Objective:To summarize the best evidence for early enteral nutrition support in postoperative patients with gastric cancer and evaluate its effectiveness.Methods:From March to August 2021, 108 postoperative patients with gastric cancer admitted to the Gastrointestinal Surgery of the First Affiliated Hospital of Ningbo University were selected. We applied evidence-based nursing methods to summarize the best evidence for early enteral nutrition support in postoperative gastric cancer patients, and constructed and implemented the best evidence application strategy through baseline review, evaluation of evidence application clinical scenarios and barriers. We compared the various indicators of two groups of patients before the application of evidence (March to May 2021, n=55) and after the application of evidence (June to August 2021, n=53) . Results:No adverse events occurred during the application of evidence. After applying evidence, the correct nutritional assessment rate increased from 41.82% (23/55) at baseline review to 90.57% (48/53), the implementation rate of early postoperative enteral nutrition increased from 0 to 45.28% (24/53), the start time of postoperative enteral nutrition shortened from (3.75±2.33) days to (2.06±1.38) days, and the implementation rate of postoperative priority oral nutrition increased from 63.64% (35/55) to 86.79% (46/53), nutritional related complications decreased from 40.00% (22/55) to 20.75% (11/53), and the differences were all statistically significant ( P<0.05) . Conclusions:The application of the best evidence for early enteral nutrition support in postoperative gastric cancer patients can shorten the start time of postoperative enteral nutrition, reduce postoperative nutrition related complications, and promote early recovery of patients.

Objective:To retrieve relevant evidence for early enteral nutrition support in patients after gastric cancer surgery and summarize the best evidence, so as to provide evidence-based evidence for clinical implementation of postoperative enteral nutrition management for gastric cancer.Methods:Evidence-based questions were established according to PIPOST principles, UpToDate, Cochrane Library, Joanna Briggs Institute Library, BMJ Best Practice, Agency for Healthcare Research and Quality website, Medlive, European Society for Clinical Nutrition and Metabolism website, American Society for Parenteral and Enteral Nutrition website, Embase, Medline, PubMed, SinoMed, Wanfang Database, China National Knowledge Infrastructure were searched according to the "6S" evidence model. The retrieval period of every database was from January 1, 2016 to May 31, 2021. The Evidence Pre-Grading and Evidence Recommendation Grading System (2014) of Australian Joanna Briggs Institute Evidence-Based Health Care Center was used to extract evidence from the literature that met the quality standards, determine the evidence grading and recommendation level and form the best evidence.Results:A total of 317 literatures were retrieved, and 10 literatures were included, including 1 guideline, 4 expert consensus and 5 systematic reviews. The 10 evidences were summarized from 4 aspects, including indication evaluation, timing management, route and preparation management and risk management.Conclusions:Current evidence shows that early enteral nutrition is safe and feasible in patients after gastric cancer surgery. In the process of implementing enteral nutrition, medical staff should fully evaluate the indications and needs of patients and make clear and prudent choices for nutritional support channels and preparations of patients, so as to form the best evidence and clinical management programs for early enteral nutrition support for patients after gastric cancer surgery and accelerate postoperative recovery of patients.

