Advance care planning has been implemented in the health care system and protected by law in many western countries in the last century. However, advance care planning in China is still in concept promotion stage. Therefore, this review paper was taking the differences between Chinese culture and the western culture to analys the differences in the cultural, legislation and the implementation of advance care planning in health care field so that to explore the feasibility of implementing advance care planning and to provide the strategies to embed advance care planning into health care system in China.

It has been well documented that family participation and family relation have significant influences on the implementation of advance care planning. It is therefore important to involve family members in advance care planning. This article aims to describe the related concepts of family-centered advance care planning and to explore how family participation and family relations affect the implementation of advance care planning. Implications for promoting family-centered advance care planning in China are also discussed.

This paper reports the findings of focus study interviews that explores the experiences of trained nurses in the implementation of ACP. It was a process evaluation of a study that promotes ACP in hospital setting. The ACP programme in this study was developed with reference to the relevant cultural issues in the Chinese community and the format of the Serious Illness Conversation Guide. The nurses as study informants identified the exceptional roles of nurses in advocacy and communication throughout the ACP process, yet the promotion of ACP requires support at the level of macro-environment. Three themes in relation to the support needed emerged from their sharing, namely life and death education in the community, fundamental training for health care providers, as well as support and recognition from organization and management.

Objective: To investigate the knowledge, attitude and practice of Advance Care Planning (ACP) among nurses and explore the influencing factors. Methods: E-questionnaires were delivered to 1 036 nurses from all over the country by conventional sampling. Results: The score of knowledge of ACP among nurses was 6.16±2.34. And 97.2% of nurses were in favor of ACP, but the participation rate of each item of ACP was below 30.0%. The influencing factors of ACP knowledge among nurses were education, the number of terminal patients caring for within 6 months, and the experience dealing with deaths. And influencing factors of ACP practices were the number of terminal patients caring for within 6 months, attitude, age, knowledge, and education. Conclusion: The approval rating for ACP among nurses in China is very high, but the knowledge and participation rate are low. Interventions such as relevant training are needed to prepare the nursing staffs for the implementation of ACP in China.

Objective: To explore the pressure source, the inner experience process and coping styles of the nurses experienced medical disputes involving dead patients through phenomenological research. Methods: Objective sampling method was performed. Eight nurses were selected for semi-structured interview. The data were analyzed by Giorgi analysis method of phenomenological study. Results: Four themes were extracted. Theme 1: the main source of pressure for nurses involved in medical disputes of patients with death. The sub-themes included family incomprehension, hospital blame and colleagues' disrespect. Theme 2: the forms of stress of nurses involved in the dispute of patients with death. The sub-themes are misfortune and grievance, fear and confusion, and different views on nursing careers. Theme 3: dealing with the pressure of nurses in the dispute of patients with death. Theme 4: nurses' suggestions to hospitals and managers. Nurses should not be allowed to directly face patients' family members. The hospitals should provide the nurses with psychological support, and time for emotional adjustment. Conclusion: The administration department of the hospital and the nursing managers should provide psychological and emotional supports to the nurses involving in medical disputes. Nursing staff should adjust themselves and increase professional identity as well.

Objectives: To determine the shame among family caregivers of patients with Alzheimer's Disease and its relationship with caregiver burden. Methods: The convenience sampling method was used to select 141 patients and their caregivers who were investigated by the questionnaires distributed to them. Results: The shame score of family caregivers of patients with Alzheimer's Disease was (48.30±9.54). According to one-way ANOVA analysis, significant differences were observed regarding to comparison of the severity of Alzheimer's Disease, caregivers' age, the caregiver-patient relationship and time of care (P<0.05). In line with correlation analysis, disease-related shame was strongly correlated with caregiver burden. Disease-related shame was analyzed through hierarchical regression analysis, which suggested disease-related shame could account for 21.0% of the variance in dependently after general information was controlled. Conclusion: It was indicated that family caregivers of patients with Alzheimer's Disease maintained a relatively medium to high sense of shame which was strongly correlated with caregiver burden. Thus targeted and customized psychological support and interventions should be offered to caregivers of patients with Alzheimer's Disease by medical staff in order to reduce caregiver's sense of shame and improve their mental health, which can reduce their burden as caregivers.

