Objective: To explore the effect of the standardized procedure of early mobilization after cardiac surgeries on patients offered by multidisciplinary team cooperation through adoption of critical illness scoring system. Methods: A multidisciplinary team (MDT) of early mobilization after cardiac surgeries was established, together with the management system of the MDT and the standardized procedure of early mobilization basing on the critical illness scoring system which was introduced and taught to relevant staff by training. And finally the standardized procedure of early mobilization was implemented in practice as designed. Results: After the implementation of the standardization procedure of early mobilization after cardiac surgeries, the intubation time, ICU stay and hospitalization decreased significantly (P<0.05). Incidences of pulmonary infection and delirium both reduced significantly (P<0.05). Conclusion: Complications in patients and other nursing risks after cardiac surgeries could be reduced as well as the risk control ability be enhanced to ensure the safety of hospitalized patients through implementation of the standardized procedure of early mobilization after cardiac surgeries basing on the critical illness scoring system, which can also help optimize the work flow in clinical practice at the same time.

Objective: To establish a multidisciplinary diagnosis and treatment mode for chronic wounds and explore its application in the wound care clinic. Methods: In accordance with the developing trend of special nursing care in outpatient departments, a multidisciplinary diagnosis and treatment team with an optimized structure for chronic wounds was established, after which a reasonable assignment of responsibilities of each staff was figured out together with explicit paths of diagnosis and treatment of wounds and clear-cut areas for diagnosis and treatment. Thus the multidisciplinary diagnosis and treatment mode for chronic wounds which took place mainly in the wound care clinic was formulated to provide scientific diagnosis and treatment for patients with chronic wounds. Results: After normal implementation of the mode of multidisciplinary diagnosis and treatment of chronic wounds, compared with 2016, the number of medical consultation increased by 39.59% in 2017 and the cure rate also increased (P<0.05). The satisfaction degree of patients and nurses both increased significantly (P<0.05). The number of papers published, patents obtained, and new technology awards acquired by nurses working in the wound care clinic have increased significantly. More doctors and nurses from other hospitals in China came here for further study, whose number increased by 63.33%, and were granted a variety of honors and professional qualifications. Conclusion: The practice of the mode of multidisciplinary diagnosis and treatment of chronic wounds has not merely improved wound treatment but also the quality of special nursing care. In addition, it has promoted the cooperation and communication between doctors and nurses, and will contribute to establishment of an innovative development mode of special nursing services in outpatient departments as well as the development of nursing discipline.

To introduce the multi-disciplinary collaborative work pattern of the Wexner medical center of Ohio State University, including the composition and division of the team, the multi-disciplinary cooperation environment, information platform, the type and content of the work model. It was suggested that our country should make clear the division and role of team member, strengthen the construction of information sharing platform, set up the working atmosphere and guarantee mechanism for cooperation. The nursing staff should play the specialty role in the multidisciplinary team and actualize professional development.

Objective: To set up and evaluate the model of meticulous glycemic management for patients receiving insulin pump therapy in non-endocrine department with interdisciplinary team (IDT) cooperation. Methods: A total of 327 patients treated with insulin pumps in the non-endocrine department were divided into two groups according to the time of new IDT model implementation. Finally174 patients from April 2017 to September 2017 were enrolled into control groups, receiving a multidisciplinary collaborative management model; and153 patients enrolled from October 2017 to March 2018, served as observation groups receiving an IDT’s meticulous glycemic management model. According to clinical needs, experts in the same level including endocrinologists, non-endocrinologists, diabetes specialists, and core members of the diabetes quality control group were included in IDT. The IDT designed a refined glycemic adjustment program, which was implemented in the form of nursing supplement prescriptions. Quality of glycemic management were compared between the two groups. Results: The ratio of targeted range glycemic was enhanced from 41.2% to 49.4% (P<0.001), while the proportion of severe hyperglycemia was reduced from 9.8% to 7.9% (P<0.001);the proportions of severe hypoglycemia and hypoglycemia were increased (0.0% VS 0.1%, 0.4% VS 0.5%), but the differences were not statistically significant (P>0.05). Conclusion: The interdisciplinary team's meticulous management is beneficial to glycemic quality for patients receiving insulin pump therapy in non-endocrine department.

