Midwives have a vital role in protecting the health of women and children. One of the important strategies to deal with Chinese maternal and child health challenge is to strengthen the ability of midwives. The studies on midwifery policy development and the construction of the core competence of midwives in China made by the research group of Peking University School of Nursing have promoted the practice of midwifery professional reform.

Objective: To investigate the attitudes and opinions of the midwives and related groups and propose the needs of midwifery legislative in China. Method: Totally 5470 midwives and related groups were recruited and investigated by Midwifery Legislation Questionnaire and in-depth interview was conducted among midwives. Results: About 94.70% of the respondents thought that midwifery legislation is necessary. Legislative needs focused on the rights of midwives, scope of practice, responsibility and obligations, etc. Conclusion: There are urgent needs for midwifery legislation in China. We should perfect midwifery legislation from access of midwives, scope of practice , and the system of professional title and promotion.

Objective: To investigate the current status and requirement needs in midwifery talent team in Guangzhou.Methods: Totally 13 hospitals in Guangzhou were recruited using convenience sampling method, and were surveyed with selfdesigned questionnaire and expert interviews. Results: ① The educational background of midwifery was mainly college and bachelor degree (accounting for 86.3%). The professional title was mainly primary (accounting for 76.5%). The specialty was mainly midwifery (accounting for 84.8%). The length of employment was mostly 4 to 20 years (accounting for 71.1%). Most midwives were contract nurses (accounting for 66.0%). ② The number of midwives and obstetric tables in the hospitals were all not up to the standards. ③ The tertiary and secondary hospitals lost 12.5% of the existing midwives, whose educational background were mainly college and bachelor degree, and who were all primary title and contract nurses. All levels of the hospitals had a huge demand for midwives in the next three years. ④ In addition to professional skills, hospitals raised a very high claim for humanistic quality of midwives. Conclusion: The educational background and professional title of midwives were still at the low level. The hospitals were short of midwives seriously and there will be a big demand for midwives in the future. Hospitals had a higher requirement for midwives' knowledge structure. China should vigorously develop high-level midwifery education. Hospital managers should take countermeasures to stable midwife talent team.

We applied Mini-Clinical Evaluation Exercise (Mini-CEX) into midwifery training and teaching program. Midwifery Mini-CEX is created as an objective evaluation tool based on competency diversification. It could comprehensively evaluate midwives' ability for clinical practice and is congruent with modern midwifery professional ability requirements. During the implementation process, it could also benefit both teaching and learning, and provide a new idea and model to further explore a suitable teaching and evaluation method for midwifery clinical practice.

Objective: To explore the structure, reliability and validity of management training needs questionnaire for nursing department directors in the secondary hospitals. Methods: We recruited 395 nursing department directors in the secondary hospitals from 10 provinces and investigated by self-designed questionnaire, and evaluated the reliability and validity of the questionnaire. Results: The final version of the questionnaire consisted of 8 factors and 48 items. The cumulative variance contribution rate of construct validity was 68.983%. The internal consistency was 0.963. The split half reliability was 0.889. The internal consistency reliability of each factor ranged from 0.842 to 0.946. Conclusion: The management training needs questionnaire for nursing department directors in the secondary hospitals had good reliability and validity. It could be used as an effective tool to measure the management training needs of nursing department directors in the secondary hospitals.

Objective: To analyze the influencing factors of the training needs among nursing department directors in the secondary hospitals. Methods: We recruited 457 nursing department directors from 10 provinces by using convenience sampling method. We used self-designed questionnaires to investigate the training needs and its influencing factors among nursing department directors of the secondary hospital. Results: Nurses' number of the hospital, nursing department director's working years as a nurse, the highest education background of nursing department directors were the influencing factors of the training needs. Conclusion: The training should be held among the nursing department directors who had large nurses' number, short working years as a nurse, and high education background.

