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中国实用护理杂志
中国实用护理杂志

王国强

旬刊

1672-7088

huli@yizhe.net

0411-82490723

116013

辽宁省大连市西岗区南石道街丙寅巷3号

中国实用护理杂志/Journal Chinese Journal of Practical Nursing北大核心CSTPCD
查看更多>>中华人民共和国卫生部主管，中华医学会、大连理论医学研究所主办。本刊是国内外公开发行的，《中文核心期刊要目总览》临床医学/特种医学类核心期刊。被“万方数据库”收录。本刊宗旨是“突出实用，面向基层，传递护理学术信息，提高护理理论与技术水平，促进护理学科发展”。报道护理领域的科研成果和护理经验以及对临床护理有指导作用，且与临床护理密切结合的基础理论研究，体现科学性、实用性、新颖性、信息性的统一。主要读者对象为基层护理人员、管理人员及护理学院(系)教师、学生。
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    提高理论技术水平　促进护理学科发展

    武雄飞
    1页
    查看更多>>摘要：神州春潮奔涌，华夏龙瑞恒旺。值此新春佳节到来之际，我谨代表《中国实用护理杂志》向长期关注和支持《中国实用护理杂志》的编委、专家、读者、作者和各界朋友们致以衷心的感谢和诚挚的祝福！
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    分阶段主题绘画疗法对儿童情绪障碍患者应用效果的类实验研究

    陈娟陈翼飞钟慧黄闻...
    2-7页
    查看更多>>摘要：目的 探讨分阶段主题绘画疗法对儿童情绪障碍患者正性情绪、述情障碍及自我效能感的改善效果。 方法 采用类实验研究方法，便利抽样选择安徽医科大学附属心理医院儿童青少年心理科2022年1—12月收治的61例儿童情绪障碍患者为研究对象，按入院时间将2022年1 — 6月入院的31例患者列为对照组，2022年7 — 12月入院的30例患者列为观察组。对照组给予精神科常规护理，观察组在此基础上实施分阶段主题绘画疗法，干预时间6周。采用正性负性情绪量表、多伦多述情障碍量表及一般自我效能感量表对2组干预前后正性情绪、述情障碍、自我效能感进行评价。 结果 对照组男15例，女16例，年龄（14.19 ± 1.79）岁；观察组男13例，女17例，年龄（14.47 ± 1.55）岁。2组基线资料比较差异无统计学意义（P>0.05），具有可比性。2组患者干预前正性情绪、述情障碍、自我效能感比较差异均无统计学意义（均P>0.05）。干预后，观察组患者正性情绪和自我效能感得分分别为（43.20 ± 7.41）、（31.88 ± 5.42）分，均高于对照组的（33.81 ± 6.92）、（21.24 ± 5.41）分，差异均有统计学意义（t=-6.19、-5.63，均P<0.05）；干预后，观察组述情障碍总分为（53.44 ± 4.68）分，低于对照组的（60.44 ± 5.52）分，差异有统计学意义（t=-8.72，P<0.05）。 结论 分阶段主题绘画疗法可以有效提高儿童情绪障碍患者的正性情绪和自我效能感，改善其述情障碍水平，帮助其建立战胜疾病的信心，具有较好的临床实用性。 Objective To explore the effects of staged thematic painting therapy on positive emotions, alexithymia and self-efficacy in children with emotional disorders. Methods This was a quasi-experimental study. By convenient sampling, 61 children with emotional disorders admitted from January 2022 to December 2022 to the Department of Child and Adolescent Psychology, Affiliated Psychological Hospital of Anhui Medical University were selected as the research objects, 31 patients admitted from January 2022 to June 2022 were listed as the control group and 30 patients admitted from July 2022 to December 2022 were listed as the observation group according to the time of admission.The control group was given routine psychiatric care, and the observation group was given staged thematic painting therapy on this basis. The intervention time was 6 weeks. The intervention effect was evaluated by Positive and Negative Affect Scale,Toronto Alexithymia Scale, and General Self-Efficacy Scale. Results There were 15 males and 16 females in the control group, aged (14.19 ± 1.79) years old. There were 13 males and 17 females in the observation group, aged (14.47 ± 1.55) years old. The difference in baseline data between the two groups was not statistically significant (P>0.05) and was comparable. There was no significant difference in the score of positive emotions, alexithymia and self-efficacy before intervention between the two groups (allP>0.05). After intervention, the scores of positive emotions and self-efficacy in the observation group were (43.20±7.41), (31.88 ± 5.42) points, which were higher than those in the control group (33.81 ± 6.92), (21.24 ± 5.41) points, the differences were statistically significant (t=-6.19, -5.63, both P<0.05). After intervention, the scores of alexithymia in the observation group was (53.44 ± 4.68) points, which was lower than that in the control group (60.44 ± 5.52) points, the difference was statistically significant (t=-8.72, P<0.05). Conclusions Staged thematic painting therapy can effectively improve the positive emotions, self-efficacy and alexithymia level of children with emotional disorders, help the patients establish confidence to overcome the disease. It is valuable in clinical practice.

