Objective:To investigate and analyze the gap between the current clinical practice and guidelines of infant safe sleep protection strategies in China, and to provide a basis for further construction of evidence-based practice programs and evidence-based transformation of infant safe sleep protection strategies that conform to the actual situation in China.Methods:From March to May 2021, a total of 50 medical staff and 100 caregivers from the Obstetrics Ward, Neonatal Ward and Child Health Clinic in Peking University First Hospital were selected by the convenient sampling method. The survey was carried out at the organizational, the medical staff level and the caregiver. At the organizational level, the Maternity Ward, Neonatal Ward and Child Health Care Clinic of the hospital were investigated, and relevant support systems and supporting documents were reviewed. On-site observation was adopted at the medical staff level. At the caregiver level, the self-designed Infant Safe Sleep Protection Strategy Behavior Questionnaire was used to conduct the survey and the results were statistically analyzed.Results:There were 15 items with an execution rate of 0, 6 items with an execution rate of 1% to 50%, 6 items with an execution rate of 51% to 99% and 4 items with an execution rate of 100%. Multiple linear regression analysis shows that the influencing factor of caregivers' practice of infant safe sleep protection strategy was their educational level ( P<0.05) , and there was a positive correlation between them ( r=0.238, P<0.05) . Conclusions:There is still a big gap between clinical practice and guidelines of infant safe sleep protection strategies, and relevant training should be strengthened to narrow the gap between clinical practice and guidelines.

The increase in the maternal perceptions of child vulnerability will cause the mother to over-protect the child, which will affect the child's psychological and behavioral development and cause the over-utilization of medical resources. This article reviews the concept, measurement tools and research status of maternal perceptions of child vulnerability. And this article summarizes the influencing factors from three aspects, namely mother's own factors, children's factors and psychosocial factors, so as to provide a basis for further research and exploration of effective intervention measures.

Objective:To retrieve and analyze the relevant guidelines for the second and third stages of normal delivery, and summarize the evidence of high-quality guidelines so as to provide references for the formulation of clinical practice programs.Methods:We took Johns Hopkins evidence-based nursing practice model as theoretical guidance and set up an evidence-based team.We systematically searched major guideline publication websites, electronic resource databases, related academic groups and guideline networks at home and abroad, evaluated guidelines and summarized the best evidence, and the search time limit was up to June 1, 2019. The literature quality evaluation and evidence extraction were carried out independently by four researchers with evidence-based training.Results:This study included two guidelines, summarizing the 20 best evidences in 9 aspects of humanistic support, delivery companion, delivery position, fetal monitoring, delayed exertion, perineal protection, fundus compression, prevention of postpartum hemorrhage, and delayed umbilical cord clamping.Conclusions:Based on the existing evidence, it integrates the best evidence of nursing measures for the second and third stages of normal delivery. It is recommended that maternal and child institutions promote the transformation of the best evidence based on their actual conditions.

目的 探讨基于最佳证据的产妇正常分娩第二、三产程的护理方案,并评价其应用效果.方法 应用循证的方法系统检索产妇正常分娩第二、三产程护理方案的国内外指南,评价并汇总最佳证据,制订审查指标,进行基线审查,基于审查结果分析促进和障碍因素.比较证据应用前后产妇的分娩结局,助产士对产妇正常分娩第二、三产程护理措施的认知水平及审查指标的执行情况.结果 最佳证据应用后,产妇会阴完整率从7.9％提升到13.4％;助产士对产妇正常分娩第二、三产程护理措施的认知得分从培训前的25～85(54.9±14.3)分提升至50～100(77.1±13.8)分;除指标14、15外,证据应用前执行率＜50％指标的执行率均上升到70％以上.结论 本研究基于最佳证据,结合科室临床情境、患者意愿,并通过分析促进和障碍因素,制订产妇正常分娩第二、三产程的护理方案,证据应用后,产妇会阴完整率、助产士相关护理措施认知水平得到提高,助产士工作行为得到规范.

Objective? To evaluate and summarize the best available evidence of kangaroo mother care for premature infants both in China and abroad, and to provide evidence-based support for clinical practice. Methods? Evidence on kangaroo mother care including evidence-based guidelines, best practices, systematic evaluation and so on were systematically retrieved from databases such as UpToDate, Cochrane Library, Ontario Registered Nurses Association of Canada, National Institute for Health and Care Optimization of the United Kingdom and National Guidelines Network of the United States from the establishment of the database to December 15th, 2018. Four researchers were divided into two groups and evaluated the quality of literature and extracted data. Results? Eight papers were included, including one guideline and seven systematic reviews. The best evidence included suitable population, support system, skin contact (timing, duration, operator), breast feeding support, etc. After evidence extraction, evidence aggregationin combination with localized adjustment in clinical situation, this study has formed eight best evidences. Conclusions? It is necessary to strengthen and support the education of relative knowledge about kangaroo mother care, improve the facilities and promote the development of clinical kangaroo mother care based on the evidence and consider the special humanistic attributes with clinical environment at the same time .