This paper reviewed the development status of outpatient nursing in China,and analyzed the opportunities and challenges faced by outpatient nursing staff,and put forward the importance of outpatient nursing reform,so as to provide reference for the development of outpatient nursing in our country.

This paper analyzes current development situation of Nurse-led Clinics, and sums up the practice experience and related policies for better strengthening the professional development of Nurse-led Clinics in the new era.

This paper provides a brief introduction of the U.S. outpatient service system, the hospital outpatient department and the role of nurses in the hospital outpatient clinics, including the work responsibility, tasks and division of labor of nurses, and the characteristics of the advanced nursing practice clinics. The purpose of this paper is to provide knowledge and insight to improve quality of nursing practice at outpatient departments in China.

The purpose is to introduce the development of Nurse-Led Out-patient Service in Japan and its training and using of nurse specialists, to view the development of professional nursing, and to provide materials for promoting the development of Nursing Clinics and professional nursing in China.

A special nursing clinic of rehabilitation run by nurse specialists by turns was established to offer evaluation of body function, screening, health education, and rehabilitation plans to patients as well as assist physicians and therapists in professional examination and treatment so as to provide better service to outpatients with rehabilitation problems and meet their needs for rehabilitation consultation. The establishment of the clinic also aimed to help physicians and therapists with new technical programs and promote the development of special nursing of rehabilitation. Totally 220 person times of nursing assessment had been made, as well as 198 person times of individualized rehabilitation plans, 425 person times of health education, 163 person times of follow ups and consultations on 68 cases of pressure ulcer had been participated in since the opening of the clinic. Additionally, nurse specialists had assisted physicians with 109 person times of dynamic examination of urine flow, 45 person times of botulinum toxin injection, 232 person times of swallowing screening and 45 person times of swallowing videofluoroscopy. The establishment and management of the special nursing clinic helped to satisfy diversified needs of patients, physicians, nurses and therapists and improve the comprehensive satisfaction of the clinical service. Furthermore, a professional environment for better development of specialist nurses were provided, which could in turn facilitate the advancement of special nursing of rehabilitation.

Objective: In order to improve the effect of prevention and treatment of cancer in patients with hereditary colorectal cancer and their families, our hospital has established a hereditary colorectal cancer clinic based on physician-nurse collaboration for patients with hereditary colorectal cancer and their families. Methods: A hereditary colorectal cancer clinic based on physician-nurse collaboration was established and operated by a qualified chief physician with perfect training of colorectal surgery department and a clinical nurse specialist of oncology department. Qualification and training requirements of the chief physician and the nurse specialist were normalized and patients with risk of hereditary colorectal cancer and their families were considered as targeted people. The nurse made an appointment, inquired the family history, drew the family diagram, and collected the diagnosis and treatment data of the patients and their families while the director offered genetic counseling. A series of working systems and management methods were developed. Results: During the two and a half years of practice, 502 person times visited the clinic and family diagrams were collected and drew for 223 families. Besides, 120 families with hereditary colorectal carcinoma were diagnosed and offered follow-ups. Among the blood relatives of the 120 hereditary colorectal cancer patients, 52 were found to carry high-risk genes, 5 cases were diagnosed as colorectal cancer by colonoscopy, and 8 cases were polyps. Conclusion: With the help of the clinic, gene detection and tumor screening rate of high-risk relatives has been improved. Furthermore, early detection and early treatment of high-risk groups being promoted provides a practical basis for the construction of the management model of hereditary tumors.

On the basis of describing the operating characteristics of the multidisciplinary comprehensive clinic in our hospital, this article aims to summarize the important role of nurses in multidisciplinary comprehensive clinic, including the impeller for establishment of consultation teams, the guarantors for network appointments, the promoters for consultation quality, the managers for consultation data, and the participants for expert teams, so that it can provide reference for the training of nurses for multidisciplinary comprehensive clinic in China, and provide reference for the participation of nurses in multidisciplinary consultation, the development of career paths, the improvement of professional ability and influence.

