Objective To approach the problems existed in the obsevation of illness process by low seniority nurses and their solving method. Methods The obversation ability for illness of 42 registered nurses who has worked within 3 years were evaluated.The contents included:Whether the observation was comprehensive,whether the physical checkup was correct,whether the nursing care was complete,whether the recognition of existing and potential nursing problems was in time and the mastering of important points of special medication. Results There existed common problems in the contents of illness observation,special nursing checkup,application and evaluaiton of nursing care and mastering of important points of special medication. Conclusion The illness observation ability of low seniority nurses needed improvement.Study of specialized knowledge is a premise and strengthened training is a pivotal tache.

Objective The study aimed to investigate the influence of head nurse's transformational leadership style on emotional labor and psychological empowerment of nurses.Methods Totally 851 staff nurses from four 3A hospitals were investigated with the Transformational Leadership Style Sub Scale of Multifactor Leadership Questionnaire,Psychological Empowerment Scale and Emotional Labor Scale.Results The head nurse's transformational leadership style scored (2.41±0.81).The psychological empowerment of nurses scored (3.27±0.47),its autonomy dimension scored (3.81±0.50),staying at medium level.The emotional labor of nurses scored (3.68±0.61),its deep acting dimension scored (4.67±0.76),which was above medium level.The indirect correlation coefficient between head nurse's transformational leadership style and emotional labor (r=-0.13) was far higher than direct correlation coefficient (r=-0.04).The psychological empowerment was the full mediation variable by which head nurse's transformational leadership style influence emotional labor of nurses.Conclusions Head nurse's transformational leadership style can enhance nurse's selfefficacy,cognition of work significance and work autonomy,so that nurse's deep acting and positive perception of emotional display can be increased,and nurse's emotional exhaustion and job burnout can be decreased to retain nurses.

Objective:To investigate the efficacy of dexmedetomidine combined with transversus abdominis plane block in laparoscopic radical resection of colorectal cancer and its effect on serum CXCL8 level.Methods:A total of 72 patients who planned to undergo laparoscopic radical resection of colorectal cancer in Changzhou Hospital of Traditional Chinese Medicine from March 2017 to March 2021 were selected as the research subjects, and they were divided into transversus abdominis plane block anesthesia group (group A) and dexmedetomidine combined with transversus abdominis plane block anesthesia group (group B) by random number table method with 36 cases in each group. The operation time, intraoperative blood loss, fluid supplementation, visual analogue score (VAS) and Ramsay sedation score at different times after operation, and serum CXCL8 level after operation were compared between the two groups of patients. The adverse reactions of the two groups of patients were compared.Results:There was no significant difference in operation time and fluid supplementation between the two groups (both P > 0.05). The VAS scores of patients in group B at 4, 8 and 24 hours after operation were lower than those in group A [(2.8±0.6) points vs. (4.2±1.2) points, (2.1±1.0) points vs. (3.4±1.1) points, (1.8±0.4) points vs. (2.5±0.7) points, all P < 0.05], and the Ramsay sedation scores of patients in group B at 4, 8 and 24 hours after operation were higher than those in group A [(4.3±1.2) points vs. (2.7±0.7) points, (3.5±1.1) points vs. (2.2±1.0) points, (2.4±0.9) points vs. (1.6±0.6) points, all P<0.05]. Serum CXCL8 levels of patients in group B at 2, 24 and 48 hours after operation were lower than those in group A [(78±16) ng/ml vs. (87±19) ng/ml, (68±14) ng/ml vs. (75±15) ng/ml, (52±10) ng/ml vs. (61±13) ng/ml, all P<0.05]. The incidence rates of adverse reactions in group A and group B were 8.3% (3/36) and 13.9% (5/36), and the difference was not statistically significant ( P > 0.05). Conclusions:Dexmedetomidine infusion during laparoscopic radical resection of colorectal cancer under general anesthesia combined with transversus abdominis plane block can help reduce postoperative pain, increase sedative effect, and reduce serum CXCL8 level.

ObjectiveTo study the clinical efficacy of Kegel on fecal incontinence in patients with anal endoscopic microsurgery.Methods Totally 60 patients with anal endoscopic microsurgery were randomly selected by purpose sampling method from October 2013 to June 2016,and they were divided into the control group and the observation group according to the random number table method,with 30 cases in each group. Patients in the control group received routine care,while patients in the observation group was trained by Kegel exercises before and after surgery. Incidence of fecal incontinence,anal function excellent rate and duration of fecal incontinence were observed and compared between two groups.Results The incidence rate of fecal incontinence in the observation group was 3.3%(1/30),while that of the control group was 23.3% (7/30) (P=0.052). The postoperative duration of fecal incontinence in the observation group was (3.3±0.5) d,while that of the control group was (5.3±2.4) d (t=4.468,P<0.05). Four days after surgery,the number of patients with good anal function in evaluation in the observation was 28,while that of the control group was 22 (Z=-2.020,P<0.05). ConclusionsKegel exercises before and after anal endoscopic microsurgery can effectively improve patients' anal function and shorten the duration of fecal incontinence. This method is simple,practical and can be widely used.

Objective The purpose of this study was to explore the early experience of elderly patients who had the Percutaneous Coronary Intervention (PCI) for the second time due to coronary restenosis, so as to provide targeted nursing interventions. Methods Nine elderly male patients underwent the second-time PCI were interviewed by using qualitative research method. Results The main experiences of these patients were as follows: obvious emotional disorder, rational intellectual curiosity, purposeful behavior modification and eager to obtain support from the family and society. Conclusions Nursing care for elderly male patients after the second-time PCI should involve mental care, knowledge, behavior, and family and social support.

Taking the reform of payment methods based on diagnosis related groups as an opportunity, implementing performance management based on disease groups is an important lever to promote the improvement of hospital diagnosis and treatment level and high-quality development. In 2023, a tertiary comprehensive hospital introduced benchmarking management into performance management, using the average days of stay, drug costs, and consumables costs of the disease group as cost benchmark indicators. The cost benchmark values for each disease group was determined based on the big data of the disease group of the tertiary comprehensive hospital in the region and the clinical pathway management goals of the hospital. Through multidimensional and multi-level comparative analysis of the hospital′s historical values and regional big data distribution values of the benchmark indicators for each disease group, the cost benchmark values for each disease group was determined. The hospital has established a performance reward and punishment mechanism based on the benchmark value of disease group costs, and at the same time, established a performance management communication mechanism to promote relevant departments and medical groups to improve their management against the benchmark. In addition, with changes in the external environment and internal practices, the cost benchmark value of the disease group was dynamically optimized, forming a closed-loop management system that included establishing benchmarks, comparing benchmarks, achieving benchmarks, and optimizing benchmarks. Since the implementation of performance management based on disease group cost benchmarking in March 2023, the hospital′s case mix index has increased from 1.52 in March to 1.54 in September; The average days of stay decreased from 6.22 days to 5.90 days; The monthly payment weight has increased from 18 103 to 18 558; The average hospitalization cost has decreased from 16 724 yuan/person to 15 278 yuan/person, mainly due to the decrease in drug and consumables costs. The proportion of drug costs has decreased from 27.45% to 26.32%, the proportion of consumables costs has decreased from 28.75% to 26.85%, and the proportion of medical service revenue has increased from 24.64% to 26.08%; The proportion of low magnification cases decreased from 9.09% to 8.24%; The medical insurance payment rate has increased from 99.3% to 107.0%; The job satisfaction of physicians has increased from 70.00% in 2022 to 76.77% in 2023, which can provide reference for performance management practices in other hospitals.