The occurrence and development of cognitive impairment after stroke has a serious impact on the life ability and quality of life of patients, prolonging the rehabilitation cycle of patients, and increasing the burden of patients and their families. This paper summarizes the main factors that affect the cognitive impairment of post-stroke patients, including demographic factors, lifestyle, disease-related factors, psychological factors, cognitive intervention factors, and social support factors, which provide reference for the development of prevention programs of cognitive impairment after stroke.

Objective? To investigate the application status of transitional care quality indicators for chronic disease in hospitals in China so as to provide a reference for improving transitional care quality evaluation for chronic disease. Methods? We selected nursing managers from 55 hospitals participating a national nursing conference in Shanghai in 2018 as subjects by convenience sampling. The self-designed hospital transitional care quality indicators questionnaire for chronic disease was used to investigate the usage condition of transitional care quality indicators for chronic disease in 55 hospitals. χ2 test was used to compare the utilization ratio of third-level indexes of transitional care of Class Ⅱand Class Ⅲ hospitals. Results? Among 55 hospitals, the highest usage of first-level indexes was structure index (0.813±0.164). The top 3 usage of second-level indexes included hospital readiness (0.932±0.047), patient satisfaction (0.927±0.262) and adverse event rate (0.888±0.143); the bottom 3 usage included health status of patients (0.470±0.112), external hospital extension (0.418±0.280) and connect inside and outside of hospital (0.309±0.149). In importance of second-level indexes, the top 3 usage included the adverse event rate, hospital readiness and material resources; the bottom 3 usage involved the utilization ratio of medical resources, connect inside and outside of hospital and external hospital extension. There were statistical differences in the usage rates of medical resource indexes in ClassⅡand ClassⅢ hospitals, such as readmission rate, visiting rate in emergency department, hospital stay and mortality (χ2=9.406, 5.430, 6.339, 6.339;P＜ 0.05). Conclusions? Among 55 hospitals of China, the transitional care quality evaluation for chronic disease is generally insufficient which is needed to be paid attention to. Hospitals needs to optimize the proportion of indexes, improve and pay more attention to the evaluation for process indicators and outcome indicators, and perfect management and monitor for transitional care.

Objective? To understand the situation of cardiac rehabilitation from Class Ⅱ and Class Ⅲ hospitals in China, so as to provide a reference for optimizing cardiac rehabilitation. Methods? In June 2018, we selected 68 nursing managers of ClassⅡ and ClassⅢ hospitals from totals of 12 provinces, autonomous regions and municipalities directly under the central government such as Shanghai, Zhejiang Province, Jilin Province, Guizhou Province and the Xinjiang Uygur Autonomous Region as subjects by convenience sampling. We investigated the basis development condition, rehabilitation content, implementation of transitional nursing of cardiac rehabilitation in those hospitals. Results? Among 68 ClassⅡ and ClassⅢ hospitals, the score of cardiac rehabilitation was (4.75±1.73) with the lower middle level as a whole. The good development of cardiac rehabilitation included the smoking cessation guidance, diet guidance and blood pressure control. The poor development of cardiac rehabilitation involved the vocational rehabilitation guidance, assessment for quality of life and mental management. The main influencing factors of development of cardiac rehabilitation were staff shortage (70.59%), lack of perfect operational mechanism (66.18%) and lack of policy support (52.94%). Conclusions? In China, the Class Ⅱ and Class Ⅲ hospitals have developed cardiac rehabilitation in succession however with many deficiencies. Hospitals should strengthen the basic construction of cardiac rehabilitation, perfect the rehabilitation content and promote the development of transitional nursing.

Objective? To investigate the status of follow-up service of discharged patients from ClassⅡ or ClassⅢ comprehensive hospitals in China. Methods? In June 2018, we selected 150 clinical departments and 228 nurses of 89 ClassⅡ or ClassⅢ comprehensive hospitals in 17 provinces, Municipality and autonomous regions by convenience sampling. The self-designed questionnaire was used to investigate the ways, contents, existing problems and suggestions of follow-up of discharged patients. Results? Follow-up service was mainly carried out by nurses including ward primary nurses and full-time nurses. Besides, the follow-up was mainly with the telephone follow-up, and its content tended to disease health education and consultation. The main existing problems of discharged patients in follow-up service were "follow-up form was too simple and lacking specialty characteristics", "follow-up way was single and follow-up effects were unsatisfactory", "human resources limits and lack of special follow-up staff", "follow-up effects lacking aggregate and analysis" and"nursing problems existing in follow-up lacking following and evaluation". Nurses suggested that "aggregate as well as feedback of follow-up data should be done regularly", "increase follow-up center unified management for discharged patients", "follow-up form should reflect specialty characteristics" and "develop multidisciplinary teamwork". Conclusions? Follow-up service has great significance for improving rehabilitation and quality of life among discharged patients. There are a lot of problems in follow-up service system for discharged patients. We should perfect the common discharged follow-up forms applied to specialties, construct multidisciplinary support platforms and make follow-up management system scientific and informative.