Objective: To evaluate the effects of nine mouthwashes on the prevention of oral mucositis (OM) in patients with cancer by network Meta-analysis. Methods: Databases including PubMed, Embase, Scopus, the Cochrane Library, Google Scholar, CNKI, VIP, CBM, and WanFang were searched. Studies were limited to randomized control trials (RCT) about the effects of nine mouthwashes in the prevention of OM up to August 2018. The Cochrane Handbook was used to evaluate the methodological quality. Two authors screened literature and extracted data independently. The network Meta-analysis was performed using Stata 15.0 softwares. Results: A total of 28 RCTs involving 1 811 patients were included. The network Meta-analysis results showed that chlorhexidine, benzydamine, honey and curcumin significantly reduce incidence of mucositis compared to placebo (P<0.05), honey and curcumin significantly reduce incidence of mucositis compared to povidone-iodine (P<0.05). According to SUCRA, probability ranking in descending order is curcumin, honey, benzydamine, chlorhexidine, allopurinol, sucralfate, GM-CSF, povidone-iodine, aloe. Conclusion: This Meta-analysis found that curcumin is significantly effective in preventing the incidence of oral mucositis in patients with cancer compared with other mouthwashes. However, more randomized controlled trials with larger sample size are needed for further verification.

Objective: To investigate the help-seeking intention for early detection of dementia and it's related factors of adults with subjective memory complaints (SMC), and to provide reference for early intervention with dementia risk group. Methods: A questionnaire survey was conducted among adults with SMC from 4 community health centers in Chongqing by convenient sampling, and the related factors of help-seeking intentions were analyzed with logistic regression. Result: For the 344 adults with SMC, there were 126 adults with help-seeking intention (36.63%). Logistic regression analysis showed that marital status (OR=1.869, P=0.011), education level (OR=1.364, P=0.012), family history of dementia (OR=1.989, P=0.010) were the related factors of help-seeking intention for early detection of dementia among adults with SMC. Conclusion: The help-seeking intention for early detection of dementia among adults with SMC is poor. Marital status, education level and family history of dementia are the main related factors of help-seeking intention for early detection of dementia among adults with SMC.

Objective: To investigate the knowledge, attitude and practice of the ICU nurse specialists to the early mobilization of patients with mechanical ventilation and to explore the influential factors. Methods: A self-designed general information questionnaire, and the knowledge, attitude and practice questionnaire about early mobilization of patients with mechanical ventilation were used to collect data, and the ICU nurses who participated in the ICU nurse specialists training project in the First Affiliated Hospital of Chongqing Medical University from 2016 to 2018 were included in the study. Results: The score of early mobilization knowledge of mechanical ventilation patients was 7.44±1.51, the score of attitude was 25.42±2.89, and the score of behavior was 24.79±6.64. Multiple linear regression analysis showed that the training was the influential factor of ICU nurse specialists' knowledge, attitude and practice (P<0.01). Conclusion: ICU nurse specialists have good knowledge and attitude towards early mobilization of patients with mechanical ventilation, but management behaviors is inconsistent with attitude. Managers should pay more attention to the nurse training on early mobilization of patients with mechanical ventilation.

Objective: To investigate the knowledge status on palliative care of nurses from the oncology department in our hospital and analyze the influencing factors so as to provide references for further improvement of nurses' continuing education on palliative care. Methods: Totally 63 nurses in the oncology department of our hospital were enrolled and investigated by using the questionnaire of general information and knowledge of palliative care. Data about their knowledge and influencing factors was analyzed. Results: The standardized total scores of palliative care knowledge and attitudes of oncology nurses were (56.30±15.98) and (67.81±15.28), respectively. In case of palliative care knowledge, the standardized score of physical therapy was the highest and that of spiritual therapy was the lowest. As to palliative care attitudes, the standardized score of "the attitude of providing palliative care to patients and their families" was the highest, while the standardized score of "the current status of palliative care in hospitals" was the lowest. The results of multiple regression analysis showed that, educational backgrounds, professional titles, working time in the oncology department and religious beliefs were the influencing factors on palliative care knowledge of oncology nurses, and professional titles, working time in oncology and religious beliefs were the influencing factors on palliative care attitudes of oncology nurses. Conclusion: Nurses from the oncology department posses relatively little knowledge of palliative care, targeted education and training measures should be taken for nurses.

