Medication safety management is an important part of patient safety management. As the final implementer of patient medication, the level of medication safety management of nurses is crucial to ensure the medication safety of hospitalized patients. This paper reviews the current situation of medication safety management and practice at home and abroad, summarizes the progress and effectiveness of nurses in medication safety management practice in China, in order to provide references for promoting the further improvement of the medication safety level of patients in China.

Objective: To understand the cognitive experience of nurses on the influencing factors of High-Alert Medications (HAM) safety practice, and provide a reference for nurses to manage HAM more safely and effectively. Methods: Thirteen clinical nurses and nursing managers from different departments were selected by purposive sampling method. The clinical event analysis model was used as the theoretical framework, and the descriptive qualitative research method was used to conduct semi-structured interviews and key event interviews. Data were analyzed by content analysis method. Results: A descriptive model of the practice of preventing HAM errors, HAM safety: organizational, nursing and cooperation influences, was constructed. Three themes and 8 subthemes were extracted: organizational factors, nurse abilities and responsibilities, communication and cooperation. Conclusion: The medication safety of HAM in nurses is affected by organizational culture, their knowledge and ability, communication and cooperation between doctors, nurses and patients. This study provides a conceptual framework for the practice of safety management of HAM, and a theoretical basis for medical institutions to manage HAM safely and effectively.

Objective: To construct a medication safety management plan for tertiary hospitals based on Team Resource Management (TRM) and evaluate its application effectiveness, and to provide a reference for improving the medication safety of patients. Methods: We constructed a tertiary hospital medication safety management plan from 4 modules of TRM: leadership coordination, condition monitoring, mutual assistance and cooperation, and effective communication, and developed specific implementation strategies as well. Key process indicators of medication, nurse medication safety ability, and safety attitude were compared before and after the implementation of plan. Results: After the implementation of plan, the number of medication near error events increased, drug configuration execution rate within 2 hours, pre-medication double check matching rate, and intravenous drug infusion velocity recording compliance rate all improved (P<0.05). The scores of nurse medication safety ability and safety attitude were higher than that before the implementation of plan (P<0.05). Conclusion: The medication safety management plan based on TRM can enhance the safety medication ability of nurses, standardize the medication execution process, and enhance the safety culture awareness of medical staff teams.

Objective: To retrieve and summarize the evidence on the prevention and management of drug-related falls in older adults and provide evidence-based basis for reducing the incidence of drug-related falls in older adults. Methods: The clinical decision, guidelines, expert consensus, evidence summary and systematic evaluation on the prevention and management of drug-related falls in older adults were systematically searched according to the evidence-based resource "6S" model from top to bottom. The search time limit was from the establishment of the database to December 1, 2023, quality evaluation and data extraction was carried to included literature, and the evidence was extracted and integrated according to the principle of evidence summary. Results: A total of 16 literature were included, including 1 clinical decision making, 3 guidelines, 5 expert consensus, 2 evidence summary and 5 systematic evaluations. Totally 21 pieces of evidence were formed in five dimensions: fall risk assessment, assessment of drug-related falls, preventive strategies, use management and health education of high-risk drugs in older adults. Conclusion: The evidence summary in this study can assist medical staff in developing personalized intervention programs based on the actual situation of patients, so as to reduce the incidence of drug-related falls in older adults.

Objective: To investigate the current status of medication safety in patients with chronic diseases and to analyze its influencing factors. Methods: Totally 405 patients with chronic diseases from 4 tertiary grade A hospitals and 4 community health care centers were enrolled by convenience sampling method from August to November, 2023. A questionnaire survey was conducted, which included demographic information, disease conditions, medication literacy, self-efficacy for appropriate medication and medication safety status. Multiple linear regression was used to analyze the influencing factors of medication safety in chronic disease patients. Results: The medication safety score of chronic disease patients was 47.86±11.96, and the multiple linear regression analysis result showed that the better the medication literacy, self-efficacy for appropriate medication, and exercise status of chronic disease patients, the higher their medication safety score. Conclusion: The medication safety status of chronic disease patients needs to be improved. Medication literacy, self-efficacy for appropriate medication and exercise status are influential factors for medication safety.

