目的:检索并整合改善结肠镜检查前肠道准备质量及病人耐受性的最佳证据,为临床实践提供参考.方法:使用PIPOST模式确定问题,按照"6S"证据模型检索国内外结肠镜检查前肠道准备质量及病人耐受性的相关文献,对纳入研究的证据进行质量评价和分级.结果:共纳入文献19篇,包括4篇指南、1篇临床决策、5篇证据总结、4篇系统评价、4篇随机对照试验、1篇文献综述,共总结了23条证据,包括结肠镜检查前肠道准备的指导及宣教、饮食准备、导泻剂的方案选择、用药时机、辅助措施、不良反应的处理6个方面.结论:临床医护人员需结合病人偏好及临床实践选择最佳证据,降低肠道准备不耐受发生率,提高肠道准备质量.

目的 将预防腹腔镜手术患者术中非计划性低体温的最佳证据应用于临床并评价其效果,为临床医护人员提供参考.方法 根据最佳证据,制订8条审查指标并开展证据应用.证据应用前后各纳入腹腔镜手术患者 30 例及 40 名手术室护士作为研究对象,比较最佳证据应用前后腹腔镜手术患者术中非计划性低体温的发生率、手术室护士对腹腔镜手术患者术中非计划性低体温的预防及管理的认知水平以及手术室护士依据证据采取预防低体温措施的执行率.结果 证据应用后,通过临床审查,腹腔镜手术患者术中非计划性低体温的发生率由证据应用前的33.3%降至证据应用后的 10.0%,手术室护士对腹腔镜手术患者术中非计划性低体温的预防及管理的认知水平合格率由证据应用前的 62.5%上升至证据应用后的 95.0%.证据应用前,对审查指标 6的执行率为90.0%,审查指标7的执行率为 70.0%,其余审查指标的执行率均在70.0%以下;最佳证据应用后,审查指标1、2、3、4、5、7、8的执行率均有明显提高,与应用前比较,差异具有统计学意义(P＜0.05).结论 预防腹腔镜手术患者术中非计划性低体温最佳证据的临床应用可降低患者术中非计划性低体温的发生率,提高手术室护士对腹腔镜手术患者术中非计划性低体温的预防及管理的认知水平及依据证据采取预防低体温措施的执行率.

ObjectiveTo construct perioperative nursing quality sensitive indicator for patients undergoing laparoscopic hysterectomy based on diagnosis related groups（DRGs） concept.MethodsBased on the concept of DRGs and guided by three⁃dimensional quality structure model，perioperative nursing quality sensitive indicator for patients undergoing laparoscopic hysterectomy was constructed by literature review and expert consultation.The weights of the indicators were determined by analytic hierarchy process.ResultsThe perioperative nursing quality sensitive indicator for patients undergoing laparoscopic hysterectomy based on DRGs concept were constructed，including 3 first⁃level indicators（structural indicators，process indicators，and outcome indicators），10 second-level indicators，and 40 third⁃level indicators.The effective rates of 2 rounds of expert inquiry questionnaires were 93.75% and 100.00%，respectively.The expert authority coefficients were 0.87 and 0.89，respectively.And Kendall harmony coefficients were 0.23 and 0.15，respectively.Among the first-level indicators，outcome indicators had the highest weight（33.99%），followed by process indicators（33.65%），and structural indicators had lowest weight（32.36%）.ConclusionsThe perioperative nursing quality sensitive indicator for patients undergoing laparoscopic hysterectomy based on DRGs concept constructed in this study have certain characteristics of the times.It conforms to the principles of scientificity and practicality，and have certain guiding significance for quantifying the perioperative nursing quality of patients undergoing laparoscopic hysterectomy.

To investigate their compliance with postoperative oral nutritional supplementation and nutritional outcomes.A total of 84 patients with colorectal cancer surgery with NRS-2002 risk score ≥ 3 who were treated with oral nutritional supplementation were selected and divided into control and observation groups according to the random number table method, with 42 cases in each group. The control group received conventional oral nutritional supplementation and dietary nutrition education; the observation group established a nutrition intervention group based on the Goal Attainment Theory and carried out individualized nutrition education based on the Goal Attainment Theory. The nutritional indicators at 1 day postoperative, 7 days postoperative, oral nutritional supplementation adherence scores at 7 and 14 days postoperative, and the attainment rate of trans-oral nutritional intake at 21 days postoperative were compared between the 2 groups of patients.There was no statistically significant difference between the nutritional status indexes of the 2 groups of patients before the intervention, p > 0.05; when comparing the prealbumin of the 2 groups of patients at 7 days postoperatively, the prealbumin level of the patients in the observation group at 7 days postoperatively (200.25 ± 53.25) was better than that of the control group (165.73 ± 43.00), with a p value of 0.002, and the difference was statistically significant (p < 0.05). Comparison of oral nutritional supplementation adherence scores at 7 and 14 days postoperatively showed that ONS treatment adherence scores were better than those of the control group, with statistically significant differences (p < 0.05). When comparing the attainment rate of oral nutritional intake at 21 days after surgery, the difference was statistically significant (p < 0.05).Nutritional education based on the Goal Attainment Theory can effectively improve the adherence to oral nutritional supplementation therapy and protein intake attainment rate of colorectal cancer patients after surgery and effectively improve the nutritional status of patients.