    儿童情绪障碍绘画疗法正性情绪述情障碍

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    不同胃黏膜准备方案对无痛胃镜检查质量的影响

    石亚男张晓王燕时文萍...
    8-12页
    查看更多>>摘要：目的 分析不同胃黏膜准备方案对无痛胃镜检查质量的影响，为制订胃黏膜准备方案提供参考。 方法 采用前瞻性、随机对照研究方法，便利抽样选取2021年3月至2022年12月在山西省运城市中心医院接受无痛胃镜检查的150例患者为研究对象，按照随机数字表法分为对照组、清水组和苏打水组，每组50例。3组患者均于检查前口服链霉蛋白酶+二甲硅油+碳酸氢钠溶液。对照组：检查前4 h禁饮；清水组：检查前2 h饮用纯净水200 ml；苏打水组：检查前2 h饮用苏打水200 ml。比较3组患者胃黏膜清晰度评分以及微小病灶检出率。 结果 对照组男28例，女22例，年龄（47.62 ± 13.83）岁；清水组男30例，女20例，年龄（44.68 ± 13.61）岁；苏打水组男24例，女26例，年龄（46.92 ± 12.79）岁。3组患者食管、胃体、胃窦黏膜清晰度评分以及黏膜清晰度总评分比较差异均有统计学意义（F值为3.68～25.75，均P<0.05）。两两比较：对照组食管、胃窦黏膜清晰度评分以及黏膜清晰度总评分分别为（1.87 ± 0.58）、（1.37 ± 0.34）、（6.72 ± 0.92）分，高于清水组的（1.47 ± 0.41）、（1.18 ± 0.31）、（5.97 ± 0.86）分和苏打水组的（1.42 ± 0.41）、（1.02 ± 0.22）、（5.50 ± 0.79）分，差异均有统计学意义（t值为2.67～5.95，均P<0.05）；清水组胃窦黏膜清晰度评分和黏膜清晰度总评分高于苏打水组，差异均有统计学意义（t=7.11、2.71，均P<0.05）；对照组胃体黏膜清晰度评分为（1.98 ± 0.74）分，高于苏打水组的（1.64 ± 0.54）分，差异有统计学意义（t=2.66，P<0.05）。对照组胃镜检查时间、冲洗次数分别为（135.20 ± 21.60） s、（1.37 ± 0.43）次，清水组分别为（115.52 ± 14.74） s、（0.90 ± 0.29）次，苏打水组分别为（107.48 ± 13.02） s、（0.62 ± 0.23）次，对照组高于清水组和苏打水组，清水组高于苏打水组，差异均有统计学意义（t值为2.38～11.40，均P<0.05）。3组微小病灶检出率比较差异均无统计学意义（均P>0.05）。 结论 无痛胃镜检查前2 h饮用苏打水可明显改善患者胃黏膜清晰度，缩短检查时间，减少冲洗次数，但未明显提高微小病灶检出率。 Objective To analyze the effect of different gastric mucosa preparation programs on the quality of painless gastroscopy, so as to provide reference for developing mucosal preparation programs. Methods This was a prospective, randomized controlled study. A total of 150 patients with painless gastroscopy from March 2021 to December 2022 in Shanxi Yuncheng Central Hospital were selected by convenience sampling in this study, they were assigned to control group, water group, and soda water group by random digits table method, each group contained 50 patients. All patients received oral administration of pronase + dimeticone + sodium bicarbonate solution. In addition, control group: prohibited from drinking 4 hours before examination water group: drinking 200 ml of pure water 2 hours before examination and soda water group: drinking 200 ml of soda water 2 hours before examination. The clarity score of gastric mucosa and the detection rate of small lesions were compared among the three groups. Results There were 28 males and 22 females in the control group, aged (47.62 ± 13.83) years old. There were 30 males and 20 females in the water group, aged (44.68 ± 13.61) years old. There were 24 males and 26 females in the soda water group, aged (46.92 ± 12.79) years old. The difference of esophagus, gastric body, gastric antrum and total mucosal clarity scores among the three groups were statistically significant (F values were 3.68-25.75, all P<0.05). Multiple comparison showed that the esophagus, gastric antrum and total mucosal clarity scores were (1.87 ± 0.58), (1.37 ± 0.34), (6.72 ± 0.92) points in the control group, which were higher than (1.47 ± 0.41), (1.18 ± 0.31), (5.97 ± 0.86) points in the water group, and (1.42 ± 0.41), (1.02 ± 0.22), (5.50 ± 0.79) points in the soda water group, the differences were statistically significant (t values were 2.67-5.95, all P<0.05). The gastric antrum and total mucosal clarity scores in the water group were higher than in the soda water group, the differences were statistically significant (t=7.11, 2.71, both P<0.05). The gastric body mucosal clarity score was (1.98 ± 0.74) points in the control group, which was higher than (1.64 ± 0.54) points in the soda water group, the difference was statistically significant (t=2.66, P<0.05). The gastroscopy examination time and flushin times were (135.20 ± 21.60) s and (1.37 ± 0.43) times in the control group, while (115.52 ± 14.74) s, (0.90 ± 0.29) times and (107.48 ± 13.02) s, (0.62 ± 0.23) times in the water group and soda water group, the control group was higher than the water group and the soda water group, and the water group was also higher than the soda water group, the differences were statistically significant (t values were 2.38-11.40, all P<0.05). However, there was no statistically significant difference in the detection rate of small lesions among the three groups (allP>0.05). Conclusions Drinking soda water 2 hours before painless gastroscopy can significantly improve the clarity of patients′gastric mucosa, shorten the examination time and reduce flushing times, but it does not improve the detection rate of small lesions.

