The 21st century is the era of globalization, competitiveness, innovation, and information. Each country faces different conditions, such as war, disaster, climate changes, diseases outbreak, resource shortage, economic crisis or difficulties. The above factors affect the global health and wellbeing; in the meanwhile threaten the humanity and human right. Nurses are the core of health care system to take the responsibilities on health promotion, illness prevention and treatment. They always stand the first line. If nurses can stand up and speak up, to lead the voice by presenting the knowledge, evidence and influence to protect minorities, or make efforts on policy making and problem solving. They will make great contribution to the society and benefited to achieve the SDGs.

Xijing Hospital is devoted to explore the delicacy management via reducing the average length of stay and developing novel medical technologies, as well as the implementation of clinical project management. Through the practice, what we learned is that focusing on the clinical details is the most significant aspect of the delicacy management, which request the administrators to lead the hospital from the perspective of global criteria and international concept. With the delicacy management,the constant development in the national health care reform could be obtained only if the hospital could provide the greatest experience and therapeutic effects to all patients with the lowest medical costs.

Specialist nurses play an important role in saving lives, improving quality of life and promoting rehabilitation. However, the training and utilization of specialist nurses are still need improvement in China. Improving training and utilization of specialist nurses and speeding up to establish management system have become a great issue that we have to face.

Evidence-based medicine has been played an essential role in promoting nursing practice. However, there are some misunderstandings in the definition of evidence-based practice and evidence. This article summarized core concepts, basic ideas, and key contents pertaining to evidence-based nursing practice, and also its impact, aimed to promote evidence-based medicine in nursing.

Nowadays, numerous successes have been produced for evidence-based medicine practice. This article focused on the definition of evidence-based medicine and the methodology, and also the effectiveness of evidence and the categories of recommendations. In the end of the article, the challenges in research and practice were indicated.

Objective: To assess the levels of state-trait anxiety among patients in the preoperative holding area and explore its influencing factors. Methods: A cross-sectional study was designed and a convenience sampling was adopted to recruit patients from the preoperative holding area of a tertiary hospital in Hubei. Patients were asked to complete the State-trait Inventory. Results: The state anxiety score was 44.79±10.04, and the trait anxiety score was 36.01±6.72. The cut off value for high or low state anxiety lever was 49 points, and there were 272 (36.61%) preoperative patients in a high level anxiety group. Multivariate stepwise regression analysis showed that sequence of operation, sleep quality, surgery experience (negative or positive), gender, operation type (obstetrics and gynecology), marital status (unmarried, divorced or widowed), and age were the influencing factors of state anxiety, while age, gender, surgery experience (sad), marital status (divorced or widowed), etc were the main influencing factors of trait anxiety. Conclusion: Severe state anxiety may exist among patients in preoperative holding area, and nurse should focus on psychological intervention for them, particularly for patients with consecutive surgery, female, unmarried, divorced or widowed, younger, obstetrics and gynecology and those who had a negative surgery memory.

Objective: To evaluate the reliability and validity of the Chinese version of Children's Quality of Life Scale (PedsQLTM 13-24 months). Methods: A total of 250 healthy parents were selected, and were asked to evaluate the quality of life of their children by convenience sampling in April, 2016 to July 2016, in Zhongguancun Children's Preventive Care Clinic. The Chinese version of Children's Quality of Life Scale (PedsQLTM 13-24 months) was used to investigate the children's parents and to test the reliability and validity of the scale. Results: The scale of Cronbach's α was 0.949. Content validity assessment: Scale I-CVI0.80, S-CVI / UA was 0.888. Factor analysis showed that: KMO value was 0.895, Bartlett test of sphericity statistical value was 6615.487, P<0.001. Based on the case of eigenvalues >1, in the case of 5 common factors, the cumulative variance contribution rate was 52.5%, respectively. The scale continues to use the original scale dimension. Conclusion: The Chinese version of Children's Quality of Life Scale (PedsQLTM 13-24 months) has good reliability and validity, which can be used to measure the quality of life of children from 13 to 24 months.

