Table of Content

15 September 2024, Volume 21 Issue 9 Previous Issue    Next Issue

Digitization and Intelligence Development of Nursing Education

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Construction and application of knowledge graph in Health Assessment Course YANG Zhihui, LI Xingwen, BI Xiaojun, LIN Jinqiu, ZHAO Qianqian, LIU Suting, LUO Yuanyuan, ZHANG Lili 2024, 21 (9):  1035-1040.  doi: 10.3761/j.issn.1672-9234.2024.09.001 Abstract ( 630 )   HTML ( 0 )   PDF (1620KB) ( 13 )   Save Figures and Tables | References | Related Articles | Metrics Objective To construct a knowledge graph for the Health Assessment Course and investigate students’ usage experiences. Methods The Neo4j graph database was utilized to construct a knowledge graph for the Health Assessment Course. From May to July 2023，the knowledge graph was implemented in the Health Assessment Course for 83 second-year nursing undergraduate students from the Grade 2021 of a medical university who had not used a knowledge graph previously. After the course，students’ practice duration and frequency on knowledge points，overall satisfaction with the knowledge graph platform，and willingness to continue using it for learning were evaluated. Additionally，17 students were purposively sampled for semi-structured interview to collect their feedback. Results The constructed knowledge graph consisted of 199 knowledge points，2 890 nodes，and 2 628 attributes，with 168 types of inclusion relationships，97 types of sequential relationships，and 37 types of correlation relationships established among the nodes. The average learning duration for knowledge points among the 83 students was 0.17（0.17，3.37） hours，with an average practice frequency of 1（1，33） times. The overall satisfaction with the knowledge graph platform was 8.00（7.00，9.00） out of 10，and 99%（82/83） of students expressed willingness to continue using the knowledge graph for learning. Interviews revealed that students believed the application of the knowledge graph for the Health Assessment Course enhanced their learning engagement，alleviated exam anxiety，facilitated clearer learning paths，ensured comprehensive content coverage，and deepened understanding and memory of knowledge. However，there were still some unmet learning needs. Conclusion Positive feedback is got for using the knowledge graph in the Health Assessment Course，which can facilitate the efficient and systematic learning，and ultimately improving their learning effects.

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A study on the design of a medical terminology digital game and its application in undergraduate nursing students XUE Xiaoyan, LI Hongmei, LI Linjie, HAO Limin 2024, 21 (9):  1041-1045.  doi: 10.3761/j.issn.1672-9234.2024.09.002 Abstract ( 146 )   HTML ( 0 )   PDF (1391KB) ( 2 )   Save Figures and Tables | References | Related Articles | Metrics Objective To explore the application effect of a digital game in learning medical terminology for nursing undergraduates. Methods A digital learning game based on the WeChat applet was designed to organize the medical terminology base，break down the learning tasks into levels of different difficulty and progress，present them in the form of text，voice，pictures，and animation，and set up instant feedback and reward mechanisms such as achievement badges，experience values and leaderboards. A total of 90 nursing undergraduates were recruited and were randomly divided into 3 groups with 30 students in each group. These groups shared same learning content. In teaching method，the first group employed WeChat applet（digital game），while the second group learned through an online platform，and the third group applied a paper version of the learning materials to study on their own. Participants in three groups were required to learn medical terminology for at least 30 min per day for 1 month. The terminology test was administered to the students before，after，and 3 weeks after the intervention. At 3 weeks post-intervention，the first group’s evaluation and satisfaction with the digital game were investigated. Results Students’ medical terminology test scores were analyzed by repeated-measures ANOVA cross-effects（F=32.591，P<0.001）. Simple effect analysis showed that the scores of the first group were higher than those in the second and third groups after the intervention and 3 weeks after the intervention （P<0.05），while difference between the scores of the second and third groups was not statistically significant（P>0.05）. The students were satisfied with the digital games and evaluated its effect as good. Conclusion Digital games can enhance learners’ understanding and memory of medical terminology，which can be used as an auxiliary tool for nursing undergraduates’ medical terminology learning.

