目的:对脑卒中后认知障碍风险预测工具进行范围综述,为临床护理实践及未来研究提供参考.方法:遵循澳大利亚JBI循证卫生保健中心范围综述方法学框架,检索9个中英文数据库,检索时限为建库至2022年8月31日.结果:共纳入25项研究,其中7项研究在脑卒中急性期采用神经心理评估工具预测脑卒中后认知障碍,19项研究基于脑卒中后认知障碍危险因素建立预测模型.患者在脑卒中后3～6个月认知障碍的发生率为31.4％～65.3％,预测区分度为0.732～0.969.结论:脑卒中后认知障碍发生率高、疾病负担较重,早期预警值得关注,脑卒中后认知障碍风险预测工具仍处于发展阶段,有待进一步验证及完善.

目的 分析母乳喂养对妊娠期糖尿病产妇及子代糖脂代谢的影响.方法 计算机检索Cochrane Library、EBSCO、Embase、PubMed、Scopus、Web of Science、中国生物医学文献服务系统、中国知网、维普网和万方数据库中母乳喂养对妊娠期糖尿病产妇及子代糖脂代谢影响的相关研究,检索时限为建库至2022年2月15日.由2名研究者独立检索、筛选文献及资料提取.结果 共纳入21篇文献,包括中文文献5篇,英文文献16篇.母乳喂养对妊娠期糖尿病产妇及子代糖脂代谢的影响主要体现在调节血糖血脂、提高胰岛素敏感性、帮助产后减重、降低代谢相关疾病的发生率等方面.结论 母乳喂养有利于妊娠期糖尿病产妇及子代的糖脂代谢.医护人员应加强妊娠期糖尿病产妇母乳喂养益处的健康宣教,提供充分母乳喂养咨询和支持,提高妊娠期糖尿病产妇的母乳喂养率.

目的 分析慢性乙型肝炎(CHB)患者口服核苷(酸)类似物进行抗病毒治疗的依从性的影响因素及用药依从性与生活质量的相关性.方法 采用便利抽样法选取2021年3—7月在南京鼓楼医院肝炎门诊接受抗病毒治疗的CHB患者191例,应用一般资料调查表、Morisky用药依从性量表(MMAS-8)和慢性肝病问卷(CLDQ)对其用药依从性和生活质量进行调查,采用SPSS 21.0软件进行统计分析.结果 191例CHB患者MMAS-8平均得分为(6.54±1.45)分,CLDQ平均得分为(168.23±20.77)分.统计学分析结果表明,用药依从性与生活质量显著正相关.MMAS-8得分在居住地、当前药物治疗时长、当前药物治疗方案及随访次数方面差异有统计学意义(P<0.05);居住地为城市、随访≥3次是用药依从性的保护因素(P<0.05),当前药物治疗时长≥6个月是用药依从性的独立危险因素(P<0.05).结论 CHB患者用药依从性处于中等水平,用药依从性影响生活质量.医护人员应重点评估行抗病毒治疗的CHB患者的居住地、当前药物治疗时长和随访次数,帮助患者达到并保持高度用药依从性,提高生活质量.

相较于男科学的飞速发展,男科专科护理才刚刚起步.国家一系列关于护理事业发展政策的出台,为护理事业带来了新的机遇和挑战[1-3],护理专业呈横向、纵深、精细化发展,护理亚专科也逐渐起步和发展[4].我院男科自2017年开始探索护理亚专科建设,通过完善组织架构、开展特色护理、强化人才培养、重视教学科研、扩大学科品牌影响,保障男科护理亚专科模式逐步完善实施.