Objective: To test the reliability and validity of the Chinese version of Care Dependency Scale (CDS) in cancer patients. Methods: Three hundred and twenty-nine cancer patients were selected by convenience sampling. The construct validity was tested using an exploratory factor analysis, the reliaility was estimated using Cronbach’s α coefficient and rest-retest reliability. Results: Factor analysis identified two factors, and the cumulative variance contribution rate was 69.8%. The Chinese version of CDS and ADL were significantly correlated (r=0.91, P<0.001). The content validity index was 0.833. The Cronbach’s α coefficient (0.944) and test-retest reliability (0.667) was acceptable. Conclusion: The Chinese version of CDS has high reliability and validity, which may be used for monitoring the level of CDS in Chinese cancer patients.

Objective: To investigate the application effect of nursing quality management by Quality Control team combined with Professional Care team (QC&PC) having all staff participation in the operating room. Methods: Using the QC&PC method, all staff took participate in the process of quality control using PDCA method. The nursing quality score, the surgeon satisfaction and patient satisfaction were compared before and after carrying out the new management method. Results: After implementing the new quality control method, the nursing quality score, the surgeon satisfaction and patient satisfaction were all higher than before (P<0.05). Conclusion: QC&PC team having all staff participation could effectively improve the nurses' work enthusiasm, make up for the deficiency which exist in the traditional quality control method, effectively improve the care quality, the surgeons' and patients' satisfaction in the operating room.

Objective: To investigate the pressure injury prevalence among secondary and tertiary general hospitals in different areas of Guangdong province. Methods: A cross-sectional design was used in this study. Totally 25 264 hospitalized patients from 25 secondary and tertiary general hospitals in different regions of Guangdong province were recruited. There were 267 pressure injury patients among them. The authors used pressure injury questionnaire to describe the source of pressure injury occurrence, location and stage of pressure ulcer. Results: The overall prevalence rates of pressure injury in 25 hospitals ranged from 0 to 3.5%, with an average of 1.3%. When the stage I was excluded, the total prevalence rates range from 0 to 3.1%, with an average of 1.1%. Pressure injury prevalence rates were higher in intensive care unit, geriatrics, respiratory medicine and so on. The most common stages of pressure injuries were stage II and stage III, the most common locations of pressure injuries were sacrum and feet. Conclusion: The overall prevalence of pressure ulcers in 25 hospitals was slightly lower than the rate reported in the results of other studies. The management and report of stage I pressure injury were still inadequate, and the treatment should be more active. Communications between study centers and various clinical departments of the hospital need to be improved.

Objective: To analyze risk factors of the community elderly people's fall within one year, to validate the accuracy of the modified fall risk assessment tool for elderly people in communities, and to provide prevention measures. Methods: In March and April 2016, geriatric specialist nurses and community workers used a general information questionnaire and the modified fall risk assessment tool to investigate the older adults in two communities, which were randomly selected. Results: The fall rate of the community elderly people in the recent year was 22.01%. The risk factors of falls were age65, foot problem, incorrect activity ability assessment and unsafe living environment. The accuracy of the modified fall risk assessment tool was validated. Conclusion: Fall prevention of community elderly people is always the focus of transitional care and community nursing. Geriatric specialist nurses and community workers should develop prevention measures according to the risk factors to avoid falls.

In this review, the authors analyzed the current status and trends of teaching evaluation in Massive Open Online Courses (MOOCs) from aspects of the definition and purpose, evaluation forms and methods, and evaluation contents. Evaluation contents included teachers and learners, teaching contents and resources, network teaching platform and learning support service system, etc. It would provide reference for evaluation of teaching in MOOCs in China.

Time management disposition is a psychological and behavioral characteristic in terms of individuals' using of time. The paper summarized the mechanism of action and assessment tools of time management disposition, expounded the difference of time management disposition among nursing undergraduates with different characteristics, summed up the research progress of the relationship between time management disposition and anxiety, learning adaptability, self-esteem, self-efficacy, and procrastination. This paper summarized the current research progress in order to improve the time management ability among nursing undergraduates.