Objective:To build enhanced recovery after surgery (ERAS) ward management system based on the staff, stuff, structure space and systems (4S) management model, and explore the implementation effects of accelerated rehabilitation nursing management.Methods:A retrospective analysis was carried out on the implementation process of ERAS before 2020 in the Department of Hepatobiliary and Pancreatic Surgery, Ningbo First Hospital, Zhejiang Province. It was found that there were problems such as imperfect multidisciplinary team personnel, lack of systems, and lack of standardized process implementation rules. In April 2020, we created an ERAS ward based on the concept of 4S management model, improved the multi-disciplinary professional staff, equipment and venues, and formulated an ERAS ward system process. Patients undergoing ERAS in Hepatobiliary and Pancreatic Surgery Department from April to September 2019 were selected as the control group (383 cases of gallbladder surgery and 59 cases of liver surgery) , and patients admitted to the ERAS ward from April to September 2020 were selected as the experimental group (332 cases of gallbladder surgery and 72 cases of liver surgery) . The satisfaction, average length of hospitalization, hospitalization expenses and complication rate of the two groups of patients were compared, and doctors and nurses' specification implementation rate of the ERAS ward was counted.Results:The average length of hospitalization of patients with gallbladder surgery and liver surgery in the experimental group was shorter than that of the control group, and the hospitalization expenses were lower than those of the control group, and the differences were statistically significant ( P<0.01) . The complication rate (9.9%, 33/332) of patients undergoing gallbladder surgery in the experimental group was lower than that (16.7%, 64/383) in the control group, and the difference was statistically significant ( P<0.01) . The satisfaction of patients in the experimental group was higher than that in the control group, and the difference was statistically significant ( P<0.01) . The specification implementation rate of doctors and nurses was 96.7% (58/60) . Conclusions:The ERAS ward is based on the scientific supervision of staff, stuff, structure space and systems according to the concept of 4S management model, which is conducive to the comprehensive and standardized implementation of ERAS treatment and nursing, improves patient clinical outcomes and increases patient satisfaction.

Objective:To explore the effect of narrative video combined with teach-back method on full-time caregivers' knowledge, attitude and practice level of preventing aspiration.Methods:The convenient sampling method was used to select full-time caregivers from a ClassⅢ Grade A hospital as the research objects. A total of 89 full-time caregivers from July to August 2018 were set as the control group, and 76 full-time caregivers from October to November 2018 were set as the observation group. The control group adopted conventional health education, while the observation group adopted narrative video combined with teach-back method to carry out aspiration prevention education on the basis of the control group. The scores of knowledge, attitude and practice of the two groups were compared.Results:The knowledge score of the observation group was 44 (37, 49) , higher than 39 (31, 45.5) of the control group, and the difference was statistically significant (Z=-3.463, P<0.01) . The attitude score of the observation group was 50 (45, 54) , which was higher than 44 (44, 52) of the control group, and the difference was statistically significant ( Z=-3.566, P<0.01) . The practice score of the observation group was 47 (41, 51) , which was higher than 41 (35, 53) of the control group, and the difference was statistically significant ( Z=-2.462, P<0.05) . Conclusions:The narrative video combined teach-back method is an effective form of health education, which helps to improve knowledge, attitude, behavior levels of preventing aspiration and clinical care ability of full-time caregivers.

Objective:To develop bundled and continuous nursing measures for patients during daytime chemotherapy after gastric cancer surgery and explore its effects.Methods:Literature search, expert consultation and field visits were used to understand the needs of patients during daytime chemotherapy after gastric cancer surgery, specify the corresponding measures, and determine the final evidence-based bundled and continuous nursing measures. Totally 62 patients undergoing the first chemotherapy after gastric cancer surgery from May to December 2018 were included into the control group, and 53 patients undergoing the first chemotherapy after gastric cancer surgery from January to July 2019 were included into the intervention group. Patients in the control group received conventional continuous nursing, while patients in the intervention group received evidence-based bundled and continuous nursing. The laboratory tests and chemotherapy compliance during the eight chemotherapy treatments were compared between the two groups of patients, and the quality of life and satisfaction with the medical and nursing staff after the eight chemotherapy treatments of the two groups of patients were observed.Results:After the implementation of evidence-based bundled and continuous nursing measures, the compliance of the intervention group was higher than that of the control group ( P<0.05) . There were statistically significant differences in the quality of life between the two groups, except for cognitive function, sleep and economic status ( P<0.05) . The satisfaction with the medical and nursing staff in the control group was 79.03% (49/62) lower than 92.45% (49/53) in the intervention group, and the difference between the two groups was statistically significant ( P<0.05) . Conclusions:The evidence-based bundled and continuing nursing measures can improve the compliance, quality of life and satisfaction with the medical nursing staff in patients undergoing the first chemotherapy after gastric cancer surgery.