ObjectiveTo understand the self-acceptance among nurses at a Class Ⅲ Grade A hospital and to analyze its influencing factors so as to provide a basis for psychological health education by hospitals. MethodsIn July 2018, we selected 202 nurses at a Class Ⅲ Grade A hospital in Shanghai by convenience sampling. The general information questionnaire and Self-Acceptance Questionnaire (SAQ) were used to investigate the self-acceptance of nurses. ResultsAmong 202 nurses, the total score of self-acceptance, self-acceptance factor score and self-assessment factor score were (42.29±4.40), (22.12±3.16) and (20.19±2.82) respectively. Single factor analysis showed that there were statistical differences in self-acceptance among nurses with different departments, genders, ages, working lives, marital status, titles, posts, education levels, whether recruited with authorized strength, monthly income and times of night shift (P＜0.05). Multiple linear regression showed that the influencing factors of self-acceptance of nurses included departments, genders, ages, titles, posts, education levels and monthly income. ConclusionsAs a whole, nurses of this hospital can adopt appropriate self-acceptance. Hospital managers need to take targeted measures based on self-acceptance of nurses to carry out psychological health education to help nurses know and accept themselves so as to provide high quality nursing for patients.

Objective? To investigate the current condition and correlation of coaching leadership ability and psychological capital of nursing managers. Methods? A cross-sectional study was conducted at the National Nursing Conference on "Efficient Nursing Management and Clinical Practice in the Context of Great Health" in June 2018. Totally 217 nursing managers from 107 hospitals and 38 regions were selected by convenience sampling and investigated by the General Information Questionnaire, Coaching Leadership Perception Assessment Scale (CLPAS), and Psychological Capital Questionnaire(PCQ). Rank-based non-parametric statistical method was used to compare the scores of coaching leadership of nursing managers with different general information. Spearman correlation analysis was used to analyze the correlation between coaching leadership and psychological capital, and stratified regression analysis was used to analyze the influencing factors of coaching leadership. A total of 222 questionnaires were distributed with 217 valid ones retrieved, yielding an effective recovery rate of 98%. Results? The 217 nursing managers achieved a total score of (64.15±6.19)points from CLPAS, (90.00±9.31) points from PCQ, there was positive correlation among each dimensions in CLPAS and PCQ (P＜0.01); there was good effect of the psychological capital in predicting the coaching leadership ability (P＜0.01). Conclusions? The coaching leadership ability of nursing managers needs to be improved. The psychological capital of nursing managers will affect their coaching leadership ability and should be paid attention to; effective measures should be taken to improve the psychological capital of nursing managers so that it can play a greater role in the nursing team and improve the efficiency of nursing management.