    胃镜检查链霉蛋白酶二甲硅油苏打水胃镜视野

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    基于信息-知识-信念-行为模式的护理干预在肿瘤放疗患者预防放射性皮炎中的应用效果研究

    张俊萍董新寨李铮赵芳...
    13-19页
    查看更多>>摘要：目的 探讨基于信息-知识-信念-行为（IKAP）模式下的护理干预对于肿瘤放疗患者预防放射性皮炎的影响。 方法 采用类实验研究方法，便利抽样选取2022年8—10月山西医科大学第二医院肿瘤科接受放疗的72例肿瘤患者为研究对象，运用随机数字表法分成试验组和对照组各36例。对照组采取常规皮肤护理，试验组则基于IKAP模式进行护理，并于放疗前1 d和结束时评估2组患者的自我管理效能感、放射性皮炎、自我感受负担以及皮肤病生命质量指数情况。 结果 每组各有35例患者完成研究。对照组男11例，女24例，年龄（58.09 ± 7.33）岁；试验组男13例，女22例，年龄（58.06 ± 7.28）岁。干预前2组患者的自我管理效能感、自我感受负担、皮肤病生命质量指数评分比较差异均无统计学意义（均P>0.05），干预后试验组患者的自我管理效能感、自我感受负担、皮肤病生命质量指数得分分别为（106.89 ± 3.78）、（18.69 ± 2.21）、（8.09 ± 1.27）分，对照组分别为（80.69 ± 5.76）、（29.97 ± 2.48）、（15.91 ± 2.37）分，2组比较差异均有统计学意义（t=2.50、1.12、7.24，均P<0.01）。试验组放射性皮炎2级以上发生率低于对照组，分别为31.4%（12/35）、60.0%（21/35），差异有统计学意义（χ2=4.64，P<0.01）。 结论 基于IKAP模式的护理干预可以提高肿瘤放疗患者的自我管理效能感，降低其自我感受负担，降低放射性皮炎的发生率，进一步改善患者的生命质量。 Objective To explore the effect of nursing intervention based on information-knowledge-attitude-practice model (IKAP) in preventing radiodermatitis in tumor radiotherapy patients. Methods This was a quasi-experimental study. A total of 72 patients who received radiotherapy in the Department of Oncology, the Second Hospital of Shanxi Medical University from August to October 2022 were selected and divided into the experimental group and the control group with 36 patients in each group by randomized digits table method. The control group received routine nursing, while the experimental group received nursing based on the IKAP. The self-management efficacy, radiodermatitis, self-perceived burden and quality of life of patients in the two groups were evaluated one day before and at the end of radiotherapy. Results Thirty-five patients from each group completed the study. There were 11 males and 24 females in the control group, aged (58.09 ± 7.33) years old. There were 13 males and 22 females in the experimental group, aged (58.06 ± 7.28) years old.There was no statistically significant difference in self-management efficacy, self-perceived burden, and quality of life scores between the two groups of patients before intervention (all P>0.05). After intervention, the self-management efficacy,self-perceived burden, and quality of life scores of the experimental group were (106.89 ± 3.78), (18.69 ± 2.21), and (8.09 ± 1.27) points, respectively, the control group was (80.69 ± 5.76), (29.97 ± 2.48), and (15.91 ± 2.37) points, respectively. The differences between the two groups were statistically significant (t=2.50, 1.12, 7.24, all P<0.01). The incidence of radiodermatitis above grade 2 in the experimental group was 31.4%(12/35), which was lower than 60.0%(21/35) in the control group, the difference was statistically significant (χ2=4.64, P<0.01). Conclusions Nursing intervention based on IKAP can improve the self-management efficacy, reduce the self-perceived burden and the incidence of radiodermatitis, and further improve the quality of life of tumor radiotherapy patients.