Objective: To applicate the intelligent dispensing and delivery system in chemotherapy drugs and explore its effects, and provide a reference for ensuring medication safety and improving clinical work efficiency. Methods: We compared the time required for dispensing of chemotherapy drugs and the residual amount of drugs between nurse and robots by field observation method. The amount of chemotherapy drugs dispensed by manud and robots, the frequency of drug delivery between workers and robots were compared before and after the use of intelligent dispensing and delivery system. Results: The time required for manual dispensing of chemotherapy drugs was longer than that of robot dispensing (P<0.01), and the residual amount of drugs in manual dispensing was more than that of robot (P<0.01). The amount of chemotherapy drugs dispensed by robots was lower than that of manual (P<0.01). The amount of drugs delivered by robots per month was higher than that by workers (P<0.01). Conclusion: By applying the intelligent dispensing and delivery system for chemotherapy drugs, the accuracy and efficiency of drug administration can be improved, the frequency of contact between personnel and chemotherapy drugs can be reduced, which is beneficial for reducing the risk of occupational injury and is worthy of promotion and application.

Objective: To analyze the effect of solution-focused approach on self-efficacy and self-management of peritoneal dialysis patients, so as to provide new ideas for the nursing of peritoneal dialysis patients. Methods: A total of 72 peritoneal dialysis patients who were treated in a tertiary hospital in Beijing from March 2022 to June 2023 were selected as subjects by convenience sampling method, and were randomly divided into the control group and the experimental group, with 36 cases in each group. The control group was given routine nursing, and the experimental group was given nursing intervention combined with solution-focused approach on the basis of routine nursing. The intervention time was 12 weeks. The differences in self-efficacy and self-management ability between the two groups after intervention were compared. Results: A total of 67 patients completed the study, 34 in the experimental group and 33 in the control group. After the intervention, the self-efficacy score of the experimental group was 9.37±0.45, which was higher than that of the control group (5.29±0.85), and the difference was statistically significant (P<0.05). The score of self-management ability in the experimental group was 172.12±2.25, which was higher than that of the control group (151.73±12.77), and the difference was statistically significant (P<0.05). The incidence of complications and unplanned readmission rate of the experimental group were lower than that of the control group, and the differences were statistically significant (P<0.05). Conclusion: Nursing intervention based on solution-focused approach can improve the self-efficacy of peritoneal dialysis patients, improve their self-management ability, and reduce the incidence of complications and unplanned readmission rate.

Objective: To investigate the status and influencing factors of dyadic illness appraisals congruence between patients with Chronic Heart Failure and their caregivers. Methods: A total of 198 patients with Chronic Heart Failure and their caregivers were recruited from the cardiology department of a tertiary grade A hospital in Wuhan from August 2021 to September 2022. Patients and their caregivers were investigated with a general information questionnaire, the Memorial Symptom Assessment Scale, Dyadic Coping Inventory, the Revised Piper's Fatigue Scale-Chinese Version, and Self-Concealment Scale. Results: There was a significant difference in psychological symptoms between patients with Chronic Heart Failure and caregivers in dyadic illness appraisals (P<0.05) and the caregiver score was lower than the patient score. Multiple linear regression results showed that patients' binary coping, self-concealment, number of comorbidities, gender, and fatigue level of caregivers were the main influencing factors for dyadic illness appraisals congruence. Conclusion: Caregivers underestimated the severity of patients' psychological symptoms. Medical professionals should encouraged patients to take the initiative to disclose, and conduct communication and empathy training for caregivers to improve the consistency of dual disease evaluation for those patients with dual coping passivity, high level of self-concealment, and a large number of comorbidities, as well as male and high level of fatigue caregivers.