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A descriptive qualitative study on the experience of using artificial intelligence generated content tools among nursing postgraduate students LIU Ting, YANG Fuguo, YANG Li, YANG Xiuling, HAN Jing, WANG Aimin 2024, 21 (9):  1046-1051.  doi: 10.3761/j.issn.1672-9234.2024.09.003 Abstract ( 258 )   HTML ( 0 )   PDF (1091KB) ( 4 )   Save Figures and Tables | References | Related Articles | Metrics Objective To investigate the real experience of using artificial intelligence generated content（AIGC） tools among nursing postgraduate students and explore related driving and hindering factors，so as to provide implications for improving their digital literacy. Methods Using descriptive qualitative research design，a semi-structured interview was conducted on 14 nursing postgraduate students from February to April 2024. The interview audios were transcribed verbatim into text，and the interview data was analyzed through thematic analysis. Results Three themes were extracted：strong interest in AIGC tools，perceived benefits of using AIGC tools， and concerns about using AIGC tools. Conclusion Nursing postgraduate students embrace and accept the auxiliary role of AIGC tools in their research，which benefits them in promoting self-directed learning and improving academic writing. However，information reliability，accessibility，and security risks are obstacles in using AIGC tools. These results provide implications for nursing educators to develop educational strategies to enhance their digital literacy in the context of the artificial intelligence era.

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Construction of evaluation index system of virtual simulation experiment course on major of nursing PANG Bing, WANG Xiuhong, WANG Li, LI Hong 2024, 21 (9):  1052-1058.  doi: 10.3761/j.issn.1672-9234.2024.09.004 Abstract ( 163 )   HTML ( 0 )   PDF (1243KB) ( 3 )   Save Figures and Tables | References | Related Articles | Metrics Objective To construct an evaluation index system for virtual simulation experiment teaching in nursing，and provide references for improving the quality of virtual simulation experiment courses in the major of nursing. Methods Under the guidance of CIPP evaluation mode，Delphi expert letter inquiry method was adopted for the construction based on the results of literature review and semi-structured interviews. Results The positive coefficient of experts in three rounds of expert correspondence was 94%（16/17），100%（16/16），100%（16/16） respectively，and the variation coefficient was 0.05~0.34，0~0.32，0~0.11. Kendall’s W coefficient was 0.121，0.152 and 0.154（all P<0.001） in three rounds of consultation respectively，with a authority coefficient of 0.903. The evaluation index system of virtual simulation experiment course of nursing specialty included four dimensions of background，input，process，and effectiveness evaluation，which was composed of eight first-level indexes，24 second-level indexes and 69 third-level indexes. Conclusion The evaluation system constructed is reliable and scientific，and can comprehensively evaluate the quality of the virtual simulation experiment course of nursing major. This evaluation system can be used to guide nursing teachers to implement the teaching work before，during and after the virtual simulation experiment course.

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Construction and practice of virtual simulation training teaching system for medical and health care professional groups MAO Cui, YAO Shuihong, GAN Chunchun, ZHAO Hua, LIANG Xia, HU Ye 2024, 21 (9):  1059-1065.  doi: 10.3761/j.issn.1672-9234.2024.09.005 Abstract ( 174 )   HTML ( 0 )   PDF (1342KB) ( 5 )   Save Figures and Tables | References | Related Articles | Metrics The development of Virtual Training Bases has presented significant challenges，including an excessive focus on infrastructure and hardware while ignoring practical application，an abundance of disparate applications without systematic integration，and a bias towards existing technologies and resources over innovation. In line with our commitment to drive digital transformation and reform professional education，we have created a range of application scenarios utilizing virtual training setups，accompanied by a comprehensive set of meticulously executed educational guidelines. The practice shows that the redesigned virtual training platform boasts numerous advantages，including superior alignment with local needs，seamless cross-device data sharing，diverse functional modules，and a suite of meticulously crafted operational regulations；and not only facilitates educational reform in practical training but also improves the quality of comprehensive education.