    护理放射性皮炎自我管理信息-知识-信念-行为模式放疗

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    不同雾化时机对无创通气治疗的慢性阻塞性肺疾病急性加重患者的效果比较

    徐静娟杨燕刘艳姚莉...
    20-26页
    查看更多>>摘要：目的 对比无创间歇期雾化与无创同时雾化对慢性阻塞性肺疾病急性加重患者雾化过程中经皮二氧化碳分压（PtCO2）动态变化及治疗效果的影响。 方法 采用随机平行对照试验方法，便利抽样选取2021年10月至2022年9月常州市第一人民医院收治慢性阻塞性肺疾病急性加重患者70例，根据随机数字表法分为对照组和试验组各35例，对照组给予无创间歇期雾化吸入，试验组给予无创同时雾化吸入，观察2组雾化0、5、10、15 min（雾化结束点）的PtCO2数值，记录每日的动脉血气分析指标（主要包括PaCO2、PaO2、pH），记录治疗前、治疗第4天、治疗第7天临床肺部感染评分和慢性阻塞性肺疾病患者自我评估评分。 结果 最终纳入对照组和试验组各33例患者。对照组男25例，女8例，年龄（75.33 ± 8.24）岁；试验组男25例，女8例，年龄（72.39 ± 8.56）岁。对照组患者雾化0、5、10、15 min PtCO2数值分别为（63.83 ± 12.47）、（64.40 ± 12.57）、（65.42 ± 13.77）、（66.62 ± 14.59） mmHg（1 mmHg=0.133 kPa），各时间点PtCO2之间总体上差异有统计学意义（F=8.05，P<0.01），进一步采用Sidak法两两比较显示雾化15 min与雾化0、5、10 min的PtCO2差异均有统计学意义（均P<0.05），试验组雾化0、5、10、15 min PtCO2数值分别为（67.62 ± 11.89）、（67.15 ± 12.12）、（67.82 ± 12.22）、（68.15 ± 12.09） mmHg，各时间点PtCO2之间总体上差异无统计学意义（F=2.00，P>0.05）；2组患者PaCO2和pH值均随治疗时间好转，但对照组最早在治疗第4天开始与治疗前比较差异有统计学意义（P<0.05），而试验组在治疗第2天开始与治疗前比较差异有统计学意义（P<0.05）。 结论 2种雾化方式均取得良好的治疗效果，但无创同时雾化在雾化过程中更能维持PtCO2的平稳，安全性更高，且能够更早改善患者动脉血气指标PaCO2和pH值，是无创通气与雾化治疗联合运用尤其是患者伴有高碳酸血症时更宜选择的雾化方式。 Objective To compare the dynamic changes of transcutaneous partial pressure of carbon dioxide (PtCO2) and treatment effect of non-invasive intermittent nebulization and non-invasive simultaneous nebulization in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods This was a randomized parallel controlled trial study. A total of 70 patients with acute exacerbation of COPD in Changzhou First People′s Hospital from October 2021 to September 2022 were selected by convenience sampling method, and divided into control group and experimental group by randomized digits table method with 35 cases in each group. The control group was given non-invasive intermittent oxygen-driven nebulization, and the experimental group was given non-invasive simultaneous oxygen-driven nebulization. The PtCO2 values at 0, 5, 10, 15 min (the end point of atomization) of the 2 groups were observed, the daily arterial blood gas analysis indexes (mainly including PaCO2, PaO2 and pH) were recorded, and the clinical pulmonary infection score and the self-assessment score of COPD patients were recorded before treatment, on the 4th and 7th day of treatment. Results Finally, 33 patients were included in both the control group and the experimental group. There were 25 males and 8 females in the control group, aged (75.33 ± 8.24) years old. There were 25 males and 8 females in the experimental group, aged (72.39 ± 8.56) years old. The PtCO2 values at 0, 5, 10, 15 min in the control group were (63.83 ± 12.47), (64.40 ± 12.57), (65.42 ± 13.77), (66.62 ± 14.59) mmHg (1 mmHg=0.133 kPa). There were statistically significant differences in PtCO2 at all time points (F=8.05, P<0.01). Further pairwise comparison by Sidak method showed that there were statistically significant differences in PtCO2 at 15 min compared with 0, 5, 10 min (all P<0.05). The PtCO2 values at 0, 5, 10, 15 min in the experimental group were (67.62 ± 11.89), (67.15 ± 12.12), (67.82 ± 12.22), (68.15 ± 12.09) mmHg. There was no statistically significant difference in PtCO2 at all time points (F=2.00, P>0.05). The PaCO2 and pH value of the two groups were improved with the treatment time, the control group had a statistically significant difference on the 4th day of treatment compared with before treatment (P<0.05), while the experimental group on the second day of treatment compared with before treatment (P<0.05). Conclusions Both kinds of nebulization have achieved good therapeutic effects, but non-invasive simultaneous nebulization can better maintain the stability of PtCO2 in the process of nebulization with higher safety, and can improve the arterial blood gas index PaCO2 and pH value of patients earlier, which is a more suitable nebulization method for the combination of non-invasive ventilation and nebulization, especially for patients with hypercapnia.