Pregnancy complicated with acute aortic dissection is rare and the mortality rate is high. The author reviewed the intraoperative nursing plan of a patient with aortic dissection in the third trimester of pregnancy who underwent Bentall operation and cesarean section, and introduced the evidence-based methods of preoperative nursing and nursing measures to prevent the complications that may occur in the perioperative period. Including preoperative preheat preservation, prevention of perioperative pressure injury, postoperative observation of cesarean section, intraoperative temperature regulation of Bentall, which can provide a reference for the clinical nursing measures of similar patients.

Objective:To explore the management experience of clinical nursing managers and to provide reference for the implementation of the reform of DRGs-PPS.Methods:15 clinical nursing managers were surveyed in an in-depth semi-structured interview by phenomenological research methods, and the data were analyzed by Colaizzi 7 analysis method.Results:Four themes were extracted: the positive effect of the reform, the value reflection of nursing work, the promotion and obstacles of nursing management during DRGS implementation.Conclusions:Clinical nursing managers, there are positive experience as well as negative experience for the implementation of the reform of DRGs-PPS, so we need to constantly improve the staff′s cognition, to maximize the value of nursing, draw support from policy guidance and third-party building platforms, optimizes the allocation of human resources, strengthen the management of consumables, promote nursing quality and cost effective integration and effective supervision, and promote healthy development of the DRGs-PPS.

Background: This study sought to implement evidence-based nursing practices for patients undergoing laparoscopy surgery to prevent unplanned hypothermia, to develop review indicators for evidence-based nursing practices, and to analyze obstacles and contributing factors. Methods: Using the Joanna Briggs Institute health care model as the evidence-based theoretical framework, clinical problems were identified, evidence was systematically researched, evaluated and summarized, an index and method of examination was established, and quality items were examined. According to the results of the baseline review, the obstacles and promoting factors were analyzed, and methods and countermeasures were developed. Results: This study summarized 15 pieces of best evidence in relation to the following 5 aspects: risk assessment, body temperature monitoring, ambient temperature, passive insulation, and active insulation. There were 11 quality review indicators, only 4 of which had compliance rates of 100%. The main obstacle factors were a lack of nursing norms and operating procedures, a lack of information, and a lack of motivation among nursing staff. Conclusions: Based on the best evidence and the professional judgment of clinical staff, the quality review index is scientific and implementable. In the application of this clinical evidence, obstacles and other factors should be solved to promote the transformation of evidence.

目的 探讨医护患协同模式在下肢动脉硬化闭塞症患者中的应用效果研究.方法 采用便利抽样法抽取2019年1月—2020年12月就诊于我院血管外科的下肢动脉硬化闭塞症住院患者80例,采用随机数字表法,分为两组各40例,对照组采用传统护理模式,试验组采用医护患协同护理干预方案.通过行走受损问卷、慢性病自我效能量表、自制的锻炼依从性评价表及焦虑自评量表评估两组在入院时及干预12周后的行走能力、自我管理能力和焦虑水平.结果 干预12周后,在行走能力方面,试验组的行走距离、步行速度、行走受损总分方面均优于对照组,两组差异在爬梯能力方面无统计学意义;在自我管理能力方面,试验组的慢性病自我效能评定、锻炼依从性方面均优于对照组;在焦虑水平方面,试验组的焦虑自评得分优于对照组.结论 医护患协同模式的应用,不仅加强了下肢动脉硬化闭塞症患者的行走能力、自我管理能力,缓解了肢体症状,降低了焦虑水平,改善了预后,提高了生活质量,还提升了医护工作质量.

BACKGROUND:This study aimed to search, analyze, and summarize relevant evidence for the prevention of unplanned hypothermia in patients undergoing laparoscopic surgery, so as to reduce the incidence of unplanned hypothermia in patients undergoing laparoscopic surgery and provide a reference for clinical medical staff.METHODS:According to the evidence pyramid model, relevant literature were retrieved by computer in databases. Literature quality evaluation and the evidence grading system of the Australian JBI Evidence-Based Health Care Centre Evidence Recommendation Rating System were used to evaluate the literature quality and determine the level of evidence. The time limit for retrieval was from the establishment of the databases to March 31, 2021.RESULTS:A total of 12 studies were included in this study. Of these, 5 evidence items were finally extracted, and 15 pieces of best evidence were summarized, including the risk assessment of hypothermia in patients undergoing laparoscopic surgery, temperature monitoring, ambient temperature, passive insulation measures, and active insulation measures.CONCLUSIONS:The evidence for the prevention of unplanned hypothermia in patients undergoing laparoscopic surgery provided evidence-based approaches for reducing the incidence of intraoperative hypothermia for clinical staffs. It is suggested that the cultural characteristics of China, medical resources, and patients' own conditions should be considered when applying the evidence.