Objective: To explore the training needs among nursing department directors in the secondary hospitals, in order to make a guidance for designing training courses for them. Methods: We recruited 457 nursing department directors from 10 provinces by using convenience sampling method. We used self-designed questionnaires to investigate the training needs about time, content, and types. Results: The first five contents were performance appraisal and management, hospital grade assessment and the practice of constant improvement of nursing quality management, patient safety management,high quality nursing service and standardization management, and the hierarchical use of nurses. The preferred training time was from Monday to Friday. The training types for performance appraisal and management, hospital grade assessment and the practice of constant improvement of nursing quality manageme, high quality nursing service and standardization management, the hierarchical use of nurses were giving lessons and visiting hospitals. The training types for practice of constant improvement of nursing quality management, patient safety management were giving lessons and case analysis.Conclusion: The training for nursing department directors in the secondary hospitals should be held on working days and take different training types according to their needs.

Objective: To discuss factors related to self-efficacy for social participation of individuals with mental illness. Methods: Using convenience sampling, a total of 117 people with mental illness were recruited from the outpatient department in a psychiatric hospital. All participants completed an anonymous self-report questionnaire that assessed selfefficacy for social participation, self-esteem, general mental health, social support, and life satisfaction. Results: Multiple regression analysis showed that general health, life satisfaction with community, life skills are the major factors influencing the self-efficacy for social participation of people with mental illness. Conclusions: It was implicated that we can promote social participate efficacy of people with mental illness from individual, family & community, and social & cultural dimensions.

Objective: To systematically review the effect of HME on preventing pulmonary infection in patients with artificial airway. Methods: The Cochrane Library, JBI Library, Medline, Embase, Pubmed, CNKI, VIP and WanFang databases were searched to retrieve randomized controlled trials and controlled clinical trails about the effect of HME on preventing pulmonary infection in patients with artificial airway. According to the inclusion and exclusion criteria,the literature searching, screening, information extraction and quality evaluation were completed by two reviewers independently. Meta analysis was conducted using RevMan 5.3 software. Results: Totally, 14 RCTs were included. The meta-analysis showed that compared with non HME, using HME can prevent pulmonary infection in patients with artificial airway [Random effect model, OR=0.76, 95% CI (0.47, 1.20) ], and the significant differences existed. The differences were no significant in the mortality rate [OR=0.97, 95% CI (0.65, 1.46)] . Conclusion: HME can reduce the incidence of pulmonary infection in patients with artificial airway and it is worth being popularized.

Objective: To explore the current states of moral distress and its related factors in nurses in tertiary grade A hospitals in Changsha, so as to provide reference to improve nursing management, and to strengthen the intervention of moral dilemmas, maintain the stability of nursing team. Method: Totally 378 nurses from clinical departments in 3 tertiary grade A hospital in Changsha were investigated with the Chinese version Moral Distress Scale-Revised (MDS-R). Result:The total score of moral distress was (53.42±29.91), and the mean sorces of moral distress frequency and intensity were (1.44±1.00) and (1.63±1.16), which were at lower level; Futile care and providing patients with false hope were major sources of moral distress in nurses; Moral distress of nurses has a significantly correlation with age, work experience, education,professional title, position, department, staffing of government affiliated institution, daily time contact with patients (P<0.05).Conclusion: The nursing managers should pay attention to the experience of moral distress in nurses, strengthening ethical and legal knowledge education, timely communicating with nurses, improving the allocation of the nursing human resources, so as to alleviate the level of moral distress in nurses.

Objective: To investigate the status of attitude, knowledge and skills of new nurse staff for the BLS group training with scenario simulation, and to evaluate the effectiveness of the group training, so as to provide evidence for developing a suitable training model for the new nurse staff. Methods: A total of 529 newly employed nurses from 2013 to 2015 were recruited to receive BLS group training with scenario simulation according to the method of AHA. The same survey tool was used to investigate nurses' attitude, knowledge and skills of BLS before and after the training. Results:Before the training, the knowledge and skills level of BLS among 529 newly employed nurses were poor, and they were lack of confidence for rescue. However, their attitude, knowledge and skills were greatly improved after the training, and the difference was statistically significant (P<0.05). Conclusion: BLS group simulating training can effectively increase new nurses' application competence of BLS knowledge and their confidence in dealing with on-site emergence situation.Besides, it also can improve their skills level and the ability to coordinate with doctors in the process of rescue. Thus, BLS group simulating training may be recommended to be applied into the orientation training for new nurse staff.

