Table of Content

15 November 2023, Volume 20 Issue 11 Previous Issue    Next Issue

Research Paper

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Construction and application of a parent-led health management program for children with epilepsy HE Qiuping, LIU Tingting, CUI Weiwei, WANG Wei, CAO Miaomiao, MA Xiaoli, YE Bei 2023, 20 (11):  1285-1291.  doi: 10.3761/j.issn.1672-9234.2023.11.001 Abstract ( 156 )   HTML ( 0 )   PDF (944KB) ( 20 )   Save Figures and Tables | References | Related Articles | Metrics Objective To construct a parent-led health management program for children with epilepsy based on Health Action Process Approach（HAPA） and evaluate its effect in application. Methods Based on literature research and group discussions，a parent-led health management program for children with epilepsy was constructed after two rounds of expert consultation. Using the convenience sampling method，parents of children with epilepsy admitted to a tertiary hospital in Henan Province from February to May 2022 were selected as the control group（30 cases），and parents of children with epilepsy admitted from June to September 2022 were selected as the experimental group （30 cases）. While the control group received conventional health education，the experimental group received a parent-led health management program based on the control group. The knowledge of epilepsy disease，the level of disease management，and the number of epileptic seizures were compared between the two groups three months after discharge from the hospital. Results A total of 12 experts responded to the consultation. The coefficient of expert familiarity was 0.84，the coefficient of authority was 0.89，the coefficient of judgment was 0.93，and the coefficients of Kendall’s harmony ranged from 0.172 to 0.333（all P<0.05）. The constructed parent-led health management program for children with epilepsy was divided into three stages：pre-intention，intention，and action. Three months after discharge，the epilepsy disease knowledge score of the experimental group was（85.13±6.99），higher than that of the control group（78.20±10.97），with a statistically significant difference（t=2.920，P<0.05）. Meanwhile，the disease management difficulty subscale score of the experimental group was（27.40±5.91），lower than that of the control group（33.67±9.92），with a difference of statistical significance（t=2.973，P<0.05）. In addition，the subscale score of disease management ability was（48.10±4.85），which was higher than that of the control group（44.87±6.06），and the difference was statistically significant（t=2.281，P<0.05）. There was no statistically significant difference in the number of seizures between the two groups（Z=0.187，P=0.852）. Conclusion The parent-led health management program for children with epilepsy constructed in this study is scientific，reliable，safe，and effective，and can improve the family’s knowledge of the disease and disease management ability.

Special Planning—Palliative Care

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The design and practice of ideological and political in infiltrating curriculum in virtual simulation experiment teaching of hospice care ZHANG Lu, YANG Meifang, HUANG Yuelin, WU Xiaoqin, LAI Hongmei, FU Jing 2023, 20 (11):  1292-1297.  doi: 10.3761/j.issn.1672-9234.2023.11.002 Abstract ( 420 )   HTML ( 2 )   PDF (1507KB) ( 24 )   Save Figures and Tables | References | Related Articles | Metrics Objective To explore the design and implementation effect of infiltration curriculum ideological and political education in the virtual simulation experiment teaching of hospice care. Methods Based on the training requirements of hospice care talents，the teaching objectives of ideological and political education were clarified，the virtual simulation experiment teaching system integrated with ideological and political elements was developed，and the infiltrating teaching environment was constructed. Then the BOPPPS teaching model was used to carry out the situational infiltration experience ideological and political education based on virtual simulation experiment for 160 full-time nursing undergraduates. Finally，we clarified the teaching effect through the process evaluation of students’ achievement，internal and external evaluation. Results The students’ preview video and topic browsing rate, as well as the completion rate of topic posts, all exceed 95%. The average comprehensive score was 85.6. The scores of emotional attitude in the experimental report，moral quality knowledge and learning perception in the after-class test were more than 90 points，accounting for 86.3%，84.8% and 87.6%，respectively. The analysis of high-frequency words in students’ discussion showed that the topics that students reflected on most were humanistic care（143 times），the meaning of life（125 times），death cognition（109 times） and professionalism（103 times），and all of them could take positive cognition. The course has been approved as the provincial first-class undergraduate virtual simulation experiment teaching course. Conclusion The effect of infiltrating ideological and political education in hospice care virtual simulation experiment teaching is good，which promotes the unity of knowledge teaching and value leading，and can provide reference for the ideological and political education reform of similar colleges and universities.