    肺疾病,慢性阻塞性无创机械通气雾化吸入经皮二氧化碳分压

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    多学科营养支持小组对肺癌化疗患者营养状况及生命质量的影响

    杨鑫王吉平邬丽红李冬利...
    27-33页
    查看更多>>摘要：目的 探讨多学科营养支持小组对肺癌化疗患者营养状况及生命质量的影响，为肺癌化疗患者营养干预方案的制订提供参考。 方法 采用类实验研究方法，便利抽样选取2021年2月至2022年7月就诊于复旦大学附属金山医院的74例肺癌化疗患者为研究对象。按照入院时间将2021年2—8月收治的37例患者设为对照组，给予常规护理干预；将2021年9月至2022年7月收治的37例患者设为观察组，给予多学科营养支持小组模式干预。干预时间为3个化疗周期，比较2组患者干预前后血清营养学指标及生命质量变化的差异。 结果 对照组男27例，女10例，年龄（68.14 ± 6.82）岁；观察组男30例，女7例，年龄（65.92 ± 9.17）岁。2组患者干预前血清营养学指标及生命质量比较差异均无统计学意义（均P>0.05）。观察组患者干预后血清总蛋白、白蛋白、前白蛋白含量分别为（69.41 ± 5.87）、（38.11 ± 4.04） g/L和（243.57 ± 67.58） mg/L，高于对照组的（65.54 ± 8.33）、（35.78 ± 5.39） g/L和（200.84 ± 60.84） mg/L，差异均有统计学意义（t＝-2.31、-2.10、-2.86，均P<0.05）。观察组患者干预后情绪功能、整体健康/生命质量的评分分别为（88.29 ± 16.72）、（60.36 ± 13.24）分，高于对照组的（76.80 ± 17.58）、（46.40 ± 16.38）分；疲倦、恶心呕吐、失眠、食欲丧失症状领域的评分分别为（34.53 ± 22.19）、（11.26 ± 8.83）、（20.72 ± 16.39）、（24.32 ± 18.67）分，低于对照组的（45.65 ± 22.95）、（25.68 ± 18.67）、（36.94 ± 23.29）、（40.54 ± 22.41）分，差异均有统计学意义（t值为-4.03～4.24，均P<0.05）。 结论 在肺癌患者化疗期间，实施多学科营养支持小组可以显著改善患者的营养状况，提高患者生命质量。 Objective To explore the effects of multi-disciplinary nutrition support team on nutritional status and quality of life in lung cancer patients undergoing chemotherapy, so as to provide reference for the formulation of nutritional intervention plans for lung cancer patients undergoing chemotherapy. Methods This was a quasi experimental study. A total of 74 patients with lung cancer undergoing chemotherapy in Jinshan Hospital of Fudan University from February 2021 to July 2022 were selected as the research object by convenient sampling method. They were divided into two groups according to their admission time, 37 cases of patients from February to August 2021 for the control group, using conventional nursing interventions, 37 cases of patients from September 2021 to July 2022 for the observation group, with multi-disciplinary nutrition support team. A follow-up was conducted for three chemotherapy cycles, serum nutrition indicators and quality of life were compared between the two groups. Results There were 27 males and 10 females in the control group, aged (68.14 ± 6.82) years old. There were 30 males and 7 females in the observation group, aged (65.92 ± 9.17) years old. There was no significant difference in the serum nutrition indicators and quality of life before intervention between the two groups (all P>0.05). The serum total protein, albumin and prealbumin levels in the observation group were (69.41 ± 5.87), (38.11 ± 4.04) g/L, and (243.57 ± 67.58) mg/L, which were higher than those in the control group (65.54 ± 8.33), (35.78 ± 5.39) g/L, and (200.84 ± 60.84) mg/L, the differences were statistically significant (t=-2.31, -2.10, -2.86, all P<0.05). After intervention, the observation group showed higher scores for emotional function and overall health/life quality, with (88.29 ± 16.72), (60.36 ± 13.24) points, compared to the control group with (76.80 ± 17.58), (46.40 ± 16.38) points. The scores for fatigue, nausea/vomiting, insomnia, and loss of appetite were (34.53 ± 22.19), (11.26 ± 8.83), (20.72 ± 16.39), (24.32 ± 18.67) points in the observation group, which were lower than the scores in the control group (45.65 ± 22.95), (25.68 ± 18.67), (36.94 ± 23.29), (40.54 ± 22.41) points, all the differences were statistically significant (t values were -4.03-4.24, all P<0.05). Conclusions During chemotherapy in lung cancer patients, the multidisciplinary nutrition support team has been shown to significantly improve the patients′ nutritional status and enhance their quality of life.

