％;不同受教育程度和工作年限的护士的PCL-C评分差异有统计学意义(P＜0.05),其他差异无统计学意义(P＞0.05),受教育程度与PCL-C得分呈正相关.结论 新冠疫情后护理人员呈轻微PTSD症状,需要及时进行心理干预.

目的 探讨尖锐湿疣患者自我表露、恐惧疾病进展、心理弹性之间的关系.方法 选择2021年12月-2023年4月于郑州市某三级甲等医院确诊为尖锐湿疣的295例患者为研究对象.采用患者一般资料调查表、中文版恐惧疾病进展简化量表、中文版痛苦表露指数量表、心理弹性量表简表等进行调查分析.结果 患者恐惧疾病进展得分为(38.56±6.370)分,心理弹性得分为(68.64±11.085)分,自我表露得分为(35.00±4.653)分;恐惧疾病进展与心理弹性呈负相关(r=-0.665,P＜0.001),与自我表露呈负相关(r=-0.669,P＜0.001);自我表露在尖锐湿疣患者心理弹性和恐惧疾病进展间的中介效应为-0.165(95％CI:-0.221～-0.113),占总效应的43.20％.结论 自我表露在尖锐湿疣患者心理弹性和恐惧疾病进展间起部分中介效应.通过提高患者心理弹性和自我表露水平,可有效降低患者对疾病进展和复发的恐惧感.

Objective To develop the colorectal cancer screening for colorectal cancer patients’ family members questionnaire and test its reliability and validity.Methods The primary item pool was constructed according to the literature analysis and related guidelines. The initial questionnaire was developed through consultation with 19 experts using Delphi method. A total of 189 colorectal cancer patients’ family members were selected for the survey to test the reliability and validity of the questionnaire.Results The questionnaire was made up of 3 dimensions and 32 items. The Cronbach’s α was 0.77. The item-level content validity index was 0.87-1.00, the scale-level CVI average index was 0.98. The exploratory factor analysis showed 3 factors, and accounting for 66.84% of the total variance.Conclusion The questionnaire has good reliability and validity, it can be used as a colorectal cancer screening tool for colorectal cancer patients’ family members.

ObjectiveTo translate the Medical Professionals Resilience Scale（MeRS） into the Chinese，and to test its reliability and validity among medical staff.MethodsMeRS was translated and back⁃translated according to the Brislin translation model，and the Chinese version of MeRS was adjusted and revised through expert consultation and pre⁃investigation.The convenience sampling method was used to select 474 medical and nursing staff from a tertiary grade A hospital in Zhengzhou to conduct a questionnaire survey to evaluate the reliability and validity of the Chinese version of MeRS.ResultsThe Cronbach's α coefficient of Chinese version of MeRS was 0.961.And the Cronbach's α coefficient of each dimension ranged from 0.864 to 0.924.The test⁃retest reliability was 0.918.And the test⁃retest reliability of each dimension ranged from 0.803 to 0.876.The Scale⁃Content Validity Index（S⁃CVI/Ave） was 0.942.And the Item⁃Content Validity Index（I⁃CVI） ranged from 0.857 to 1.000.Exploratory factor analysis extracted 4 common factors，and the cumulative contribution rate of variance was 62.281%.With the Chinese version of the Connor⁃Davidson Resilience Scale as the criterion，the correlation value of the criterion was 0.873（P<0.01）.ConclusionThe Chinese version of MeRS had good reliability and validity，and could be used to measure the resilience of medical staff in China.

Objective:To investigate the related risk factors of occurrence of lymphedema in upper limbs after modified radical mastectomy for breast cancer.Methods:This study was a retrospective analysis. A total of 91 patients with breast cancer who underwent modified radical mastectomy in the First Affiliated Hospital of Zhengzhou University from March 2020 to March 2021 were selected; among them, 54 patients with postoperative lymphedema in upper limbs were included in the occurrence group, while 37 patients without lymphedema in upper limbs were included in the non occurrence group. The relevant data collected in the database were consulted to screen the risk factors of occurrence of lymphedema in upper limbs after modified radical mastectomy for breast cancer. The clinical data of two groups were collected and compared. The factors with statistically significant differences were brought into the Logistic regression equation to analyze the risk factors for upper limb edema.Results:The comparison of clinical data between the two groups showed that there were a statistically significant differences in age, body mass index (BMI), lymph node dissection range, number of lymph nodes dissected, and radiotherapy status ( P<0.05). Logistic regression analysis showed that older age, high BMI, wide lymph node dissection range, large number of lymph nodes dissected, and radiotherapy were risk factors for occurrence of lymphedema in upper limbs. Conclusions:Older age, high BMI, wide range of lymph node dissection, large number of lymph nodes dissected, and radiotherapy are the risk factors for lymphedema in upper limbs after modified radical surgery for breast cancer. Corresponding preventive measures should be taken for patients with high risk of upper limb edema.