Objective: To investigate the job function of Clinical Nurse Specialists (CNS) in secondary and tertiary hospitals in Hubei province, and to provide references for administration and usage of CNS in mainland China. Methods: A total of 121 secondary and tertiary hospitals in Hubei province were investigated using a self-designed questionnaire, which had 6 dimensions of quantity, distribution, role, position, treatment, hospital support of CNS. Results: There were totally 2 235 CNS in 121 hospitals in Hubei province. CNS majorly worked in operating room (95 hospitals, 78.51%), ICU (90 hospitals, 74.38%) and PICC center (84 hospitals, 69.42%). CNS played an important role in clinical care, teaching, health education, nursing administration, and transitional care. Totally 95.04% hospitals arranged CNS to work as a charge nurse. Only 62.07% hospitals raised the wages of certified CNS, and 59.29% hospitals set up a career path for CNS. Conclusion: The number of CNS had attained certain scale, despite unbalanced distribution. CNS roles were majorly in clinical care, teaching, and health education. Hospitals administrators need to develop a person-job fit system; meanwhile, cultivate the competencies in nursing research and evidence-based nursing of CNS.

Objective: To explore the effect of positive psychology in improving the subjective well being and job satisfaction of junior nurses. Methods: The psychological intervention group was established, to develop 4 stages of training, and intervention was implemented according to the positive psychology during the whole training program. And patients in two groups were investigated with the general well being scale and the nurses' job satisfaction scale before and after the intervention. Results: The total score of subjective well-being was 90.54±3.23 and nurses' job satisfaction was 5.06±0.64 in the intervention group, which were significantly higher (P<0.01 or P <0.05) than that of the control group (which was 78.76±6.14 and 3.03±0.22 respectively). Conclusions: Group psychological training based on positive psychology could improve patients' subjective well being and job satisfaction.

Objective: To explore the relationship between the job burnout and presenteeism of ICU nurses. Methods: Totally 210 ICU nurses from 4 hospitals were investigated with the Chinese version of Maslach Burnout Inventory (MBI) and Stanford Presenteeism Scale (SPS-6). Results: The total score of the job burnout was (63.94±14.50). The scores of each dimension were emotional exhaustion (23.59±9.64), depersonalization (7.63±5.95), personal accomplishment (33.07±9.01) respectively. The total score of SPS-6 was (17.25±3.51). There was significant positive correlation between presenteeism and job burnout (r=0.303, P<0.01). Conclusion: The job burnout of ICU nurses are moderate to high level. Nursing management are expected to improve nurses work environment in order to reduce the productivity loss induced by presenteeism.

Clinical nurse shortage has been a serious issue in recent years. The nursing mobile library as a new form of human resource emerged to alleviate nurse shortage. This paper reviewed the complexity management of nurse mobile library, including the requirement of library staff, the selection methods and conditions, job responsibilities, training and performance appraisal review. It is expected to provide nurse manager some information nursing mobile library to conquer the nurse shortage issue.

Objective: To explore the sleep disorder and its influencing factors in psychiatric nurses and internal medicine nurses. Methods: A sleep condition questionnaire was completed by 291 psychiatric nurses from two first-class tertiary psychiatric hospitals and 368 internal medicine nurses from one first-class tertiary general hospital. Results: Among the 659 nurses who were investigated, 460 nurses of them reported that they had experienced at least one kind of sleep disorder, accounting for 69.8%. The proportions of whom experienced sleep disorder among psychiatric nurses and internal medicine nurses were 68.7% and 70.7%, respectively. Gender, years in nursing service and reported history of alcohol use were identified to be significantly associated (P<0.05) with sleep disorder. Only 58 nurses (8.8%) who reported sleep disorder choose to see a doctor for their sleeping problems; while 86 nurses choose to take medication, accounting for 13.1%. Years in nursing service, reported history of smoking and alcohol use were identified to be significantly associated (P<0.05) with the choice of taking sleep-aid medications. Conclusion: The sleep disorder was a commonly observed problem among nurses. Nurses with male gender, more than 10 years of nursing services and history of alcohol use were more likely to suffer from sleep disorder. There were a very low proportion of nurses who actually sought for medical help for their sleep disorder. Specific prevention and treatment actions should be taken for nurses with different gender and years of nursing service, so as to improve the sleep disorder among nurses and improve the nursing service in the long run.