Objective: To establish a clinical alarm management model based on multidisciplinary team cooperation and evaluate the implementation effect, and to explore new methods of patient safety management. Methods: According to the four important links in the life cycle of alarm including generation, transmission, identification and response, the key members and responsibilities of the alarm management team are clarified taking multi-parameter monitors as examples through the method of expert discussion. Besides, specific alarm management measures were obtained via evidence-based literature reviews, expert consultation as well as experimental researches, and finally put into practice. Results: The number of alarms in care unit was significantly reduced. Meanwhile the alarm set pass rate, alarm response rate, and equipment accessory pass rate were significantly improved. Statistical differences could be observed when contrasting scores of nurses' knowledge of alarm, their attitudes and behaviors before and after the implementation of the model. Conclusion: The establishment of a clinical alarm management model for medical device based on multidisciplinary team cooperation has improved nurses' competence to address clinical alarms and thus enhanced management over clinical alarms.

Objective: To investigate the current situation of nursing interruptions and multitasking and analyze its correlation with mental workload of nurses. Methods: The convenience sampling method was performed. Total 126 shifts among 10 registered nurses were observed. The nursing interruption, multitasking and mental workload of nurses were analyzed. Results: The frequency of work interruption was (3.00±1.36) times/h and multitasking accounted for (17.80±7.56)%. The nursing interruption, multitasking and mental workload among nurses with different qualification were different (P<0.05). There were significant positive correlations between nursing interruption, multitasking and mental workload (P<0.05). Conclusion: Nursing interruption and multitasking happen sometimes. Nurses can have heavy workload. Reducing nursing interruption and multitasking can improve work efficiency, nursing quality and nurses’ physical and mental health.

Objective: To assess the application of Ishii's scores in the screening for sarcopenia in community elderly, to provide methodological basis for early detection of sarcopenia. Methods: A total of 122 eligible community elderly were assessed by using the Ishii's scores. Based on the diagnostic criteria of recommended by the Asian Sarcopenia Working Group, the sensitivity, specificity and ROC curves were used to evaluate the accuracy of Ishii's scores in the elderly community. Results: The AUC of men was 0.917, the 95% CI was from 0.823 to 1.000, P<0.001; the AUC of women was 0.859, the 95% CI was from 0.763 to 0.956, P<0.001. Score of 105 was the cut-off point for men when the Youden's index reached the highest; 120 was the cut-off point for women when the Youden's index reached the highest. Conclusion: The Ishii's scores have high value for the screening of sarcopenia in community old adults.

Objective: To translate the English version of Concerns About Recurrence Scale (CARS) into Chinese and evaluate the reliability and validity of the chinese version of CARS. Methods: The CARS was translated and adapted according to standard forward-back translation techniques. Cross-cultural revision of the translated CARS was carried out through group discussion and pretesting. A total of 261 breast cancer patients were recruited to test its reliability and validity. Results: Factor analysis indicated five dimensions of the scale and the cumulative variance contribution rate was 58.4%. Internal consistency was confirmed by Cronbach’s α coefficient of 0.922 , the Cronbach’s α of five factors was 0.871, 0.845, 0.786, 0.746, and 0.638 respectively. The split half reliability was 0.890 for total scale and 0.740~0.896 for its dimensions. The test-retest reliability was 0.956 for CARS and 0.819~0.943 for its dimensions. The content validity index was 0.884. Conclusion: The Chinese version of CARS shows good reliability and validity, and can be used as a valid tool to assess the fear of cancer recurrence of breast cancer patients in China.