Objective: To investigate the effects of cognitive behavior and mother-infant relationship therapy on perinatal depression patients. Methods: Totally 148 perinatal depression patients were randomly divided into two groups. The experimental group underwent "cognitive behavioral therapy" and "mother-to-child relationship therapy" interventions in late pregnancy and early postpartum. The control group received medical consultation and mental health guidance in midwifery clinic during the same period. Results: The cure rate of the experimental group (61.3%) was significantly higher than that of the control group (20.5%) (P<0.01). After intervention, the total score of PDSS scale and the score of its five domain factors in the experimental group were significantly lower than those in the control group (P<0.05). The scores of the WHOQOL-BREF scale in the areas of physiological, psychological and social relations were significantly higher than those of the control group (P<0.05). The total score of social support scale and the score of subjective support and support utilization factor of the experimental group were significantly higher than those of the control group (P<0.05).Conclusion: This cognitive behavior and mother-infant relationship therapy can effectively relieve depression symptoms in perinatal depression patients, improve their quality of life and social support.

Objective: To explore the influencing factors of neonatal PICC-related infections. Methods: We searched this topic in database which is published before September 1, 2018. Meta-analysis was performed by Revman 5.3 software. The odds ratios of the influencing factors were calculated as OR and 95% CI. Results: A total of 15 articles were included in the study, including a total of 8 466 neonates and 495 PICC-related infections. Meta-analysis showed factors related to neonatal PICC-related infection includes placental abruption 3.45 (1.54, 7.69), birth weight≤1 500 g 2.42 (1.84, 3.18), preterm birth (gestational age≤37 weeks) 2.83 (1.76, 4.53), respiratory distress 1.79 (1.15, 2.79), 5 min Apgar 7 points 5.08 (2.62, 9.85), time consuming for puncture (30 minutes) 0.04 (0.01, 0.24), number of puncture ( Related Articles | Metrics

Objective: To revise the Nursing Practice Environment Scale and evaluate its reliability and validity. Methods: Totally 3 023 nurses from 5 hospitals were pre-tested using the Nursing Practice Environment Scale revised by Nursing Center of National Institute of Hospital Administration. Totally 375 281 nurses from 602 hospitals were formally tested. SPSS and AMOS were used to evaluate the reliability and validity of the scale. Results: Pre-test found that 36 items of the revised scale met the requirements. Formal test found that the overall Cronbach's α coefficient of the scale was 0.983, the Cronbach's α coefficient of each dimension ranged from 0.846 to 0.948; the overall split-half reliability coefficient of the scale was 0.957, and the split-half reliability coefficient of each dimension were between 0.755 and 0.932. The extracted 10 common factors by exploratory factor analysis explained 87.576% of the total variation; the first-order confirmatory factor model found that RMSEA value was 0.043, GFI value was 0.943, and AGFI value was 0.930, which were consistent with the model. Conclusion: The Nursing Practice Environment Scale had good reliability and validity, and could be used for the evaluation of the nursing practice environment in China.

Objective: To apply a standardized classification and transportation system to critically ill patients in hospital to improve the quality of medical services. Methods: Criteria and procedures of the classification and transportation system for critically ill patients in hospital were established and standardized, and the Transportation Assessment Form for Critical Patients was used through the transportation process. Meanwhile, a sound and complete quality control system and standards were formulated to make room for continuous improvement. Besides, education and training were offered all around the country to ensure that effective transportation could be carried out both professionally and normally. Results: After the implementation of the classification and transportation system for critically ill patients in hospital, the average time spent on Class I, II, and III transportation was significantly reduced, and the incidence of adverse events observed during patient transportation decreased from 7.49% to 1.40%. The satisfaction degree of both family members and receiving departments was significantly improved (P<0.05). Conclusion: The classification and transportation system for critically ill patients in hospital has reduced the risk of transportation, ensured patients' safety, and fully demonstrated the meaning and continuous improvement of nursing service.

