Systematic approach of occupational health protection for healthcare workers was advocated and practiced in Chinese pilot hospitals, through the application of the Model of Corporative Initiatives on Systematic Prevention and Control of Occupational Disease (CISCOD Model) in hospitals. Starting from the implementation of the national occupational health standard-Guideline for Prevention and Control for Occupational Exposure Bloodborne Pathogen (code: GBZ/T 213), alongside with further implementation and promotional work of the HealthWISE, the Model of Hospital Initiative on Systematic Occupational Health (HISOH Model) was gradually created and developed. The core principle of HISOH Model is the protection and maintenance of the highest degree of safety, health and well-being of healthcare workers, the purpose of HISOH Model is to establish a safe and healthy working environment and working conditions. This article illustrated the key points of HISOH Model from its theoretical design to good practice, described the core concepts, characteristic, development and future directions of the Model, and summarized the three key development stages of occupational health for healthcare workers and its characteristic in China. With the aim to maximize the mutuality of benefits of healthcare workers, patients and the grand public, as well as to help hospitals who commit to occupational health and well-being of healthcare workers to take the leading role in this filed, the article introduced the national and international network of occupational health protections of healthcare workers, where cooperation opportunities and technical resources are available.

It is crucial to prevent the occupational exposure of AIDS in the high risk working area. Unfortunately occupational exposure to AIDS occurs sometimes. Frontline medical staffs are under great pressure. In order to reduce the occurrence of AIDS occupational exposure, the following information are discussed: construction of occupational safety organization, development of precaution mechanism and preventive methods, enhancement of psychological counseling service, and improvement of humanistic care. It is expected to reduce the incidence of AIDS occupational exposure through the health intervention system.

Occupational exposure protection for medical staff are very important for the management in large general hospitals. These strategies are considered as the important prerequisites of occupational exposure protection management in medical institutions, including establishment of a complete system of occupational exposure protection, education medical staff on occupational protection, improvement of self-protection consciousness of medical staff, implementation of occupational preventive measures for occupational hazards. It is expected to reduce the incidents of occupational exposure through these strategies.

The occupational safety of medical staff is a prominent issue for medical institutions. How to effectively reduce the occupational hazards in the work place needs to be explored. Project management combines the project management theory and management method. This paper introduced the effects of the project management in general hospital,including occupational hazards and infection control, occupation musculoskeletal risk factors and ergonomics management,solutions to workplace violence. It is expected to provide information for further studies in this area.

HealthWISE (Work Improvement in Health Services) is the product of a joint International Labor Office and the World Health Organization. It is a practical methodology for improving the quality of health care facilities. The practical process of health institutions and the experience by this tool was discussed. According to the HealthWISE checklist, the effectiveness of the key points and methods were analyzed regarding the need of improvement and hazard assessment of health institutions. Some Suggestions are put forward for the improvement of the workplace conditions for health institutions.

Objective: To explore the relationship between medication environment and nurses' unsafe medication behaviors, and to provide scientific basis for nurses' safe medication management. Methods: Totally 1 012 clinical nurses from 5 tertiary hospitals in Harbin were investigated, using demographic questionnaire, Nurses Unsafe Medication Behaviors Scale, and Nurse Perceived Medication Environment Scale. Results: Nurses' unsafe medication behavior detection rate was 74.3% and the median score of nurses' unsafe medication behavior was 8. The mean score of nursing perceived medication environment was 134.96±16.28. Multiple regression analysis showed that nurses themselves, medication related personnel,system and supervision, professional title were the influencing factors of nurses' unsafe medication behavior, which could explain 26.9% of the total variance. Conclusion: The current status of nurses' unsafe medication behavior should be further improved and nursing managers should actively improve the nurses' medication environment in order to reduce the occurrence of nurses' unsafe medication behavior.