Objective: To explore effects of combing of resistance exercises with aerobic exercises on promoting rehabilitation of patients with coronary heart disease. Methods: Randomized Controlled Trials (RCT) on effects of employing both resistance exercises and aerobic exercises on rehabilitation of patients with coronary heart disease were searched through computers in both Chinese and English databases. All those literature reviews selected were then screened according to the inclusion criteria as well as the exclusion criteria. Datas extracted were integrated and analyzed through Meta-analysis using RevMan 5.3 software. Results: A total of 9 RCTs were included in this experiment which had reported positive results that combination of resistance exercises and aerobic exercises could increase the VO2peak value, WRpeak value and AT value, enhance muscle force and reduce total cholesterol value. Combination of resistance exercises and aerobic exercises is mainly useful to patients with stable coronary disease. It is recommended that combination of resistance exercises and aerobic exercises be conducted under the guidance and supervision of professionals to ensure patient safety. Conclusion: Combination of resistance exercises and aerobic exercises can promote rehabilitation of patients with coronary disease more significantly than doing aerobic exercises alone.

Objective: To investigate the social adaptation level of the migrant elderly, and the relationship among demographic data, self-acceptance, loneliness, family intimacy and adaptability. Methods: A total of 168 migrant elderly were investigated. The Social Adaptation Scale, Self-acceptance Questionnaire, the short-form of the UCLA Loneliness Scale, and Family Adaptability and Cohesion Scale were used to collect the data. The social adaptability of the elderly and the related factors were analyzed. Results: The average score of family adaptation was 21.36±5.43. The comparison between groups showed that older people from rural areas were significantly more socially maladapted than those from urban areas, especially in the dimension of psychological adaptation. For the old people in new cities within one year, the total scores of the adjustment of interpersonal relationships and social maladjustment significantly increased, P<0.05. The correlation analysis and multi-factor regression analysis showed that the independent factors affecting the social adaptation of the migrant elderly were loneliness, self-acceptance, whether from rural area and whether migration time over 1 year by the descending order, which explained 52.30% of the total variance. Conclusion: In order to improve the social adaptability of the migrant elderly, community nurses can improve self-acceptance and decrease loneliness of the elderly, and pay attention to the elderly who come from rural areas and migrate within one year.

Objective: To explore the applicability and effect of nursing professional group training model, and to provide reference for the further development of specialized training of nurses. Methods: The nursing professional group training model was established and implemented based on Pareto's 28 law principle and Donald Beattie Ann's structure-process-result assessment model, and Kirk Patrick's "learning-reaction-behavior-result" four level training evaluation model was used to evaluate the effect. Results: Fifteen professional nursing teams involving 747 nurses (35.1% of the total number of nurses in the hospital) were established, and the nurse professional training model was used to train the nurses in theory and skill. The results in reaction layer, the learning layer, the behavior layer and the result layer are all satisfied. Conclusion: The nursing professional group model is a scientific model, and it contributes to the development of nursing professional training.

Objective: To investigate the career status of nurses with master degree from class A tertiary hospitals in Chongqing, and analyze the influencing factors. Methods: Nurses with master degree from class A tertiary hospitals in Chongqing were investigated using cluster sampling method. The self-designed demographic questionnaire and career status evaluation scale were applied. Results: Total 99 nurses with master degree recruited from 13 class A tertiary hospitals completed the survey, the score of career status evaluation scale was (78.38±12.70). Multivariate regression showed that nurses with master degree with more papers (β=0.497), higher titles (β=0.424), and higher monthly income (β=0.344) showed higher career status. Conclusion: The total number of nurses with master degree in Chongqing is few and the career status needs to be improved. Managers should promote management of academic achievements and outputs, perfect professional title incentives and increase income to promote scientific development of the career status of highly educated nurses.

This paper aims to provide a basis for the development and training of clinical nursing consultant in China by summarizing the connotation, clinical function and contribution to nursing work of nursing consultant at home and abroad.