Objective: To investigate the current status of health literacy and its influencing factors among patients with Chronic Heart Failure (CHF). Methods: totally 180 CHF patients were recruited by convenience sampling method from outpatient department in 3 tertiary general hospitals in Shanghai from October, 2017 to September, 2018. Self-designed demographic and health status questionnaire, Social Support Rating Scale and the Chinese version of Heart Failure Specific Health literacy scale were applied. Results: The mean score of health literacy was 28.72±9.36. The mean score of critical health literacy was 2.08±0.85. Multiple hierarchical regression analysis suggested that age, place of residence, education, NYHA class and social support were the main influencing factors of health literacy in CHF patients. Conclusion: Health literacy especially critical health literacy in CHF patients is relatively poor. Enhancing social support may improve CHF patients' health literacy. Health workers should pay more attention to CHF patients who are older, living in rural areas, less educated, and have poorer NYHA class.

Objective: To develop the rehabilitation strategy and improve bleeding and range of motion (ROM) in hemophilia patients with Total Knee Arthroplasty (TKA). Methods: The action research method was performed as the framework. The literature research, expert meetings were applied to collect and analyze data. Totally 132 hemophilia patients were included. The incidence of bleeding and the ROM were analyzed. Results: After the application of optimization of CPM program, the incidence of bleeding was significantly reduced and the ROM was significantly increased (P<0.05). After the application of construction of 3 phases active exercise, the ROM was significantly increased (P<0.05). Conclusion: Action research is an effective method to solve multidisciplinary cooperation and complex problems. Based on action research, rehabilitation strategy for hemophilia patients with TKA are developed. It is expected to apply the rehabilitation strategy to clinical practice to improve the quality of nursing care.

Objective: To systematic review the experience of caring stroke patients by family members at home and to provide basis for community transitional care. Methods: We searched the databases including PubMed, EMbase, CINAHL, PsycINFO, CBM, CNKI, Wanfang Date, and VIP to collect qualitative studies about experience of caring stroke patients by family members at home, evaluated the quality of included studies according to JBI Critical Appraisal Tool for qualitative studies in Australia. Results: A total of 18 qualitative studies were recruited and 60 complete findings were extracted. Totally 7 new categories were summarized, and 3 integration results were obtained:①Caregivers experienced heavy burdens, changes in family relationships, and sacrifices in their lives.②With the care time-lapse, caregivers gradually adjusted and adapt to obtain spiritual support.③With the sudden onset of stroke disease, the caregivers lacked care ability and were eager to obtain support from the hospital-community-family-social support system in the home care process. Conclusion: The caregivers had a heavy burden and lacked care ability. In the process of transitional care, we should support, guide and improve the coping ability of family members.

Objective: To explore the incidence and risk factors of patients with Intraoperative Acquired Pressure Injury (IAPI). Methods: Scott Triggers Preoperative Evaluation Scale was performed. Totally 610 patients were selected. Logistic regression analysis was used to analyze the risk factors of IAPI. Results: Totally 121 (19.8%) patients had intraoperative acquired pressure injury, among which 89 (73.6%) had stage 1 pressure injury, 8 (6.6%) had stage 2 pressure injury, and 24 (19.8%) had deep tissue injury. There were significant differences of IAPI between surgery time, different surgical position, intraoperative position movement, extracorporeal circulation, and use of heating blanket perspectively (P<0.001). Conclusion: Patients with high risk pressure injury and special surgical position should be monitored during and post operation. The preventive strategies of IAPI need to be applied for the high risk patients in order to reduce the incidence of pressure injury, ensure the safety of the patients and improve the quality of nursing in the operation room.

Objective: To observe the effects of Skin-to-Skin Contact (SSC) on breastfeeding during cesarean section. Methods: According to the requirements of immediate SSC, a specific implementation procedure was established. 100 pairs of maternal and child ectopic cesarean delivery were included in the study. They were divided randomly into intervention group (n=50) and control group (n=50). The intervention group was implemented immediately SSC, the control group was given routine care. The differences in the Infant Breastfeeding Assessment Tool (IBFAT) scores and maternal lactation start-up time between the two groups were compared. Results: The IBFAT scores of the intervention group were higher than that of the control group on the dimensions of willingness to breastfeeding, dimensions of sucking motivation and total scores (P<0.05). The lactation start time of the intervention group was earlier than the control group (P<0.05). Conclusion: Immediate SSC during cesarean section is conducive to the successful initiation of breastfeeding.

