Objective:To develop a network-structured clinical pathway grouping rule based on the principles and methods of China healthcare security diagnosis related groups(CHS-DRG), for references for optimizing clinical pathway management.Methods:From August to November 2024, this study constructed a network-structured clinical pathway management framework, followed the grouping principles of CHS-DRG, and developed a network-structured clinical pathway grouping rule through literature analysis and expert discussions. 54 clinical specialists from the sample hospital were organized and grouped according to the rule for the normal magnification cases(139 218 cases) of DRG medical insurance settlement in the hospital in 2023. Using a stratified random sampling method, 205 physicians from 54 clinical specialties in the hospital were selected to quantitatively evaluate the rationality, homogeneity, and clarity of the grouping results. The Likert 5-level scoring method was wsed to assign scores.Results:The network-structured clinical pathway grouping rule and nomenclature was established. A total of 341 main pathways and 35 sub-pathways covering 169 adjacent diagnosis related groups were formed. The quantitative assessment scores for rationality, homogeneity, and clarity were 4.90, 4.87 and 4.87 points, respectively.Conclusions:The network-structured clinical pathway grouping rule based on CHS-DRG had good, feasibility and standardization, and could meet the practical needs of clinical applications.

Objective:To develop a network-structured clinical pathway grouping rule based on the principles and methods of China healthcare security diagnosis related groups(CHS-DRG), for references for optimizing clinical pathway management.Methods:From August to November 2024, this study constructed a network-structured clinical pathway management framework, followed the grouping principles of CHS-DRG, and developed a network-structured clinical pathway grouping rule through literature analysis and expert discussions. 54 clinical specialists from the sample hospital were organized and grouped according to the rule for the normal magnification cases(139 218 cases) of DRG medical insurance settlement in the hospital in 2023. Using a stratified random sampling method, 205 physicians from 54 clinical specialties in the hospital were selected to quantitatively evaluate the rationality, homogeneity, and clarity of the grouping results. The Likert 5-level scoring method was wsed to assign scores.Results:The network-structured clinical pathway grouping rule and nomenclature was established. A total of 341 main pathways and 35 sub-pathways covering 169 adjacent diagnosis related groups were formed. The quantitative assessment scores for rationality, homogeneity, and clarity were 4.90, 4.87 and 4.87 points, respectively.Conclusions:The network-structured clinical pathway grouping rule based on CHS-DRG had good, feasibility and standardization, and could meet the practical needs of clinical applications.

Objective To explore the current status and influencing factors of subjective well-being (SWB) in student nurses so as to provide a basis for formulating corresponding countermeasures.Methods A total of 652 student nurses at a classⅢ grade A hospital in Wenzhou City were selected as subjects by chester sampling from January 2015 to January 2017. They were investigated with the general condition questionnaire and the Chinese version of the Warwick-Edinburgh mental well-being scale (WEMWBS) . Results The total score of WEMWBS was (51.29±9.34) with a middle level in student nurses. Belief, self-report character, sexes, annual household income, body mass index had influences on SWB of student nurses (P<0.01).Conclusions The level of SWB of student nurses needs to be improved. Nurse educators and managers should pay high attention to mental health of student nurses and take positive measures to improve the SWB of student nurses so as to stabilize the construction of nursing team.

Objective To explore the influence of double tutor teaching model on nursing students'ideological quality and comprehensive ability cultivation in nursing clinical teaching. Methods From July 14th,2015 to April 24th,2016,a total of 136 full-time undergraduate nursing students in the Second Affiliated Hospital of Wenzhou Medical University were randomly divided into experimental group (n=68) and control group (n=68) according to random number table method. Post tutor teaching mode was applied as clinical teaching method in the control group,while double tutor teaching mode was administered in the experimental group. Theory,nursing intervention had been tested in each ward during internship for both two groups as well as a unified practice examination form for comprehensive evaluation. Results Theoretical score,operation score,comprehensive evaluation,general scores of the experimental group students were higher than those of the control group (t=27.52,14.82,13.89,14.95;P<0.01). Conclusions Application of double tutorial system teaching mode in clinical nursing practice is conductive to improve theoretical knowledge,operation skills,strengthen the ideological quality of nursing students as well as to elevate their ability of observation,learning,adaptation and communication.

