Objective:To apply the ORTCC (objective, rule, training, check, and culture) refined management model for the systematic management and overall construction of a specialty nurse team in a tertiary grade A general hospital, and to promote the cultivation and development of specialty nurses.Methods:The management framework of specialty nurses was investigated and a survey on their work was conducted. The ORTCC model was used to implement fine management of specialty nurses, including determining the integrated objective of "training, use, and management"(objective):, improving the rule system (rule), building a hierarchical training platform (training), streamlining the whole process check (check), and shaping the specialty nursing culture (culture). The effects were evaluated after one year of implementation.Results:After the implementation of ORTCC refined management, the number of specialty nurses increased to 367 in 2023, and a three-level progressive specialty nurse team was formed. The total and dimensional scores of perceived professional benefits ( P<0.001) and clinical competence ( P<0.001 or P<0.05) were higher than the scores in 2022. Additionally, 12 specialized nursing techniques were established, and six provincial or higher-level specialized quality improvement awards were obtained, further enhancing the capacity for specialized nursing services. Conclusions:The refined management practice of specialty nurses based on the ORTCC model provides a theoretical and practical basis for the hierarchical cultivation, effective use, and scientific management of specialty nurses in tertiary hospitals, thereby promoting specialty nurse team development and enhancing specialized service capacity.

Objective:To apply the ORTCC (objective, rule, training, check, and culture) refined management model for the systematic management and overall construction of a specialty nurse team in a tertiary grade A general hospital, and to promote the cultivation and development of specialty nurses.Methods:The management framework of specialty nurses was investigated and a survey on their work was conducted. The ORTCC model was used to implement fine management of specialty nurses, including determining the integrated objective of "training, use, and management"(objective):, improving the rule system (rule), building a hierarchical training platform (training), streamlining the whole process check (check), and shaping the specialty nursing culture (culture). The effects were evaluated after one year of implementation.Results:After the implementation of ORTCC refined management, the number of specialty nurses increased to 367 in 2023, and a three-level progressive specialty nurse team was formed. The total and dimensional scores of perceived professional benefits ( P<0.001) and clinical competence ( P<0.001 or P<0.05) were higher than the scores in 2022. Additionally, 12 specialized nursing techniques were established, and six provincial or higher-level specialized quality improvement awards were obtained, further enhancing the capacity for specialized nursing services. Conclusions:The refined management practice of specialty nurses based on the ORTCC model provides a theoretical and practical basis for the hierarchical cultivation, effective use, and scientific management of specialty nurses in tertiary hospitals, thereby promoting specialty nurse team development and enhancing specialized service capacity.

To summarize the nursing care of a patient with acute myocardial infarction complicated with cardiogenic shock before operation.The main nursing points are as follows:in the acute stage,the integrated rescue was implemented with rapid on-machine coordination of external cardiopulmonary resuscitation,multidisciplinary collaboration to ensure safe patient transport;during the bridging period,the combined operation care of extracorporeal membrane oxygenation,intra-aortic balloon counter pulsation and continuous kidney replacement therapy was carried out with goal-oriented anticoagulation care,prevention of catheter-related infection with the assistance of mechanical circulation,and neurological function monitoring.The patient successfully passed the waiting period for heart transplantation and underwent heart transplantation 21 days after admission.With the follow-up for 1 year,the patient recovered well.

The treatment and nursing experience of a patient with acute coronary syndrome with ketoacidosis and chronic gastric volvulus were summarized.The nursing points are as follows:dynamic assessment of chest pain,timely warning of disease changes,helping early identification of chest pain etiology;accurately monitoring hemodynamics,ensuring rapid fluid resuscitation,preventing heart failure;closely observation of bleeding and bleeding tendency,doing gastrointestinal bleeding care;phased posture therapy and cardiac rehabilitation to improve chronic gastric volvulus;applying positive dual intervention strategy and implementing psychological nursing.After active diagnosis and treatment and careful care,the patient was discharged smoothly after 20 d of hospitalization and followed up for 1 year in good condition.

Objective:Anterior cruciate ligament injury is the most common type of knee joint ligament injury.Anterior cruciate ligament reconstruction has a high failure rate,with bone tunnel abnormalities as the most significant factor in these failures.Digital orthopedic technology can effectively develop implementation plans for the revision,thus increasing the success rate.This study aims to develop a surgical plan for anterior cruciate ligament revision by employing multiplanar reconstruction(MPR)for measuring bone tunnel position and diameter,and simulating bone tunnel creation via 3D printing preoperatively. Methods:A total of 12 patients who underwent anterior cruciate ligament revision at the Third Xiangya Hospital of Central South University between 2014 and 2021 were retrospectively studied.The data included patient demographics,preoperative formulated knee joint 3D printing models,and preoperative knee CT scans.The study measured the bone tunnel's diameter and position to guide the establishment of revision bone tunnels during surgery,reassessed the postoperative bone tunnels,and evaluated knee joint functional scores[including International Knee Documentation Committee Knee Evaluation Form(IKDC)score,Lysholm score,and Tegner exercise level score]. Results:Preoperative measurements revealed suboptimal femoral tunnels positions in 4 patients and tibial tunnels positions in 2 patients.MPR and 3D printing technology were used to guide the establishment of a new bone canal during surgery,and postoperative measurements were satisfactory for all patients.Preoperative measurements demonstrated the interclass correlation coefficient for femoral tunnels and tibial tunnels diameters were 0.843(P<0.05)and 0.889(P<0.001),respectively.Meanwhile,the intraclass correlation coefficient were 0.811(P<0.05)and 0.784(P<0.05),respectively.The intraoperative diameter of femoral and tibial tunnels showed excellent correlation with postoperative CT measurements,with intraclass correlation coefficient values of 0.995(P<0.001)and 0.987(P<0.001),respectively.All bone tunnel positions were within the normal range.At the final follow-up,knee joint function scores in all 12 patients improved significantly compared to pre-surgery(P<0.001),and the reoperation rate was zero. Conclusion:MPR and 3D printing technology can accurately measure the parameters of reconstructed anterior cruciate ligament bone tunnels.Personalized revision plans for patients with reconstruction failure enhances the success rate of revision surgery and improves patient prognosis.