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The bibliometrics analysis of the literature status，hotspots and trends in nursing virtual simulation in China QIN Yuting, YANG Binbin, GENG Xuemei, WANG Shiyuan, ZHAO Qingyang 2024, 21 (9):  1066-1071.  doi: 10.3761/j.issn.1672-9234.2024.09.006 Abstract ( 169 )   HTML ( 0 )   PDF (880KB) ( 2 )   Save Figures and Tables | References | Related Articles | Metrics Objective To explore the current literature status，hotspots，and development trends in the field of nursing virtual simulation in China in last decade. Methods Through literature searching in CNKI database，articles related to the application of virtual simulation technology in the nursing field published from 2014 to 2023 were retrieved. CiteSpace 6.3R1 software was employed to analyze the number of publications，author collaborations，publishing institutions，as well as keyword co-occurrence，clustering，timeline，and burstness. Results A total of 487 literature were included. From 2014 to 2023，the annual number of publications in the field of nursing virtual simulation in China showed an overall upward trend. There were 113 core authors；and 3 institutions had published more than or equal to 5 articles. Literature hotspots mainly focused on experimental and clinical teaching，rehabilitation and pain nursing，etc. The close integration of virtual simulation technology with the Internet and augmented reality technology，as well as the application of virtual simulation technology in maintaining joint function and for hemiplegic patients，showed to be the development trends in this field. Conclusion Literature in the field of nursing virtual simulation in China indicates a rapid development stage，with diversified literature hotspots. In the future，interdisciplinary，cross-unit，and cross-regional collaborations should be promoted. More in-depth research should be conducted from a broader perspective，focusing on the literature hotspots and development trends in this field，thereby further advancing the application of virtual simulation in nursing field.

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Application of artificial intelligence in career planning and its implications for nursing education LI Jinliang, FAN Xiuzhen 2024, 21 (9):  1072-1075.  doi: 10.3761/j.issn.1672-9234.2024.09.007 Abstract ( 202 )   HTML ( 0 )   PDF (1117KB) ( 1 )   Save References | Related Articles | Metrics Artificial intelligence（AI） can enrich career guidance resources，as well as optimize career paths by recommending personalized careers based on abilities and characteristics. However，AI may be a potential risk in terms of algorithms，privacy，and ethics. Analyzing the role and risks of AI in career planning can provide a new approach to solving the employment problems of nursing students and help educators to guide nursing students in career planning better，which is helpful in solving the employment problems of students.

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Potential application value，challenges，and prospects of generative artificial intelligence in nursing simulation education WANG Yaqi, GAO Jie, WANG Kefang 2024, 21 (9):  1076-1081.  doi: 10.3761/j.issn.1672-9234.2024.09.008 Abstract ( 334 )   HTML ( 0 )   PDF (1160KB) ( 7 )   Save References | Related Articles | Metrics The vigorous development of Artificial Intelligence Generated Content（AIGC） has presented immense opportunities in nursing simulation education. This paper delved into every aspect of simulation teaching，focusing on the potential application value of AIGC in the field of nursing simulation education. It encompassed areas such as improving the efficiency of simulation teaching design，generating personalized simulation preparation resources，assisting in writing multimedia simulation teaching case scripts，creating highly realistic security simulation environments，utilizing human-computer interaction technology to achieve communication simulation training，and providing continuous process simulation teaching feedback. This comprehensive analysis disclosed AIGC’s tremendous potential in strengthening teaching outcomes and fostering the refinement of nursing students’ skills. Furthermore，the paper objectively examined the challenges that accompany the application of this technology and proposes corresponding strategies to address them. By maximizing the potential value of AIGC in nursing simulation education，this paper aims to further propel the overall improvement of nursing simulation education quality，ultimately contributing to the cultivation of high-quality nursing professionals.

