Objective To analyze the effect and the problems of the comprehensive application of quality management tools in order to improve nursing quality and ensure patient safety.Methods To summarize the implementation of Plan,Do,Check,Action(PDCA),quality control circle(QCC),root cause analysis(RCA),healthcare failure mode and effect analysis(HFMEA) in the nursing quality improvement.Aiming at problems arising in application process,the measures such as systematic training of quality management knowledge,case demonstration,standardized evaluation throughout the whole process,holding competition activities,inviting experts to give immediate guidance were applied.Results Among 1 798 PDCA and QCC programs,the result of 1 795 programs reached the target value,3 substandard programs reached the expected outcome finally after cause analysis,procedure break down and adjust of improvement contents.No nursing error or adverse events occurred.The indicators of nursing quality improved and patient satisfaction was 98.58％,which got the third position among all national hospitals.Conclusions The comprehensive application of four quality management tools was helpful in enhancing the effect of nursing quality improvement.

Objective To investigate the effect of wire?reinforced epidural catheters on the success rate of epidural catheterization for labor analgesia. Methods A total of 200 nulliparous parturients who re?ceived labor analgesia voluntarily, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 20-45 yr, with body mass index<35 kg∕m2, were divided into 2 groups (n=100 each) using a random number table: common catheter group ( group Ⅰ) and reinforced catheter group ( group Ⅱ) . After suc?cessful epidural puncture, the corresponding catheter was inserted inⅠandⅡgroups. The development of difficult insertion, intravascular catheter insertion or paresthesia during insertion was defined as a failure of epidural catheterization. The occurrence of the failure of epidural catheterization was recorded. Results Compared with group Ⅰ, the failure rate of epidural catheterization was significantly decreased in groupⅡ( P<0.05) . Conclusion Wire?reinforced epidural catheters can raise the success rate of epidural catheter?ization for labor analgesia.

Objective: To investigate the influence of job burnout on subjective well-being and health status among employees in China. Methods: The data from the 2014 China Labor-force Dynamic Survey were used to analyze the association of job burnout with subjective well-being and health status among 7289 employees aged 18-64 years from 29 provinces in China.Some items from the Maslach Burnout Inventory-General Survey were used to investigate job burnout; subjective well-being assessment included life happiness and degree of satisfaction with living condition; the questions for self-evaluation of health status were used to analyze health status. Results: Of all employees,30.5% had low subjective well-being and 4.7% had poor health status based on self-evaluation. The logistic regression analysis showed that emotional exhaustion(two items), reduced sense of personal accomplishment,and cynicism were risk factors for low subjective well-being(OR=1.07,1.11,1.10,and 1.06,P<0.001),and emotional exhaustion(two items)was a risk factor for poor health status (OR=1.10 and 1.07,P<0.001).Reduced sense of personal accomplishment and cynicism had no significant influence on health status(P>0.05). Conclusion Emotional exhaustion is a major influencing factor for health status,and reducing job burnout may be an effective method for improving subjective well-being and health status.

Catheter-associated urinary tract infection (CAUTI) is one of the common nosocomial infections in burn patients. It not only extends the length of hospital stay of patients, increases the economic burden on family and society, but also seriously affects the prognosis and quality of life of patients, increases the risk of death of patients. In this paper, the epidemiological characteristics, influencing factors, and prevention measures of CAUTI in burn patients are reviewed to draw high attention of clinical medical staff and to provide some reference for clinical practice.