    肺肿瘤生活质量化疗营养支持小组营养状况

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    肿瘤遗传护士岗位角色职能指标体系构建

    吴晓丹王纤蒋超南杜芊芊...
    34-42页
    查看更多>>摘要：目的 构建适合我国国情的肿瘤遗传护士岗位角色职能指标体系，为肿瘤遗传护士岗位的设立、肿瘤遗传护理实践的开展提供基础。 方法 通过文献研究、半结构式访谈，初步拟订肿瘤遗传护士岗位角色职能指标体系。2022年9—12月，运用德尔菲法及层次分析法确立肿瘤遗传护士岗位角色职能指标体系。 结果 共纳入43名函询专家，2轮函询问卷有效回收率分别为93.62%（44/47）和97.73%（43/44），专家权威系数分别为0.821和0.853。2轮函询各级指标的Kendall协调系数分别为0.100～0.150（均P<0.01）和0.101～0.237（均P<0.01）。最终构建的肿瘤遗传护士岗位角色职能指标体系共包括一级指标5项，二级指标17项，三级指标86项。 结论 该研究构建的肿瘤遗传护士岗位角色职能指标体系科学、可靠、合理、专业特异性强、内容全面，能为肿瘤遗传护士岗位的设立及肿瘤遗传护理实践的开展提供理论依据。 Objective Based on the needs of advanced nursing practice development, to establish an indicator system of role function of position of oncology genetic nurses suitable for our national condition, and to provide a basis for position establishing of nocology genetic nurses. Methods Initial indexes were generated through the literature review and semi-structured interviews. From September to December 2022, two rounds of expert consultations and analytic hierarchy process were conducted to establish the evaluation index for role function of position of oncology genetic nurses. Results A total of 43 experts were included in the study, the response rates of 2 rounds were 93.62%(44/47) and 97.73%(43/44), and the authority coefficients of the experts were 0.821 and 0.853. The Kendall′s coefficients of concordance for the 2 rounds of consultations were 0.100-0.150 (all P<0.01) and 0.101-0.237 (allP<0.01). Finally, the role function system of position for oncology genetic nurses was formed, which consisted of 5 first-level indexes, 17 second-level indexes and 86 third-level indexes. Conclusions The system of role function of position for oncology genetic nurses is reasonable, scientific and reliable, professional and specific, which can provide a theoretical reference for the development of advanced nursing practice on hereditary oncology in China.