Experimental and Practical Teaching and Learning

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Implementation of the Nursing Practical Skills Assessment Program and its implications for student competency development SHENG Yu, JIA Yuling, ZHANG Liming, CHEN Wei, LI An, ZUO Fenglin 2024, 21 (9):  1082-1087.  doi: 10.3761/j.issn.1672-9234.2024.09.009 Abstract ( 179 )   HTML ( 0 )   PDF (861KB) ( 5 )   Save Figures and Tables | References | Related Articles | Metrics To address the needs and challenges of nursing education，the Health China Research Center，under the National Health Commission，launched the “Nursing Practical Skills Assessment Program” in 2021. This program aims to enhance the alignment between nursing students’ graduation assessments and new nurses’ pre-employment training，so as to improve the teaching capabilities of nursing schools，and provide quantitative references for employers in selecting candidates for employment. From 2018 to 2023，the program got implemented in 38 nursing schools and two clinical hospitals across 18 provinces in China，involving nearly 100 000 candidates. The assessment covered 27 practical skills outlined in the “Training Outline for Newly Employed Nurses” and utilized a “case-based + multi-station skills assessment” approach. Preliminary results indicated that the program effectively improved nursing students’ understanding of job competence and the teaching capabilities of participating schools，and explored the feasibility of a comprehensive nursing evaluation system. Through introducing the design and implementation of the evaluation program，this paper analyzed the challenges encountered during its execution，and discusses its implications for student competency development，which provides valuable insights for enhancing the quality of nursing talent cultivation in China.

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Design and practice of clinical nursing skills training proposal with incorporation of competition and education LIN Dan, ZHANG Yixiong, SUN Rong, BAI Yamei, ZHANG Xueqing, SONG Yulei 2024, 21 (9):  1088-1092.  doi: 10.3761/j.issn.1672-9234.2024.09.010 Abstract ( 123 )   HTML ( 0 )   PDF (736KB) ( 1 )   Save Figures and Tables | References | Related Articles | Metrics Objective To investigate the effect of a clinical nursing skill training proposal that incorporates both competition and education. Methods The study involved 236 grade three nursing undergraduates who completed a clinical nursing skill training proposal，which covered different aspects including overall thinking，teaching content，teaching resources，teaching activities，and teacher teams. Pre class guidance，OSCE and guided feedback during class，and post class consolidation were conducted in practical training. Results OSCE was conducted to access the competency of the students. Time to complete the task of the first station in OSCE was（564 ± 240） s. Time to complete the task of the second and third station was（618 ± 121） s and （653 ± 166） s respectively. The score range for theoretical foundation，operational skills，team cooperation，humanistic care，and clinical thinking varied from 78.9% to 91.7%. Moreover，the satisfaction rate of students with teaching methods，teaching content，teaching process arrangement，and teaching environment arrangement varied from 89.7% to 97.6%.The feedback from the students indicated that integrating competition and education was highly engaging，which assisted them to improve their knowledge and skills. Conclusion The clinical nursing skills training proposal that incorporates competition and education is highly feasible and effective in improving students’ comprehensive ability in clinical nursing.

