Background: Frailty is a common multifactorial clinical syndrome in older patients that seriously affects their prognosis. However, most studies to date have ignored the dynamics of frailty.The purpose of this study was to explore the frailty status and changes in older patients who underwent major abdominal surgery, identify the different categories of frailty trajectories, and analyze the factors. Methods: We employed a three-month observational longitudinal study.155 older patients who underwent major abdominal surgery were assessed preoperatively, at discharge, and at one-month follow-up. Data collection included frailty scores, specific demographic and clinical characteristics, and scores for the influencing factors. A latent class growth model was used to explore the frailty trajectories. Multiple logistic regression analysis was conducted to identify factors influencing the frailty trajectories. The STROBE checklist was used in the reporting of this study. Results: Four frailty trajectory patterns were identified among the 155 older patients (average age: 70.38±0.55 years): No frailty (20.1%), frailty exacerbation (39.6%), frailty improvement (13.6%), and persistent frailty (26.7%). Logistic regression analysis showed that body mass index, Charlson comorbidity index score, type of surgery, intraoperative drainage tube retention time (drainage time), first time to get out of bed after surgery, the time of the first oral feed after surgery, postoperative complications, mobility, nutritional risk, and anxiety were associated with frailty trajectories. Conclusion: We identified four frailty trajectories in older patients after major abdominal surgery and found that these were influenced by multiple factors. Focusing on individual specificity is conducive to accurately dealing with frailty-associated clinical problems and guiding relevant nursing decisions.

目的:了解腹腔镜胰腺坏死组织清除术后病人疾病不确定感现状,并探讨其影响因素.方法:便利抽样法选取行腹腔镜胰腺坏死组织清除术的105 例病人作为研究对象,采用一般情况调查表、疾病不确定感量表和社会支持评定量表了解病人疾病不确定感现状,结合多元线性回归明确其影响因素.本研究共发放调查问卷105 份,回收有效调查问卷105 份,有效回收率为100%.结果:腹腔镜胰腺坏死组织清除术后病人疾病不确定感得分为(95.40±8.46)分,处于中等偏高水平.Pearson分析显示,社会支持水平与病人疾病不确定感呈负相关(P<0.01);多元线性回归结果显示,文化程度越低、住院期间清创次数>1 次、出院时带管、住院时间长是病人疾病不确定感的危险因素(P<0.05～P<0.01).结论:目前胰腺坏死组织清除术后病人疾病不确定感处于中等偏高水平,临床护理中应给予重视,分析其影响因素并制定针对性的护理策略,可为降低病人疾病不确定感,提供优质护理服务提供参考.

Objective:To retrieve, evaluate, and integrate the evidence on perioperative nutritional management in patients with bladder cancer, and summarize the optimal evidence to inform clinical practice.Methods:Evidence on nutritional management, including guidelines, systematic reviews, evidence summaries, best practices, and expert consensus, was retrieved from BMJ Best Practice, UpToDate, Registered Nurses' Association of Ontario Evidence-Based Nursing Care Guidelines, Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, European Society for Clinical Nutrition and Metabolism, Cochrane Library, PubMed, CINAHL, Springer Link, Elsevier Science Direct, OVID, Medlinker, China National Knowledge Infrastructure, Wanfang Data, VIP Database for Chinese Technical Periodicals, and China National Biomedical Literature Database. Records published from the establishment of the databases until December 31, 2022 were included. The methodological quality of the guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation II tool, and other types of studies were evaluated using the corresponding criteria in the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports (2016 edition).Result:A total of 11 articles were included, and four themes were identified based on expert panel review, namely nutritional screening and assessment, nutritional support, intestinal management, and health education, on which a total of 24 pieces of best evidence were summarized.Conclusions:This study used an evidence-based approach to generate the best evidence on perioperative nutritional management in patients with bladder cancer, providing solid rationales for standardized nutritional care in these patients. In clinical practice, healthcare professionals should take in to account the clinical environment, patient conditions, and patient preferences, and translat the evidence to tailored management plan to improve patients' clinical outcomes and quality of life.