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Construction of hospice care training content for emergency nurses YU Qin, GOU Yuqi, LI Peiyao, LIU Mengjie 2023, 20 (11):  1298-1304.  doi: 10.3761/j.issn.1672-9234.2023.11.003 Abstract ( 233 )   HTML ( 2 )   PDF (1072KB) ( 17 )   Save Figures and Tables | References | Related Articles | Metrics Objective To construct and determine the training content of hospice care for emergency nurses. Methods On the basis of literature research，questionnaire survey，and the research group discussion，the original training content was developed. Then the Delphi technique was used. A total of 17 experts from six provinces were invited for three rounds of correspondence，and the final training content for emergency nurses was constructed. Results The effective response rates of three-round consultation were both 100% and the expert’s authority coefficients were 0.91，0.92 and 0.92 respectively. The coordination coefficient of items at all levels were 0.224—0.258（P<0.001）. The final hospice care training content for emergency nurses included 6 first-level items（the general introduction of hospice care in emergency department，body care，psychosocial and spiritual care，emergency department hospice care referral，end-stage care，and self-care and improvement of emergency nurses），18 second-level items，and 53 third-level items. Conclusion The content of hospice care training for emergency nurses is progressive and practical，and the construction is scientific and reasonable. We suggest that hospice care training can be incorporated into the on-the-job training system for emergency nurses to make up for the deficiencies of current training.

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A systematic review of the palliative care needs assessment tool for cancer patients HE Jiali, GAO Jing, WU Chenxi, BAI Dingxi, LUO Huan, GONG Xiaoyan, WANG Wei 2023, 20 (11):  1305-1312.  doi: 10.3761/j.issn.1672-9234.2023.11.004 Abstract ( 197 )   HTML ( 0 )   PDF (899KB) ( 20 )   Save Figures and Tables | References | Related Articles | Metrics Objective To systematically evaluate the measurement properties of the palliative care needs assessment tools for cancer patients. Methods Computer searches of databases were conducted to comprehensively search studies on the evaluation of measurement properties of the hospice needs assessment tool for cancer patients from their establishment to July 4，2022，including PubMed，Embase，Web of Science，CINAHL，Scopus，Wanfang Data，CBM，CNKI，and VIP. The literature was independently screened by two researchers，and the methodological quality and measurement properties of the included assessment tools were evaluated using COSMIN guideline-based information after extraction. Results A total of 10 studies were included，involving 10 scales assessing the palliative care needs with cancer patients. None of 10 assessment tools reported cross-cultural validity，measurement error，and responsiveness. Based on high-quality evidence，the internal consistency of "the evaluation questionnaire on demand of terminal cancer patients" and "the revised Chinese version of the problems and needs in palliative care questionnaire"，as well as the structural validity of the Chinese version of the PNPC-sv，were found to be “inadequate”. Therefore，the three scales were recommended as grade C. The other seven scales were recommended as grade B. Among them，the structural validity，internal consistency，and hypothesis testing of the Chinese version of the PPCI were found to be "adequate" based on high-quality evidence，and more balanced measurement properties were reported. Conclusion Compared with the other nine assessment scales，the Chinese version of the PPCI measurement attribute report is more comprehensive and can be recommended for provisional use，though needs further validation of measurement attribution.