目的 探讨思维导图联合上肢运动操对乳腺癌患者术后康复的影响.方法 82例乳腺癌手术患者随机分为两组,对照组予以常规健康指导与功能锻炼,观察组在对照组基础上予以思维导图联合上肢运动操,比较两组的干预效果.结果 干预后,观察组的锻炼依从性高于对照组,锻炼知识掌握评分高于对照组,患肢前屈、后伸角度均大于对照组,患肢淋巴水肿发生率低于对照组(P<0.05).结论 思维导图联合上肢运动操可有效提高乳腺癌手术患者的术后锻炼依从性,缓解淋巴水肿.

Objective To explore the effect of narrative therapy combined with positive elements refining feedback nursing on the post-traumatic growth of patients with permanent enterostomy.Methods A total of 86 patients with permanent enterostomy treated in Zhoukou Central Hospital from June 2020 to January 2022 were divided into control group（n=43） and observation group（n=43） by random number table method. The control group was given routine nursing, and the observation group was given narrative therapy combined with positive elements refining feedback nursing intervention on the basis of routine nursing. The scores of posttraumatic growth inventory（PTGI）, social impact scale（SIS）, ostomy adjustment inventory-20（OAI-20）, connor-davidson resilience scale（CD-RISC） and exercise of self-care agency scale（ESCA） before and after nursing intervention were compared between the two groups. The incidence of stoma-related complications was compared between the two groups.Results After intervention, the scores of PTGI, OAI-20, CD-RISC and ESCA in two groups were increased, and each of the above scores of observation group was higher than that of control group（P＜0.05）. After intervention, the SIS scores in the two groups were decreased, and the SIS score of observation group was lower than that of control group（P＜0.05）. The total incidence of stoma-related complications in the observation group [4.65%（2/43）] was lower than that [25.58%（11/43）] in the control group（P＜0.05）.Conclusion Narrative therapy combined with positive elements refining feedback nursing can effectively eliminate stigma of patients with permanent enterostomy, improve the patient’s stoma adaptation ability, psychological resilience, self-care ability and the level of post-traumatic growth, and has a positive effect on reducing the incidence of stoma-related complications.

目的 探讨主要照顾者参与式营养管理对农村胃癌术后化疗患者营养知信行及营养状况的影响.方法 将80例胃癌术后化疗的农村患者随机分为观察组和对照组,各40例.对照组接受常规护理;观察组接受主要照顾者参与式院内集中营养管理及院外微信营养管理干预,共24周.干预前后采用消化系统肿瘤患者营养知信行问卷评价患者营养知信行水平,比较两组患者营养相关生化指标水平及营养不良发生率.结果 干预后,观察组营养知信行水平优于对照组,血红蛋白、白蛋白、总蛋白水平均高于对照组(均P<0.05),但两组患者营养不良发生率差异无统计学意义(P>0.05).结论 主要照顾者参与式营养管理可提高农村胃癌术后化疗患者的营养知识、态度、行为水平及营养状况.

目的 了解肠造口患者重返工作适应性现状,并分析其影响因素.方法 2021年9-10月,采用便利抽样抽取郑州市某三级甲等医院复诊且已重返工作的300例肠造口患者为研究对象,采用一般情况调查表、癌症患者重返工作适应性量表、社会支持评定量表及中文版癌症自我管理效能感量表对其进行调查.结果 肠造口患者重返工作适应性得分为(57.86±9.81)分,社会支持得分为(34.17±4.82)分,自我管理效能感得分为(71.29±12.41)分.不同文化程度、工作性质、工作模式、医保类型、造口类型、是否合并造口并发症的肠造口患者的重返工作适应性得分的差异均有统计学意义(均P<0.05);多重线性回归分析显示,支持利用度、主观支持、客观支持、是否合并造口并发症、文化程度为重返工作适应性的正相关因素,工作性质和造口类型为负相关因素(F=541.52,P<0.05),影响因素可解释总变异的78.2％.结论 医护人员应综合评估肠造口患者重返工作适应性及其影响因素,并给予针对性的干预,帮助患者提高重返工作适应性.