Objective: To investigate the relationship between the nurse job transfer and demographic characteristics of nurses in basic medical institutions, in order to provide reference for the stability of nursing team and rational allocation of nursing staff. Methods: 52 primary medical institutions in a district of Chongqing city were investigated through questionnaire and interview, then data was compared between grade II, class A and grade III, class A hospitals. Results: transfer rate of nurses was 18.3% in basic medical institutions, significantly higher than that of grade II, class A and grade III, class A hospitals (P<0.05). There was significant difference between job transfer nurses and on-the-job nurses (P<0.05) in the age, the eduation background academic degree, post-graduate academic degree, professional title, employment forms, training, and training will. Logistic regression analysis showed that professional title (OR=1.854, P=0.010), employment forms (OR=7.898, P<0.001), training (OR=0.469, P=0.010) and training will (OR=0.118, P<0.001) were major influencing factors of job transfer. There was significant difference between different level hospitals (P<0.05) in the age, academic degree, post-graduate academic degree, professional title, and employment forms. Conclusions: The problem of job transfer is serious among nurse in basic medical institutions. especially among those with high academic degree, high professional title, and those nurses in the series. Professional title, employment forms, training, and training will are factors relevant to job transfer. Relevant measures should be taken to stabilize the nursing team in the basic medical institutions.

We reviewed the definitions, attributes, measuring tools, positive influences, improving methods of nurses' work engagement, and provided suggestions for nursing management.

Objective: To understand the current status of work stress among geriatric nursing assistants in Changsha and to investigate the main influencing factors of work stress. Methods: Participants were screened using stratified and cluster sampling methods. And they were investigated by the self-designed demographic data sheet, Work Stress Scale (WSS) and social support scale. Results: A total of 500 valid questionnaires were received. Geriatric nursing assistants' work stress score was 75.16±20.32, social support score was 38.76±4.37, and the three dimension of social support had negative correlation with the work stress (P<0.001); marital status, having children, ways of scheduling, major, the number of elderly cared, income and social support were the influencing factors of work stress in geriatric nursing assistants (P<0.01). Stepwise regression analysis showed that the number of elderly cared, income and subjective support levels were the main factors that influenced the work stress (F=5.537, P<0.001). Conclusion: Geriatric nursing assistants face a moderate level of work stress, and social support is not high. The related department should take effective measures, so as to decrease geriatric nursing assistants' work stress.

Objective: To investigate inpatient pediatric fall rate within three years, and to describe the characteristics of pediatric inpatient falls in a tertiary Grade A children's hospital. Methods: A retrospective investigation was conducted in a tertiary Grade A children's hospital. The data was collected from the nursing sensitive indicators reporting system in the hospital. The investigation duration was three years between July 1st, 2013 to Jun 30th, 2016. The study period was divided into six intervals by each six months. We reported the incidence in different intervals. Results: The inpatient pediatric falls rate was 0.34/1000 patient days. The incidence rate was significantly lower than those in other countries. Boys had a higher falling ratio than girls. About 81.6% of falls was falling out of bed and most falls happened in the middle shift with minimal or no injury. About 76.3% children's parents were present during the fall which is similar to worldwide reports. Conclusion: Pediatric falls differ greatly from adult and geriatric patients and injuries are not as severe as those patients. The falls rate is lower than those in other countries. For children, it is very important to monitor the severity of the injury which maybe the most valuable indicator of the fall prevention quality.

Objective: To investigate the time and place distribution characteristics of falls from the adverse events report system. Methods: All of the fall events which were reported on the reporting platform from a tertiary grade A hospital in Zhengzhou from 2011 to 2015 were analyzed. Results: 60.0% fall happened in the bathroom, and 50.2% of falls happened during the night shift. The most common primary disease were tumor related diseases, circulatory system disease, endocrine, nutritional and metabolic disease. The peak occurrence periods were 7:00 to 9:00, 11:00 to 13:00, and 5:00 to 7:00. Most falls led to mild injury, the injury which caused by fall in the bathroom was much heavier than that in other places (P<0.05). Conclusion: Medical staff should strengthen safety management during night and the peak fall risk time, pay close attention on the patients' transfer, the effect of health education and the patients' fall preventive behaviors, and then constantly improve patients' awareness and compliance of fall prevention.