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Application of hospice care consultation in cancer patients：a scoping review ZHANG Yurui, LI Ruiling, WANG Yuanyuan, SU Yaping, WANG Yiman, JI Yajie 2023, 20 (11):  1313-1318.  doi: 10.3761/j.issn.1672-9234.2023.11.005 Abstract ( 170 )   HTML ( 0 )   PDF (805KB) ( 19 )   Save Figures and Tables | References | Related Articles | Metrics Objective To conduct a scoping review on the application of hospice counseling in cancer patients，and provide a reference for developing the hospice counseling programs for cancer patients. Methods We systematically searched the literature on palliative care counseling for cancer patients in Cochrane Library，PubMed，CINAHL，Embase，Web of Science，CNKI，Wanfang，and CBM databases after clarifying the research question. The search period was from the establishment of the database to May 2023. Then we selected literature according to inclusion and exclusion criteria，and extracted，summarized，and analyzed the content of the included literature. Results A total of 12，572 relevant papers were searched，and 18 of them were finally included，including 12 retrospective studies，three descriptive studies，and three prospective studies. Hospice consultation for cancer patients is carried out by the judgment of the attending physician，triggered tools assessment and the patient’s active request. The consultation time generally occurred within 1-3 months before end-of-life. About 4-8 cancer-related symptoms are involved in the consultation process，and the consultation location is mostly conducted in hospital wards followed by outpatient settings. Palliative care consultations can increase referral rates for palliative care while reducing unplanned hospital admissions，intensive care unit occupancy rates，and among others. However，due to barriers from patients，healthcare professionals，and a lack of triggering criteria，many unmet palliative needs exist among cancer patients. Conclusion The trigger criteria for hospice consultation for cancer patients lacks specificity，the timing of counseling is often delayed，and the counseling process needs to be further explored. In the future，further multidisciplinary randomized controlled trials or prospective studies should be conducted to explore the optimal timing of hospice consultation for patients，and to develop appropriate triggering criteria and counseling processes based on different cancer types.

Nursing Education

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The experience of higher vocational nursing students in breakthrough assessment in the course of Fundamental Nursing RAO Yan, JIANG Dawei, SHEN Yuxin, RAO Heping 2023, 20 (11):  1319-1323.  doi: 10.3761/j.issn.1672-9234.2023.11.006 Abstract ( 109 )   HTML ( 0 )   PDF (927KB) ( 17 )   Save Figures and Tables | References | Related Articles | Metrics Objective To explore the experience of higher vocational nursing students in breakthrough assessment in the course of fundamental nursing，so as to provide reference for improving the breakthrough assessment. Methods A semi-structured interview was conducted on 13 nursing students who received breakthrough assessment. Then，data was transcribed and analyzed using Colaizzi’s phenomenological method to identify themes. Results Through analysis，three themes were identified including positive experience（stimulating self-compassion，obtaining precise guidance，enhancing sense of learning achievement，improving interaction between teachers and students and peers，and establishing clinical thinking），challenges brought by breakthrough assessment，and the expectations for breakthrough assessment（expectations for the breakthrough team，to oneself and teachers）. Conclusion Breakthrough assessment plays a very essential role in promoting learning through examination，and a high degree of recognition is hold by nursing students. Meanwhile，it creates higher requirements for the breakthrough team and support from teachers.

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Investigation on clinical practice of double-qualified young teachers in nursing vocational colleges ZHOU Yue, YAN Qiaoyuan, ZHENG Minjuan, ZHANG Huailei 2023, 20 (11):  1324-1328.  doi: 10.3761/j.issn.1672-9234.2023.11.007 Abstract ( 95 )   HTML ( 1 )   PDF (673KB) ( 17 )   Save Figures and Tables | References | Related Articles | Metrics Objective To understand the current clinical practice of young nursing teachers in vocational colleges in Guangdong Province，in order to improve the clinical practice quality of young nursing teachers in vocational colleges and provide reference for strengthening the construction of a dual skilled nursing team. Methods A self-designed questionnaire was used to conduct a survey among 114 young nursing teachers under the age of 45 years old in 13 public vocational colleges offering nursing major in Guangdong Province. Results Among the participants，98.2% of young teachers believed it is necessary to participate in clinical practice. In addition，31.6% of young teachers in universities had no specific requirements for nursing teachers to participate in clinical practice. Beside，78.1% of young teachers proposed that "teaching and research tasks" was the factor that affect their enthusiasm for participating in clinical practice. Conclusion Sufficient support is lack in universities for young nursing teachers in clinical practice，with a short duration of clinical practice，a single form，and a focus on single nursing work. Therefore，supporting policies are suggested for clinical practice of young nursing teachers in universities to incorporate clinical practice into the evaluation indicators for professional titles of young teachers in vocational colleges. Meanwhile，clinical practice system needs to be improved to establish a hierarchical and professional clinical practice evaluation standard with local characteristics，and provide important guarantees for the high-quality development of nursing vocational education.