目的 探讨健康教练技术在肠造口患者管理中的应用效果,以期促进患者早期适应造口,提高自我护理能力,改善预后.方法 便利选取2020年10月1日-2022年4月30日收治的70例肠造口患者,随机分为对照组和干预组,各35例.对照组进行围术期常规护理,干预组在对照组基础上实施健康教练技术.按照接触、观察、强化、澄清、帮助、鼓励、教育和引导8个步骤,提供造口定位、并发症预防、造口袋更换等护理.分别于出院前、术后1个月通过造口自我管理能力量表、造口适应性量表、评价患者自我护理能力、适应性;同时收集术后1个月内造口并发症发生率、造口熟练天数和护理满意度,采用两样本均数t检验比较造口自我护理能力、适应性及护理满意度.结果 干预组出院前、术后1个月造口并发症发生率为12.90％、19.35％,低于对照组23.81％、34.92％,差异有统计学意义,P＜0.05;造口自我护理能力(28.30 ±5.19、34.49±5.67)分、造 口适应性得分(46.19±3.75、49.67±7.83)分高于对照组(24.24±2.53、28.02 ±1.38、40.68±2.93、43.67±7.83)分,术后1个月测评护理满意度(96.64±5.18)分高于对照组(92.74 ±6.23)分,差异有统计学意义,P＜0.05;造口平均熟练天数(5.5天)低于对照组(9天),差异有统计学意义,P＜0.05.结论 健康教练技术在肠造口患者应用中效果较好,有效降低造口并发症发生率,促进患者早期熟悉造口、接受造口,掌握自我护理技能,提高了护理满意度,可在临床推广应用.

临床护理教师在实践教学中发挥主导作用,教师教学能力直接影响教学行为和教学效果.本研究总结了临床护理教师教学能力在教学和护理中的意义,并对教学能力的提升策略进行综述.首先,重视临床护理教师选拔,提高遴选标准,实施多维度、全程化评价.其次,完善教学培训体系,个性化管理发挥不同教师的优势.此外,健全教学激励机制和职业素质教育,培养护理和教学专业的双重认同感,旨在为提高临床护理教学质量提供保障.

Many studies at home and abroad have focused on the quality of life and influencing factors of patients with gastroesophageal reflux after surgical treatment. However, the improvement of patients' quality of life is affected by many factors. Therefore, this article reviews the evaluation tools, influencing factors and intervention measures of patients' quality of life after laparoscopic fundoplication, aiming to provide reference for promoting the recovery of patients' quality of life after surgery and the formulation of nursing plans.

目的 探讨跨媒体健康教育形式对肠造口患者自我护理能力和造口适应性的影响.方法 选取首都医科大学宣武医院2018年8月至2020年5月的66例肠造口患者为研究对象,根据随机数字表法将其分为对照组和干预组,对照组35例,干预组31例.对照组给予肠造口常规健康教育,干预组在对照组基础上行跨媒体健康教育.比较两组出院前1 d及出院后1、3个月造口自我护理能力和造口适应性.结果 整体分析发现,两组造口自我护理能力得分组间、时点及交互比较,差异有统计学意义(P＜0.05),进一步分析,组内比较:两组组内各时间点造口自我护理能力评分比较,差异有统计学意义(P＜0.05),组间比较:出院后1、3个月,干预组造口自我护理能力评分高于对照组,差异有统计学意义(P＜0.05).整体分析发现,两组造口适应性得分组间、时点及交互比较,差异有统计学意义(P＜0.05),进一步分析,组内比较:干预组组内各时间点造口适应性得分比较,差异有统计学意义(P＜0.05),组间比较:出院前1 d、出院后3个月,干预组造口适应性得分高于对照组,差异有统计学意义(P＜0.05).结论 跨媒体健康教育形式能有效提高肠造口患者自我护理能力,促进早期适应造口,改善术后生活质量.

Objective:To construct cluster intervention strategy with medical adhesive-related skin injury (MARSI) based on multi-criterion decision analysis (MCDA) .Methods:Literatures related to nursing care of MARSI were systematically searched in Cochrane Library, PubMed, EMBASE, Chinese Biomedical Literature Database, CNKI, VIP database, Wanfang Database and other Chinese and English databases. The retrieval period was from January 1, 2008 to December 31, 2018. A total of 10 correspondence experts used MCDA to assign scores to various nursing measures of cluster intervention strategies for MARSI patients. The recommendation score of each measure was calculated to form the recommendation, and the feasibility of cluster intervention strategy was verified through pre-test.Results:The authority coefficient of 10 letter experts was 0.830 and the positive coefficient of experts was 100%. After consultation with experts, 14 nursing recommendations were drawn up and entered into the item pool of cluster intervention strategies. The top 5 nursing measures were strengthening education and training for medical staff, standardization of application and removal of medical adhesives, application of alcohol-free skin protectants before using medical adhesives, complete skin dryness before using medical adhesive products (≥30 s) and correct description of damage type, color, range, etc.Conclusions:The use of MCDA can scientifically construct MARSI cluster intervention strategies.

对胰十二指肠切除术后患者引流管护理的研究进展进行综述,包括加强引流液监测、关注胰瘘高危人群以及制定引流综合管理策略,为预防术后患者发生胰瘘提供参考.