Objective: To develop and validate the factors related to physical activity questionnaire in pregnant women based on the Socioecological Model. Methods: The primary questionnaire was developed through literature review, semi-structured interviews, expert consultation and pilot survey. The convenience sampling was adopted to recruit 250 and 300 pregnant women from August to September, October to December, 2022, respectively, in a tertiary grade A hospital in Guangzhou. The items screening and the test of reliability and validity were carried out. Results: The questionnaire had 3 dimensions and 31 items. The positive coefficients of 2 rounds of letter consultations were all 100.0%, the authority coefficients were all 0.895, and the coordination coefficients were 0.117-0.496. Three common factors were extracted from the exploratory factor analysis, explaining 61.4% of the total variances. The confirmatory factor analysis showed that the factor structure model of the factors influencing physical activity of pregnant women was well fitted. The Cronbach's α coefficient was 0.932, the split reliability was 0.667, the test-retest reliability was 0.886, the content validity was 0.87-1.00, and the average content validity of the questionnaire was 0.99. Conclusion: The factors related to physical activity questionnaire in pregnant women based on the Socioecological Model has good reliability and validity. It is a reliable tool to evaluate the influencing factors of physical activity in pregnant women.

Hospital nursing security system is an important part of the smooth running of large-scale international sports events. In this paper, we summarized the four aspects of the selection and training of nursing support staff, the initiation of nursing support team, the establishment of one-stop Nursing Service process, and the quality control and management in a general hospital during the process of medical security for the 19th Asian Games Hangzhou and the 4th Asian Para Games Hangzhou 2022. The construction of the hospital nursing security system provided efficient and accurate nursing care for international large-scale sports events. It is expected to provide reference for the future medical security work of similar international sports events.

Objective: To develop a lower limb exercise device and explore its effects of on straight leg elevation training in Adolescent Idiopathic Scoliosis patients after surgery to provide a basis for clinical work. Methods: A total of 119 patients who underwent posterior correction internal fixation and bone graft fusion from January 2021 to December 2022 were enrolled and divided into the experimental group (n=62) and the control group (n=57) according to the random number table. In the control group, the traditional education method was used by nurses instructing and supervising the patients to carry out straight leg elevation training. In the experimental group, nurses used the lower limb exercise device to guide and supervise patients in the straight leg elevation training, and the results of straight leg elevation training of the two groups was recorded separately. Results: Participants in the experimental group showed significantly better compliance and accuracy in straight leg elevation training and satisfaction than in the control group (P<0.05). Besides, patients in the experimental group also passed gas earlier and had higher satisfaction than those in the control group. Conclusion: The lower limb functional exercise device can significantly improve the compliance and accuracy of straight leg elevation training and patients' satisfaction, and promote the functional recovery of gastrointestinal tract after surgery.

This paper summarizes the application of digital health technology in the self-management of heart failure patients, by introducing its concept, reviewing its effectiveness in the self-management of heart failure patients, to point out the remaining problems and improvement strategies for better application of this technology in the self-management of these patients and provide reference for its further application in China.

Objective: To construct a Clinical Decision Support System (CDSS) for physical restraints in ICU patients and explore its clinical application effect, in order to provide convenience for nurses' restraint decision making. Methods: A research team was set up to construct and validate the prediction model of physical restraint for ICU patients. A CDSS for physical restraints in ICU patients was constructed based on the prediction model. Totally 764 ICU patients from August 2022 to March 2023 in a tertiary hospital in Jiangsu province were selected as the research participants. The patients were divided into intervention group (n=366) and control group (n=398) by random method. In control group, nurses made a decision about physical restraint based on empirical assessment. And the physical restraint CDSS for ICU patients was used to help nurses to make a decision about physical restraint in intervention group. The physical restraints rate, delirium incidence rate and unplanned extubation rate of the two groups were compared, and the consistency of CDSS and restraint decision wheel was verified. Results: After using the CDSS, the physical restraints rate was 24.9%, and the incidence of delirium was 2.2% in intervention group, which were significantly lower compared with the control group (P<0.05). There was no statistically significant difference in the incidence of unplanned extubation between the two groups (P>0.05). The Kappa consistency test between CDSS and restraint decision wheel was 0.853 (P<0.001), showing good consistency. Conclusion: The physical restraint CDSS in ICU patients can be applied to clinical practice and assist nurses in decision-making. It can effectively reduce the rate of physical restraint and delirium without increasing the rate of unplanned extubation.