Objective: To explore the effect of early enteral nutrition(EEN) and parenteral nutrition(PN) on the postoperative outcomes of patients with gastric cancer and nutritional risk in enhanced recovery after surgery. Methods: A total of 130 patients with gastric cancer hospitalized in department of surgery of Ningbo First Hospitalfrom September 2016 to May 2018 were selected and divided into early enteral nutrition support group (EEN) which was placed with jejunal nutrition tube during the operation, and enteral nutrition started within 12-24 hours after the operation, and parenteral nutrition support group (PN) which was given parenteral nutrition support one day after surgery. Patients in both groups were given nutrients of equal heat and nitrogen.The incidence of nutrition-related complications, the incidence of infection-related complications, the length of postoperative hospital stay and the time of anal exhaust were compared between the two groups. Results: The incidence of nutrition-related complications was 10 cases (15.38%) and 4 cases (6.15%)in EEN group and PN group, that was not statistically different (P=0.157). The incidence of infection-related complications was 3 cases (4.61%) and 5 cases (7.69%) in EEN group and PN group, that was not statistically different (P=0.715). The postoperative hospital stay was 11 days (range, 10-15) and 12 days (range, 11-13)in EEN group and PN group, that was not statistically different (P=0.233). The first anal exhaust time and defecation timewere 64 hours (range, 52-77) and 87 hours (range, 76-100) in EEN group and 72 hours(range, 60-86) and 96 hours(range, 86-120) in PN group, that was statistically different(P=0.001, P=0.034). Conclusion Enhanced recovery after surgery, early enteral nutrition after gastric cancer surgery may promote the recovery of intestinal function, but the complications and hospital stay after operation are not improved.

Objective To explore the clinical effect of applying standard process management in early enteral nutrition support for elderly patients with gastric cancer after operation. Methods A total of142 elderly patients with gastric cancer in our hospital were randomly divided into control group ( n=71) treated with the traditional nursing of enteral nutrition and intervention group ( n=71) adopting the standardized process man-agement, and then enteral nutrition tolerance, complications, nutritional status and recovery of gastrointestinal function were compared between the two groups. Results There was no significant difference in age, sex and preoperative nutritional condition and operation situation between the two groups ( P>0. 05) . The incidence of nutritional intolerance and the cost of nutritional support were lower than those in the control group ( P<0. 05) . The completion rate of enteral nutrition target in the intervention group was significantly higher than that in the control group ( P<0. 05) . The anal exsufflation time and defecation time of patients in the intervention group were shorter than those in the control group ( P<0. 05) . There was no significant difference in pulmonary infec-tion, incision infection and postoperative hospital stay between the two groups ( P>0. 05 ) . Conclusions Standardized process management of early enteral nutrition after operation could significantly improve the toler-ance of enteral nutrition, meanwhile, it has positive significance in promoting rapid recovery of elderly patients with gastric cancer.

Objective? To construct a nursing intervention model based on the theory of planned behavio(r TPB), to prevent deep venous thrombosis (DVT) of lower extremities, and to explore its application in patients with gastrointestinal cancer after operation. Methods? By convenience sampling, a total of 163 patients admitted in the Department of Gastrointestinal Surgery, Ningbo First Hospital, Zhejiang Province who underwent gastrointestinal surgeries from January to December in 2018 were selected as the research objects in this study. The 79 patients admitted from January to June in 2018 were taken as the control group and the conventional perioperative DVT prevention nursing care was given. The other 84 patients admitted from July to December in 2018 were taken as the observation group and the TPB based DVT nursing intervention model was adopted. The two groups were compared in terms of the patient's scores in cognition about DVT, postoperative ankle pump movement, quadriceps femoris movement, first out-of-bed activity within 24 hours and compliance with walking target volume within 3 days after surgery, as well as the number of cases of DVT during hospitalization after surgery. Results? The score of DVT knowledge in the observation group was higher than that in the control group; the compliance of ankle pump movement, quadriceps femoris movement and the proportion of patients getting out of bed for the first time within 24 hours after operation in the observation group were higher than those in the control group; the differences between the two groups were statistically significant (P＜0.05). The rate of achieving 500 m walking goal in the observation group was higher than that in the control group 3 days after operation, but there was no significant difference between the two groups (P＞0.05). There were 7 cases of DVT in control group and 1 case in observation group after operation, and there was statistically significant difference between the two groups (P＜0.05). Conclusions? The DVT nursing intervention model based on TPB is helpful to improve the cognitive level of DVT in patients undergoing gastrointestinal cancer surgery, improve the compliance of lower limb activities and early ambulation, and reduce the incidence of DVT after surgery, establish good healthy behavior for patients undergoing gastrointestinal cancer surgery and effectively prevent DVT.