Objective: To evaluate clinical application of quantitative nursing program of acupoint massage on retention of urine among spinal cord injury patients. Method: Totally 98 patients were randomly divided into the treatment group (n=50) and control group (n=48) according to random number table. Both groups were treated with intermittent catheterization and conventional treatment, while the treatment group were added quantitative nursing program of acupoint massage. Result: The mean scores of SF-36 in the treatment group were (61.12±14.16), (87.93±15.05), (110.34±16.19) in 1month, 2 months and 3 months, respectively, and were significantly higher than those in the control group (P<0.05). The days of automatic urination (23.52±11.51) days, residual urine (80.96±57.72) mL and bladder volume (420.62±60.15) mL were better than those in the control group (P<0.05). There were 30 urinary tract infection cases in the treatment group which was significantly lower than that in the control group (P<0.05). The clinical effect in the treatment group was better than that in the control group (P<0.01). Conclusion: The quantitative nursing program of acupoint massage opened up a new idea and method for caring retention of urine among spinal cord injury patients to recover the function of automatic urination as early as possible, to reduce urinary system infection, and to improve patients' quality of life.

Objective: To investigate the level and influencing factors of Self-Perceived Burden (SPB) in elderly patients with chronic non-communicable diseases (chronic disease). Methods: A convenience sample of 1056 elderly patients with chronic diseases and their main caregivers from six centers in Sichuan province were investigated with the self-made patients' general information questionnaire, Self-perceived Burden Scale (SPBS), Barthel Index (BI), FRAIL Scale, Simple Nutritional Evaluation Method (MNA-SF), Geriatric Depression Scale (GDS-15), Zarit caregiver burden interview (ZBI). Results: The score of SPBS of elderly patients with chronic disease was (24.62±7.06), which was at mild to moderate level. The influence factors of SPB were the score of Barthel Index, the place of residence, depression, self-rated health, and gender. Conclusion: The elderly patients with common chronic diseases experience of mild to moderate levels of SPB, we should be aimed at the main influence factors of SPB and take positive measures to alleviate their SPB.

Objective: To analyze the effect of group counseling on perceived career barriers, career decisionmaking self-efficacy and career identity of undergraduate nursing students. Methods: We conducted group counseling for 58 undergraduate nursing students who were grade one or grade two from a certain university. Then we compared perceived career barriers, career decision making self-efficacy and career identity of undergraduate nursing students before and after the group counseling. Results: The scores of perceived career barriers, career decision making self-efficacy and career identity of undergraduate nursing students were different before and after the intervention, and the differences were statistically significant (P<0.05, P<0.001). Conclusion: Group counseling can effectively improve the career decisionmaking self-efficacy and professional identity of undergraduate nursing students, and reduce their perceived career barriers.

Objective: To explore an effective method to assess the ability of new nurses' skills in standardized training under the real clinical situation. Methods: Use Direct Observation or Procedural Skills (DOPS) to evaluate the ability of new nurses' skills using 10 indicators. Results: Only the item of interpretation and informed consent before operation exceeded targets, the other nine items close to or reaching the goals. And the three aspects that are in implementation of the relevant systems, laws and industry standards, patient experience and dealing with goods after operation are the weakest spots to new nurses. The proportion no reaching the goals is more than 17%. There isn't difference in average scores between the DOPS test and traditional assessment (P>0.05). Conclusion: The DOPS examination is an objective and multidimensional assessment tool in evaluating new nurses' clinical skills from their behaviors and abilities.

Based on searching, sorting and analyzing the qualitative research literature, the concept and writing of reflective journal, the teachers and students' interview, the content research, feedback and evaluation of the reflective journal were introduced. The effects of reflective journal in clinical nursing practice were also summarized in this review.

Objective: To assess a specialized training system for graduate nursing students majoring in Intensive Care. Methods: Twenty seven experts were invited to participate in a two-round Delphi study for assessing the importance and appropriateness of each indicator. Results: The response rates were 87.9% and 93.1% in a two-round study, authorities coefficient were 0.88 and 0.89, and the Kendall's W were 0.264 and 0.337, respectively (P<0.001). Six dimensions, including the training goal, admission requirements, credits and curriculum, clinical practice arrangement, training mode and quality evaluation, and their corresponding 29 primary indicators and 78 secondary indicators were established. Conclusion: The expert's representative and consistency were acceptable. They also had high response rates and authorities coefficient. The index system should be useful for formulating the training program of graduate nursing students.