Objective: To explore the effects of group education basing on social support model on stigma of firstdegree relatives of patients with first-episode schizophrenia. Methods: A total of 150 first-degree relatives of patients with first-episode schizophrenia diagnosed by Shanghai Mental Health Center were recruited. Patients of the control group (n=75) received routine group education, while those of the observation group (n=75) received group education basing on social support model additionally. The effect was assessed using Perceived Devaluation Discrimination Scale (PDD). Results: After intervention, the PDD level of the observation group (28.14±4.72) were lower than that of the control group and the effect in the observation group was significantly better than that of the control group (30.63±5.59). Conclusion: Group education basing on social support model can effectively reduce the level of stigma perception of first-degree relatives of patients with first-episode schizophrenia.

Objective: To verify the effect of individualized drug management based on Information-Motivation-Behavioral (IMB) model in the patients with Parkinson's Disease, in order to provide a new path for clinical nursing practice.Methods: A total of 100 patients with Parkinson's Disease in department of neurology in a tertiary grade A hospital were randomly divided into experimental group (n=50) and control group (n=50). The patients in the control group were given routine medication guidance, while patients in the experimental group were treated with the individualized drug management based on the IMB model. The medication beliefs, self-efficacy, medication compliance and quality of life were measured when grouped, the second week, first month and third month after discharge. Results: The change of medication belief, selfefficacy and quality of life in the experimental group were better than those in the control group (P<0.05), and the medication belief, self-efficacy,medication compliance and quality of life were significantly higher in the experimental group than those in the control group at three time points after discharge (P<0.05). Conclusion: The individualized medication administration based on IMB model can effectively improve the medication belief and self-efficacy, thereby improves patients' medication compliance and the patients' quality of life, thus provide a new path for clinical management.

Objective: The aim of the study was to explore symptom clusters in patients with chronic stable heart failure.Methods: Symptoms were measured using heart failure-related-symptom items in the Minnesota Heart Failure Quality of Life Scale. Results: The results of exploratory factor analysis showed that two symptom clusters were identified based on the incidences of given symptoms. They were named as physical symptom cluster and emotional symptom cluster, respectively.The Cronbach's α coefficients of each symptom cluster were 0.826 and 0.832. The results showed that age, gender, place of residence, work, educational level, income, smoking history, regular exercise, etiology, duration, CCI and NYHA are influencing factors of physical symptom cluster. Whether living alone, regular exercise, BMI, etiology, duration, CCI, NYHA and medication are influencing factors of emotional symptom cluster. Conclusion: Symptom clusters play a crucial role in symptom management of heart failure patients. The results of the study were helpful to guide health care providers to develop interventions based on the symptom clusters.

Objective: To develop a quantitative evaluation tool for assessing safety of catheters in adults with indwelling PICC at home. Methods: Delphi expert consultation and face to face interviews with patients were used under the guidence of nursing practice standards of infusion treatment of Intravenous Nurses Society (INS) (2011th Edition), in order to develop and establish an assessment tool to record and assess patients' subjective perceptions about occurance of complications related to PICC at home. Results: Expert positive coefficient of three rounds of expert consultation was 88.9%, 100% and 94.4%, respectively. The expert authority coefficient was 0.89. The Cronbach alpha coefficient of Self Perception Scale of Adult Patients with PICC at Home was 0.83, including 9 first-level indicators, such as pain, skin ulceration, local bleeding, catheter displacement, arm swelling, limitation of activity, catheter damage, subjective symptoms and abnormal temperature, whose Cronbach alpha coefficient was all beyond 0.70. Kendall coordination coefficient (W) significant test was statistically significant (P<0.001). Conclusion: This study was reliable and accurate. The assessment tool established could be used for transitional observation of PICC catheters between home and hospital. It can be used as an assessment tool for PICC patients in the home.