To improve the quality of emergency treatment for trauma patients, the In-Hospital Trauma Management Team was established in 2015, and it included four sub-groups, emergency treatment group, quality control group, training group and mobile group, and the group-training were carried out according to their different functions. The management responsibilities, job contents and main tasks of each team are clarified, the professional ability and quality management awareness of trauma members are trained, the level of trauma knowledge and the ability of emergency response of the members were improved, the treatment process of trauma patients was standardized, and the patient satisfaction, the overall professional quality of members, and the quality of treatment for trauma patients were improved after 2 years of practice.

Objective: To investigate ICU nurse' score competence and related factors in Fujian province. Methods: ICU nurses from 12 level 2 or level 3 hospitals in Fujian province were included by convenient sampling, and the related factors were analyzed by multiple linear regression. Results: A total of 473 valid questionnaires were returned. The mean score of ICU nurses' core competence was 66.89±16.71, the professional technical score was the highest with 21.38±5.76, the professional competence score was the lowest with 12.80±3.68. The related factors of ICU nurses' core competence included the professional title, years of working, hospital level, further education experience and autonomous learning ability (P<0.05). Conclusion: The core competence of ICU nurses from Fujian province needs to be improved, especially those in level 2 hospitals and junior nurses. The multi-channel, multi-level and targeted post education training modes were expected in the future, and the scientific research and independent learning enthusiasm need more attention.

Objective: To analyze the relationship of job stress and job satisfaction in ICU nurses, and to examine the moderating effect of perceived organizational support in their relationship. Methods: A convenience sample of 263 ICU nurses were selected from four level-3 hospitals in Hangzhou. The general information questionnaire, Job Satisfaction Assessment Scale (JSAS), Job Stressor Scales (JSS) and Perceived Organizational Support Scale (POSS) were used to collect data. Results: The mean score of job satisfaction was 2.95±0.79, job satisfaction was negatively correlated with job stress (r=?-0.486, P<0.01) and positively correlated with organizational support (r=0.358, P<0.01). The multiple linear regression analysis showed that organizational support could moderate the relationship between job stress and job satisfaction (β=0.149, ΔR2=0.042, P<0.01). Conclusion: ICU nurses experience a lower level of job satisfaction. The organizational support could moderate the relationship between job stress and job satisfaction. Developing a climate to reduce job stress and improve organizational support may be benefit to increase ICU nurses' job satisfaction.

Objective: To explore the effect of applying project management on reducing clinical nursing adverse events. Methods: In 2015-2016, project management methods were applied to improve the top three nursing adverse events in the hospital (pressure injury, falls and unplanned extubation). The annual assessment rate, accuracy rate and incidence rate of high-risk patients with pressure injury, falls and unplanned extubation were compared after the implementation of project management. Results: Since the implementation of project management, the assessment rate and accuracy rate of high-risk patients with nosocomial pressure injury, and unplanned extubation were increasing year by year, and the incidence rate of pressure injury, falls were decreasing year by year, and the difference was statistically significant (P<0.001). Conclusion: The use of project management method can effectively reduce the incidence of nursing adverse events, reduce medical and nursing costs and improve work efficiency.

Objective: To examine the current informatics competency levels of post graduate nursing students and to identify the influencing factors of these competencies. Methods: The self-reported Nursing Informatics Competencies Scale (NICS) was used to investigate 92 postgraduate nursing students from 6 universities. Results: The informatics competency of these post graduate nursing students was under the moderate (2.89±0.57). Multiple linear regression analysis indicated that grade, work or practice time, computer level, informatics-related education, and experience of using nursing informatics system were significant factors influencing competency levels. Conclusion: The informatics competency of these post graduate nursing students need to be improved. Nurse educators should set up proper nursing informatics curricula to improve their informatics competency.

Objective: To establish a nurse-led case management for discharged stroke patients and evaluate its practical effect. Methods: Totally 182 patients who met the inclusion criteria were randomly divided into two groups. The intervention group (n=93) were given case management, while the control group (n=89) were provided regular follow-up. We compared differences in MBI, mRS scores and use of health service between the two groups after the patients discharged from hospital for 1 month, 3 months, 6 months respectively. Results: The MBI scores between the two groups were statistically significant after they discharged from hospital for 1 months, 3 months and 6 months (Ftime=784.447, P<0.001; Fgroup=21.942, P<0.001; Ftime*group=11.145, P=0.001 respectively). The differences of mRS scores were also statistically significant (Ftime=52.019, P<0.001; Fgroup=3.980, P=0.049; Ftime*group=12.312, P<0.001 respectively). The numbers of out-patient and emergency visits between two groups were significantly different (P<0.05). Conclusion: Nurse-led case management can facilitate the nurses to provide continued care to patients after they discharged from hospital. It can improve the patients' ability of daily living and use of medical resources as well.