Objective To evaluate the applicability of the Chinese version of SF-36 ( v. 2 ) scale for evaluating the quality of life of hospitalized patients with chronic heart failure. Methods From September 2013 to December 2014, 159 patients with chronic heart failure(NYHA I-IV), who were older than 18 years, clear mind and well self-expressed, were selected as participants. Questionnaire surveys included general survey and SF-36(v. 2) scale. Internal consistency reliability, binary reliability and construct validity were all analyzed as indicators to evaluate SF-36 ( v. 2 ) scale. Results A total of 159 questionnaires were issued and 159 valid questionnaires were recovered. The eight dimensions of SF-36(v. 2) scale including physical function (PF), role-physical (RP), bodily pain (BP), general health (GH), social function (SF), vitality (VT), role-emotion(RE), and mental health (MH) score conversion were (41.57 ±24.86), (48.35 ±21.64), (69.18 ± 25. 68), (31. 28 ± 16. 01), (48. 90 ± 19. 53), (45. 05 ± 22. 76), (59. 43 ± 24. 31), (57. 55 ± 19. 03); the floor effects were 2. 5%, 4. 4%, 3. 1%, 4. 4%, 3. 1%, 6. 3%, 0. 6%, 1. 3%; the ceiling effects were 0. 0%, 3. 8%, 21. 4%, 0. 0%, 0. 0%, 1. 9%, 3. 1%, 0. 0%. The item-convergent validity all achieved the standard (r≥0. 4), and the total scaling success rate of item-convergent was 100. 00%; the dimensions′success rates of item-discriminant validity of RP, BP, RE and SF were all 100%, the rest of four dimensions were PF 95. 71%, GH 85. 71%, VT 89. 29%, MH 94. 29%, and the total success rate was 94. 69%. Internal consistency reliability ranged from 0. 738 to 0. 919; the binary reliability ranged from 0. 808 to 0. 963. Within factors analysis, two common factors were confirmed, separately representing physical health and mental health, altogether making contribution of 61. 66% cumulative variance. Conclusions As the revision of SF-36(v. 1), SF-36(v. 2) scale seemed more friendly in layout for questions and answers, the floor and ceiling effects significantly reduced. Additionally, it also shows good reliability and validity in the evaluation of quality of life of hospitalized patients with chronic heart failure, and the SF-36(v. 2) scale can be used to evaluate the quality of life ( QOL) of patients with chronic heart failure.

Objective To explore the influence of the dual tutorial teaching mode on the undergraduate
nursing students′ critical thinking in the clinical training. Methods Two hundred and sixteen full-time undergraduate nursing students who did internships in the second Affiliated Hospital of Wenzhou Medical University from September 1st, 2013 to September 1st, 2015 were divided into the experimental group ( n=111) and the control group ( n=105) using the random number table. The nursing students in the control group received the traditional post tutor teaching mode, while the nursing students in the experimental group received the dual tutorial system teaching mode in the clinical teaching. After the internship, nursing students in the two groups completed the general information questionnaire and the critical thinking disposition inventory.Results The scores of critical thinking ability, open-minded ability, analytical ability, systematic ability, critical thinking self-confidence, curiosity, cognitive maturity dimension of the nursing students in the experimental group were (280.32±29.83), (40.53±5.75), (43.08±5.32), (37.69±6.08), (40.16±5.60), (43.89±6.71), (38.53± 7.17) respectively, which were significantly higher than the scores gained by the nursing students in the control group (t=-7.587, -6.138, -8.555, -3.530, -6.727, -8.023, -3.097;P<0.05).In the control group, they were (210.63±25.25), (29.86±6.31), (26.61±5.71), (32.19±6.17), (28.76±5.82), (25.96±6.53), (32.99±7.41), respectively.Conclusions The dual tutorial teaching mode improves undergraduate nursing trainees′critical thinking ability including open-minded ability, analytical ability, systematic ability, critical thinking self-confidence, curiosity, cognitive maturity, which can be applied in the clinical teaching of nursing students.