Clinical Teaching

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Application of panoramic video based on virtual reality technology in clinical teaching of nursing interns in operating room ZHANG Ju, WEI Lili, GU Ruting, WANG Jing, MIAO Chengqiong, FAN Leli 2023, 20 (11):  1329-1334.  doi: 10.3761/j.issn.1672-9234.2023.11.008 Abstract ( 97 )   HTML ( 0 )   PDF (893KB) ( 17 )   Save Figures and Tables | References | Related Articles | Metrics Objective To explore the application effect of panoramic video based on virtual reality technology in nursing teaching of the operating room. Methods Through convenient sampling，72 nursing interns practiced in the operating room from October 2021 to March 2022 were selected as the control group，and another 72 nursing interns practiced in the operating room from April to October 2022 were selected as the experimental group. While the control group adopted the conventional clinical teaching method，the experimental group applied panoramic video teaching based on virtual reality technology with conventional clinical teaching. The anxiety scores of the two groups of nursing interns before and after two weeks of practice and the scores of the theoretical operation examination before leaving the course were compared，and the satisfaction of the experimental group was evaluated. Results At the end of the second week of practice，the anxiety score of nursing interns in experimental group of（34.75±3.06） was lower than that of control group （45.07±2.59） with a statistically significant （t=21.832，P<0.05）. The theoretical scores of nursing interns in experimental group were（80.24±5.22），which was no significant difference when compared with control group（79.58±4.73）（t=1.589，P=0.114）. Besides，there was no significant difference between the experimental group（92.04±4.08） and the control group（91.93±4.32） in the score of operation examination（t=0.159，P=0.874）. In addition，97% of nursing interns in the experimental group had a high level of satisfaction with immersive VR panoramic video teaching. Conclusion Panoramic video based on virtual reality technology can effectively reduce the anxiety and fear of nursing interns in the early stage of operating room practice and improve teaching satisfaction.

Continuing Education

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Development of a nursing training program of breast cancer-related lymphedema for nurses WEI Tingting, WANG Ying, WU Peipei, QIANG Wanmin, LI Xia, LI Miaomiao, CHEN Yuhong, WANG Qing, WANG Yan, REN Hailing 2023, 20 (11):  1335-1341.  doi: 10.3761/j.issn.1672-9234.2023.11.009 Abstract ( 81 )   HTML ( 1 )   PDF (873KB) ( 17 )   Save Figures and Tables | References | Related Articles | Metrics Objective The aim of this study is to develop a nursing training program of breast cancer-related lymphedema for oncology nurses，and provide guidance for improving lymphedema care competence of clinical nurses. Methods Based on behavioral objectives theory，literature analysis and semi-structured interview were conducted for initially formulation of the draft of nurse training program of lymphedema. After that，Delphi technique was adopted for the revision of the training program from June 2022 to September 2022. Results A two-round experts consultation was undertaken involving 25 experts came from seven provinces. The positive coefficients of experts were 100% and 96%（24/25），and the authoritative coefficient of experts were 0.944 and 0.933，respectively. The final training system consisted of training aims and training contents. The training aims included three first-level items，16 second-level items，and the training contents included five first-level items，10 second-level items and 26 third-level items. Conclusion The development of nursing training program of BCRL is scientific and reliable，meets the demand of nurses in caring for patients with breast cancer-related lymphedema and provide guidance for the training of nurses in cancer hospitals.

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Reliability and validity of the Questionnaire on Nurses’ Clinical First Aid Ability in Cardiovascular Medicine Department JIA Shuxian, LÜ Tingting, JIAO Linlin, FENG Yaxin, ZHANG Jingli, LI Ya, LI Linlin, YANG Chunling 2023, 20 (11):  1342-1346.  doi: 10.3761/j.issn.1672-9234.2023.11.010 Abstract ( 83 )   HTML ( 0 )   PDF (758KB) ( 20 )   Save Figures and Tables | References | Related Articles | Metrics Objective To develop a questionnaire on the clinical first aid ability of cardiovascular internal medicine nurses，and to examine its reliability and validity，so as to provide a tool for evaluating the clinical first aid ability of cardiovascular internal medicine nurses. Methods Based on the competency iceberg model，an item pool of the questionnaire was formed based on literature review and group discussions. The questionnaire was drafted through two rounds of Delphi expert consultation. After that questionnaire was distributed among 239 cardiovascular internal medicine nurses from 10 secondary and above general hospitals in Liaocheng City in order to test the reliability and validity of the questionnaire. Results Through exploratory factor analysis，five common factors were extract，namely theoretical knowledge reserve，operational skills，first aid ability，communication and coordination ability，and occupational characteristics，with a cumulative variance contribution rate of 65.854%. A questionnaire with 25 items was formed，with an item level content validity index of I-CVI 0.875 to 1.000. The content validity index of the scale of S-CVI was 0.995. The Cronbach’s α coefficient of the questionnaire was 0.934，and the Cronbach’s α coefficient of each dimension ranged from 0.736 to 0.832. Conclusion The Questionnaire of Nurses’ Clinical First Aid Ability in Cardiovascular Department has good reliability and validity，which can be used to evaluate nurses’ clinical first aid ability in cardiovascular department.