Objective: To explore the effects of the cloud-based feedback health education on patients with Inflammatory Bowel Disease at home. Methods: Patients with Inflammatory Bowel Disease discharged from the Department of Gastroenterology of a tertiary grade A hospital in Qingdao were recruited by convenience sampling method. Fifty-six patients admitted from October to December 2022 were treated as the control group and routine out-of-hospital follow-up was provided. Another 56 patients admitted from January to March 2023 were assigned to the observational group and feedback education based on cloud platform was provided. The self-management ability, knowledge level, medication compliance, BMI, serum albumin, prealbumin and observation group were compared 3 months after discharge. Results: Two patients in the control group and two patients in the observational group withdrew from the study. There were no statistically significant differences in the dimensions of self-management ability, knowledge level, medication compliance, Body Mass Index, serum albumin and prealbumin between the two groups before intervention (P>0.05). After 3 months of discharge, scores of all dimensions of self-management ability, knowledge level, medication compliance and BMI of patients in the observational group were higher than those of the control group. The knowledge level and medication compliance of patients in both groups were better than those before intervention (P<0.001). Three months after discharge, there were no significant differences in serum albumin and prealbumin between the two groups. The total number of reading in the cloud platform was 3500 , and the mean length of reading duration was 5.84±2.11 min. Conclusion: The feedback health education based on cloud platform can improve patients' self-management ability, knowledge level, medication compliance, and body mass index. However, such an education cannot change the serum albumin and prealbumin level.

Objective: To realize the development of WeChat mini program for family support care of premature infants, and provide a feasible tool for family support care of premature infants. Methods: Using a "user-centered design" approach, through literature review and semi-structured interview, the family support care needs of premature parents were discovered, and the module content of the mini program was constructed according to the needs, through the design of rapid prototype model, the development of WeChat mini program for family support care of premature infants was realized, and the test and usability evaluation were carried out. Results: The WeChat mini program client and backstage data management system had been successfully developed, including NICU hospitalization period, discharge transition period and discharge home period, each period is accompanied by knowledge modules, skills modules and experience modules. The WeChat mini program named "Nursing of premature infants" had been released and used with good user experience and usability. The test results showed that the total average score of the System Usability Scale was 82.73 points. Conclusion: The development of WeChat mini program of family support care for premature infants can provide parents with the integration of family care support during hospitalization period, transition period and home period, which is worthy of clinical promotion.

Objective: To retrieve, evaluate and summarize the evidence on lipid management in breast cancer patients, so as to inform evidence-based practice. Methods: Literatures related to lipid management in breast cancer patients were systematically retrieved and screened from guideline websites, professional association websites and comprehensive databases. The retrieval period was from the inception of databases to June 12, 2023. The quality evaluation and evidence extraction of literature were independently completed by 4 researchers, and the evidence was systematically summarized and integrated. Results: A total of 11 articles were included, including two guidelines, four expert consensus, and five systematic reviews. Finally, a total of 24 pieces of evidence were summarized from four aspects on determining lipid adjustment goals, regulating lifestyles, drug lipid-lowering management, and regular follow-up. Conclusion: This article provides evidences for improving lipid management and decreasing cardiovascular disease risk, and provides a new way to improve the prognosis of breast cancer patients.