Objective: To study the relationship between the career success perceived by enterostomal therapist and the nursing environment. Methods: A total of 185 enterostomal therapists were investigated with self-designed general information questionnaire, nursing work environment scale and nurse career success scale. Results: The total score of nursing working environment was 109.04±18.05, and the total score of career success was 33.13±6.60. Regression analysis showed that nursing work environment could independently predict 42.2% career success of enterostomal therapists by controlling general factors, and occupational development and recognition atmosphere entered the regression equation. Conclusions: Hospital administrators should take professional advantages of enterostomal therapists fully, adopt a positive and multi-perspective management strategies, and improve the working environment of enterostomal therapists to improve their career success.

Objective: To construct specialist nursing indicators applicable of spine-related surgeries. Methods: Semi-structured expert interviews were carried out based on the methods of evidence-based medicine and results from domestic and international researches conducted by nursing specialists to establish the specific content and evaluation criteria of nursing quality indicators of spine-related surgeries. Results: Totally 13 nursing quality indicators of spine-related surgeries were established, including the accuracy of neurologic function, the pass rate of axis roll, the incidence of foot droop/joint stiffness, and so on. Conclusion: The establishment and application of nursing quality indicators of the spine-related surgeries can provide scientific supervision over specialist nursing of spine-related problems, which is a useful and objective reflection of the connotation of nursing. At the same time, it is beneficial to provide data for continuous quality improvement and promote the construction of nursing discipline.

Objective: To analyse the information accuracy of the surgical process publishing system and satisfaction of patients' family members. Methods: Surgical patients of June 2015 and June 2016 in a tertiary hospital in Beijing were assigned into control group and experimental group respectively using convenient sampling method. The subjects in the control group were performed standard surgical process publishing system, while the subjects in the experimental group were providing improved surgical process publishing system. The accuracy of the surgical process publishing system, the satisfaction of the family members and hospital environment were analyzed. Results: The scores of the experimental group were significantly higher than the control group in the accuracy of information dissemination, family members' satisfaction and environmental impact of the hospital (P<0.05). Conclusion: The improvement of the quality of the key links in the surgical process publishing system can effectively enhance the accuracy of the system information, the satisfaction of family members and the hospital environment.

Objective: To analyze the effect of environmental risk factors assessment in reducing the fall of hospitalized patients. Methods: The control group included 200 803 hospitalized patients from January 2015 to June 2016, with the traditional management to prevent fall, and the intervention group included 222 867 hospitalized patients from July 2016 to December 2017, with the intervention that based on the assessment of environmental risk factors to prevent fall, and the traditional fall management intervention. The incidence of fall of the two groups was compared. Results: 46 patients fell in the control group, of which 31 (67.39%) patients fell due to environmental reasons, and 32 patients fell in the intervention group, of which only 12 (37.5%) patients fell due to environmental reasons (P<0.05). Conclusions: The assessment of environmental risk factors can significantly reduce the incidence of environmental related falls in hospitalized patients, improve nurses' awareness of environmental risk factors, and ensure the patients' safety.

Objective: To explore the application effect of the resuscitation process of the women of advanced reproductive age in the emergency obstetrics department, and to provide the basis for the emergency obstetric care for elder multipara. Methods: Through the establishment of the emergency medical group for the women with advanced reproductive age, we established an effective management system, then analyzed and improved the key steps of first aid procedure in the urgent labor of the elder multipara. Results: After implementing the new optimized plan, the pre-diagnosis triage time was shortened from (4.45±0.40) min to (4.20±0.29) min (P<0.05), and the obstetrician consultation time was shortened from (8.72±0.80) min to (5.56±0.66) min (P<0.01). The time from hospital to medication was shortened from (15.62±0.64) min to (11.36±1.00) min (P<0.01), and the time from hospital to ultrasound was shortened from (15.58±0.71) min to (11.47±0.95) min (P<0.01); the time from hospital to the interpretation of laboratory results was shortened from (34.94±0.65) min to (30.95± 1.29) min (P<0.01). The time from admission to delivery room/operating room was shortened from (25.75±1.02) min to (18.92± 1.29) min (P<0.01). The time from delivery room to operating room/delivery operating room during dystocia was shortened from (4.97±0.47) min to (1.75±0.67) min (P<0.01). The incidence of postpartum maternal complications decreased from 13.7% to 1.9% (P<0.05), and the incidence of neonatal complications decreased from 11.8% to 1.9% (P<0.05). Conclusion: The optimized maternal emergency treatment process could effectively shorten the time for treatment and reduces the incidence of complications.