This paper analyzed the internet based diabetes management research reports, including the subjects, methods, contents and effects. It identified the advantages and issues in the internet based diabetes management. Some suggestions are provided for future studies in China.

Objective: To explore the incidences of gastrointestinal complications of patients with severe brain injury using the enteral nutrition support, and compare the incidences of gastrointestinal complications between the patients with enteral nutrition preparations in thermoneutral temperature infusion and heating infusion. Methods: Totally 234 patients with enteral nutrition support were selected from five hospitals in China using group sampling method. The subjects were randomly divided into thermoneutral temperature infusion group and heating infusion group. The thermoneutral group remain the ICU room temperature at (24.0±1.5). The heating group using enteral feeding pump with heating temperature between 37℃and 40. Results: The main complications of the subjects were constipation 62 cases (26.5%), gastric retention 51 cases (21.8%), diarrhea 50 cases (21.4%), abdominal distention 6 cases (2.6%), vomiting 2 cases (0.9%). The incidences of constipation and gastric retention in the thermoneutral groupwere significantly higher than the heating group (χ2=8.777, P<0.05) (χ2=4.237, P<0.05) respectively. The incidence of diarrhea in the thermoneutral group was significantly lower than the heating group (χ2=26.045, P<0.05). Conclusions: The gastrointestinal complications are the major issues in the process of the enteral nutrition support in patients with severe brain injury. Nursing intervention to prevent and reduce the gastrointestinal complications should be emphasized.

Objective: To explore the effect of group dynamics intervention based on the self-management and quality of life in young hemodialysis patients. Methods: The satuation of young hemodialysis patients, self-management was investigated in the hemodialysis centre. Forty-one young haemodialysis patients were randomly assigned into an intervention group (n=20) and a control group (n=21). The intervention group received education based on group dinamics intervention program which last for eight weeks and the control group received routine health education in the hospital. Results: After intervention, the scores of self-management and quality of life in the intervention group were significantly higher than those in the control group (P<0.05). Conclusion: The health education based on group dynamis intervention program could improve the self-management and quality of life in young hemodialysis patients.

Objective: To analyze the effect of multidisciplinary cooperation on the optimization of process management in the inter-hospital transfer of critically ill patients with brain diseases. Methods: A process management team was set up to select the core transfer procedures and develop a core flow chart. All the transfer work was run according to the optimized process. We compared the effects before and after the optimized process was applied. Results: After the implementation of the optimized process management, the preparation time before transfer was reduced from (10.25 ± 2.45) min to (6.24 ± 2.56) min (P<0.001), the incidence rate of nursing defects decreased from 23.3% to 7.9% (P<0.001), and patients' relatives satisfaction was improved (P<0.001). Conclusion: The process management for the transfer of patients with severe brain diseases can enhance the high quality and efficient completion of transfer tasks, and promote the continuous improvement of transfer quality and improve patients' relatives satisfaction.

We reviewed the concept of illness acceptance, evaluation tools and research status and found that the level of illness acceptance was affected by many factors, such as demographic, disease, social and psychological factors. There was still no specific targeted intervention except psychological therapy. In addition, the development of localized assessment tools and exploring the specific interventions are the research focuses in this area in the future.

The psychological status of cancer patients can seriously affect their social function and quality of life, which is an important issue faced by clinical health care workers. In this review, the authors summarized the assessment tools, level, influencing factors and intervention measures of benefit finding among cancer patients from the positive psychology perspective, and provided evidence for research of benefit finding and psychological nursing in cancer patients.

