Objective To understand the nurses' evaluation of current grading nursing system.Methods Self-questionnaire was designed and used to investigate 141 clinical nurses coming from three general hospitals sampled conveniently.Results (1)Clinical nurses lacked in-depth study of grading nursing instruction principle;(2)Doctors and nurses lacked the cooperation during the process of identifying the level of care;(3)Level of care was not consistent with the patients' condition and self-care ability;(4)Disease inspection and primary care were not consistent with patients' level of care;(5)Health guidance and mental nursing couldn't meet the actual needs of patients;(6)Senior nurses' evaluation of the implementation of grading nursing was lower than Junior nurses; (7)Clinical nurses held positive attitudes to nurses and patients participating in grading nursing.Conclusions Nurses thought poorly of grading nursing system in operation,it was necessary to improve the content of principles about grading nursing manner,health instruction and psychological nursing,and implement grading nursing system correctly.It was also important to take patients' willingness of participating in care into account.

Objective To investigate how surgical patients are assessed regarding pressure ulcer risks and the usage of evaluation tools in different stages during perioperative period.Methods Totally 210 nurses from operating rooms and surgical wards in 7 tertiary hospitals of Jiangsu Province were investigated with self-designed questionnaire.Results Operating room nurses of 7 hospitals used different kinds of scales for pressure ulcer risk assessment,the same scale document was used during the different stages of operation,the frequency and time for pressure ulcer risk assessment varied from one to three times,preoperative visit to handover in surgical ward were different;the Braden scale was used by surgical nurses to evaluate pressure ulcer risk after operation,while most surgical nurses believed that the existing scale lacked specificity and intraoperative risk factors that should be considered when assessing postoperative patients.Conclusion The frequency and time of pressure ulcer risk assessment of patients during perioperative period are not standardized,the content of scale is limited and lacks specificity,the assessment of pressure ulcer risk during perioperative period is discontinuous and non-dynamic.There are no specific risk assessment scales targeting preoperative,intraoperative and postoperative pressure ulcer risk assessment.

Objective To explore the effect of flushing uterine cavity with metronidazole solution at different temperatures on postpartums with high risk of infections during cesarean section.Methods One hundred and two puerperas with high risks of infections undergoing caesarean section were randomized according to random sampling into three groups equally.Groups A,B and C were treated with uterine cavity flushing with metronidazole solution at three temperatures of 22~24℃,39~40℃and 37.5~37.8℃respectively.Comparisons were done between the three groups in terms of vaginal bleeding 2h after operation,heart rates 15 min before operation and 15 min after operation and the temperatures.Results The differences in temperature and heart rate 15 min after operation were significantly different arnong the groups(P<0.05).The temperature and heart rates of group A were higher and faster than the other two groups(both P<0.05)but no differences between group B and group C(P>0.05).In group A,the temperature and heart rate after operation were significantly lower and faster than those before operation(P<0.05),while there were no differences within group B and C respectively (P>0.05).The vaginal bleeding volume 2 h after operation in groups A and B was significantly more than group C(P<0.05)and that of group B was significantly smaller than group A(P<0.05).Conclusion Uterine cavity flushing using metronidazole at the temperature of 37.5~37.8℃after cesarean section can reduce postpartum hemorrhage and relieve patient’s discomfort.