Objective:To explore the epidemiological characteristics and risk factors of catheter-associated urinary tract infections in patients with perineal and/or hip burns.Methods:This study was a retrospective case series study. From January 2018 to December 2022, 260 patients with perineal and/or hip burns and urinary catheters indwelling who met the inclusion criteria were admitted to the Department of Burns and Wound Repair of the Second Affiliated Hospital of Zhejiang University School of Medicine, including 192 males and 68 females, aged 20-93 years. The total incidence of catheter-associated urinary tract infections in patients with perineal and/or hip burns, the detection of pathogenic bacteria, and the resistance of major Gram-negative and Gram-positive bacteria to commonly used antimicrobial drugs in clinic were recorded. According to whether catheter-associated urinary tract infection occurred or not, the patients were divided into infection group (43 cases) and non-infection group (217 cases). The basic conditions including gender, age, total burn area, depth of perineal burn, depth of hip burn, and burn site on admission, complications of diabetes mellitus, inhalation injury, and hypoproteinaemia, invasive operations including tracheotomy and non-perineal/hip debridement/skin transplantation surgery, duration of catheter retention, number of urethral catheterization, and bladder irrigation of patients between the two groups were compared, and the independent risk factors influencing the occurrence of catheter-associated urinary tract infections in patients with perineal and/or hip burns were screened.Results:The total incidence of catheter-associated urinary tract infections in patients with perineal and/or hip burns in this study was 16.5% (43/260). The pathogens detected were predominantly Gram-negative, followed by fungi; the main Gram-negative bacterium was Klebsiella pneumoniae, and the main Gram-positive bacterium was Enterococcus faecalis. The resistance rates of Klebsiella pneumoniae to amoxicillin/clavulanic acid, amitraz, amikacin, ciprofloxacin, ceftriaxone, and levofloxacin were higher than 70.0%, the resistance rates of Klebsiella pneumoniae to cefoxitin, cefoperazone/sulbactam, cefepime, meropenem, imipenem, and piperacillin/tazobactam ranged from 56.3% to 68.8%, and the resistance rates of Klebsiella pneumoniae to ceftazidime and tigecycline were lower than 50.0%. The resistance rates of Enterococcus faecalis to ciprofloxacin and penicillin were both 85.7%, the resistance rates of Enterococcus faecalis to erythromycin, clindamycin, moxifloxacin, and tetracycline ranged from 14.3% to 57.1%, and the resistance rates of Enterococcus faecalis to linezolid, tigecycline, and vancomycin were all 0. The differences were statistically significant between the two groups in terms of gender, status of complication of hypoproteinaemia, depth of perineal burn, status of non-perineal/hip debridement/skin transplantation surgery, status of bladder irrigation, number of urethral catheterization, and duration of catheter retention of patients (with χ2 values of 7.80, 4.85, 10.68, 9.11, and 16.48, respectively, and Z values of -4.88 and -5.42, respectively, P<0.05). There were no statistically significant differences in the age, total burn area, complications of diabetes mellitus and inhalation injury, burn site, depth of hip burns, and status of tracheotomy of patients between the two groups ( P>0.05). Multifactorial logistic regression analysis showed that gender, deep partial-thickness perineal burns, non-perineal/hip debridement/skin transplantation surgery, bladder irrigation, and duration of catheter retention were the independent risk factors for catheter-associated urinary tract infections in patients with perineal and/or hip burns (with odds ratios of 2.86, 2.63, 2.79, 2.34, and 1.04, respectively, with 95% confidence intervals of 1.21-6.73, 1.03-6.71, 1.03-7.59, 1.05-5.22, and 1.02-1.06, respectively, P<0.05). Conclusions:The incidence of catheter-associated urinary tract infections is high in patients with perineal and/or hip burns, with Klebsiella pneumoniae as the predominant pathogenic bacteria having a high resistance rate to commonly used antimicrobial drugs in clinic. Gender, deep partial-thickness perineal burns, non-perineal/hip debridement/skin transplantation surgery, bladder irrigation, and duration of catheter retention are the independent risk factors for catheter-associated urinary tract infections in patients with perineal and/or hip burns.