Objective: To evaluate the level of Ultra-fine Particle (UFP) contamination caused by electrosurgical tools (ESTs) in operating room and explore the influencing factors. Methods: Measurements performed during 98 open surgical operations by ultrafine particle counters. Measurements have been carried out simultaneously at 2 cm, 30 cm and 150 cm away from the source, and also before using and 10 min after stop using ESTs. Results: The densities of UFP before using and 10 min after stop using ESTs were 16.45 μg/m3 and 9.18 μg/m3. The densities of UFP at 2 cm, 30 cm and 150 cm away from the source are respectively 201.73 μg/m3, 115.20 μg/m3, and 25.52 μg/m. The densities of fine particles were 1 289.00 m3, 17 906.00 m3, 8 854.00 m3, 2 896.00 m3 and 929.00 m3 respectively. Patients' BMI, tissue type, vacuum suction, closed operating room were influence factors (P<0.05). Conclusion: electrosurgical smoke is a significant airborne contamination in operating room. Strategies of reducing exposure of surgical staff from electrosurgical smoke should be done to guarantee the surgical staff's physical and mental health.

Objective: To investigate the sense of career success and its influencing factors among nurses with master or higher degree. Methods: A total of 1 510 nurses with master or higher degree from tertiary hospitals in 22 provinces were investigated with the Career Success Scale (CSS). Results: The average score of CSS was 3.17±0.69. The scores of the three dimensions were career satisfaction (3.23±0.79), inside competitiveness (3.18±0.85), outside competitiveness (3.07±0.87) respectively. Multiple linear regression analysis showed that nurses satisfied with monthly income, meeting job wishes, having participated in academic conferences, not participating in theoretical teaching at nursing school, working at a clinical department, hosting the continuing education program, having published SCI papers, undertaking a teaching position, with learning experience abroad and doctor degree had higher CSS scores, these factors explained 26.6% of the total variance. Conclusion: The sense of career success in nurses with master degree or above was at a moderate level and was influenced by multiple factors. It is suggested that nursing managers should provide personalized positions and working contents in line with the nurses' job wishes and training objectives, which can improve nurses' sense of career success.

Objective: To evaluate the impact of Intermittent Subglottic Secretion Drainage (ISSD) on Ventilator-Associated Pneumonia (VAP) related to critical illness. Methods: Cochrane Library, Pubmed, Excerpta Medica Database, Web of Knowledge, CBMdisc, CNKI, and Wanfang Database were searched for the Randomized Control Trials (RCTs) on the ISSD effect on VAP prevention, while the reference lists of all included studies were also reviewed. Two authors independently screened all the literatures, extracted data and assessed the quality of included studies. All eligible analyses were performed using Review Manager, Version 5.3. Results: Nine eligible trials with total of 1 225 patients (including 2 Chinese and 6 English papers) were included in the analysis. ISSD could decrease the VAP incidence, including early-onset VAP and late-onset VAP. It also could shorten the ICU days, duration of mechanical ventilation duration and hospital days (P<0.05), but there was no significant difference in mortality (P>0.05). Conclusion: ISSD might be associated with lower VAP incidence, but it did not clearly decrease patients' mortality.

Objective: To translate the English version of Coaching Leadership Perception Assessment Scale (CLPAS) into Chinese and to test its reliability and validity. Methods: Prepared, translated and adapted CLPAS in Chinese culture. The Chinese version CLPAS was tested in 124 head nurses. Results: The Chinese version of CLPAS consisted of 20 items. Four factors were extracted by factor analysis which could explain 68.471% of the total variance. The Cronbach's α coefficient was 0.940 for the total scale and the Cronbach's α coefficient of each factor ranged from 0.867-0.874. The content validity index was 0.98. The correlation coefficient between each dimension score ranged from 0.514 to 0.711 and the correlation coefficient between each dimension score and the total score ranged from 0.826-0.870. Conclusion: The Chinese version of CLPAS is reliable and valid, and can be used to assess coaching leadership behavior of head nurses.

Objective: To explore the effect of Six Sigma DMAIC process management in improving the quality of pediatric specialized nurse training. Methods: The Six Sigma DMAIC process management was introduced to the pediatric specialized nurse training, and the results of training were evaluated. Results: The systematic training model based on Six Sigma DMAIC process management was developed, and the students' knowledge and core competencies was significantly improved. Conclusion: The systematic training conforms to the development of pediatric specialized nursing, and can be generalized in the future.