Objective To deeply understand the self-management obstacles in patients with ankylosing spondylitis(AS)in emerging adulthood,so as to provide a reference for the development of future self-management intervention protocols for these patients.Methods From February to October 2021,a total of 14 patients were selected by convenience sampling who visited or were hospitalized in the Rheumatology and Immunology Department of a Grade III-A hospital in Nanjing for AS in emerging adulthood.They underwent face-to-face semi-structured in-depth interviews based on the interview outline designed from the Integrated Model of Change and the descriptive phenomenological approach.Then,the interview data were analyzed by Colaizzi's 7-step analysis method.Results A total of 3 themes and 7 sub-themes were extracted address the self-management obstacles in patients with AS in emerging adulthood as follows.Lack of self-management willingness in the awareness stage:weak self-management willingness,lack of self-management knowledge and skills,and insufficient perception of the benefits and consequences of self-management behaviors;lack of health management beliefs in the motivation stage:lack of health management beliefs,and insufficient information support for effective self-management;lack of social support and supervision in the action stage:poor compliance with self-management behaviors,low level of self-efficacy,and weak support and supervision of family members and healthcare providers.Conclusion Healthcare providers should strengthen the self-management awareness of patients with AS in emerging adulthood and improve their perception of disease risk.They should also expand access to professional information so as to help patients establish correct health management beliefs.Furthermore,they should fully mobilize the social support system and actively explore a disease management model for patients with AS in emerging adulthood that aligns with China's realities.

目的 总结卵巢癌患者术前营养管理的相关证据,为卵巢癌患者的术前营养管理提供依据.方法 由3名熟悉卵巢癌临床护理及营养管理的研究者按照"6S"证据模型自上到下检索文献,文献类型包括临床指南、系统评价、证据总结、专家共识等.检索时间限定为2017年1月至2022年4月.对检索到的文献进行独立质量评价,并共同提取和汇总相关证据.结果 共纳入16篇文献,包括7篇临床指南,8篇专家共识、1篇系统评价,获得27条证据,涵盖组织管理、筛查与评估、营养干预、监测与评价、个性化干预、身体活动共6个方面.结论 本研究总结了卵巢癌患者术前营养管理的最佳证据,为卵巢癌患者术前营养管理提供循证依据.

Pancreaticoduodenectomy (PD) is a complex and traumatic abdominal surgery with a high risk of postoperative complications. Nutritional support, including immunonutrition (IMN) with added glutamine, arginine, and ω-3 polyunsaturated fatty acids, can improve patients’ prognosis by regulating postoperative inflammatory response. However, the effects of IMN on PD patients’ outcomes require further investigation. PMC, EMbase, web of science databases were used to search literatures related to IMN and PD. Data such as length of hospital stay, infectious complications, non-infectious complications, postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), mortality, systemic inflammatory response syndrome (SIRS) duration, IL-6, and C-reactive protein (CRP) were extracted, and meta-analyses were performed on these data to study their pooled results, heterogeneity, and publication bias. This meta-analysis involved 10 studies and a total of 572 patients. The results showed that the use of IMN significantly reduced the length of hospital stay for PD patients (MD = -2.31; 95

Objective:To construct endocrinology nursing subspecialty model and explore its clinical effect.Methods:In December 2018, the organization structure of endocrinology nursing subspecialty was constructed in the Drum Tower Hospital Affiliated of Nanjing University Medical School and applied in clinic. In this model, the data of 2018 were taken as the data before application and the data of 2020 were taken as the data after application. The comprehensive ability of nurses, nurse satisfaction, related nursing workload and scientific research ability of nurses were compared before and after the application of the model.Results:After the application of subspecialty nursing mode, nurses′ comprehensive ability score was (92.00 ± 2.36) points. Compared with (84.25 ± 3.24) points before implementation, the difference was statistically significant ( t=-9.46, P<0.01); nurses′ satisfaction evaluations including specialty development (7.92 ± 1.41), self-quality improvement (8.00 ± 1.69), work pressure (6.42 ± 2.67), salary and welfare (3.96 ± 0.85), compared with (5.79 ± 2.31), (6.17 ± 2.82), (8.33 ± 1.50), (2.88 ± 1.59) before implementation, the difference was statistically significant ( t values were -3.86--2.73, all P<0.05). The annual workload of related nursing increased and the scientific research ability of nurses was improved. Conclusions:The application of endocrinology nursing subspecialty mode is beneficial to improve nurses′ comprehensive ability of clinical work, improve the level of specialized nursing, improve the quality of nursing service and promote the improvement of economic benefits, which is worthy of clinical promotion.