Ideological and Political Education and Quality Education

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Design and implementation of ideological and political theory education in Community Nursing ZHUANG Jiayuan, SHEN Ling, WANG Zhuzhu, HU Rong, ZHANG Yanyan, WANG Yan, CHEN Xiaohua, LIU Xiaoru 2024, 21 (9):  1093-1098.  doi: 10.3761/j.issn.1672-9234.2024.09.011 Abstract ( 184 )   HTML ( 0 )   PDF (892KB) ( 5 )   Save Figures and Tables | References | Related Articles | Metrics Objective To construct an ideological and political teaching plan for the course of Community Nursing and explore its application effect. Methods The main steps of establishing the ideological and political teaching plan for Community Nursing included determining the ideological and political goals of the course，identifying ideological and political elements，and integrating course content with ideological and political elements. After construction，the ideological and political teaching of Community Nursing courses was implemented among 183 full-time nursing undergraduate students of the 2020 grade of a medical university. Results The process assessment score of the nursing undergraduate students of the 2020 grade was（92.15±2.22） points，and the overall course score was（75.31±5.77） points. After the ideological and political teaching of the Community Nursing course，98%（100/102） of the students believed that community health services were of great significance to residents’ health，and 77% （79/102） of the students expressed their willingness to engage in community nursing work. The average score of students’ evaluation of the teaching team’s teachers was above 95 points. This course awarded the provincial ideological and political demonstration course，and the third prize of the Third National Teachers’ Innovation Competition of Curriculum Ideological and Political of the Positive and Higher-Level Group in 2023. The “family-centered nursing” chapter’s ideological and political teaching was recognized as an Excellent Teaching Case of Ideological and Political of Courses in Fujian Province Colleges and Universities. Conclusion The ideological and political teaching of Community Nursing courses has been recognized by students and peers，achieving good results，which helps to change students’ attitude towards community health services and improve their awareness of serving the grassroots level.

Health Education and Health Promotion

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Construction and application of cognitive intervention program for secondary prophylactic medication compliance in patients with ischemic stroke in community ZHANG Bingyan, LI Jin, YAO Ying, HE Jingru, YANG Huimin 2024, 21 (9):  1099-1105.  doi: 10.3761/j.issn.1672-9234.2024.09.012 Abstract ( 154 )   HTML ( 1 )   PDF (1189KB) ( 3 )   Save Figures and Tables | References | Related Articles | Metrics Objective To construct a cognitive intervention scheme for secondary prophylactic medication compliance in patients with ischemic stroke in community，and evaluate its application effect. Methods Based on the framework of health behavior interaction model，a cognitive intervention program for secondary preventive medication compliance of ischemic stroke patients in community was developed through literature review，interview and expert consultation. From April 2023 to July 2023，study subjects were selected from two communities in Luoyang City by convenient sampling method and were divided into control group（n=34） and experimental group（n=35）. The control group was treated with routine health education，and the experimental group was treated with the cognitive intervention program of secondary preventive medication compliance of ischemic stroke patients in the community. The medication compliance，rational drug use self-efficacy，medication belief and health status indexes were compared between the two groups after intervention. Results The compliance rate of experimental group was 94%，which was higher than that of control group 71%（P<0.05）. After intervention，the scores of rational drug use self-efficacy，belief dimension，blood pressure and low density lipoprotein cholesterol of test group were better than those of control group，and the differences were statistically significant（P<0.05）. Conclusion Community secondary preventive medication compliance cognitive intervention program is beneficial to improve the cognition of medication compliance in patients with ischemic stroke，and is conducive to promoting and improving their health outcomes.