Objective To assess the reaching ability of hemiplegic stroke survivors using a motion capture unit (MCU) combined with surface electromyography (sEMG).Methods Sixteen stroke survivors with hemiplegia formed the experimental group,while healthy counterparts were selected as the control group.Both groups were asked to sit on a chair and reach for a cup on a table in front of their shoulder at arm's length using their affected arms in the experimental group and their right arms in the control group.MCUs were fixed on their spines and arms to obtain kinematic signals,and the sEMG signals of the trapezius,the anterior deltoids,biceps and triceps of the tested limb were recorded.Each subject repeated the test 3 times,and the best result was retained for further analysis.After signal processing,the range of movement of the shoulders and elbows was extracted along with the time used to reach the cup,peak angular velocity,time to peak velocity of the shoulders and elbows,work of the muscles and work ratios of the trapezius/deltoid and biceps/triceps.The upper limb section of the Fugl-Meyer assessment (FMA) was also administered to evaluate the patients' upper limb function.Independent sample rank sum tests compared the patients with the controls in terms of kinematics and sEMG parameters.Spearman analysis was used to explore the correlation between the FMA scores and the kinematics and sEMG characteristics.Results Significant differences in the kinematic and myoelectric indicators were found between the patients and the controls.The average FMA score of the patients was correlated with the peak velocity of the shoulder joint.Moreover,the ROM of the shoulder was closely related to the work of the trapezius,while the time for the shoulder joint to reach peak velocity was closely related to the work ratio of the biceps and triceps.Conclusion An MCU integrated with synchronous sEMG can quantitatively assess the kinematics and kinetics of hemiplegic stroke survivors,at least in reaching.This can provide objective guidance to optimize clinical rehabilitation.

Impaired awareness of hypoglycemia is an acquired complication of insulin therapy, which affects people with type 1 and insulin-treated type 2 diabetes mellitus, whereby the ability to perceive the onset of hypoglycemia becomes diminished or absent, which not only affects life health, but also causes fear of hypoglycemia , and causing a serious burden on the quality of life. The paper reviews the concept,the assessment tools,the occurrence,the influencing factors and intervention strategies of impaired awareness of hypoglycemia.In order to provide suggestions for the researches of impaired awareness of hypoglycemia in China.

Objective To investigate the caring experiences of family caregivers of patients with enterostomy in different stages based on"Timing It Righ"framework. Method Phenomenological research method was used to conduct an unstructured interview with 40 caregivers of patients in different stages (perioperative period, discharge preparation period, adjustment period and adaptation period).The acquired data were analyzed by Colaizzi phenomenological research method. Result According to the"Timing It right"framework, five themes about nursing experience of caregivers of patients with enterostoma at different stages were extracted: 1) uncertainty of disease and post-traumatic stress disorder at the perioperative period; 2) Re-challenges after subjective initiative adjustment during the discharge preparation period; 3) practice and re-cognition during the adjustment period; 4) post-traumatic growth during the adaptation period.Conclusions The caregiver's experience of an enterostomal patient presents a dynamic process. There are different experiences and needs for inner-heart care in different stages.Family caregivers were with strong information and emotion need at the perioperative period;they were with strong helpless feeling during the dischsrge preparation;they were with information and stoma instrument need in adjustment period;they were with care ability need during adaption period. Nursing staff should provide relevant mental support and professional guidance up to the different stages so as to improve mental health of caregivers of stoma patients and enhance their knowledge and skills on care-giving.

Objective:To explore the application effect of SBAR communication mode based on early warning hierarchical management in emergency observation room.Methods:Formulating the handover program of SBAR communication mode based on the early warning hierarchical management, systematically training the nurses of the observation room and put into effect.The 455 patients transferred by 18 nurses in the observation room from November to December 2018 were listed as the control group, and the traditional SBAR communication mode was implemented for the handover.A total of 443 patients with nurse handover from November to December 2019 were included in the observation group, and the SBAR communication mode based on early warning hierarchical management was implemented. The incidence of adverse nursing events, quality of nursing handover, doctors' and nurses' satisfaction with the handover were compared between the two groups.Results:The incidence of adverse events was 1.81%(8/443) in the observation group and 7.91%(36/455) in the control group, the difference between the two groups was statistically significant (χ 2 value was 17.96, P < 0.05).In the observation group, the nursing handover quality and nurse's knowledge of the patients’ condition were (91.37±2.73) points and (96.7%,58/60) respectively, while those in the control group were (89.07±2.76) points and (81.7%, 49/60).The difference between the two groups was statistically significant ( t value was -2.38, χ 2 value was 6.99,all P<0.05).The satisfaction of doctors and nurses on nursing handover was 95.0%(57/60) and 95.0%(57/60)in the observation group respectively, and that in the control group was 83.3%(50/60) and 81.7%(49/60) respectively.The difference between the two groups was statistically significant (χ 2 values were 4.23, 5.18, P < 0.05). Conclusions:SBAR communication mode based on early warning classification can significantly improve the early warning ability of nurses in emergency observation room during the shift, reduce the occurrence of adverse nursing events, improve the quality of nursing shift, and improve the satisfaction of doctors and nurses.