基于早期预警评分系统,构建了急诊患者早期分级预警方案,并借助信息化手段,将方案嵌入急诊护理信息系统中,设置了颜色分级提醒功能,实现了分级预警闭环管理.实施后,急诊患者生命体征监测频次增加,抢救成功率提高,护理不良事件发生率降低.认为基于信息化的急诊患者早期分级预警方案提高了急救质量,保障了患者安全,但需在医护协作、护理人力分配、信息资源整合等方面持续改进.

目的 探讨青年强直性脊柱炎(ankylosing spondylitis,AS)患者不同阶段疾病感知的特征.方法 2020年9月至2021年2月,目的抽样法选取南京市某三级甲等医院风湿免疫科门诊就诊或住院治疗的15名青年AS患者为研究对象.采用现象学研究方法,对其进行半结构式深度访谈,并运用Colaizzi 7步法对访谈资料进行分析.结果 青年AS患者在不同阶段的疾病感知各具不同特点.确诊前:躯体异常症状感知显著、求医经历曲折;确诊后:不良情绪感知突出、多途径寻求疾病信息支持、感知治疗的益处、预后态度过于乐观;康复期:忽视疾病进展风险、怀疑治疗可控性、主动或被动接纳疾病、社会参与水平下降、渴望理解与支持.结论 青年AS患者不同阶段的疾病感知存在差异,建议医护人员根据患者不同时期疾病感知的特点,制定针对性的疾病管理方案.

安宁疗护是对疾病终末期患者通过控制痛苦和不适症状,提供身体、心理、社会、精神等方面的照护和人文关怀等服务,来提高生命质量,帮助患者舒适、安详、有尊严地离世.2017年国家卫生健康委员会连发两文:《安宁疗护实践指南(试行)》[1]和《安宁疗护中心基本标准和管理规范(试行)》[2] ,并在北京、上海、洛阳等地区开展第一批安宁疗护试点工作.在第一批安宁疗护试点工作取得突破性进展后,2019年10月国家卫健委等部门联合印发的"两个《意见》"中均指出要加强安宁疗护服务发展,安宁疗护进入全面推进新局面,并开展了全国第二批安宁疗护试点工作,其中南京市作为第二批安宁疗护试点城市.本规范拟针对安宁疗护的服务模式、服务内容、质量评价制定标准,借鉴国内外各指南标准和实验研究,结合实践经验,归纳总结出符合南京市的安宁疗护标准,以提供更科学、同质化的安宁疗护服务,更好地发挥安宁疗护作用.

目的:了解日间腹腔镜胆囊切除术病人术后疼痛管理的真实体验,为制订针对性疼痛管理方案提供依据.方法:采用目的性抽样法,对11例日间腹腔镜胆囊切除术病人进行半结构式访谈,采用Colaizzi 7步分析法整理与分析访谈资料.结果:提炼出疼痛感知、疼痛的影响、消极应对、期望落差、多重需求5个主题.结论:日间腹腔镜胆囊切除术病人在疼痛管理方面存在诸多需求,医务人员应关注其术后疼痛的感受与体验,完善个体化的疼痛管理策略,以提高病人的就医体验和满意度,进一步推动日间手术的发展.

目的:了解中青年强直性脊柱炎病人的疾病感受和体验,为医护人员制订高效、优质的疾病管理措施提供参考.方法:采用目的抽样法,对16例中青年强直性脊柱炎病人进行半结构式访谈,应用Colaizzi 7步分析法整理资料形成主题.结果:中青年强直性脊柱炎病人疾病感受和体验包含4个主题:①疾病症状的影响;②人生规划的限制;③孤独和孤立的体验;④应对疾病的多种策略.结论:中青年强直性脊柱炎病人在生理、心理及社会参与等方面经历诸多挑战,医护人员应关注其疾病的感受和体验,完善个体化的疾病管理策略.