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Application of role-playing card game program in perioperative period of tonsillectomy children ZHENG Ying, YU Ranhui, QIU Fei, LU Tongyao, SUN Danhua, WU Xiaohua, XU Hongzhen 2024, 21 (9):  1106-1112.  doi: 10.3761/j.issn.1672-9234.2024.09.013 Abstract ( 138 )   HTML ( 2 )   PDF (1108KB) ( 5 )   Save Figures and Tables | References | Related Articles | Metrics Objective To design a role-playing card game program and explore its application effect in the perioperative period of pediatric tonsillectomy patients. Methods Based on the tabletop card game of “Medical Little Team” developed by our hospital，a role-playing card game program was formulated through literature review. A convenience sampling method was used to recruit 126 pediatric patients undergoing tonsillectomy in a tertiary pediatric hospital in Zhejiang Province as study participates. The patients were divided into a control group （admitted from March to June 2023，n=60） or an intervention group（admitted from July to October 2023，n=66） depending on the order of admission. The control group received routine perioperative nursing，while the intervention group received role-playing card game intervention in addition to routine perioperative nursing. Medical fear，postoperative delirium occurrence，postoperative medication adherence，and parental readiness for discharge were assessed and compared between the two groups. Results Finally, 63 cases in the experimental group completed the study, and all the cases in the control group completed the study. On the first postoperative day，the medical fear score in the intervention group was（21.02±1.90），lower than that in the control group of （22.30±3.34）（P=0.011）. The incidence of delirium within 2 hours from entering the recovery room to returning to the ward after surgery was lower in the intervention group[5%（3/63） vs. 17%（10/60），P=0.032]. The medication adherence score on the first postoperative day was （3.11±0.70） in the intervention group，higher than that in the control group of （2.53±0.60）（P<0.001）. The parental readiness for discharge score was （239.21±28.15） in the intervention group，higher than that in the control group of （211.55±29.38）（P<0.001）. Conclusion The application of role-playing card game can alleviate perioperative medical fear in pediatric tonsillectomy patients，reduce postoperative delirium，improve medication adherence，and enhance parental readiness for discharge.

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Analysis of mediating role of sense of coherence in the relationship between illness intrusiveness and demoralization syndrome among young and middle-aged maintenance hemodialysis patients SONG Jia, ZHANG Wang, SHAO Yajuan, WANG Xinhong 2024, 21 (9):  1113-1119.  doi: 10.3761/j.issn.1672-9234.2024.09.014 Abstract ( 113 )   HTML ( 0 )   PDF (915KB) ( 2 )   Save Figures and Tables | References | Related Articles | Metrics Objective To explore the impact of sense of coherence（SOC） and illness intrusiveness on the demoralization syndrome among young and middle-aged patients undergoing maintenance hemodialysis（MHD），and to test the mediating effect of SOC between illness intrusiveness and demoralization syndrome in this disease population. Methods Using convenience sampling，a total of 215 young and middle-aged MHD patients from a tertiary hospital in Shaoxing were investigated by the general information questionnaire，Chinses version of Demoralization Scale-Ⅱ，Illness Intrusiveness Rating Scale，and Sense of Coherence-13 from March 2022 to March 2023. Results A total of 203 valid questionnaires were collected，with a recovery rate of 94.4%. The scores of demoralization syndrome，illness intrusiveness，and SOC among the 203 young and middle-aged MHD patients were （13.64±4.68），（44.05±13.05），and（49.80±14.75），respectively. SOC had a negative impact on demoralization syndrome in young and middle-aged MHD patients（P<0.001），while illness intrusiveness had a positive impact on demoraliza-tion syndrome（P<0.001）. SOC partially mediated the relationship between illness intrusiveness and demoralization syndrome in young and middle-aged MHD patients（β=0.52，P<0.001），accounting for 60.5% of the total effect. Conclusion SOC and illness intrusiveness have impacts on the demoralization syndrome in young and middle-aged MHD patients. The level of illness intrusiveness can influence the level of demoralization syndrome by affecting the level of SOC. Nursing managers can adopt effective measures to reduce the degree of illness intrusiveness and enhance the SOC of young and middle-aged MHD patients，thereby reducing the adverse impact of demoralization syndrome on this patient group.