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A systematic review of the evaluation tools for core competencies of head nurses based on COSMIN guidelines WANG Jinyun, YANG Lili, YU Jie, WU Chen, YANG Heng 2023, 20 (11):  1347-1354.  doi: 10.3761/j.issn.1672-9234.2023.11.011 Abstract ( 109 )   HTML ( 0 )   PDF (935KB) ( 18 )   Save Figures and Tables | References | Related Articles | Metrics Objective To comprehensively collect core competencies evaluation tools for head nurses at home and abroad，and systematically evaluate the methodological and psychometric properties quality of them，in order to provide a reference for the scientific selection and training of head nurses. Methods We systematically searched PubMed，Embase，Web of Science Core Collection，CINAHL，CNKI，Wanfang Data，VIP and CBM to collect studies about core competencies evaluation tools for head nurses from the time of database establishment to March 31，2023. The content of each tool was extracted，and Consensus-based Standards for the selection of health Measurement Instruments（COSMIN） was used to evaluate the quality of tools. Results A total of 11 core competence evaluation tools for head nurses were included，including three comprehensive ability evaluation tools and eight specific ability evaluation tools. Among the 11 evaluation tools，there are 10 self-evaluation tools. All of the ten self-evaluation tools were recommended at grade B. Conclusion The head nurses’ transformational leadership self-appraised scale has better quality than other scales，which can be temporarily recommended. At present，the concept of the core competencies of head nurses has not been unified. A mature，comprehensive and targeted core competence evaluation tool for head nurses has not been found. We suggest that in the future，we should further clarify the concept and content of the core competencies of head nurses in line with the characteristics of Chinese hospitals，and develop a related high-quality evaluation tool.

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The current status and influencing factors of the clinical nurses’ health education ability in Ningxia ZHENG Donglian, MA Fuzhen, JI Shuangdui, MA Hongya, YANG Shuhua, TIAN Xiaoyan, ZHU Yayuan, GUO Shuping 2023, 20 (11):  1355-1359.  doi: 10.3761/j.issn.1672-9234.2023.11.012 Abstract ( 84 )   HTML ( 0 )   PDF (841KB) ( 15 )   Save Figures and Tables | References | Related Articles | Metrics Objective To investigate the current status of the clinical nurses’ health education ability in Ningxia，and to explore the main influencing factors. Methods A survey was conducted on nurses from 15 public hospitals in Ningxia autonomous region using a demographic data questionnaire and the Chinese version of Nurses’ Health Education Ability Scale. Results The total score of the health education ability for clinical nurses was（230.96±19.68） points，and the mean total score rate was 79.64%，the items with the lowest five scores mainly focus on the dimension of health education knowledge. The mean score rates of health education knowledge，health education skill，and health education emotion and attitude dimension were 78.57%，80.21% and 80.73% respectively. The bottom five items were concentrated in the dimension of health education knowledge. Multiple linear regression analysis showed that position level，hospital level，whether they had participated in health education training，whether they had published teaching-related papers and the time of health education were the factors affecting nurses’ health education ability，which explained 10.4% of the total variation. Conclusion The health education ability of clinical nurses in Ningxia is at the middle-high level，but the knowledge of health education is still weak. Health education training should be increased for clinical nurses to improve their health education ability，so as to encourage them to play a leading role and advantages in patient health management.