    德尔菲技术肿瘤遗传护士角色职能岗位遗传性肿瘤

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    终末期糖尿病肾病血液透析患者血糖管理最佳证据总结

    张红梅张宁孙玉娇沈莉莉...
    43-50页
    查看更多>>摘要：目的 检索、评价并整合终末期糖尿病肾病血液透析患者的血糖管理最佳证据，为临床循证实践提供依据。 方法 计算机系统检索包括BMJ最佳临床实践、Cochrane Library、OVID、Scopus、UpToDate、中国知网、万方、医脉通等数据库、指南网以及专业协会网站中关于终末期糖尿病肾病血液透析患者血糖管理的相关证据，检索时限为建库至2023年5月10日。 结果 共纳入文献14篇，其中指南5篇、系统评价6篇、临床决策1篇、随机对照试验1篇、专家共识1篇，总结出关于终末期糖尿病肾病血液透析患者血糖全程管理最佳证据25条，涵盖透析前评估、透析前血糖管理、透析过程中血糖管理、透析间歇期血糖管理、饮食与营养管理、运动管理、生活方式干预、健康教育8个方面内容。 结论 该研究总结了终末期糖尿病肾病血液透析患者血糖全程管理的最佳证据，为医护人员临床实践提供全面的循证依据。 Objective To retrieve, evaluate and integrate the best evidence of blood glucose management in hemodialysis patients with end-stage diabetic kidney disease, so as to provide a basis for clinical evidence-based nursing practice. Methods BMJ Best Clinical Practice, Cochrane, OVID, Scopus, UpToDate, CNKI, Wanfang Database, Medical Pulse database, and other guideline networks and professional association websites and databases were searched for blood glucose management in hemodialysis patients with end-stage diabetic kidney disease. The search time limit was from the establishment of the database to May 10, 2023. Results A total of 14 articles were included, including 1 clinical decision, 5 guidelines, 6 systematic reviews, 1 randomized controlled trial, and 1 expert consensus. The best evidences for blood glucose management in hemodialysis patients were summarized, including 8 aspects of pre-dialysis assessment, pre-dialysis blood glucose management, blood glucose management during dialysis, blood glucose management during dialysis interval, diet and nutrition, exercise management, lifestyle intervention and health education, with 25 pieces of evidence. Conclusions This study summarizes the best evidence of blood glucose management in hemodialysis patients with end-stage diabetic kidney disease, and provides evidence-based basis for clinical practice for medical staff.

    糖尿病肾病血液透析血糖全程管理证据总结

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    急性白血病住院患儿主要照顾者准备度现状及其影响因素分析

    王俊霞郑红张慧敏杨苗苗...
    51-57页
    查看更多>>摘要：目的 调查急性白血病患儿主要照顾者准备度现状，探讨其影响因素，为后续制订针对性护理干预方案提供理论依据。 方法 利用便利抽样法，采用一般资料调查表、照顾者准备度量表、Herth希望量表、照顾者照顾能力量表及疾病不确定感家属量表对2021年6—12月中国医学科学院血液病医院收治的急性白血病住院患儿主要照顾者160名进行横断面问卷调查，采用描述性分析、Mann-Whitney U检验及Kruskal-Wallis H检验、Spearman秩相关分析、多元逐步线性回归分析进行统计分析。 结果 有效回收问卷159份，男13名，女146名，年龄（34.61 ±8.60）岁。急性白血病住院患儿主要照顾者的准备度总分为（26.47 ± 7.53）分，希望水平总分为（37.72 ± 4.11）分，疾病不确定感总分为（61.96 ± 17.02）分，照顾者照顾能力总分为（15.06 ± 12.94）分。急性白血病住院患儿主要照顾者准备度与希望水平、照顾能力呈正相关（r=0.166、0.254，均P<0.05），与疾病不确定感呈负相关（r=-0.300，P<0.05）。多元逐步线性回归分析显示，照顾者疾病不确定感、照顾者性别、有无共同照顾者、照顾者希望水平是照顾者准备度主要影响因素，可解释其20.4%的变异。 结论 急性白血病住院患儿主要照顾者准备度处于中等水平，临床中应重点关注男性、对疾病认知不足、无共同照顾者、希望水平低的主要照顾者，及时采取针对性措施，提高照顾者准备度，改善照护质量。 Objective To investigate the current status and influencing factors of care preparedness in primary caregivers of children with acute leukemia, so as to provide theoretical basis for targeted nursing intervention plans in the future. Methods A total of 160 primary caregivers of children with acute leukemia in Hematology Hospital of the Chinese Academy of Medical Sciences recruited by convenient sampling were investigated by the general data questionnaire, the Preparedness for Caregiving Scale, the Herth Hope Index, the Family Caregiver Task Inventory and the Mishel Uncertainty in Illness Scale-Family Member Form. Descriptive analysis, Mann-Whitney U test, Kruskal-Wallis H test, Spearman rank correlation and multiple stepwise liner regression were used for statistical analysis. Results One hundred and fifty-nine questionnaires were effectively collected, including 13 males and 146 females, aged (34.61 ± 8.60) years old. The total score of care preparedness, hope, uncertainty in illness, care ability for caregivers were (26.47 ± 7.53), (37.72 ± 4.11), (61.96 ± 17.02), (15.06 ± 12.94) points. The total score of care preparedness for caregivers was negatively correlated with the score of uncertainty in illness(r=-0.300, P<0.05), and positively correlated with the hope and care ability of main caregivers (r=0.166, 0.254, both P<0.05). Caregivers′ uncertainty in illness, caregiver gender, availability of other caregivers, caregivers′ hope entered the multiple stepwise regression equation, which could explain 20.4% of the total variation of resilience. Conclusions The preparation of the primary caregivers for children with acute leukemia is at a medium level. The primary caregivers who are male, who have insufficient knowledge of the disease, who have no co-caregivers, and who have low hope level should be focused on in clinical practice. Pertinent measures should be taken to improve care preparedness and care quality.