Nurse Growth and Career Development

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Analysis of reflective practice level and its influencing factors in clinical nurses CHEN Xiangjun, HU Fang, TANG Li, TAN Xiaomei 2024, 21 (9):  1120-1125.  doi: 10.3761/j.issn.1672-9234.2024.09.015 Abstract ( 165 )   HTML ( 0 )   PDF (736KB) ( 1 )   Save Figures and Tables | References | Related Articles | Metrics Objective To investigate the current situation of reflective practice among clinical nurses and explore its influencing factors，in order to provide reference for improving reflective practice for clinical nurses. Methods A total of 874 nurses in Guangdong and Hunan Province were surveyed using a general information survey questionnaire，the Sieloff-King Assessment of Work Team/Group Empowerment with Organization，the Chinese version of Evidence-based Nursing Implementation Climate Scale，the Workplace Spirituality Scale，and the Chinese version of Reflective Practice Questionnaire. Results The total score of reflective practice among clinical nurses in this group was（168.19±23.70） points. The results of linear regression analysis showed that group empowerment for nursing，evidence-based nursing implementation climate，workplace spirituality，and marriage（referring to unmarried individuals） were the main influencing factors of reflective practice among clinical nurses，accounting for 56.5% of the total variance. Conclusion The reflective practice of clinical nurses is at a high level，and nursing managers can take measures to improve and maintain the level of reflective practice of clinical nurses based on relevant influencing factors.

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Construction of the re-evaluation management system for the cardiovascular specialty nurses CHEN Yuan, WU Linjing, YU Haiyan, WANG Ligang 2024, 21 (9):  1126-1131.  doi: 10.3761/j.issn.1672-9234.2024.09.016 Abstract ( 150 )   HTML ( 1 )   PDF (931KB) ( 1 )   Save Figures and Tables | References | Related Articles | Metrics Objective To develop a re-evaluation management system for cardiovascular specialty nurses. Methods A preliminary draft of the re-evaluation management system was formulated through literature review and semi-structured interviews. From December 2023 to January 2024，Delphi method was employed in two rounds of consultations with experts from 13 provinces to revise and improve the preliminary draft. Results The effective response rate for the two rounds of expert consultations was 100%（20/20） and 95%（19/20），respectively. The expert authority coefficient was 0.953 and 0.955，respectively. The Kendall’s W coefficients of concordance was 0.140 and 0.223 （both P<0.05），respectively. The final re-evaluation management system for cardiovascular specialty nurses consisted of 3 first-level items，12 second-level items，and 37 third-level items. Conclusion The re-evaluation management system for cardiovascular specialty nurses is scientific，which can provide a reference for the training and re-evaluation of cardiovascular specialty nurses.

Professional Practice

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Application of the buttonhole puncture management program for difficult autologous arteriovenous fistula in hemodialysis patients CHAI Jianli, WU Chunyan, YUAN Aiqin, LUO Puying, FENG Jian, LU Mingxi 2024, 21 (9):  1132-1140.  doi: 10.3761/j.issn.1672-9234.2024.09.017 Abstract ( 144 )   HTML ( 0 )   PDF (1445KB) ( 5 )   Save Figures and Tables | References | Related Articles | Metrics Objective To establish a management program for difficult autologous arteriovenous fistula buttonhole puncture and to explore its application effect in hemodialysis patients. Methods Based on literature review and expert consultation，a management program for difficult autologous arteriovenous fistula buttonhole puncture was developed. A buttonhole puncture information handover sheet and a buttonhole puncture diagram were designed. A total of 77 hemodialysis patients with difficult autologous arteriovenous fistula treated in the blood purification center of a tertiary hospital in Zhejiang Province from September 2020 to January 2022 were selected as the study subjects. They were randomly divided into the experimental group（n=38） and the control group（n=39） using a random number table. The experimental group received the management program for difficult autologous arteriovenous fistula buttonhole puncture，while the control group received the conventional buttonhole puncture program. The success rate of one-time blunt needle insertion，arteriovenous fistula infection rate，vascular intimal hyperplasia at the buttonhole puncture site，and buttonhole with a service life of ≥12 months rate were compared between the two groups. Results The success rate of one-time blunt needle insertion in the experimental group was higher than that in the control group，the degree of vascular intimal hyperplasia at the buttonhole puncture site was lower than that in the control group，and the buttonhole with a service life of ≥12 months rate was higher than that in the control group （P<0.05）. There was no significant difference in the arteriovenous fistula infection rate between the two groups（P>0.999）. Conclusion The application of the management program for difficult autologous arteriovenous fistula buttonhole puncture in hemodialysis patients can improve the success rate of one-time blunt needle insertion，delay vascular intimal hyperplasia at the buttonhole puncture site，and prolong the service life of arteriovenous fistula buttonholes，which is worthy of promotion and application.