Objective: To evaluate the outcome of practical skills test of midwives standardized training in 2016. Methods: We analyzed the level of difficulty, discrimination, reliability, validityand the correlation between each test station. Results: The average test score was 72.48±8.72. The overall difficulty level of all stations was 0.691. The discrimination was 0.291 and the reliability was 0.582. Each index was within the acceptable range. The content validity index was 0.90. Factor analysis of construct validity yielded three dimensions, which was accorded with the test theory conception. Moderate correlation was shown between the first station and the sixth station, as well as the second station and the fifth station, but no significant correlation between other stations were seen. This indicated that the content of each test station was independent of each other, which was in accordance with the test design. Conclusion: The test shown a moderate difficulty level, proper discrimination, satisfying reliability and validity, which can accurately evaluate the outcome of practical skills test of midwives standardized training assessment and promote clinical nursing as well as teaching work of nursing.

We improved and facilitated series of the orthopedics nursing of quality management measures, including the revision and improvement of relevant rules, norms, standards and procedures; continuing training and passing assessment; developing and implementation of the clinical nursing path of orthopedic disease; establishing quality assessment indicators for orthopedics nursing and delivering evaluation, strengthening field management; regulating intervention behaviors, etc. The results showed that it could improve qualification rate of nursing interventions of preventing the complications of orthopedics and effectively reduce the complications.

Objective: To promote the nursing quality of pain assessment, and to improve the quality of pain management in hospital. Methods: Guided by the Precede-Proceed Model, we analyzed the predisposing factors, enabling factors and reinforcing factors that affected the nursing quality of pain assessment, and took measures to promote the development of various factors. Results: Guided by the Precede-Proceed Model, the pain assessment rate for new in-patients was increased significantly; the intervention rate and reassessment rate for patients with pain scores greater than or equal to four points were increased significantly; the pain assessment coincidence rate for patients with pain scores greater than or equal to four points were increased significantly (P<0.05). Conclusion: The Precede-Proceed Model is helpful to improve the nursing quality of pain assessment, and improve the quality of pain management in hospital.

Objective: To analyze the effect of Supportive Self-Management Mode on rehabilitation administration and management of discharged patients with depression. Methods: Patients with depression discharging from mood disorders ward were recruited during August of 2015 to October of 2016. Participants were randomly divided into the observation group (n=34) and the control group (n=33) using random number method. Both groups were given typical antidepressant treatment, conventional discharge nursing and health education. Moreover, the observation group was also given supportive self-management interventions according to Supportive Self-Management Mode. Hamilton Depression Scale (HAMD), Self-Efficacy Scale (SES) and WHO Quality of Life-Abbreviated Version (WHOQOL-BREF) were used to assess patients before their discharge, 2 months, 4 months and 6 months after their discharge separately. Results: Patients of the observation group scored significantly lower than the control group using HAMD. Patients of the observation group got significantly higher scores than the control group as to self-efficacy level, psychological dimension and physical dimension using WHOQOL-BREF. Conclusion: Supportive Self-Management Mode could help control symptoms of patients with depression and improve their self-efficacy and quality of life.

Postoperative Urinary Retention (POUR) is a common complication after surgery. Inappropriate management of POUR may be responsible for bladder overdistention, urinary tract infection, and catheter-related complications. The key strategy to successfully prevent POUR is early accurate diagnosis. The article systematically reviewed the current risk assessment of postoperative urinary retention to provide reference for nurses to quickly identify potential high-risk patients and to provide prospective care.

This article described the concept of Self-Perceived Burden, and reviewed the current situation, and research progress of influencing factors and intervention strategies for Self-Perceived Burden inpatients with chronic diseases, in order to provide reference for clinical nursing practice.

With the development of evidence-based medicine, the Trans-Theoretical Model has been widely concerned as a new effective nursing intervention model. The paper summarizes the connotation and framework of the Trans-Theoretical Model of change and introduces the tendency of application in stroke nursing at home and abroad.