Objective? To explore the application effects of bundle care strategy to enhanced recovery after surgery (ERAS) based on evidence-based nursing practice for patients with gastric cancer during perioperative period. Methods? From July 2017 to June 2018, a total of 100 patients undergoing radical gastrectomy in Ningbo First Hospital were selected and divided into control group and observation group according to admission time, with 50 cases in each group. The control group received routine enhanced recovery nursing based on guidelines. Bundles of care was determined and implemented in the observation group based on the embodiment of ERAS after literature review combined with expert consultation. The first anal exhaust time, defecation time, ambulation time, hospitalization days, ADL score on the third day after operation, pain score at 24 and 48 hours after operation, and complications of infection were compared between the two groups. Results? The first anal exhaust time, defecation time and ambulation time of the observation group were 66 (53,78) h, 88 (76,100) h and 29 (24,36) h, which were all lower than those of the control group [72 (60,90) h, 96 (82,120) h and 36 (24,48) h], and the differences were statistically significant (P＜0.05). The ADL score on the third day after operation was (65.88±14.37), which was higher than that of the control group (59.18±14.31), and the difference was statistically significant (P＜0.05). The hospitalization duration of the observation group was 11 (10,12) days, which was shorter than that of the control group 12 (11,13) days, and the difference was statistically significant (P＜0.05). There was no statistical significance in the difference in the pain score at 24 and 48 hours after operation and the complications of infection between the two groups (P＞0.05). Conclusions? Bundle care strategy of enhanced recovery after surgery for patients with gastric cancer can promote postoperative gastrointestinal function recovery, improve postoperative self-care ability and shorten postoperative hospital stay.

Objective To explore the effects of patient-participating nursing mode in improving the nursing quality for chemotherapy patients in day-care ward. Methods A total of 80 cases of chemotherapy patients in the Day-care Ward of Ningbo First Hospital from April to September 2017 were selected and randomly divided into control group and observation group, with 40 patients in each group. Routine nursing care was applied in the control group. On the basis of routine nursing, patient-participating nursing mode was applied in the experimental group. The safety of intravenous chemotherapy (venous exudation and phlebitis), patient satisfaction and quality of life of the two groups were observed and compared. Results The incidences of phlebitis, venous exudation and patient satisfaction of the control group were 22.5%, 5.0% and 80.0% respectively. Those of the observation group were 15.0%, 0% and 97.5% respectively, and the differences were statistically significant (P< 0.05). After the application of patient-participating nursing mode, the patients in the observation group were superior to the control group in their overall condition, body, role, cognition, emotion and social support. The scores of fatigue, insomnia, loss of appetite, diarrhea and constipation were lower than those of the control group, and the differences were statistically significant (P<0.05). There were no statistical differences in the incidences of nausea and vomiting, pain and shortness of breath (P> 0.05). Conclusions Patient-participating nursing mode is conducive to improve the safety and effectiveness of intravenous chemotherapy, reduce the adverse reactions of chemotherapy, and improve patient satisfaction and quality of life to some extent.