Objective: To systematically evaluate and integrate nurses' experiences regarding missed nursing care, so as to provide suggestions for reducing missed nursing care. Methods: The computer retrieval was performed in databases from inception to August 2023 to collect qualitative studies on nurses' experiences of missed nursing care. The Meta-integration methods were applied to integrate the included literature. Results: A total of 23 studies were included, and 10 new categories and 4 synthesis results were obtained. Synthesis result 1: types prone to missed nursing care; Synthesis result 2: the impact of missed nursing care; Synthesis result 3: factors causing the missed nursing care; Synthesis result 4: nurses desired to improve the status of missed nursing care Conclusion: There are various types of missed nursing care with complex causes and adverse consequences. In order to improve the quality of clinical nursing care and the satisfaction of patients and nurses, nursing managers should pay attention to the current situation of missed nursing care, seek solutions actively and take effective preventive measures.

Objective: To search and integrate the evidence of early exercise in adult patients with Extracorporeal Membrane Oxygenation (ECMO) to provide reference for clinical practice. Methods: Literature on early exercise in adult ECMO patients was systematically searched from domestic and foreign databases, the quality of the included literature was evaluated, and the evidence was extracted and summarized from the literature that met the quality standards. Results: A total of 14 papers were included, including 3 guidelines, 3 expert consensus articles, 3 systematic reviews and 5 original studies. Totally 20 pieces of evidence from 6 aspects including feasibility, multidisciplinary team evaluation, preparation before exercise, exercise monitoring, exercise program and effect evaluation were finally summarized. Conclusion: The evidence of early exercise in adult patients with ECMO summarized in this study is scientific and practical, which can guide clinical practice and promote the standardized management of early exercise in adult patients with ECMO.

Objective: To integrate the evidence for the prevention and management of neonatal PICC related thrombosis, so as to provide evidence-based evidence for clinical staff. Methods: The clinical decision-making website, guideline website, professional association website, evidence-based literature resource database, and original literature databases on the prevention and management of neonatal PICC related thrombosis were systematically searched from the establishment of the database to February 2023. The methodological quality of the literature that met the inclusion criteria was evaluated, and the evidence was extracted and summarized based on professional judgment and clinical context. Results: A total of 14 literature were included, including 2 clinical decisions, 6 guidelines, 4 systematic reviews, and 2 cohort studies. Totally of 31 pieces of evidence were summarized from 6 aspects: risk assessment, catheter placement, catheter maintenance, thrombosis diagnosis, thrombosis treatment, and extubation. Conclusion: The evidence summarizes the evidence for the prevention and management of neonatal PICC related thrombosis. Clinical staff can incorporate cultural backgrounds and clinical situations to select evidence, develop scientific thrombosis prevention and management plans, so as to enhance the quality of nursing care.

Objective: To retrieve and obtain the relevant evidence for pulmonary rehabilitation in patients with Chronic Heart Failure and to summarize the evidence. Methods: Based on the 6S Hierarchy of EBM Resources, literature of pulmonary rehabilitation in patients with Chronic Heart Failure was retrieved. The literature was then evaluated to extract evidence according to relevant criteria. Results: A total of 17 articles were enrolled, including 3 guidelines, 4 expert consensus, and 10 systematic evaluations. Finally, 19 pieces of evidence of pulmonary rehabilitation in patients with Chronic Heart Failure were summarized. Conclusion: This study summarizes the evidence for pulmonary rehabilitation in patients with Chronic Heart Failure, which can provide an evidence-based basis for clinical practice. In the process of implementation, it should be carried out step by step on the premise of ensuring the safety of patients and taking into consideration patients' cultural background and their medical institutions.

Objective: To systematically integrate qualitative study findings on stigma experience in cancer patients, and to provide references for nursing interventions. Methods: Qualitative studies on stigma of cancer patients in Chinese and English databases were searched from inception to July 2023. The quality of the included literature was evaluated, and the results were integrated by Meta-integration. Results: A total of 21 studies were included with 70 topics being extracted, and 10 categories summarized. Four integrated results were formed: sources of stigma, effects of stigma, coping with stigma, and psychological growth of stigma in cancer patients. Conclusion: Cancer patients have obvious negative psychological experiences, and the stigma of cancer patients needs more attention, more social and psychological supports to reduce the sense of shame.