目的 探讨"对分课堂"模式在麻醉科护理教学查房中的应用效果.方法 选择郑州大学第一附属医院50名麻醉科护士为研究对象,按随机数字法分为试验组和对照组,各25人,试验组采用"对分课堂"教学模式,对照组采用传统课堂授课模式.比较两组护士自主学习能力、护理查房满意度及自信心.结果 试验组麻醉科护士自主学习能力评价量表总分及查房满意度和自信心量表得分均高于对照组,差异有统计学意义(P<0.05),差异有统计学意义.结论 "对分课堂"模式应用于麻醉科护理教学查房,有助于提升麻醉科护士自主学习能力、护理查房满意度、自信心,值得应用.

目的:调查直肠癌永久性肠造口病人重返工作自我效能及其影响因素.方法:便利选取2021年3月—2021年7月于河南省某三级甲等医院造口门诊复查的167例永久性肠造口病人为研究对象.采用重返工作自我效能问卷、肠造口接受度问卷、简易应对量表对其进行调查.结果:有58例病人已重返工作,重返工作率为34.7％;Logistic回归分析显示,年龄、每日工作时长、造口术后时间和积极应对是直肠癌永久性肠造口病人重返工作自我效能的影响因素.重返工作自我效能与积极应对呈正相关(r=0.185,P<0.05),与消极应对呈负相关(r=-0.180,P<0.05).结论:医护人员应综合考虑直肠癌永久性肠造口病人重返工作自我效能及其影响因素,并给予针对性的健康教育及职业康复干预,以提高病人重返工作率.

目的 探讨医护一体化模式联合术后康复训练对发育性髋关节脱位患儿疼痛程度及并发症的影响.方法 选取2019年1月至2021年7月郑州大学第一附属医院收治的90例发育性髋关节脱位患儿.根据入院顺序分为观察组和对照组,各45例.给予对照组患者常规护理,观察组在此基础上联合医护一体化模式联合术后康复训练.比较两组住院指标、髋关节功能(FMA下肢运动量表)、疼痛程度、并发症、护理满意度.结果 观察组住院时间短于对照组(P<0.05).术后3、6 d,观察组FMA评分高于对照组,疼痛评分低于对照组(P<0.05).观察组并发症发生率较对照组低,护理满意度较对照组高(P<0.05).结论 对发育性髋关节脱位患儿采用医护一体化模式联合术后康复训练,可增强肢体功能训练效果,降低并发症风险,有助于缓解术后疼痛.

Objective:To investigate the theoretical knowledge level of clinical nurses engaged in enterostomy nursing in secondary and tertiary general hospitals in Henan Province, so as to provide the basis for departments to carry out specialized training and improve the quality of enterostomy special nursing.Methods:On the basis of literature review and expert letter consultation, enterostomy knowledge test for clinical nurses was formed, including the dimensions of enterostomy special nursing and patient health education. Using the convenient sampling method, clinical nurses who engaged in enterostomy-related nursing work in 39 secondary and tertiary general hospitals in Henan Province were selected as the research objects from February to May 2019. The enterostomy knowledge test for clinical nurses was used to investigate enterostomy specialized knowledge of nurses, and their scores were analyzed by single factor analysis. In this study, a total of 420 tests were issued and 382 valid tests were effectively recovered, with an effective recovery rate of 90.95%.Results:The total score of the enterostomy knowledge test of 382 nurses was (65.80±13.84) , the total score of enterostomy special nursing dimension was (32.17±7.12) , and the total score of patient health education dimension was (33.64±7.66) . 62.83% (240/382) of nurses basically mastered the knowledge of enterostomy. In the enterostomy knowledge test for clinical nurses, the error rates of prevention and identification of complications, management of complications and clinical selection and application of stoma bag were relatively high. There were statistically significant differences in the scores of the enterostomy knowledge test among nurses of different hospital levels, highest educational background, technical title, working time limit and the time limit of engaging in enterostomy nursing work ( P<0.05) . Conclusions:Professional nurses engaged in enterostomy nursing do not have a comprehensive grasp of enterostomy related knowledge, so the departments should pay more attention to special nursing training of enterostomy and improve overall level of enterostomy nursing in the department.

目的 了解ICU高年资护士护理临终患者及经历患者死亡时的体验.方法 应用描述性质性研究,按照目的抽样法,选取河南省郑州市某三级甲等综合性医院11名ICU高年资护士进行半结构式访谈,采用Colaizzi 7步分析法进行资料分析.结果 共提炼出4个主题:死亡应对经验丰富、临终及死亡沟通技能缺乏、感到力不从心及职业价值感强烈.结论 综合医院ICU高年资护士具有成熟的护理临终患者及应对患者死亡的技能,但他们的临终沟通技能欠佳及存在职业疲惫感.