Objective: To investigate ICU nurses' knowledge, attitudes, and practices on pain, agitation, and delirium (PAD). Methods: A convenience sampling method was implemented. The questionnaire composed of demographics data, questions related to knowledge, attitudes, and practices on PAD. Results: Totally 252 nurses from 28 hospitals were included. The score of ICU nurses' knowledge, attitudes, and practices on PAD was 28.67±8.00, 40.10±5.59, and 27.15±9.22 respectively. Multiple regression analysis showed PAD training, knowledge and hospital's level were the influencing factors of practice. Conclusions: ICU nurses' knowledges on PAD are insufficient. Their attitudes are positive. Their practices need to be improved. Training on PAD management are suggested to enhance clinical outcomes.

Objective: To investigate the recognition and extent to clinical alarms fatigue among ICU nurses and to identify the barriers and current status of alarms management. Methods: Totally 622 nurses in a tertiary Grade A comprehensive hospital in Jilin province were recruited and investigated using questionnaires about cognitive status, fatigue extend, clinical alarm management obstacles and alarm management status and we analyzed the influencing factors. Results: The highest score of nurses' recognition of alarm fatigue was "staff sensitive to alarm, quick response". The average score of nurses' alarm fatigue was 19.50±6.40. Among them, anxiety and mental stress fatigue score were the highest. The difference of fatigue extend scores among nurses with different working years and professional titles was statistically significant (P<0.05). Nurses were facing difficulties in improving alarm status, the top three were "frequent false alarm reduces the attention and response to alarms", "difficulties to understand the alarm priorities", " difficulties to hear the alarm in time". Conclusion: The nurses’ attitude to alarm fatigue are positive. The psychological fatigue is more serious than physical fatigue. There are fatigue differences among nurses with different working years and professional titles. The false alarm is a major obstacle to the clinical response of nurses. The management response to alarms is insufficient. We need to take targeted intervention and management measures in future to effectively reduce the alarm harm and guarantee quality and safety of nursing care in ICU.

Objective: To analyze the role of programmed nursing intervention in improving the breastfeeding rate of premature and extremely low birth weight newborns. Methods: The programmed nursing intervention for prematurity and extremely low birth weight newborns was implemented in neonatal intensive care unit, including setting up the programmed intervention team, promoting early lactation intervention, using PDCA method to maintain lactation, encouraging early skin contact and oral intervention, and giving programmed nursing intervention after discharge, etc. Results: The breastfeeding rate and growth rate of preterm and low birth weight newborns of neonatal intensive care unit were significantly improved. Conclusion: The programmed nursing intervention model has positive effect on promoting breast feeding rate and growth rate of preterm birth and low birth weight newborns.

Objective: To investigate the effect of comprehensive and systematic interventions on depressive symptoms of caregivers of patients with Alzheimer's Disease. Methods: 80 caregivers of patients with Alzheimer's Disease from tertiary hospitals in Kunming were chosen and randomly divided into the control group (n=40) and the experimental group (n=40). Basic interventions, thematic interventions and short-term group CBT were provided for each patient in the experimental group, while no specific training was supplied to the control group. 2 months after the intervention, all subjects were evaluated through scales including SCL-90, SDS, LES and HADM. Results: After the intervention, scores of SCL-90, SDS, LES, and HADM of the two groups both decreased significantly (P<0.05). The scores of SCL-90, SDS, LES, and HADM of the experimental group were lower than those of the control group (P<0.05). Conclusion: The comprehensive and systematic intervention could effectively alleviate depressive symptoms of caregivers of patients with Alzheimer's Disease. We suggest the comprehensive intervention should be applied widely to the community.

Objective: To investigate the prevention effect of early-stage ambulation activity on postoperative complications of Total Hip Arthroplasty (THA). Methods: A multi-disciplinary team was established to implement early activity one day after surgery in patients with THA. Then the postoperative complications of patients who got THA in two different periods (before and after the new intervention) were compared. Results: After implementing early-stage activity, the incidence of Deep Vein Thrombosis (DVT) of lower extremity, the occurrence of constipation and prosthesis dislocation cases in observation group were less than those in the control group, and the occurrence of DVT and constipation were statistically different (P<0.05). The hip joint function recovery in the observation group was better than that in the control group, Harris scores in 15 days and 1 month after operation were statistically higher in the intervention group than those in the control group (P<0.05). Conclusion: Implementing early-stage activity after total hip arthroplasty can effectively reduce postoperative complications, accelerate the recovery of hip joint function and improve the quality of life after surgery.