Health Education

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A study of intervention strategies based on ecological systems theory on health-promoting lifestyle of empty nesters with chronic diseases WANG Peina, WEI Xing, JIN Ruihua, ZHANG Peili, DING Yongxia, NIU Baobei 2023, 20 (11):  1360-1365.  doi: 10.3761/j.issn.1672-9234.2023.11.013 Abstract ( 122 )   HTML ( 1 )   PDF (838KB) ( 18 )   Save Figures and Tables | References | Related Articles | Metrics Objective To explore the effect of health intervention based on ecological systems theory on the health-promoting lifestyle of the community empty nesters with chronic diseases. Methods A total of 116 empty nesters with chronic diseases from two communities which separated from each other were selected as subjects from March 2021 to May 2021，with 58 cases in the control group and 58 cases in the experimental group. Health intervention strategy based on ecological systems theory was adopted in the experimental group，such as developing personal interests and implementing home visits of “medical clown” for micro-system level intervention. Meso-systemic intervention through family support and neighborhood assistance；Interventions were carried out at the macro system level，such as setting up health clubs for empty nesters，carrying out health lectures and evaluation，and publicizing medical insurance policies. Routine management was carried out in the control group. After 3 months of intervention，the health promotion lifestyle of the empty nest elderly in the two groups was compared. Results The scores of all dimensions and total scores of health-promoting lifestyle in the experimental group were higher than those in the control group（P<0.05）. Conclusion The intervention strategies based on ecological systems theory can improve the health-promoting behavior level of empty nesters with chronic diseases and help them form a healthy lifestyle.

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Longitudinal study of psychological condition in young and middle-aged patients of maintenance dialysis LI Rui, WU Yue, ZHENG Xiaofeng, MA Lu, SONG Hong 2023, 20 (11):  1366-1370.  doi: 10.3761/j.issn.1672-9234.2023.11.014 Abstract ( 76 )   HTML ( 0 )   PDF (688KB) ( 16 )   Save Figures and Tables | References | Related Articles | Metrics Objective To explore the mental health status of young and middle-aged patients of maintenance dialysis at different time points and its change tendency. Methods From February 2020 to December 2022，a total of 108 dialysis patients diagnosed with end-stage renal disease，who underwent maintenance dialysis were selected as participants. The general information questionnaire and the Chinese version of the Kessler Psychological Distress Scale were used to conduct the questionnaire survey at different time points，including diagnosis，initial dialysis，one month，two-months，three-month，six-month，nine-month and 12-month. Single factor repeated measure ANOVA was used to compare the difference of mental health scores of the participants at different time points. Results The average score of mental health status of the participants was above 30 points within six months from diagnosis to regular dialysis，indicating poor mental health status. From nine to 12 months of regular dialysis，the average score of mental health status was above 22 points，suggesting the worsening of the mental health status. The results of single factor repeated measure ANOVA showed a significant change the mental health status of the participants at the eight time points（F=212.89，P<0.001）. The scores were all above 40 points from diagnosis to initial dialysis，with no statistical difference（P=0.103）. The score of mental health status decreased rapidly from one-month to three-month of dialysis，which reached statistical differences at each time point（P<0.05）. There was no significant difference in mental health status scores at other times（P>0.05）. Conclusion The mental health status of young and middle-aged patients of maintenance dialysis displays different levels from diagnosis to regular dialysis of 12-month. Clinical staff should pay close attention to young and middle-aged dialysis patients from their diagnosis to regular dialysis for six months. Timely identification of patients with possible adverse psychological conditions and provide targeted psychological care are needed.

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Evaluation of the validity and reliability of the form C of the Multidimensional Health Locus of Control ZHANG Xiaomin, ZHAO Yanle, YU Jingli, NIU Wenchang, JIA Yunling, LOU Qingqing, YANG Huimin 2023, 20 (11):  1371-1376.  doi: 10.3761/j.issn.1672-9234.2023.11.015 Abstract ( 72 )   HTML ( 0 )   PDF (793KB) ( 15 )   Save Figures and Tables | References | Related Articles | Metrics Objective To translate the English version of the form C of the Multidimensional Health Locus of Control（MHLC-C） into Chinese, and to test the validity and reliability of the Chinese version of the MHLC-C. Methods After obtaining the authorization of the original author，MHLC-C scale was translated back and forward according to the Brislin scale translation principle. Two rounds of expert consultation and pre-survey were used to complete the cultural adjustment. A total of 321 patients with type 2 diabetes hospitalized in the Department of Endocrinology of a three Grade A hospitals were selected by convenience sampling for item analysis，reliability analysis and validity analysis，thirty patients were randomly selected for retest two weeks after the first survey to evaluate the retest validity. Results The Chinese version MHLC-C has 4 sub-scales and 18 items. The mean content validity index was 0.960 at the scale level，and ranged from 0.780 to 1.000 at the entry level. Exploratory factor analysis extracted four common factors named internal，chance，doctors and other people. Four factors were extracted by exploratory factor analysis，and it could explain 73.079% of the total variance. Then，the confirmatory factor analysis was conducted according to four factors，and the results revealed a good model fit（χ2/df=1.560，RMSEA=0.052，CFI=0.945，GFI=0.901，AGFI=0.876，NFI=0.862，IFI=0.946，TLI=0.938）. The Cronbach’s α coefficient was 0.825 for the total scale，and the correlation of test-retest reliability was 0.940. Conclusion The Chinese version of the MLHC-C has good validity and reliability，which can be used as a tool to assess the healthy locus of control in patients with type 2 diabetes.