目的 对重返工作自我效能问卷(return-to-work self-efficacy questionnaire,RTW-SE)进行汉化和信效度检验.方法 通过翻译、回译、跨文化调试及预调查,形成中文版RTW-SE问卷,并对郑州市1所三级甲等医院330例有长期工作的癌症患者进行问卷调查,分析问卷的信度和效度.结果 中文版RTW-SE问卷项目分析各条目与总分相关系数均在0.5以上,决断值检验结果差异均有统计学意义(均P<0.01).内容效度为0.97.探索性因子分析提取出1个公因子,累计方差贡献率为67.491％.验证性因子分析结果显示,模型各项指标均达到标准,模型拟合度良好.总量表的Cronbach'sα系数为0.932,折半信度为0.925,重测信度为0.827.结论 中文版重返工作自我效能问卷具有良好的信效度,可用于评估癌症患者重返工作自我效能水平.

目的 探讨主要照顾者参与营养管理对胃癌术后化疗患者营养状况的影响.方法 选取2019年8月至2020年8月在郑州市某三级甲等医院胃肠外科就诊的80例胃癌术后化疗患者,随机分为干预组和对照组,每组各40例.对照组实施常规护理;干预组接受主要照顾者参与院内集中营养管理及院外微信营养管理的干预.干预前、化疗中期、干预结束后采用患者主观整体营养状况评估量表(PG-SGA)及营养相关指标评价患者营养状况.结果 化疗中期干预组PG-SGA得分显著优于对照组,差异有统计学意义(F时间=335.606,F组间=4.218,F交互=34.555,P<0.05).干预组与对照组化疗中期及干预结束后血红蛋白、清蛋白、总蛋白水平比较,差异有统计学意义(P<0.05).结论 主要照顾者参与营养管理可改善胃癌术后化疗患者营养状况.

Objective:To investigate the risk factors of neck anastomotic fistula after thoracoscopic-laparoscopic esophagectomy for esophageal cancer.Methods:The clinical data of 259 esophageal cancer patients underwent thoracoscopic-laparoscopic esophagectomy in the First Affiliated Hospital of Zhengzhou University from March 2016 to March 2019 were retrospectively selected. The incidence of neck anastomotic fistula was counted. Multivariate analysis of the risk factors of neck anastomotic fistula was performed by Logistic analysis.Results:In 259 patients, 41 cases of neck anastomotic fistula occurred, the incidence rate was 15.83%. Low preoperative albumin level, diabetes mellitus, single-layer manual anastomosis, lesions located in the upper segment, preoperative radiotherapy and chemotherapy, and pulmonary infection were independent risk factors for neck anastomotic fistula ( OR =3.148, 1.863, 1.755, 2.610, 2.128, P=0.011, 0.005, 0.007, 0.018, 0.001). Conclusions:Preoperative body malnutrition, manual anastomosis, lesion location, preoperative treatment, lung infection, and diabetes mellitus are risk factors of neck anastomotic fistula after thoracoscopic-laparoscopic esophagectomy for esophageal cancer.

Objective:To explore the effect of hospital-family CCM on postoperative rehabilitation of children with posterior urethral rupture and its effect on the nursing ability of children′s family members.Methods:Forward-looking selection between January 2015 and January 2019 in our hospital 72 cases of traumatic posterior urethral disruption of children as the research object, the random number table method were randomly divided into 2 groups. The control group ( n=36) was implemented routine nursing, observation group ( n=36) was given hospital-family CCM. The prognosis of postoperative pain and complications of two groups, children′s family psychological status before and after the intervention and nursing ability were compared. Results:Compared with the control group, the scores of Numerical Rating Scale (NRS) of 12h after the operation, 1d after the operation and 2d after the operation respectively 5.89±0.71, 4.50±0.51, 2.42±0.50, all of which were significantly lower than those of the control group 6.92±0.87, 5.89±0.85, 4.31±0.47, with statistically significant differences ( t values were 5.23, 8.904, 16.525, P<0.05). The total incidence of complications in the observation group was 5.56% (2/36), significantly less than 22.22% (8/36) of the control group with statistical significance difference ( χ2 value was 4.181, P<0.05). The scores of Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Family Caregiver Task Inventory (FCTI) in the families of children of the observtion group were 34.6±5.36, 31.67±6.11, 8.65±2.40 after the intervention, significantly lower than the control group (41.09±6.44, 39.64±7.31, 11.64±3.10) with statistical difference ( t values were 4.647, 5.019, 4.576, P<0.05). Conclusions:The hospital-family CCM can effectively promote the rehabilitation of children undergoing posterior urethral rupture and improve the nursing ability of their families.