    儿童急性白血病照顾者照顾者准备度疾病不确定感希望水平

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    母婴依恋在产妇孕期身体意象与产后抑郁间的中介效应

    杨依云周晖朱珠蒲丛珊...
    58-63页
    查看更多>>摘要：目的 调查产妇孕期身体意象、母婴依恋和产后抑郁的现状，探讨母婴依恋在产妇孕期身体意象与产后抑郁间的中介效应，以期为有效降低产后抑郁发生率和减轻抑郁症状提供参考和指导。 方法 采用便利抽样法选取2022年7—9月南京医科大学附属妇产医院（南京市妇幼保健院）产科住院孕妇362名，应用爱丁堡产后抑郁量表、孕妇身体意象量表和母婴依恋量表对其进行横断面调查。采用SPSS宏程序PROCESS中的模型4检验母婴依恋在产妇孕期身体意象和产后抑郁之间的中介作用。 结果 回收有效问卷362份，其中≤30岁194名，>30岁168名。孕期身体意象得分为（89.24 ± 15.56）分，母婴依恋得分为（71.40 ± 8.05）分，产后抑郁得分为7.50（4.00，11.00）分。产妇母婴依恋与孕期身体意象和产后抑郁均呈负相关（r= -0.368、-0.512，均P<0.01），孕期身体意象与产后抑郁呈正相关（r=0.402，P<0.01）。Bootstrap法检验结果显示，母婴依恋在产妇孕期身体意象和产后抑郁间的中介效应为0.056（95%CI 0.038～0.076），占总效应的43.08%。 结论 孕期身体意象不仅可以直接预测产后抑郁，还可通过母婴依恋的中介效应间接预测产后抑郁。护理人员应从积极心理学的角度开展以影响产后抑郁路径为依据的干预研究，从而达到预防或减少产妇产后抑郁发生的目的。 Objective To investigate the current status of maternal body image during pregnancy, mother-infant attachment and postpartum depression and explore the mediating effect of mother-infant attachment on maternal body image during pregnancy and postpartum depression, in order to effectively reduce the incidence of postpartum depression and provide reference and guidance for alleviating depressive symptoms. Methods A total of 362 pregnant women admitted to obstetric wards in Women′s Hospital of Nanjing Medical University were selected for a cross-sectional investigation by applying the Edinburgh Postnatal Depression Scale, the Body Image in Pregnancy Scale and the Maternal Postnatal Attachment Scale by convenient sampling from July to September 2022. Model 4 in the SPSS macro program PROCESS was used to test the mediating effect of maternal infant attachment between body image and postpartum depression. Results Totally 362 valid questionnaires were retrieved including 194 individuals aged ≤30 years old and 168 individuals aged >30 years old. The scores of maternal body image during pregnancy, mother-infant attachment and postpartum depression were (89.24 ± 15.56), (71.40 ± 8.05), 7.50 (4.00, 11.00) points. Mother-infant attachment was negatively correlated with body image during pregnancy and postpartum depression (r=-0.368, -0.512, both P<0.01), body image during pregnancy was positively correlated with postpartum depression (r=0.402, P<0.01). The results of Bootstrap test showed that the mediating effect of mother-infant attachment on the relationship between body image during pregnancy and postpartum depression was 0.056 (95%CI 0.038-0.076), accounting for 43.08% of the total effect. Conclusions Body image during pregnancy can not only directly predict postpartum depression, but also indirectly predict postpartum depression through the mediating effect of mother-infant attachment. In order to prevent or reduce the occurrence of postpartum depression, nursing staff should carry out intervention research based on influencing the path of postpartum depression from the perspective of positive psychology.

    抑郁母婴依恋身体意象中介效应

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