Heel is the second most common site of all pressure injuries, which is prone to cause limb dysfunction and affect the quality of life significantly compared to other sites, thus it has drawn a wider attention from research scholars. This paper analyzes the current situation of heel pressure injury from the aspects of epidemiology, risk factors, evaluation and nursing, so as to provide scientific guidance for clinical practice.

Objective: To explore the application effect of closed-loop safety management of molecular targeted drug trastuzumab (herceptin). Methods: Using closed-loop concept and intelligent information management system, several steps were improved, including setting herceptin orders sheet, automatic calculation of dosage, a single-dose billing, medication donation standardization, centralized configuration, standardizing drug use check, and infusion process safety management. Results: The time of prescriptions and the time on the drug check increased (P<0.001). The times of first drug delivery and drug allocation were shortened (P<0.001). There was no significant difference in infusion time between the two groups (P>0.05). Adverse events of herceptin decreased significantly (P<0.001). Conclusion: The closed-loop safety management process of herceptin was a kind of the patient centered service, which could obviously improve the drug use safety, reduce the process errors and improve the efficiency of medical care.

Objective: To increase the management level of high-risk pregnant women. Methods: The advanced technology of cloud computing & Internet was adopted to establish the high-risk pregnancy management platform, which focused on the whole process integrated management of maternal healthcare information, involving high-risk factors screening, risk assessment, intelligent reminder, education, and follow up, etc. Results: An early intervention via project management was performed to improve the real-time and efficient management of high-risk pregnancy, eliminate or reduce the maternal risk factors, improve the maternal perception of pregnancy risk factors, and promote the change of maternal health behaviors. Conclusion: The high-risk pregnancy management platform based on Internet technology achieved real-time pregnancy record updates, project management and timely follow-up of high-risk pregnant women, solved the difficulties of high-risk pregnant women follow up and management, provided convenient and high-quality health management services for this population. It could improve the management of high-risk pregnant women, and ensure the safety of mothers and infants.

The information technology has been applied to transitional care more and more frequently abroad, but in our country transitional care still depends on the traditional family visits and telephone follow-up. This article reviewed the research progress of remote transitional care in patients with heart failure in the United States, summarized its inspiration for the development of remote transitional care in China, in order to provide basis for the implementation of remote transitional nursing for patients with heart failure, and thus promote the better development of transitional care.

This article described the positions and causes of perineal injury during delivery and summarized interventions to reduce perineal injuries based on evidence, including perineal massage, antenatal pelvic floor muscles and yoga ball exercise, free position, delayed pushing, epidural anesthesia, limited episiotomy, hands off technique, continuous support for maternal and so on. Based on our national conditions, some key interventional dimensions were proposed, such as improving prenatal health services, promoting free positon during delivery, establishing the labor analgesic medical service system suitable for Chinese conditions, clarifying indicators of episiotomy, and improving the delivery service system.

Objective: To explore the prognosis and risk factors of patients with proximal Deep Venous Thrombosis (DVT). Methods: Totally 72 patients with proximal DVT were investigated from January 2014 to December 2014. The incidence and risk factors of death related to Pulmonary Embolism (PE), VTE recurrence, Post-Thrombotic Syndrome (PTS) were analyzed. Results: Total 22(30.6%) patients developed poor prognosis, including 2 patients died (2.8%), 4 patients with VTE recurrence (5.6%) and 16 patients with PTS (22.2%). Logistic regression analysis indicated that risk factors were non-standardized anticoagulant therapy, high D-Dimer concentrations after 3 months oral anticoagulation treatment and inherited thrombophilia. Conclusion: The incidence of poor prognosis in patients with proximal DVT is high. Nurses should provide continuity of care to patients with DVT, ensure them with standardized anticoagulant therapy, and monitor the effects of anticoagulant therapy with D-Dimer. Nurses should provide information to patients with inherited thrombophilia to avoid acquired risk factors as well.