Objective:To investigate the status of transition preparation in patients with ankylosing spondylitis (AS) in emerging adulthood and analyze its influencing factors.Methods:The convenient sampling method was used to select 180 patients with AS in emerging adulthood who visited the outpatient department of Drum Tower Hospital Affiliated to Nanjing Medical School from November 2020 to July 2021. General Information Questionnaire, Self-Management and Transition to Adulthood with Rx Treatment Questionnaire (STARx) , Chronic Disease Self-Management Behavior Scale, Bath Ankylosing Spondylitis Disease Activity Index Inventory (BASDAI) , Bath Ankylosing Spondylitis Disease Activity Index Scale (BASFI) and Numerical Rating Scale (NRS) were used to survey patients. Multiple linear regression analysis was used to analyze the influencing factors of transition preparation in patients with AS in emerging adulthood.Results:The transition preparation score of patients with AS in emerging adulthood was (45.23±8.25) , and the score rate was 68.5%. The results of univariate analysis showed that the transition preparation total scores of patients with different gender, age, marital status, work situation, education level, monthly family income, payment method, type of medication, duration of disease, erythrocyte sedimentation rate, C-reactive protein, nocturnal pain and overall pain were compared, and the differences were statistically significant ( P<0.05) . The results of correlation analysis showed that self-management behavior was positively correlated with transition preparation ( P<0.01) , and AS disease activity index and AS disease function index were negatively correlated with transition preparation ( P<0.01) . The results of multiple linear regression analysis showed that, age and self-management behaviors could positively predict transition preparation scores (standardized regression coefficients were 0.414 and 0.211; P<0.01) , while medication type and AS disease function index could negatively predict transition preparation scores (standardized regression coefficients were -0.246 and -0.243; P<0.01) . Conclusions:The overall level of transition preparation of patients with AS in emerging adulthood is low, which is affected by age, medication type, AS disease function index and self-management behavior. Medical staff should pay more attention to patients with young age, oral medication use, high disease function index and low level of self-management behavior and formulate systematic and personalized interventions to improve their transition preparation.

Objective:To investigate the current status of anticipatory grief among caregivers of major relatives of hospitalized patients with hematological malignancies and analyze its influencing factors.Methods:Convenience sampling method was used to select 208 primary relatives and caregivers of patients with hematological malignancies who were hospitalized in the Department of Hematology, Nanjing Drum Tower Hospital from March to November 2020. Self-designed general information questionnaire, Chinese version of Anticipatory Grief Scale, caregiver burden scale and simple coping style questionnaire were used. The current status and influencing factors of anticipatory grief among caregivers of major relatives of hospitalized patients with hematological diseases were also analyzed.Results:The expected sadness score of caregivers of major relatives of hospitalized patients with hematological malignancies was 79(72, 91). The results of multiple linear regression analysis showed that the main influencing factors of anticipatory grief among caregivers of major relatives of hospitalized patients with hematological malignancies were the stage of treatment, the severity of subjective symptoms, whether to seek medical treatment in other places, the working status of caregivers of major relatives was unemployed, relationships with patients were parents, caregiver burden, and negative coping styles, which explained 83.1% of the total variation.Conclusions:Anticipatory grief is more serious among the caregivers of major relatives of hospitalized patients with hematological malignancies. It is recommended that nurses in the Hematology Department detect and assess the level of anticipatory grief of caregivers in a timely manner, and give corresponding interventions according to individual differences, so as to improve the physical and mental health of the caregivers, and then improve the quality of care and promote the recovery of patients.