Objective: To analyze the causes of fall, make and implement relevant improvement measures. Methods: We delivered retrospective analysis of causes of 46 fall cases in our hospital in 2015. The reasons were nurses' improper assessment or not timely assessment, poor effect of health education about drug and physical activity among patients with physical disabilities, nurse visits not in place, and patients' poor compliance, etc. In order to reduce the incidence of falls, we established improvement project, including establishment of fall team, fall assessment and health education training, formulating health education manual, standardizing 5p patrol mode, using mobile logo and fall informed consent, and using quality control method to ensure the effectiveness of the project measures. Results: There were 29 fall cases in 2016, and the incidence was 0.58 per thousand. Compared to 2015, the incidence in 2016 decreased significantly (P<0.05). The incidence of severe damage reduced significantly from 43.5% to 10.3%. The regression analysis showed that improvement project was a protective factor for fall patients with severe damage. Conclusion: Through the analysis of the causes of fall adverse events, we can use improvement project to reduce the incidence of falls, reduce the degree of injury, ensure the safety of patients, and improve the quality of nursing.

Objective: To implementing best evidence-informed practice of skin toxicity caused by EGFRIs, to improve the nurses' compliance of skin toxicity symptom management, to decrease the incidence and severity of patients' skin toxicity, and to improve the patients' quality of life. Methods: We adopted the standard procedure of Practical Application of Clinical Evidence System (PACES) of JBI evidence-based nursing center, and obtained the best related practice evidence in the Clinical Online Network of Evidence for Care and Therapeutics (COnNECT+) database of JBI, and formulated corresponding review criteria. The data were collected by field observation, interviews, and medical records. Results: About 5 criterion in the second audit achieved 100.00% compliance. The patients' score of Skindex-16 was reduced from 25.18±17.29 to 7.59±6.79 (P=0.001). Conclusion: Audit of current practice and the implementation of strategies to improve compliance with evidence-informed practice were effective and appeared to reduce the incidence and severity of common EGFRIs-induced skin toxicities.

Background: Despite increasing demand for structured processes to guide clinical handover, nursing handover tools are limited in the intensive care unit. Objective: The study aim was to identify key items to include in a minimum dataset for intensive care nursing team leader shift-to-shift handover. Methods: This focus group study was conducted in a 21-bed medical/surgical intensive care unit in Australia. Senior registered nurses involved in team leader handovers were recruited. Focus groups were conducted using a nominal group technique to generate and prioritise minimum dataset items. Nurses were presented with content from previous team leader handovers and asked to select which content items to include in a minimum dataset. Participant responses were summarised as frequencies and percentages. Results: Seventeen senior nurses participated in three focus groups. Participants agreed that ISBAR (Identify-Situation-Background-Assessment-Recommendations) was a useful tool to guide clinical handover. Items recommended to be included in the minimum dataset (≥65% agreement) included Identify (name, age, days in intensive care), Situation (diagnosis, surgical procedure), Background (significant events, management of significant events) and Recommendations (patient plan for next shift, tasks to follow up for next shift). Overall, 30 of the 67 (45%) items in the Assessment category were considered important to include in the minimum dataset and focused on relevant observations and treatment within each body system. Other non-ISBAR items considered important to include related to the ICU (admissions to ICU, staffing/skill mix, theatre cases) and patients (infectious status, site of infection, end of life plan). Items were further categorised into those to include in all handovers and those to discuss only when relevant to the patient. Conclusion: The findings suggest a minimum dataset for intensive care nursing team leader shift-to-shift handover should contain items within ISBAR along with unit and patient specific information to maintain continuity of care and patient safety across shift changes.