Objective:To explore the effects of an improved perioperative diet management based on the concept of enhanced recovery after surgery (ERAS) in patients undergoing total hip arthroplasty (THA) .Methods:From May 2020 to May 2022, convenience sampling was used to select 320 patients who underwent their first unilateral THA at the First Affiliated Hospital of Zhengzhou University. According to the random number table method, patients were divided into control group ( n=160) and observation group ( n=160). The control group adopted a routine perioperative diet management, while the observation group improved the perioperative diet management based on the ERAS concept, and nurses performed preoperative fasting and postoperative diet and drinking water nursing according to the plan. We compared the preoperative hunger and thirst between two groups of patients, and recorded the gastrointestinal function such as postoperative anal exhaust and defecation time, bowel sound recovery time, postoperative nausea and vomiting degree, and post eating nausea and vomiting degree between the two groups. Results:The number of preoperative hunger and thirst patients in the observation group was less than that in the control group, and the postoperative exhaust time, defecation time, and bowel sound recovery time were shorter than those in the control group ( P<0.05). The degree of nausea and vomiting after eating after surgery was lower than that in the control group. The differences were all statistically significant ( P<0.05) . Conclusions:The improved perioperative diet management based on ERAS has good clinical effects in THA patients, reducing perioperative discomfort and promoting postoperative gastrointestinal function recovery.

To summarize the nursing experience of an elderly postoperative laryngeal cancer patient who developed a Type Ⅳ hiatal hernia.Key nursing care points included the monitoring of shock index and MEWS to promptly activate the rapid response team and implement the Surviving Sepsis Campaign,active fluid resuscitation and continuous monitoring of central venous pressure to prevent cardiopulmonary failure,implementing a personalized postoperative respiratory rehabilitation plan to promote lung re-expansion and prevent pulmonary infection,monitoring and controlling intra-abdominal hypertension,and implementing an intra-abdominal pressure-guided enteral nutrition management plan,employing a restrictive fluid management strategy to reduce tissue edema and maintain fluid and electrolyte balance,implementing an integrated"hospital-community-home"health management plan to improve the patient's quality of life.The patient was hospitalized for 23 days and discharged smoothly,with good recovery after a 3-month follow-up.

Objective:To explore the effect of stabilizing muscle training on cervical function and quality of life in continuous nursing care of patients with cervical spondylosis.Methods:From June 2018 to June 2019, a total of 98 patients with cervical spondylosis in the First Affiliated Hospital of Zhengzhou University were selected by convenience sampling method, and divided into control group and observation group by random number table method. In the course of treatment and follow-up, 15 cases were lost in the two groups, and 42 cases were included in the control group and 41 in the observation group. The control group was given routine continuous nursing after discharge, and the observation group was given stabilizing muscle training on the basis of routine continuous nursing. The scores of Japanese Orthopedic Association (JOA) and Neck Disability Index were compared before intervention, 3 months after intervention and 6 months after intervention between the two groups. The scores of Short Form 36 Health Survey Questionnaire (SF-36) were compared after intervention between the two groups.Results:The results of repeated measurement ANOVA of JOA score and NDI score before intervention, 3 months and 6 months after intervention showed that there were interaction, inter group and time effects, and the differences were statistically significant ( P<0.01) . After the intervention, the scores of SF-36 in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:In the continuous nursing of patients with cervical spondylosis, the application of stabilizing muscle training is more conducive to relieve muscle tension, improve symptoms, and improve the quality of life of patients.

Multiple adverse symptoms such as fever, pain, fatigue, nausea, vomiting and sleep disorders can be induced in patients with liver cancer after transcatheter arterial chemoembolization, and appear in the form of symptom clusters, causing negative effects on patients. This article summarizes the concept of symptom clusters and the evaluation status and assessment tools of symptom clusters after transcatheter arterial chemoembolization, aiming to provide reference for comprehensive and effective symptom clusters management and clinical decision-making implementation.

Under the background of efficiency medical reform, the authors introduced the nursing efficiency management system of a large public hospital, which was divided into two dimensions: nursing resource allocation efficiency and nursing service efficiency. The specific four measures included the establishment of multi-campus unified management organization structure based on nursing management committee, nursing performance reform based on structured big data information platform, the construction of nurse-led patient whole process management model and the accelerated rehabilitation nursing practice from surgery to the whole hospital, so as to provide reference for the nursing efficiency management of large general public hospitals under the medical reform.