The influencing factors and assessment tools of Chemotherapy-Induced Nausea and Vomiting were summarized in this review. It could provide reference for nursing staff to identify the high risk population and use appropriate assessment tools to measure the symptoms.

This paper reviewed the assessment tools and influencing factors of aging attitude of the elderly. The assessment tools include: attitudes to aging questionnaire (AAQ), attitudes toward own aging (ATOA), the single category implicit association test (SC-IAT), Palmore's facts of aging quiz (FAQ), and Kogan's attitudes toward older people scale (KAOP). Two aspects of individual and social factors affecting aging attitude of the elderly were analyzed which mainly included: general demographic characteristic, the quality of life, physical health, mental health, self-awareness, social support, social participation and social culture. At present, there is a lack of in-depth investigation into the aging attitude of the elderly in China. Thus it is necessary to understand the current situation and influencing factors, so as to provide reference for further intervention of aging attitude of the elderly in our country.

Objective: To summarize the management experience of inter-hospital transfer for 11 critical patients with Extracorporeal Membrane Oxygenation (ECMO) from December 2016 to March 2018. Methods: A good plan to deal with possible problems in transfer, closely monitoring of patients' vital signs and ECMO system parameters, timely management of complications or accidents during transfer, serious shift changes between the two different hospitals, and self-designed "ECMO critical patient inter-hospital transfer checklist" was used to ensure a safe and effective transportation. Results: A total of 11 critical patients were transported with ECMO. The transport distance ranged from 6.5 km to 400.0 km, and the transport time was between 1.0 hour to 4.5 hours. All the patients showed stable respiratory and circulatory function and with no complications during transportation. Conclusions: It is feasible and safe to use ECMO in inter-hospital transfer of critical patients, with the supports of advanced equipments and a professional technical team. Inter-hospital transfer with ECMO saves valuable time for patients.

Objective: To summarize the best available evidence for the prevention and reconstruction of perinea injury among natural labor women and to provide decision-making reference for nurses and midwives. Methods: We systematically searched websites of professional organizations, websites of clinical practice guidelines and databases for guidelines on prevention and reconstruction of perineal injury, used AGREE II to evaluate the chosen guidelines, selected the A-level guidelines to translate, integrated the same or similar recommendations according to certain principles on the premise of ensuring the original meaning of these recommendations; and selected recommendations within the responsibilities of nurses and midwives in China through the expert consultation. Results: We have searched 331 articles and selected 4 A-level guidelines from the currently available 7 evidence-based guidelines, and integrated from 4 A-level guidelines 92 recommendations to 63 recommendations. However, only 27 recommendations can be delivered by nurses and midwives in China according to experts' opinions. Conclusion: The evidence in this field is abundant, but most beyond the nurses and midwives' permission. More practical exploration and scientific research are necessary to enrich the related evidence for nurses and midwives.

Objective: To explore the effects of collaborative intensive education on phosphorous control in hemodialysis (HD) patients with refractory hyperphosphatemia. Methods: Twenty-nine hemodialysis patients having refractory hyperphosphatemia from January to March 2016 were recruited in this study. A collaborative team including nurses, dietitian and physicians was set up to provide intensive education for these patients. After 3-month intervention, the patients' nutritional status, serum phosphorous level and mineral metabolism related knowledge were assessed and compared with those at baseline. Results: The patients' serum calcium, BMI, Kt/V and iPTH level were stable during the study period; while the serum phosphorous level decreased after the intervention. Both their dietary protein and phosphorous decreased, while their dietary phosphorous/protein ratio did not change. Meanwhile, their nutritional status and mineral metabolism related knowledge improved. Conclusion: The collaborative intensive education could improve the hyperphosphatemia control of HD patients through improving their awareness of mineral bone disorders and lowering dietary phosphorous intake without malnutrition.