Objective: To systematically evaluate the effects of exercise combined with nutritional support on the elderly with frailty or pre-frailty. Methods: Randomized controlled trials, which explored the effects of exercise combined nutrition support on the elderly with frailty or pre-frailty, were searched in China journal full-text database (CNKI), wanfang database, VIP database, China biomedical literature database (CBM), The Cochrane Library, PubMed, EMBASE, Web of Science and CINAHL. After screening the literature, extracting the data and evaluating the quality of the literature, Meta-analysis was performed using RevMan 5.3 software. Results: A total of 11 randomized controlled trials involving 853 old people were finally included. According to the Meta-analysis, exercise combined nutrition support could reverse the frailty state [OR=2.46, 95%CI (1.33, 4.55), P=0.004], increase hand grip [MD=2.10, 95%CI (1.53,2.68), P<0.001], increase walking speed [MD=0.07, 95%CI (0.03, 0.12), P=0.003], and increase energy intake [MD=0.40, 95%CI (0.26,0.54), P<0.001]. But there was no obvious advantage in improving the quality of life, leg extension force, balance and lean body weight, and the combined effect was not statistically significant (P>0.05). Conclusion: Exercise combined with nutritional support could reverse the frailty state and improve physical function, but it may not improve nutritional status. Further researches are needed in this area.

Objective: To evaluate the impact of early intensive rehabilitation care on adults undergoing valve surgery. Methods: This was a quasi-experimental study in 96 cardiac valvular surgery patients recruited from Fuwai Hospital. Participants awaiting valve surgery were divided into the experiment group and the control group. The control group received routine rehabilitation care after operation and patients of the experimental group were given earlier intensive exercises and education intervention initiated just the time of admission in addition to the above mentioned routine care. The 6-Minute Walk Test (6MWT), Maximal Inspiratory Pressure (MIP) and the MOS 36-Item Short-Form Health Status Survey (SF-36) were used at the admission and discharge of patients to analyze differences between their exercise performance, respiratory function and health-related quality of life. Results: At discharge, outcomes regarding to the 6MWT distance, Borg scores and MIP of the experimental group were significantly higher than those of the control group (P<0.05); analysis of the five items of SF-36 including bodily pain, physical functioning, general health, vitality and mental health shown significant differences between the two groups, namely those indicators were significantly improved in the experimental group as compared with the control group. Discomfort were observed in both groups when patients were having the 6MWT and no significant differences were captured in terms of role-physical, social functioning and role-emotional of SF-36 (P>0.05). Conclusion: The early intensive rehabilitation care may propose positive influences on life quality of patients undergoing non-urgent valvular surgery, particularly on the aspect of walking ability and respiratory function.

Objective: To explore the relationship of frailty level and gait performance in community-dwelling aged.Methods: A total of 191 aged over 65 years were included by convenience sampling, and divided into frail group (n=16), pre-frail group (n=111) and non-frail group (n=64) according to Simple Frailty Questionnaire (FRAIL) score. The demographic features was assessed with demographic characteristic questionnaire, cognitive function was assessed with the Mini-Mental State Examination (MMSE), and gait parameters were measured by IDEEA LifeGait. Results: The speed, step length, step frequency and stride time were statistically significant different between frail group and non-frail group (P<0.05). There was statistically significant difference in step length and speed between frail group and pre-frail group (P<0.05). There was no statistically significant difference in speed, stride time, step frequency, and step length between non-frail group and pre-frail group (P>0.05). Conclusions: The Characteristics of normal walking gait are different across frailty level. The higher the frailty, the worse the gait among the aged in community.