Objective: To analyze the effect of MDT mode on improving the self-management ability of pregnant women with gestational diabetes mellitus. Methods: Totally 80 pregnant women with gestational diabetes mellitus were recruited with 40 pregnant women from November 2016 to January 2017 in the control group and 40 pregnant women from February 2017 to April 2017 in the study group. The control group received routine prenatal examination and management, and the stduy group implemented the whole-process management mode of gestational diabetes mellitus MDT. The high-risk pregnancy management APP platform combined with the offline "one-day outpatient service for gestational diabetes mellitus" was used to conduct online and offline dynamic management. Results: Pregnant women with gestational diabetes mellitus in the study group had better self-management compliance and education knowledge awareness than those in the control group. Pregnancy weight gain and blood glucose control in the study group were better than those in the control group (P<0.05). The incidence of hyperhydramnios, 2h postpartum blood loss and macrosomia in pregnant women in the study group was lower than those in the control group (P<0.05). There was no statistically significant difference between the study group and the control group in gestational hypertension and premature rupture of membranes (P>0.05). Conclusion: The whole-process health management mode of gestational diabetes mellitus MDT has a good effect on improving the self-management ability of gestational diabetes mellitus patients, helping to improve pregnant women's weight and blood glucose control quality, and reducing the occurrence of pregnancy complications. It is also beneficial to conduct multidisciplinary communication and collaboration, and to improve work efficiency and quality.

This paper aims to summarize the concept, connotation and the application of Virtual Reality Simulation (VRS) in the training of disaster nursing. By reviewing the application progress and trends of VRS technology in the training of disaster nursing at home and abroad, to provide a reference for the managers and education trainers to develop disaster nursing training based on VRS.

Objective: To develop a home monitoring and follow-up system for long-term diet management, in order to improve chronic kidney disease dietary self-management. Methods: 30 patients with stage 3 chronic kidney disease were enrolled. Target protein intake was set according to patient's laboratory indicators and general condition. The Dietary Intake and Monitoring System APP installed on patient's mobile phone collects daily dietary intake. Patients received home e-feedbacks and transmitted data to nurses who adjusted diet management accordingly. 24-hours urine was collected before and 2 months after the intervention, and the daily sodium and DPI mean values were calculated. Results: Daily sodium and DPI intakes were significantly improved (P<0.05) after intervention. Conclusion: The home monitoring and follow-up system on chronic kidney disease can effectively improve patients' self-management ability in protein and sodium intake, and positively promote disease rehabilitation.

Based on the analysis of the causes of postoperative recurrence in patients with Chronic Rhinosinusitis, the intelligent health management software APP was designed and developed. This APP contains six modules: "Knowledge Education, Weekly Symptom Self-Assessment, Medication Review Reminder, Circle Ranking, Interactive Platform, Questionnaire", which can enhance patients' understanding of disease knowledge, make up for the deficiency of traditional health education, and promote patient compliance. The improvement of medication compliance can effectively reduce the probability of recurrence of sinusitis, thereby reducing the economic burden of patients, and achieving a health care system that is closely linked to medical care. It is suggested that the method to be applied widely in the future.

Pain, Agitation, and Delirium (PAD) is common among critically ill patients. This article reviewed nursing evaluation, management strategies and ICU PAD guidelines. We hope this review will help ICU nurses advance the management of PAD in critically ill patients, and improve patients' clinical outcomes, as well as promote establishing relevant training system for ICU nurses.