Clinical Practice

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Effect of different tunnel establishment methods in Power PICC catheterization in patients with malignant tumors LI Lan, WANG Yajiao, LIN Lihui, CAI Zhiyun, YANG Liu, WANG Ligang 2023, 20 (11):  1377-1382.  doi: 10.3761/j.issn.1672-9234.2023.11.016 Abstract ( 61 )   HTML ( 0 )   PDF (1127KB) ( 15 )   Save Figures and Tables | References | Related Articles | Metrics Objective To compare the application effect and safety of the three tunnel establishment methods in tunneled Power PICC catheterization. Methods Non-randomized historical control study design was employed. From June 2021 to August 2022，a total of 351 patients with malignant tumors in a tertiary A hospital in Xiamen，Fujian Province were recruited as participants，and were classified into group A，group B and group C according to the three different tunnel establishment methods of Power PICC catheterization. For group A，the subcutaneous tissue at the tunnel site was separated by 0.5% lidocaine after local anesthesia at the vascular puncture point and the skin exit site of the catheter to establish the tunnel. For group B，the subcutaneous tissue at the tunnel site was separated by normal saline after local anesthesia at the vascular puncture point and the skin exit site of the catheter to establish the tunnel. On the basis of Group B，group C adjusted the direction of tunnel travel to establish tunnel. The total intraoperative bleeding，the degree of pain，incidence of bleeding within 24 hours after catheterization，the degree of arm comfort after three months of catheterization，catheter dislocation rate within three months after catheterization of the three groups were evaluated. Meanwhile，the occurrence of local anesthesia drugs adverse reactions was recorded. Results There were no significant differences in total intraoperative bleeding，the degree of pain and incidence of bleeding within 24 hours after catheterization in the three groups（P>0.05）. Besides，there were significant differences in the degree of arm comfort after three months of catheterization and catheter dislocation rate within three months after catheterization in the three groups（P<0.05）. In addition，pairwise comparison showed that there was no significant difference between group A and group B（P>0.05） but significant differences between group C and group A，as well as group B（P<0.05）. In group A，one patient（0.96%） had allergic reactions to local anesthesia，while no local anesthesia drugs adverse reaction was occurred in the other two groups. Conclusion In tunneled Power PICC catheterization，it recommends that the subcutaneous tissue should be separated by normal saline，and the tunnel should be established by offsetting 30°-45° to the radial side. Such practice is proved to be high safety，and can improve the comfort of patients with tubes and worth application in clinical practice.

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Maternal experience of abnormal fetal events：a Meta-synthesis ZHOU Liping, LI Jinyun, LIU Xue, ZHANG Wen, DONG Yujiao, WANG Aihong 2023, 20 (11):  1383-1390.  doi: 10.3761/j.issn.1672-9234.2023.11.017 Abstract ( 73 )   HTML ( 0 )   PDF (1134KB) ( 16 )   Save Figures and Tables | References | Related Articles | Metrics Objective To systematically evaluate the real experience of pregnant women experiencing fetal anomaly events. Methods Qualitative studies on emotional experience of pregnant and pregnant women experiencing fetal abnormalities were searched by computer in Chinese and English databases including PubMed，Web of Science，Embase，Cochrane Library，CNKI，Wanfang Database，VIP database and Chinese Biomedical Literature database. The search period was set from the establishment of the database to October 2022. The quality of the literature was evaluated using the 2016 edition of the Australian JBI Quality Evaluation Criteria for evidence-based Health care Center quality research，and a pooled integration method was adopted. Results A total of 15 literatures were included，and 45 topics were summarized into nine categories. Finally，three integration results were formed，namely fetal abnormalities lead to a variety of negative psychological experiences in pregnant women，lacking of social support for pregnant women who are eager for and grateful for diversified external support and help，maternal mentality change，positive adjustment，reflection and personal growth. Conclusion Pregnant women who experienced fetal abnormalities generally suffer from great physical and mental pressure. Nursing staffs should understand the dilemmas they faced，pay attention to their psychological feelings，give emotional support and counseling，and assist in the establishment and improvement of their social support system in order to improve the quality of life and mental health of pregnant women.