Objective: To translate the AACN Healthy Work Environment Assessment Tool into Chinese, and test the reliability and validity of the Chinese version. Methods: The English version of the tool was translated and back-translated according to Brislin translation model. After modifying the tool according to Chinese culture, the reliability and validity of the Chinese version of the tool was tested among a sample of 425 ICU nurses in Hangzhou. Results: The Chinese version of the tool included 6 dimensions and 18 items. 6 factors were extracted by principal component analysis, which could explain 75.884% of the total variance. The Cronbach's α for the tool was 0.908, and the Cronbach's α for six dimensions was among the range from 0.734 to 0.871.The test-retest reliability was 0.870. The correlation coefficient between each dimension and the tool ranged from 0.572 to 0.817 (P<0.01). The range of item-level content validity index (I-CVI) was from 0.830 to 1.000. The average of scale-level content validity index (S-CVI/Ave) was 0.991. Conclusion: The Chinese version of the tool is reliable and valid, and is an effective tool to assess the nursing healthy work environment of ICU.

Objective: To translate the Immunosuppressant Therapy Barrier Scale (ITBS) into Chinese and test the reliability and validity of the Chinese version. Methods: The ITBS was translated into Chinese following the translation-retranslation procedure and culturally adapted according to Chinese settings. The reliability and validity were tested in 181 kidney transplant recipients by convenience sampling from the outpatient department in a tertiary hospital in Changsha. Results: The Chinese version of ITBS consisted of 13 items. Three factors were extracted by factor analysis, which could explain 61.6% of the total variance. The loading of each item on the corresponding factors was higher than 0.4. The retest reliability and the Cronbach's α coefficient for the total scale were 0.870 and 0.849, respectively. Conclusion: The Chinese version of ITBS is with simple items and with good reliability and validity, which can be used as a tool for assessment of the immunosuppressant therapy barrier in patients with organ transplantation.

Objective: To analyze the psychological empowerment status of nurses, and the influence of group psychological counseling on them. Methods: From January to March 2018, 40 nurses in our hospital were surveyed with the Chinese version Spreitzer psychological empowerment scale and self designed general information questionnaire. Group counseling was used for psychological counseling. The scores of psychological empowerment scale were compared before and after 6-week intervention. Results: After intervention, the scores of the psychological empowerment scale were significantly improved in terms of work influence, autonomy, self-efficacy, job meaning and the total score (P<0.05). Conclusion: The psychological empowerment status of nurses in our hospital need to be improved. Group counseling can significantly improve nurses' psychological empowerment and help to build a stable nursing team.

This article reviewed the current psychological status of health care professionals who engaged in emerging acute respiratory infectious diseases and summarized the potential influencing factors. We provided comprehensive coping strategies for health care professionals, in order to confront emerging acute respiratory infectious diseases more effectively and easily.

Objective: To investigate the working environment and moral distress of emergency and critical care nurses, and to analyze the relationship of working environment and moral distress. Methods: A convenience sample of 457 emergency and critical care nurses from 4 tertiary hospitals in Changsha were investigated by Practice Environment Scale and Moral Distress Scale. Results: The total score of working environment was 90.95±13.24, and the total score of moral distress was 53.98±35.89. Working environment was significantly negatively correlated with moral distress (P<0.01). Nurses' participation in hospital affairs and sufficient manpower and material resources in nursing work environment can independently explain 29.1% variation of moral distress after controlling demographic variables. Conclusion: The moral distress of emergency and critical care nurses is not optimistic, the working environment can predict moral distress partially, and the moral distress level could be relieved by improving the working environment.

Objective: To investigate the current status of utilization and management of Specialty Nurse(SN) in Guizhou province. Methods: It was an online survey. The self-designed questionnaire was used in this survey. Results: A total of 2,877 SNs from 122 hospitals and the nurse managers from 108 hospitals were participated in this survey. There was 29.4% and 44.9% SNs having the same or nearly the same job description with the other nurses, respectively. More than 30% of SNs were not satisfied with the current working status. There were registration systems for SNs in 84.3% of the hospitals. Admission system for SNs existed in 65.7% hospitals. The SNs did not get more pay in 69.4% of the hospitals. Conclusion: The duties and responsibilities of SNs in Guizhou province need to be further clarified, and the management regulations for SNs needs to be improved.