Objective:To develop a geriatric nursing core literacy evaluation scale and to test its validity and reliability.Methods:The scale item pool was constructed by referring to relevant literatures and expert consultation method was used to form initial scale. A preliminary investigation was conducted among 40 nurses to form the formal scale, and then 252 nurses were selected to test the validity and reliability of the formal scale.Results:The formal scale consisted of four dimensions and 37 items. The Cronbach α coefficient of the formal scale was 0.980, the content validity index was 0.912, exploratory factor analysis identified 4 principal factors (knowledge geriatric nursing core literacy, skill geriatric nursing core literacy, cognitive geriatric nursing core literacy, belief geriatric nursing core literacy) and explained 73.135% of the total variance.Conclusion:The geriatric nursing core literacy evaluation scale has good reliability and validity, which can be used to evaluate the geriatric nursing core literacy of nursing staffs.

Objective:To understand the present situation of self-acceptance of elderly in nursing home and explore its influencing factors, so as to provide basis for improving self-acceptance level of elderly in nursing home.Methods:Totally 415 elderly people in 3 Medical and nursing homes in Fuyang city of Anhui province were selected by Self-Acceptance Scale, and influencing factors were analyzed.Results:The total score of Self-Acceptance Scale of the elderly in nursing home was (44.11±7.25) points, the score rate was 67.86% (44.11/65), in the middle level; the results of multiple linear stepwise regression showed that the relationship with children, hobbies, number of children, length of stay in nursing home, frequency of visits and age were the main influencing factors ( F value was 48.228, P<0.001). Conclusion:The self-acceptance of the elderly in nursing home is in the middle level. The nursing home or social should pay attention to the higher age group and the newly admitted elderly in nursing home, give such people timely psychological guidance, help them to plan their later life, cultivate their interests and hobbies through recreational activities, and take corresponding measures to harmonize their relationship with their children in order to improve their self-acceptance level and promote mental health.

Objective:To investigate the resilience level and self-management status of patients with type 2 diabetes and analyze the mediating effect of mindfulness level between the resilience and self-management behavior.Methods:Totally 219 patients with type 2 diabetes from December 2019 to April 2020 were selected as the research subjects.The general information questionnaire, Mindful Attention Awareness Scale, Connor-Davidson Resilience Scale, and the Summary of Diabetes Self-Care Activities were used to investigate all patients.SPSS 22.0 was used for statistical analysis.Spearman correlation analysis was used to analyze the relationship among the variables, and multiple linear stepwise regression analysis was used to analyze the mediating effect.Results:The correlation analysis showed that resilience(45.0 (40.0, 50.0)) was positively related to self-management(14.0 (9.0, 22.0)) ( r=0.876, P<0.05), and mindfulness(46.0 (40.0, 57.0)) ( r=0.838, P<0.05). Mindfulness was positively related to self-management( r=0.821, P<0.05). The mediating effect test showed that mindfulness played a part of mediating role between resilience and self-management, with the mediation effect of 0.56, accounted for 69.80% of the total effect. Conclusion:The variables of mindfulness, mental resilience and self-management behavior in type 2 diabetic patients are positively correlated with each other.Mindfulness plays a partial mediating role between mental resilience and self-management behavior.