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Systematic review of fatigue prevalence and its influencing factors in patients with maintenance hemodialysis ZHANG Ying, LIU Xueqin, LIU Xiaohui, WEI Wei, WU Yaqi, JIANG Xiao, ZHANG Xiaofei, NIE Yajie 2023, 20 (11):  1391-1397.  doi: 10.3761/j.issn.1672-9234.2023.11.018 Abstract ( 65 )   HTML ( 0 )   PDF (899KB) ( 15 )   Save Figures and Tables | References | Related Articles | Metrics Objective To evaluate the incidence of fatigue and its influencing factors in patients with maintenance hemodialysis（MHD）. Methods PubMed，Embase，Web of Science，Cochrane Library，CINAHL，SinoMed CNKI，VIP and Wangfang were searched from inception to December 2022，aiming to collect studies on the prevalence of fatigue and its risk factors in patients with MHD. Two researchers independently conducted literature screening then data extraction and quality evaluation were conducted according to the standards. Stata 17 software was used for carrying out the meta-analysis of incidence and influencing factors. Results A total of 18 studies were included，involving 7 695 cases of MHD. The results of meta-analysis showed that the incidence of fatigue was 64.0% [95%CI（0.58，0.70）]. Serum albumin，sleep quality，gender，duration of dialysis，ultrafiltration capacity，anxiety，depression，and age were the influencing factors of fatigue in MHD patients（all P<0.05）. Conclusion The prevalence of fatigue in patients with MHD is high and there are many influencing factors. Medical workers should provide targeted intervention for them according to the factors of fatigue，so as to help them prevent the occurrence of fatigue and improve the quality of life of patients.

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Research progress of grip strength training in prevention of peripherally inserted central venous catheter-related thrombosis WANG Xu, QIAO Yuanjing, ZHAO Junyan, XIA Yuxue, LIANG Wenna, QIN Guangya, FENG Mengxuan 2023, 20 (11):  1398-1402.  doi: 10.3761/j.issn.1672-9234.2023.11.019 Abstract ( 104 )   HTML ( 0 )   PDF (826KB) ( 18 )   Save References | Related Articles | Metrics Catheter-related thrombosis is one of the most common complications for patients with peripherally inserted central catheter（PICC），which can lead to unplanned extubation，affect the treatment process and even threaten the patient’s life safety in severe cases. As one of the common intervention methods for the prevention of PICC related thrombosis，grip strength training has good effectiveness and practicability. However，due to the lack of scientific，standardized and precise training program guidance in clinical practice，training compliance of patients and the effect of intervention were varied. This article summarized and analyzed the mechanism of PICC-related thrombosis，as well as commonly used grip strength training methods and limitations. Hopefully，this paper can provide a reference for better implementation of grip strength training intervention in clinical practice.

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A review of transitional care of stroke patients during hospital-to-home YANG Hongyan, YANG Ting, WEI Hui, ZHANG Yaping 2023, 20 (11):  1403-1408.  doi: 10.3761/j.issn.1672-9234.2023.11.020 Abstract ( 124 )   HTML ( 0 )   PDF (764KB) ( 21 )   Save References | Related Articles | Metrics The transition from hospital to family is a fragile period in the continuous nursing process of stroke patients. During this period，patients are vulnerable to transition related risks，resulting in increased readmission rate，decreased patient satisfaction and safety，and poorer quality of life. Good transitional care can reduce the readmission rate and all-cause mortality of patients. This paper reviews the concept origin and development，model，scheme and influencing factors of transitional care，with a view to provide reference for the transitional care further development of stroke survivors from hospital to home in China.