Objective: To apply the 3D trauma on-site rescue training system to the first aid teaching, and explore the teaching effects of the training system on the students. Methods: The 3D trauma on-site rescue training system were developed. The 5 functional modules were set up to study the knowledge and skills of trauma on-site rescue. Totally 331 nursing students were randomly divided into experimental group and control group, and different teaching methods were adopted. The teaching effects were analyzed with t-test. Results: The students in the experimental group had higher scores in trauma rescue than the control group (P<0.05). The experimental group and the control group were significantly different in terms of improving learning interest, analysis, problem-solving ability and first aid awareness (P<0.05). Conclusion: The application of 3D trauma on-site rescue training system has a good teaching effects. It can stimulate students' learning motivation and improve their comprehensive first-aid ability.

In this paper, we reviewed the current literature of the second victim at home and abroad, including the related definition of patient safety incident, the status of second victim research, the impact of patient safety incident on the second victim and the status of second victim support, etc. We hope it could arouse the attention on the second victim in medical institutions, and increase the support level for the second victim, and provide references for researches it this field.

Skin tears is an important topic in wound care and with more attention with the publication of 2018 "Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin". There were few researches on skin tears in China. The latest definition and classification of skin tears, the occurrence and the progress in prevention and management of skin tears at home and abroad were reviewed in this paper to introduce the concept of skin tearing, and to provide theoretical basis for the future research.

This paper reviewed the continuity of care outcome evaluation indicators for stroke from process evaluation indicators and outcome evaluation indicators. Process evaluation indicators included information continuity, management continuity and relationship continuity. Outcome evaluation indicators included clinical outcome of patient, utilization rates of medical resources and patient satisfaction. In addition, this paper put forward weakness in current research and direction in future research, so as to provide a reference for future establishment of uniform and standardized outcome evaluation indicators for stroke.

This article analyzed and compared of the assessment tools under the current long-term care insurance system at home and abroad from the background, content and application. There are three weak points: firstly, the existing tools do not conform to the definition of disability; secondly, the form of the existing tool is likely to cause cross-over and overlap between items; thirdly, the existing tools do not match the current long-term care and insurance payment standards in China. Due to the above reasons, it is essential to build a disability assessment tool based on Chinese long-term care insurance system.

Objective: To investigate the current situation of processing loaner instrument and implants in Central Sterile Supply Department in domestic hospitals, in order to provide reference for the development of relevant regulations. Methods: A survey of loaner instrument and implants management was conducted in 764 hospitals. Results: Totally, 2.88% of the hospitals did not have certain regulations of loaner instrument and implants management. In terms of post-duty settings, 44.37% of the hospitals did not set post for personnel of processing loaner instrument and implants, and 16.23%, 17.15% and 50.65% respectively of the hospitals could get loaner instruments and implants for elective surgeries 8 hours, 12 hours or 24 hours before the surgeries. Nearly 71.34% of the hospitals did not meet the requirements of reprocessing loaner instruments and implants after the surgeries, and 63.61% of the hospitals claimed that they had overweight packages of loaner instrument and implant, while 55.50% of the hospitals indicated that they could not obtain the Instruction For Users (IFUs) of loaner instrument and implants from manufacturers. Conclusion: Developing and refining the regulations for the management and setting up specialized post for processing loaner instrument and implants, increasing the proportion of hospitals that have IFUs of loaner instrument and implants, and enhance their compliance to follow manufacturer's instructions are necessary to ensure safety, reduce the risk of hospital infection, in order to improve the quality of medical care.