Introduce the nurses' shift work including the shiftlength, shift pattern, rest, breaks and overtime,hopefully to provide some enlightenment and reference to our country in the nurses' shift work.

Objective: To assess the post management method of non-night shift nurse. Methods: According to the nature of the work, workload, technical difficulty, and results of a comprehensive evaluation of the risk, the non-night shift nurse posts were assigned into A, B, C, and D categories. The nursing post management was implemented on the B, C and D posts. A series of management and incentive measures were taken, including developing performance assessment methods and adjustment programs of non-night shift postal location, establishing and regulating approval process to move from night shift post to non-night shift post, revising professional title promotion requirement and so on. Results: Both the turnover rate and the application rate for non- night shift posts decreased (P<0.01). Non-night shift nurse post saved nurse manpower for 7.8%. Conclusions: Our post management method allows supervisors to focus on work rather than staff. It changed the fact that nurses' job performance bonus did not match the value of their posts. Nurses' work enthusiasm were enhanced, and the clinical nurse team is more stable.

Objective: According to Chinese new medical reform policy and the characteristics of Traditional Chinese Medicine hospital, discuss the effect of optimized nursing human resource programme, which based on the coefficient of workload. Methods: Use the Delphi method to find out the coefficient of workload in each department.Select 54 clinical departments from Guangdong provincial hospital of Traditional Chinese Medical, Self-control method was used, adopt nursing clinical quality, adverse event rates and satisfaction of patient as the indications to evaluate the effect of programme.Results: After use the optimized nursing human resource programme, the adverse event rates of every 1000 discharges was decreased by 50.0% (P<0.01); all the scores of nursing quality were significantly improved increased (P<0.01); the annual patient satisfaction was increased by 4.5%, and employee satisfaction was increased by 6.1%. Conclusion: The optimized nursing human resource programme, which use the coefficient of workload as the core measurement standard, can enhance the nursing quality, reduce adverse event rates, improve the satisfaction from both patients and employees, it offers reference for nursing human resource in tertiary hospital especially in TCM hospital.

Objective: To investigate the job satisfaction of hemopurification specialist nurses in Hunan province and to analyze the related factors. Methods: The questionnaire survey was conducted among 740 hemopurification specialist nurses who were qualified and on the position from second-class or above hospitals in Hunan Province by using the general data questionnaire and the Index of Work Satisfaction of Chinese version (IWS) with cluster sampling. Results: The total score of IWS among hemopurification specialist nurses in Hunan province was (111.88±15.75), the scores of job satisfaction among 6 dimensions were ranked at a descending order as follow: interactive cooperation, occupational status, autonomy,organizational decision-making, task requirement and income. The composition ratio of job satisfaction levels from high to low was 0%, 9.3% and 90.7%, respectively. The job satisfaction of hemopurification specialist nurses varied due to different levels of work units, job postition and monthly income, and the differences were statistically significant (P<0.01, P<0.05).Conclusion: The job satisfaction of hemopurification specialist nurses in Hunan province was not satisfactory. The income satisfaction was the worst aspect, which need to be improved in the future.

Objective: To assess the effect of mobile APP to improve the ability of self-care in discharged patients with stroke. Methods: A total of 100 patients with stroke were enrolled using convenience sample and assigned to experiment group and control group. Intervention was conducted in experimental by installing the mobile APP. The mRS, ADL, and ESCA were compared between two groups when the patients discharged, 3 months and 6 months after discharge. Results: The ADL and ESCA were significantly higher in experiment group than that of control group. The mRS showed a decreasing trend with the prolongation of time in experimental group (P<0.05). Conclusion: Mobile APPs can complete extended care and improve self-care ability of patients with stroke.

Along with the rapidly aging population, the prevalence of chronic diseases also increased greatly in the elderly. Chronic diseases are complex and lifelong conditions, and transitional care plays an important role in the chronic disease management. In this review, the authors summarized the concept of transitional care, care model, problems and suggestions for implementing transitional care in patients with chronic diseases.