Objective: Exploring the application effects of behavioral operations management theory combined with problem tracking intervention in departmental nursing quality management, in order to improve departmental nursing quality, enhance the management ability and cognitive operational skills of nurses. Methods: The inpatients of the health care department of a tertiary hospital and the nurses of the first-level quality control team of the department were recruited as the study participants during the period from April 2021 to March 2022; the behavioral operations management theory and the problem tracking method were jointly applied to carrying out the interventions; case control and the before-and-after control methods were adopted to compare the nurses' theoretical examination scores and operation skills scores, the quality control nurses' quality management ability, the quality of nursing management in the department and the patient satisfaction before and after the interventions. Results: After the implementation of behavioral operations management theory combined with problem tracking method in the department, the nurses' theoretical examination scores and operation skills, the nursing quality management ability of the first-level quality control nurses, the nursing quality evaluation score, and the patients' satisfaction were significantly improved (P<0.05). Conclusion: The implementation of the behavioral operations management theory combined with the problem tracking method can significantly improve the quality of nursing management, the management ability of the quality control nurses, the theoretical knowledge level and operational skills of the nurses, and the patient satisfaction, and improve the execution of clinical nursing management, which is worthy of being applied and popularized in the clinical nursing management.

China has entered the era of service economy. The whole process of medical experience and patients' experience needs to be continuously improved. However, traditional medical services can hardly meet the needs of people. The development of high-quality medical services has become the focus of medical and health system reform in the 14th Five-Year Plan period. Excellent service is an important way to meet the needs of patients and a prerequisite for the high quality development of hospitals. By elaborating the concept and connotation of service excellence, the status of service excellence at home and abroad, and the necessity for hospitals to carry out service excellence, this paper proposes the suggestions for hospitals in China to carry out service excellence, and provides a basis for the promotion of high-quality development of hospitals.

Objective: To construct the customized model of quality nursing talent training based on the balance between supply and demand and assess its effects. Methods: A special panel was organized to establish and implement the quality-oriented training model for nursing talents through expert meeting and focus group interviews combing the three main factors including clinical needs, discipline advancement and talent training. Later the application effect was evaluated utilizing the work-related well-being questionnaire and indicators like the total training amount, talent distribution, development of specialized nursing service and the corresponding achievement. Results: From 2021 to 2022, 330 "custom-made" high-quality nursing talents were trained. The total score of job-related well-being for nurses receiving only internal training, both internal and external training, and only external training were 52.91±4.45, 52.83±4.87, and 52.83±5.00, all showing statistically significant differences compared to the baseline data (P<0.05), and the number of specialized services and its achievement were significantly increased. Conclusion: From the perspective of supply and demand balance, the customized model of quality nursing talent training is effective to optimize the training path of nursing talents and strengthen the driving force of nursing development, and can provide a certain reference for the training of quality nursing talents in our country.

Objective: To understand the experiences and needs of clinical nurses after participating in the micro-habit training camp. Methods: Purposive sampling method was used to select 12 clinical nurses from different departments of a tertiary grade A hospital in Shanghai who participated in the micro-habit training camp from June to December 2022. Semi-structured in-depth interview was performed. The data were coded and classified using NVivo14 software and analyzed using Colaizzi seven-step analysis methods. Results: The experiences of clinical nurses' micro-habit training extracted three themes: the psychological experience of negative emotion relief and adaptability change; the experience of work ability enhancement and confidence building; the needs and suggestions for training camp arrangements. Conclusion: As an opportunity to know oneself, the micro-habit training camp improves participants' mental resilience by enhancing self-efficacy, as well as leads participants to grow together by building a platform. Habit formation is not easy. Nursing managers should pay more attention to the exploration of internal motivation of nursing staff and provide more comprehensive external support when conducting micro-habit training camps in the future.