Objective:To build a specialty nursing construction model based on subspecialty, so as to explore the practice results in clinical specialist nursing construction of hospitals.Methods:A specialty nursing construction mode with subspecialty as the entry point and medical integration mode as the core was constructed. From January 2017 to December 2019, the project was piloted in 9 key nursing specialties and gradually promoted from point to area. Specialty nursing construction effect, nurse practice environment and patient experience in the department level were comprehensively evaluated.Results:After the implementation of specialty nursing construction projects based on subspecialty, 17 specialty nursing items and 14 key nursing technologies were added and 12 subspecialty nursing brand projects were constructed. After the implementation of the specialty nursing construction project based on subspecialty, the total score of nurse practice environment assessment was (80.40±15.72) , higher than (77.97±16.99) before the implementation, and the difference was statistically significant ( P<0.05) . After implementation, the scores of quality management, internal support, medical cooperation, professional promotion, manpower allocation, social status and remuneration were higher than those before implementation, and the differences were statistically significant ( P<0.05) . After the implementation of the project, the satisfaction of discharged patients was improved and the number of hospital-level commendation cases increased from 218 to 567. Conclusions:The specialty nursing construction model based on subspecialty has positive role in promoting the construction of specialist nursing in the department, improving nurses practicing environment and enhancing medical experience of patients.

目的 探讨基于项目管理理论构建心内科住院环境噪音水平管理方案及应用效果.方法 选取心内科项目实施前住院患者60例为对照组,项目实施后住院患者60例为干预组,对照组实施常规环境噪音管理,干预组实施基于项目管理理论构建的心内科住院环境噪音水平管理方案进行噪音管理,比较实施前后心内科病区3个时间段总体噪音及护士站噪音水平、患者睡眠质量、患者受噪音的影响程度及对噪音控制的满意度.结果 干预后心内科住院环境的总体噪音水平明显下降、患者睡眠情况得到改善、受噪音影响程度下降、对环境满意度提升,差异均有统计学意义(P<0.01或P<0.05).结论 运用基于项目管理理论构建的心内科住院环境噪音水平管理方案可有效降低住院环境的噪音水平,改善患者就医体验,提升满意度.

目的 调查多发性骨髓瘤患者疲劳现况并分析其影响因素,为制订和实施针对性干预护理措施或科研人员开展高证据等级的护理研究提供科学依据.方法 采用一般资料问卷、多维疲劳量表、匹兹堡睡眠质量指数量表、Zung焦虑自评量表、Zung抑郁自评量表及自我感受负担量表对126例多发性骨髓瘤患者进行调查.结果 多发性骨髓瘤患者总体疲劳得分为(67.20±10.65)分,属重度疲劳;多重线性回归分析显示,多发性骨髓瘤患者疲劳的影响因素为家庭人均年收入、化疗疗程数量、睡眠指数、抑郁、自我感受负担(均P<0.05).结论 多发性骨髓瘤患者疲劳感处于较高水平,护理人员可基于疲劳感因素和症状评估,制订个性化干预策略,提高睡眠质量;提供个性化的心理护理等来改善患者的疲劳现况,提高其生活质量.

目的 改善ICU护士的心理健康状况,提高其生活质量.方法 对119名存在心理健康问题的ICU护士进行基于员工援助计划的心理干预,措施包括制订心理分级干预方案,采取多种措施相结合的分级干预,连续干预3个月后评价效果.结果 干预后ICU护士SCL-90得分显著下降(P＜0.01),其中71名(59.66％)恢复正常;SF-36评分8个维度中一般健康状况、情感职能、精力、社会功能和精神健康5个维度得分显著提高(P＜0.05,P＜0.01).结论 基于员工援助计划的心理健康干预方案可有效改善ICU护士的心理健康状况,从而提高其生活质量.

介绍国外社区护士培训的监督管理、组织形式、培训方式、培训内容等.国外社区护士培训具备完善的监督管理体系,通过与高校合作、政府和专业组织参与等多种培训形式,为社区护士拓展教育资源,灵活运用线上、线下培训和正式、非正式培训的方式,以社区护士岗位职责及核心能力为中心,全面提升社区护士专业素质.启示我国应完善培训制度,多方合作,为社区护士提供更多培训机会,合理使用多种培训方式,丰富社区护士培训内容.