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Contemporaneous symptom network analysis in breast cancer patients undergoing endocrine therapy HE Xiaoge, LI Huanxi, LU Qian, LIU Chunlei, KE Sangsang 2024, 21 (9):  1141-1146.  doi: 10.3761/j.issn.1672-9234.2024.09.018 Abstract ( 126 )   HTML ( 0 )   PDF (1589KB) ( 2 )   Save Figures and Tables | References | Related Articles | Metrics Objective To investigate the incidence and the degree of symptom distress in breast cancer patients undergoing endocrine therapy，and to construct a contemporaneous symptom network to identify the core symptoms and symptom clusters，so as to provide references for precise symptom management. Methods A convenience sampling method was used to select breast cancer patients undergoing endocrine therapy in outpatient clinics and day wards of a tertiary hospital in Baoding City from February 2023 to November 2023，and a total of 330 patients were included. The Chinese Breast Cancer Prevention Trial Symptom Scale（C-BCPT） was used to assess the symptoms of the patients. The principal component analysis was used to extract the symptom clusters，and the symptom network was construct by R language，and the centrality index was calculated. Results Symptoms that distressed more than 50% of patients were fatigue （60.0%），weight gain （60.0%），hot flashes（60.0%），and joint pain（52.1%），which were also the top four symptoms with the highest degree of distress. Cognitive/fatigue symptom cluster，musculoskeletal/vasomotor symptom cluster，and sexual problems symptom cluster were extracted. In the symptom network，difficult to concentrate（rS=1.09） was a symptom with the highest strength，cognitive/fatigue symptom cluster（rS=0.92） was a symptom cluster with the highest average strength，and the top three symptoms with the highest bridge strength were fatigue（rBS=0.29），weight gain（rBS=0.23），and lack of interest in sex（rBS=0.22）. Conclusion There are various symptoms in breast cancer patients undergoing endocrine therapy. Difficulty in concentration is the core symptom for breast cancer patients，the cognitive/fatigue symptom cluster is the core symptom cluster，fatigue，weight gain，and lack of interest in sex are the bridge symptoms in the network analysis. Healthcare professionals can develop precise interventions for the core symptoms，symptom clusters and bridge symptoms so as to improve symptom management efficiency and outcomes.

Review

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The development and application of middle-range nursing theories based on the Neuman Systems Model：a literature research LIN Xiaohong, FANG Jiaxin, LIU Hongxia 2024, 21 (9):  1147-1152.  doi: 10.3761/j.issn.1672-9234.2024.09.019 Abstract ( 175 )   HTML ( 1 )   PDF (681KB) ( 2 )   Save Figures and Tables | References | Related Articles | Metrics Objective To investigate the development and application of middle-range nursing theories based on the Neuman Systems Model（NSM），and to provide reference for the research and practice of nursing theory in China. Methods Databases were searched including PubMed，Scopus，Embase，CINAHL，Web of Science，OVID，EBSCOhost，SinoMed，CNKI，Wanfang and VIP，and literatures related to middle-range nursing theory based on the NSM were screened. The data was extracted and summarized for the included literatures. Results A total of 13 middle-range theories published from 1991 to 2022 were included，which all originated from the United States. The main theory-generating approaches were deduction from theories and induction from research. Thirteen theories involved all or part of the core concepts of the NSM，and 8 theories employed the concept-theory-empirical frame diagram，4 theories had empirical research evidence，and 3 theories lacked of verification process. Conclusion The middle-range theories based on NSM are mostly developed according to concept-theory-empirical framework，which has a good guiding effect on stress and coping practice of different individuals and families.