Objective To construct quality evaluation indicators for perioperative nursing in heart transplantation,and to provide standard and professional quantitative bases for monitoring and management of perioperative nursing quality.Methods This study was conducted based on the frame work of the three-dimensional"structure-process-outcome"quality model,using literature review,Delphi method and analytic hierarchy to determine the content of the indicators,and the weight of each index.Results A total of 22 experts from 14 qualified heart transplantation hospitals were included,and a total of 2 rounds of consultations were conducted.The effective recovery rates of 2 rounds of expert consultation questionnaires were 100％.The authority coefficients were 0.817.The variation coefficients of each item ranged from 0.025～0.169 and 0.039～0.157.The Kendall harmony coefficients were 0.126 and 0.225(P＜0.001).The final evaluation indicators for perioperative nursing quality in heart transplantation included 3 first-level indicators,12 second-lever indicators and 59 third-level indicators.Conclusion The evaluation indicators of perioperative nursing quality in heart transplantation was scientific,comprehensive and specialized,which can provide references for the evaluation of perioperative nursing quality in heart transplantation.

The treatment and nursing experience of a patient with acute coronary syndrome with ketoacidosis and chronic gastric volvulus were summarized.The nursing points are as follows:dynamic assessment of chest pain,timely warning of disease changes,helping early identification of chest pain etiology;accurately monitoring hemodynamics,ensuring rapid fluid resuscitation,preventing heart failure;closely observation of bleeding and bleeding tendency,doing gastrointestinal bleeding care;phased posture therapy and cardiac rehabilitation to improve chronic gastric volvulus;applying positive dual intervention strategy and implementing psychological nursing.After active diagnosis and treatment and careful care,the patient was discharged smoothly after 20 d of hospitalization and followed up for 1 year in good condition.

Objective:To explore the transition from hospital discharge to home care in heart transplant recipients based on the Meleis' transition theory, so as to provide a basis for improving the quality of life of recipients.Methods:In July 2021, purposeful sampling was used to select heart transplant recipients from the First Affiliated Hospital of Zhejiang University School of Medicine as the research subject. A total of 12 recipients of one year after heart transplantation were selected for semi-structured interviews by snowballing. The interview data were analyzed using the Colaizzi 7-step method.Results:Through reading, analysis, sorting and summarizing, 4 themes and 11 sub-themes were extracted, namely, relatively stable recovery of physical condition, lack of medication and emotional management (unmet needs for medication cognition and management, good physical condition, early emotional experience of vulnerability) , the support of family and social resources affected the transition (the communication and support of patients promoted the transition, the support of the family promoted the transition, the lack of community resources hindered the transition, and the reimbursement policy affected the transition) , a positive experience in the transition (confidence to deal with future life, return to society and self-realization) , and expecting to obtain comprehensive and continuous management of body and mind (the needs of nursing care centered on mental health, the needs of professional management teams and the communication platform among doctors, nurses and patients) .Conclusions:The experience of home self-care after discharge has many physical and psychological impacts on heart transplant recipients. It is necessary to pay attention to the recipients in the transition period, and to build a whole-of-society support system to give help to heart transplant recipients.

Objective:To explore the effect of nursery-led multidisciplinary evidence-based intervention in the management of anticoagulation in inpatients with oral warfarin.Methods:In this study, Quasi-experimental research was adopted. 478 patients were selected as the baseline review group on August 1st, 2019 and December 31th, 2019, and 494 patients were selected as the after-effect evaluation group on February 1st, 2020 and May 31th, 2020 in cardiovascular surgery and cardiovascular medicine. Established a multidisciplinary team, according to theoretical framework basing on the evidence of continuous quality improvement model, combining with evidence and clinical practice to develop evidence-based solutions, the comparison of international normalized ratio (INR) before and after the intervention in the percentage of time in therapeutic range (TTR) and anticoagulant related the incidence of complications.Results:Before and after the multidisciplinary evidence-based intervention, the mean TTR of the patients were (51.67±31.04)% and (64.34±26.37)%, with statistically significant differences ( tvalue was 6.958, P<0.01); the incidence of bleeding and embolization was not statistically significant ( χ 2values were 0.294 and 0.268, P>0.05). Conclusion:Nursing-led multidisciplinary evidence-based interventions can improve the intensity and stability of oral warfarin anticoagulant therapy in inpatients.

Objective:To summarize the nursing points of emergency heart transplantation in an elderly patient with fulminant myocarditis and acute myocardial infarction.Methods:Hemorrhage early warning care, cyclic goal-oriented care, rejection and staged care, infection prevention and control care, difficult ventilator weaning care, and individualized rehabilitation care were provided to elderly patient with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation in July 2020 in the First Hospital Affiliated to Zhejiang University and the effects were observed.Results:The patient's heart function recovered well after the transplantation, and no rejection reaction occurred. Before discharge, the patient was clear, active and optimistic, eating on his own, walking 300 meters in 6 minutes, and the vital signs were stable. One month after discharge, the patient was followed up to take care of himself and was in a stable mood.Conclusions:Carrying out bleeding prevention, circulatory care, rejection care, infection prevention and control care, ventilator difficulty weaning care and individualized rehabilitation care for elderly patients with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation are effective means to ensure the success of the operation and the recovery of patients after the operation.