Objective: To investigate the preventive nursing care of venous thromboembolism among surgical nurses. Methods: A self-designed questionnaire was used to investigate 2 285 surgical nurses from 23 tertiary hospitals in different provinces and cities in 2017. Results: Surgical nurses were poorly trained in the nursing care of venous thromboembolism, and only 60.6% of them were trained on this topic. Those with the primary professional titles were the key training group. Totally 90.4% of the surgical surveyed nurses cared the patients in accordance with the standard procedures for the prevention of venous thromboembolism, a higher proportion of nurses in orthopedics and general surgical department followed the standard procedures compared with those in ICU, neurosurgery (P<0.0024). The risk assessment of surgical venous thromboembolism was not enough, and the use rate of the risk assessment form is only 83.2%. The rate of basic preventive measures for venous thromboembolism is low. Conclusion: The preventive nursing care of venous thromboembolism among surgical nurses needs further improvement. It is suggested to develop the prevention measure standards and procedures in different departments, and to establish the corresponding quality control standards to ensure the implementation of clinical work.

Objective: To analyze the effect of early rehabilitation training on ICU-acquired myasthenia in mechanically ventilated patients. Methods: A random sample of 90 patients with ICU-acquired myasthenia were included from October 2015 to October 2017, and were randomly divided into 2 groups. In the control group, the patients were with the routine nursing care. In the experimental group, the patients received early rehabilitation training within 24 hours after mechanical ventilation. Results: The total scores of Medical Research Council were 42.6±5.7, 48.5±6.9, 54.9±5.2, and 57.8±4.7 in the experimental group at half month, 1 month, 3 month and 5 month respectively, and the scores in the control group were 35.8±4.9, 40.6±5.6, 45.7 ±4.3 and 51.7±5.1 respectively (P<0.05). The modified barthel index scores were 44.7±5.8, 60.3±6.8, 89.5±7.2, and 94.2±5.6 in the experimental group at each time, and the scores in the control group were 40.5 ±5.5, 49.2±6.3, 62.7±7.5 and 68.9±7.3 respectively (P<0.05). Mechanical ventilation time was 15.2±3.7 days, time in ICU was 7.3±2.5 days, hospital stays was 27.3±5.9 days, and the mortality was 2.2% in the experimental group, and 17.5±3.6 days, 10.8 ± 3.3 days, 32.8 ± 6.2 days and 11.1% in the control group (P<0.05). Conclusions: Early rehabilitation training is benefit for the recovery of ICU acquired muscle myasthenia in patients with mechanical ventilation.

This paper provides a comprehensive review of the literature on nurses' cognition, assessment and attitude of delirium in ICU, and the influencing factors of nurses' cognition, assessment and attitude, and to provides some references for further research and clinical management of ICU delirium.

Objectives: To analyze the effect of optimized shift mode in Central Sterilized Supply Department (CSSD). Methods: The structured shift report combined with sensitive quality indicators and SBAR model in special cases were used in shift change of CSSD. Results: Both the CSSD inner and external satisfaction were improved (P<0.05), and the proportion of quality defects caused by poor communication decreased (P<0.05). The awareness of staff in quality, communication improved after the shift mode optimizing. Conclusions: The optimized shift mode is benefit for the effective communication between the staff in the operation room and CSSD, and for the improvement of the quality management of the CSSD staff.

Objective: To evaluate the effects of "ICU-ward" extended lung nursing care based on Team Strategies & Tools to Enhance Performance & Patient Safety (Team STEPPS) on reducing ICU readmission rate caused by pulmonary infection. Methods: The control group included the patients met inclusion criteria from January to December 2016 (n=98). The experimental group included the patients met inclusion criteria from January to December 2017 (n=135). Patients in the control group received routine nursing care, while patients in the experimental group received "ICU-ward" extended lung nursing care based on Team STEPPS model. Results: The rates of unplanned ICU readmission and ICU readmission caused by lung of the experimental group were lower than the control group, and the patients' satisfaction with nursing work was higher than the control group (P<0.05). Conclusion: The "ICU-ward" extended lung nursing care based on Team STEPPS model can significantly reduce ICU readmission rate and improve patients' satisfaction.

This article reviews the development of breast cancer Multidisciplinary Team (MDT) at home and abroad, including its members, operation modes, practical effects and the participation form of nurses in MDT, in order to provide references for exploring the operation modes of breast cancer multidisciplinary team suitable for our country.

It reviewed the origin, definition, management status and working content of ICU Liaison Nurses in foreign countries, so as to provide references for the establishment and training of ICU Liaison Nurses in China.