Objective: To explore the effects of applying 4R crisis management theory to the 6 Minutes Walking Test (6MWT) management of patients with Connective Tissue Disease associated Pulmonary Arterial Hypertension (CTD-PAH). Methods: Totally 120 patients with CTD-PAH in the Department of Immunology of Peking Union Medical College Hospital from January to December 2022 were enrolled and divided into two groups. The control group was given the routine care of the 6 Minutes Walking Test (6MWT) while the experimental group received the updated care during the 6MWT based on the 4R crisis management theory. The differences of blood oxygen saturation and the occurrence of adverse events after the walking test between the two groups were analyzed. Results: As to the walking distance of patients, no significant differences between the two groups were observed. The blood oxygen saturation of the experimental group was significantly higher than that of the control group after the 6MWT and 3 minutes after the test. The incidence of hypoxia and adverse events during the 6MWT in the experimental group was significantly lower than that in the control group. Conclusion: Care based on the 4R crisis management during the 6MWT can significantly reduce the incidence of hypoxia and adverse reactions in patients with CTD-PAH, greatly ensuring the safety of those patients.

Objective: To construct a comprehensive pulmonary rehabilitation exercise program for patients with pulmonary tuberculosis and structural lung disease, and to establish a systematic and standardized reference for pulmonary rehabilitation exercise interventions. Methods: We systematically searched databases and websites for the literature on pulmonary rehabilitation exercise training in patients with structural lung disease. Investigators independently evaluated the literature and extracted evidence to form the initial draft of the program. The Delphi expert consultation method was used to further demonstrate the feasibility of the program. Results: A total of 21 studies were included, and 35 pieces of evidence related to pulmonary rehabilitation exercise for patients with structural lung disease were obtained. A total of 16 experts participated in two rounds of Delphi expert consultations, effective recovery rates of the questionnaire were 88.89% and 100.00%, and expert authority coefficients were 0.891 and 0.907, respectively. The program included the formation of a multidisciplinary team, general requirements, assessment component, exercise prescription, and effect evaluation 5 primary items, 20 secondary items, and 43 tertiary items. Conclusion: The pulmonary rehabilitation exercise program for patients with pulmonary tuberculosis and structural lung disease is scientific and practical, which can provide a basis for clinical practice.

Objective: To develop an early "standing position" functional exercise method for elderly patients after lumbar surgery, and provide a reference for clinical functional exercise. Methods: The draft of early "standing position" functional exercise method for elderly patients after lumbar surgery was developed through literature review, and the final functional exercise method was determined by expert meetings and expert consultation. Results: A total of 5 experts participated in the meeting, and the authority coefficient was 0.915. A total of 10 experts participated in the consultation, and the authority coefficient was 0.950. The importance scores of the items ranged from 4.51 to 4.92, and the coefficient of variation ranged from 0.06 to 0.15. The functional exercise method consisted of 5 primary items and 20 secondary items. Conclusion: The early "standing position" functional exercise method established in this study for elderly patients after lumbar surgery is scientific and safe, and can be further verified.

Nurses play a leading role in delirium management and participate in all stages of the management, and face many difficulties and challenges in it. This article aims to review the manifestations, influencing factors, assessment tools, recommendations and countermeasures of nursing difficulties in patients with delirium, so as to provide references for further studies and interventions.

This paper reviewed the development status and evaluation model of diagnosis related groups (DRG) at home and abroad to explain the impact of DRG on nursing management from various aspects including the nursing workload, nursing adverse events, nursing cost and the professional advancement of nursing. The nursing management strategies were put forward regarding to nursing performance model, nurse grading, predicting the number of nurses, balancing nursing cost and improving nursing efficiency under DRG reform, so as to promote nursing managers to explore new models of management.