Objective: To provide the ensurance for the feasibility on nurses' multi-sited practice, to respond for the nurses' multi-sited license policy by Guangdong government and to improve the career fulfillment among nursing team.Methods: A total of 26 experienced nurses were selected in the Houjie Hospital (a grade A, level 3 hospital), Dongguan,Guangdong province. Tele-presence technology which can provide video docking for remote patients in community care clinics was used. Home care services were also provided in certain gathering areas to help nurses' practicing. Results: Time and geographical problems in multi-sited nursing practice would be solved by tele-nursing clinic and home care services in certain congregating areas. Conclusion: The mobile information technology-based remote care clinics and multisited nursing practice in certain congregating areas mode are new interpretations for nurses' multi-sited practice policy in Guangdong province, which could solve the time and geographical problems that have troubled nurses on multi-sited practice, and provide experience for practicing nurses' multi-sited practice in Guangdong province.

Quality control and assessment is the core of quality management, this article mainly discuss the system and scheme of quality assessment of long-term care facilities for elderly, its experience and enlightenment could provide reference for the construction of quality assessment system of institutional senior citizen care that fits mainland of China.

Objective: To investigate the care status and expectations of hospitalized cancer patients, and to explore the needs and deficiencies those cancer patients perceived about nursing care in physiological, psychological and spiritual aspects in China. Method: The study was performed in the Sichuan Cancer Hospital and involved 462 hospitalized cancer patients undergoing chemotherapy or radiotherapy. Questionnaires were used as the major research method, which was based on modified Barthel index and Watson human caring theory, including physical, social, and psychological care.Results: ① In 462 participants, Barthel Index Score was 63.78±7.65, and 3.2% of the patients were not accompanied; 81.7% accompanied by family members, and 18.3% by employed caregivers. ② Care needs in daily life included providing foods,shopping, cleaning and tidying up, and more care needs were those related to treatment and emotional expression. ③ The status quo of care was those including making bed, keeping ward environment, accompanying for tests, reminding pills taken, facilitating emotional expression (including listening, talking, easing the mood and entertainments) which were not as well as expected (P<0.05). Conclusion: The cancer patients in the hospital had better self-care ability and intention,and the present care met a large proportions of the needs of the patients in daily life and the treatment related needs, but there were far from enough of the care in emotions provided for the patients. It may be easy to decrease the dependence on the family members through the humanistic care in the hospital environment, equipment and patient supporting services improvement, but the care in emotional expression has been a subject needs further study.

Cutaneous skin changes are common in patients undergoing Peripherally Inserted Central Catheter (PICC),and seriously influence patients' quality of life. In this article, contact dermatitis will be defined, potential risk factors will be identified and diagnostic framework will be explored. Finally, a synopsis of treatment approaches as well as implications for nursing practice and research will be presented.

Chemotherapy-Induced Peripheral Neuropathy (CIPN) is a major non-hematological toxicological reaction of commonly used chemotherapeutic agents like platinum compounds, taxanes and vinca-alkaloids. CIPN not only have negative influences on patients' comfort, safety and quality of life, but also interfere with regularanti-tumor treatment. Thus this article reviewed instruments for CIPN and further provides reference for the clinical nursing practices and researches.

Objective: To explore the effects of case management on the compliance behaviors in men who have sex with men (MSM) with HIV/AIDS. Method: The 108 subjects were randomly divided into the control group and experimental group. The routine nursing care and case management nursing were applied to each group separately for three months. Results: The experimental group had better performance in condom usage, fixed sexual partner and medication compliance than the control group. The difference was statistically significant (P<0.05). Conclusion:The case management nursing played a significant role in the compliance behaviors in MSM with HIV/AIDS.

To summarize and analyze the clinical outcomes and experiences of Continuous Renal Replacement Therapy (CRRT) in eight patients with Acute Kidney Injury after lung transplantation. The key measure of nursing care included: establish multi-displinary treatment team; establish and maintain the vascular access; maintain the hemodynamic stability; monitor the coagulation function. There was no complication occured in this group with CRRT.

Prenatal care is a necessary measure to ensure maternal and child health. Group prenatal care has been recognized as a mature and effective model in developed countries. The application and effects of group prenatal care are analyzed systematically. It is expected to explore a practical prenatal care model in China.