Objective: To investigate the difference and relevance between central venous pressure (CVP) measurement by automatic reading and end-expiratory manual reading and to analyze as well as discuss if they could be substituted by each other Methods: A prospective observational study included 200 critically ill patients who received CVP monitoring and received CVP measurements by automatic reading of monitor system and manual reading at the end of expiration was applied. We compared the difference between these two methods. Results:CVP measurement by automatic reading was significantly positively correlated with the results obtained by end-expiratory manual reading (r=0.905, P<0.001), and patients with difference between two measurements greater than 2 mmHg accounted for 17.0%. ②Of the 123 mechanical ventilated patients, the correlation between two measurements was r=0.915, while of the 77 spontaneous breathing patients, the correlation was r=0.886. The patients with difference between two measurements greater than 2 mmHg accounted for 28.6% (spontaneous breathing) and 9.8% (mechanical ventilation).Of the 177 patients who had sinus rhythm, the correlation between the two measurements was r=0.921, while the correlation was r=0.891 of the 23 arrhythmic patients, patients with difference between two measurements greater than 2 mmHg accounted for 30.4% (arrhythmia) and 15.3% (sinus rhythm). Conclusion: The two measurements correlated well in fully mechanical ventilated patients and the results showed that they could be replaced by each other. But the difference between two methods was greater in spontaneous breathing patients and arrhythmic patients, so we should be alerted when results of automatic reading were applied.

Objective: To explore the effects of resistance exercise on Intradialytic Hypotension episodes, nursing intervention times and pre-dialysis blood pressure. Methods: Totally 77 patients with frequent Intradialytic Hypotension from 2 hemodialysis centers were recruited and divided randomly into the intervention group (n=39) and the control group (n=38). The patients in the intervention group were guided to do resistance exercise 3 times per week for 12 weeks besides the routine care, while the patients in the control group received the routine care. The data were collected from August 2015 to March 2016. We collected the data of the two groups' Intradialytic Hypotension episodes, nursing intervention times and pre-dialysis blood pressure before and during intervention. Results: The results showed that the Intradialytic Hypotension episodes and nursing intervention times in the intervention group were significantly less than those in the control group (P<0.05). After 12-week resistance exercise, patients' diastolic pressure decreased and their systolic pressure were stable before hemodialysis . Conclusion: Resistance exercise is effective for the hemodialysis patients with frequent Intradialytic Hypotension to reduce Intradialytic Hypotension episodes, reduce the related nursing intervention times, and to improve blood pressure.

Objective: To explore the possible types of self-management in patients with Chronic Kidney Disease (CKD). Methods: Totally 217 CKD patients were assessed by the self-management instrument designed by the authors. Cluster analysis using SPSS 22.0 version was performed to categorize patients. Results: Four different types of patients were got through cluster analysis. Type I patients showed very good self-management abilities, positively and optimistically. Type II patients showed blind permissive management. Type III patients performed pessimistic and poor. Type IV patients performed poorly in emotional accommodation. Their education status, hospitalizing experience, the residence location, and professional health training experience were different among the four types of patients (P<0.05). Meanwhile, there were no difference in patients' age, gender, marital status and payment schemes (P>0.05). Conclusion: In this research, CKD patients were divided into 4 types based on their self management abilities. It could provide basis for effectively screening and implementing measures for CKD patients' management.

Background: Failure to identify and respond to clinical deterioration is an important measure of patient safety, hospital performance and quality of care. Although studies have identified the role of patient, system and human factors in failure to rescue events, the role of ‘inattentional blindness’ as a possible contributing factor has been overlooked. Objective: To explore the nature and possible patient safety implications of inattentional blindness in critical care, emergency and perioperative nursing contexts. Methods: Analysis of four case scenarios drawn from a naturalistic inquiry investigating how nurses identify and manage gaps (discontinuities) in care. Data were collected via in-depth interviews from a purposeful sample of 71 nurses, of which 20 were critical care nurses, 19 were emergency nurses and 16 were perioperative nurses. Case scenarios were identified, selected and analysed using inattentional blindness as an interpretive frame. Results: The four case scenarios presented here suggest that failures to recognise and act upon patient observations suggestive of clinical deterioration could be explained by inattentional blindness. In all but one of the cases reported, vital signs were measured and recorded on a regular basis. However, teams of nurses and doctors failed to ‘see’ the early signs of clinical deterioration. The high-stress, high-complexity nature of the clinical settings in which these cases occurred coupled with high cognitive workload, noise and frequent interruptions create the conditions for inattentional blindness. Conclusion: The case scenarios considered in this report raise the possibility that inattentional blindness is a salient but overlooked human factor in failure to rescue events across the critical care spectrum. Further comparative cross-disciplinary research is warranted to enable a better understanding of the nature and possible patient safety implications of inattentional blindness in critical care nursing contexts.