Objective? To investigate the significance,evaluation methods and blocking factors of evaluating continuous care for stroke, and to explore the evaluation strategies, so as to provide reference to improve and standardize the effect evaluation of continuous care for stroke. Methods? By convenience sampling, 125 nursing staff from 60 communities, 15 regions in Shanghai were selected in October of 2018 as the research objects, the self-designed questionnaires: Significance of Evaluation of Continuous Care for Stroke, Effect Evaluation of Continuous Care for Stroke Questionnaire, Blocking Factors of Effect Evaluation Questionnaire were used in the investigation, SPSS 20.0 software was used to analyze the data. Results? The top three most-chosen items in Significance of Evaluation of Continuous Care for Stroke were:"improving the ability of family nursing" (92.0%,115/125), "promoting the improvement and improvement of nursing quality"(86.4%,108/125) and "promoting patient's disease self-monitoring" (80.8%,101/125); in the Importance of Evaluation Content of Continuous Care for Stroke, the dimensions ranked from high to low were:"health outcome of patients" (4.63±0.43), "the outcome of caregivers" (4.58±0.51), and "the implementation rate of nursing services" (4.56±0.46); in the aspect of evaluation subjects, 74.4% of nursing staff thought that it should be evaluated by specialist nurses, 32.0% by quality control staff and 26.4% by patients; the main blocking factors of effect evaluation were: "shortage of human resources" (96.0%,120/125), "heavy workload" (88.0%, 110/125) and "patients' and family members' noncooperation"(81.6%,102/125). Conclusions? The evaluation of the effect of continuous care for stroke is of great significance to hospitals, patients and family caregivers. It is necessary to pay more attention to the evaluation of the effect of continuous care for stroke. The content of the evaluation should be standardized from the aspects of patients' health outcomes, home caregivers' outcomes and the implementation rate of nursing services. The advantages of evaluation subject, scientific selection of evaluation subject, strengthening the support of health policy, and eliminating the blocking factors of effect evaluation.

Objective? To investigate the status quo of quality of life (QOL), cognitive function and activities of daily living (ADL) in patients with ischemic cerebral stroke, explore cognitive function and ADL on QOL, and provide a reference for improving QOL in patients with cerebral stroke. Methods? Totally 140 patients with ischemic cerebral stroke hospitalized in the Department of Neurology of a hospital in Shanghai from September 2018 to January 2019 by convenient sampling and investigated with the demographic information questionnaire, Mini-Mental State Examination (MMSE), Barthel Index (BI) andWHO Quality of Life-BREF (WHOQOL-BREF). SPSS 22.0 and AMOS 22.0 were used to analyze the effects of cognitive function and ADL on QOL. Results? The total WHOQOL-BREF, BI and MMSE scores of the 140 patients with ischemic cerebral stroke was (52.56±5.34), [55 (40.00,67.25)]and[26 (23.25, 28.00)], respectively. Patients's QOL was positively correlated with ADL (r=0.173,P＜0.05) and cognitive function (r=0.276,P＜0.05). The path analysis revealed that both cognitive function and ADL had positive predictive power for QOL, whose path coefficient was 0.29 and 0.38. Conclusions? The QOL of patients with ischemic cerebral stroke stands at a medium level. Patients' cognitive function and ADL affect their QOL, which should draw attention in clinical practice, and measures should be taken for rehabilitation training of cognitive function and systematic interventions of ADL.

Objective:To systematically review and synthesize qualitative researches on self-management experience of home-based rehabilitation for patients with chronic diseases and focus on obstacles and promoting factors in the process of home self-management, so as to provide evidence for construction of self-management system of home rehabilitation for chronic diseases.Methods:Cochrane Library, Embase, Medline, PsycINFO, Scopus, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) , Wanfang Database, VIP and China Biology Medicine disc (CBMdisc) were searched by computer to collect qualitative studies related to self-management experience of home rehabilitation for patients with chronic diseases. The retrieval time was from construction of the database to May 31, 2020. The quality evaluation was carried out using quality evaluation standard for qualitative research (2016) in Australian Joanna Briggs Institute (JBI) Evidence-Based Health Care Center, and the Meta synthesis was carried out using integrative synthesis method.Results:A total of 23 researches were included and 82 results were extracted. Those researches were included into 9 classifications and were synthesized into 4 integrated results, including multiple stresses in home-based rehabilitation self-management of chronic disease, inadequate supportive resources related to home-based rehabilitation self-management of chronic disease, home-based rehabilitation self-management level of patients with chronic diseases to be further improved and positive experience of home self-management of patients with chronic diseases.Conclusions:Home-based rehabilitation for patients with chronic diseases face multiple obstacles in the process of self-management. Nursing staff should efficiently integrate the available home-based rehabilitation self-management medical resources in the area, accurately connect home-based rehabilitation self-management needs of patients and early identify potential risks in home-based rehabilitation self-management process, so as to improve their home self-management effect.

Renal transplant recipients have a high rate of unplanned readmission, which will seriously affect the quality of life of recipients and their families, increase medical costs and the medical burden. Unplanned readmission of renal transplant recipients is the result of multiple factors, which is difficult to be well intervened by a single measure. This article reviews the status quo, related reasons, influencing factors and interventions of unplanned readmission of renal transplant recipients for reference in clinical practice.