Objective: To investigate the current status of knowledge, attitude and practice of operating room nurses on terminal disinfection of infected operation and analyze the influencing factors. Methods: The study was conducted on 122 operating room nurses who attended the operating room specialist nurses training class of the Chinese Nursing Association in Beijing in July 2018. A self-developed questionnaire was used to investigate the cognition and influencing factors of terminal disinfection of infected operation. Results: The scores of terminal disinfection knowledge of infection operation in operating room nurses was (0.56±0.17), among which the score of disinfectant effect and application concentration was the highest (0.81±0.25), and the score of cleaning disinfection was the lowest (0.36±0.14). The mean score of attitude and behavior were (4.19±0.92) and (4.17±0.78), 84.43% of the nurses thought terminal disinfection was very important to prevent cross infection; 83.61% would like to participate in the training on terminal disinfection of infected operation. The influencing factors of operating room nurses' knowledge of terminal disinfection of infected operation were: working years, number of knowledge training; the influencing factor of attitude is the number of knowledge training; the influencing factor of behavior is the degree of attention paid by leaders. Conclusion: The knowledge score of terminal disinfection of infected operation in the operating room nurses is at medium level. The operating room nurses have positive attitude, while the level of practical ability is low. Head nurses should give knowledge training and strengthen the training frequency according to different characteristics of the nurses, as well as strengthen management to develop the responsibilities and advantages of the operating room nurses.

With the development of complementary and alternative medicine, mindfulness has attracted more and more attention in the field of medicine, and mindfulness-based therapy has been proven to improve mental and physical health outcomes in different populations. This paper reviewed the research progress of Mindfulness-Based Intervention in diabetic patients, introduced the methods and contents of mindfulness interventions for diabetic patients, analyzed the effects of Mindfulness-Based Intervention on health outcomes of diabetic patients. It shows that Mindfulness-Based Intervention can improve the mental health outcomes of diabetic patients, but more long-term and rigorous scientific researches will be needed to verify its physiological effects so as to draw a consistent conclusion.

Objective: To explore the effect of Otago exercise programme on balance ability and Fear of Falling in elderly patients with knee arthroplasty. Methods: Sixty-five discharged elderly patients after knee replacement were included and divided into the observation group (33 cases) and the control group (32 cases) according to the time of admission. The routine functional exercise instruction and the flow Otago exercise programme were implemented in the control group and intervention group, respectively. The Berg balance scale, single item about falling fear and modified falls efficacy scale were used to evaluate the balance ability and fear of falling after the intervention, and the occurrence of falls in two groups was recorded. Results: The patients' balance ability and the fall efficacy in the intervention group were higher (P<0.01), and the rate of falling fear was lower than that in the control group (P<0.01) after 1 month of intervention. No fall occurred in both groups. Conclusion: Otago exercise programme can improve the balance ability and fall efficacy of elderly patients after knee arthroplasty, and reduce the incidence of falling fear and the risk of fall.

In this paper, we reviewed the current research of esophageal symptom management, and introduced the common symptom clusters of esophageal cancer patients briefly and the intervention measures respectively. Then we analyzed and summarized the existing problems in the current studies, so as to provide reference for nursing staff to manage the symptom clusters.

Based on the concept of enhanced recovery after surgery, we reviewed the current situation and promotion strategies of early mobilization after abdominal surgery. It is expected to provide information for medical staff to better guide patients on early mobilization after surgery and promote the effective implementation of enhanced recovery after surgery.

This paper reviews the ICU-AW risk models released abroad in recent years and summarizes the releasing time, the scope of application and related risk factors. The purpose of this paper is to summarize the research status and progress of ICU-AW risk prediction models at home and abroad, so as to promote the construction and use of ICU-AW risk prediction models in China.

The paper described the methods, advantages and needs of parents participating in neonatal pain management. The factors affecting the implementation of parental involvement in neonatal pain management were reviewed in terms of the importance of nurses' roles, the lack of assessment tools and methods, parental knowledge, belief and behavior, along with information mismatch between parents and nurses. The aim is to provide a basis for optimal pain management and a reference for future nursing management.

Fatigue is one of the most common symptoms in Hematopoietic Stem Cell Transplant patients, the occurrence of fatigue affects the quality of life and treatment outcomes of patients seriously. This paper reviewed the influencing factors and treatment methods of fatigue in Hematopoietic Stem Cell Transplant patients, aims to find advantages and disadvantages of the current studies, and to provide references for further researches.