Objective: To identify the latent category characteristics of self-directed learning competence and innovation behavior of nurses in grade A tertiary hospitals, analyze the influencing factors of different characteristics, and put foward to the corresponding improvement countermeasures. Methods: From October to November 2022, 1 042 nurses from 3 grade A tertiary hospitals were investigated with the general information questionnaire, self-directed learning competence for nurses, and nurse innovation behavior scale. Results: There were three potential profiles of self -directed learning competence and innovation behavior of nursing staff in grade A tertiary hospitals including C1 "insufficient self-directed learning competence-low innovation behavior"(30.33%), C2"general self-directed learning competence-medium innovation behavior"(49.81%), C3 "high self-directed learning competence-proactive innovation behavior"(19.86%). Multiple Logistic regression analysis showed that the importance of nursing research on career development, scientific research atmosphere of the department, career orientation, and frequency of reading professional journals at daily time were influencing factors for different types of self-directed learning competence and innovation behavior among nursing staff ( P<0.05). Conclusion: There was heterogeneity in the self-directed learning competence and innovation behavior of nursing staff in grade A tertiary hospitals. Three expected types of self-directed learning competence and innovation behavior were identified. In particular, attention should be paid to the importance of nursing research on career development, scientific research atmosphere of the department, career orientation, and frequency of reading professional journals at daily time, so as to develop targeted nursing measures for nursing staff with different types of self-directed learning competence and innovation behavior, so as to improve their self-directed learning competence and innovation behavior.

Objective: To explore the status and needs of readiness for hospital discharge of caregivers for children undergoing living donor liver transplantations, and to provide a basis for adopting scientific and effective discharge guidance programs. Methods: Using purposive sampling method in qualitative research, 14 caregivers for children undergoing living donor liver transplantation were included, and semi-structured interviews were used in the descriptive research. The data of semi-structured interviews were analyzed by Colaizzi′s seven-step method. Results: Five themes and twelve sub-themes were extracted involvingpost-discharge nursing knowledge and skills needs (including the need of postoperative care and emergency treatment of liver transplantation, information acquisition and screening needs), medication guidance needs (including immunosuppressant drug guidance needs and abnormal medication treatment guidance needs ), rehabilitation guidance needs (including rehabilitation exercise guidance needs and vaccination guidance needs), psychological needs (including the needs of alleviating negative emotions, children′s social function adaptation needs), needs of material, informational, and emotional support (including medical technology support needs, needs of knowing social resources and accessing methods, professional platform support needs, and peer support needs). Conclusion: Caregivers have a high demand for the transition period after the discharge of children undergoing living donor liver transplantation, so it is recommended that medical staff should provide professional health guidance and psychological support, and establish multi-party support channels to improve the readiness for hospital discharge of caregivers for children undergoing living donor liver transplantation and ensure the safety of discharge.

Objective: To explore the mediating role of social support on self-regulated fatigue and quality of working life. Methods: Participants were selected from young and middle-aged postoperative lung cancer patients which returned to work for ≥1 month in a cancer hospital with Grade A，Level 3 in Tianjin. This study was conducted using convenience sampling. Questionnaire survey was conducted using the general information questionnaire，Self-regulated Fatigue Scale，Perceived Social Support Scale，and Quality of Working Life Questionnaire for Cancer Survivors. The data analysis were performed by SPSS 22.0 and Process plug-in. Results: The mean score of Quality of Working Life Questionnaire for Cancer Survivors for all participants was 51.93±24.31. Pearson correlation analysis showed that the working life quality was negatively correlated with self-regulated fatigue( r=-0.133， P<0.05) and positively correlated with social support( r= 0.319， P<0.01) in young and middle-aged lung cancer patients. Bootstrap analysis indicated that social support played a complete mediating role on self-regulated fatigue and working life quality，with a mediating effect size of -0.251(95% CI -0.529~-0.011； P<0.05). The intermediate effect accounted for 34.813% of the total effect. Conclusion: The quality of working life of young and middle-aged adults with postoperative lung cancer patients needed to be improved and social support can play a completely mediating role in self-regulated fatigue and working life quality. It′s indicated that family，society and medical staff should actively take measures as soon as possible，and carry out personalized continuing nursing interventions to improve the quality of working life.

Objective: To explore the effects of Otago Exercise Program on pre-frailty state and lower extremity function in the elderly. Methods: Eighty-two pre-frail elderly individuals from two communities in Nanchang were selected and divided into the intervention group and control group according to their residence, with 41 participants in each group. The intervention group participated in the Otago Exercise Program for 12 weeks, three times a week, with each session lasting 30 to 40 minutes. The control group received no intervention (blank control).The Fried Frailty Phenotype (FFP) score, Five Times Sit-To-Stand (FTSTS) test time, and Timed Up and Go Test (TUGT) time were evaluated before the intervention and at the 4th(early stage), 8th(middle stage), and 12th weeks(late stage) of the intervention. Results: During the early, middle, and late stages of the intervention, the FFP scores in the intervention group were lower than those in the control group ( P<0.05). In the middle and late stages of the intervention, the intervention group had shorter times for the FTSTS and the TUGT compared to the control group( P<0.05). Conclusion: The Otago Exercise Program can reverse pre-frailty state in elderly individuals, enhancing the lower extremity muscles strength and improving mobility and walking ability.

Objective: To explore the relationship and internal mechanism of self-efficacy, readiness for hospital discharge and Internet medical treatment willingness. Methods: A total of 307 patients were selected from a third-class hospital in Tianjin on the day before discharge. Self-efficacy level, readiness for hospital discharge and willingness to adopt“Internet + nursing service” of the patients were investigated by general information questionnaire, readiness for hospital discharge scale, general self-efficacy scale and willingness to adopt “Internet + nursing service” questionnaire. Data were statistically analyzed using SPSS 21.0 and AMOS 21.0. Results: There was a positive correlation between patients’ discharge readiness, self-efficacy and willingness to adopt “Internet + nursing service”( P<0.001). Discharge readiness could not only directly affect patients’ willingness to adopt “Internet + nursing services”, but also indirectly affect the willingness to adopt“Internet + nursing services” through self-efficacy. Conclusion: Self-efficacy plays an intermediary role between middle-aged and elderly patients’ readiness for hospital discharge and willingness to“Internet + nursing service”. Managers should pay full attention to improve the self-efficacy level of such people and enhance their willingness to seek medical treatment on the Internet.

Objective: To evaluate the application effect of quality management standards for intravenous access care clinics in Secondary and above medical institutions in Tianjin. Methods: A total of 280 patients who visited intravenous access care clinics from October to December 2018 were selected as the control group and 280 patients who visited intravenous access care clinics from October to December 2019 were selected as the intervention group. The intervention group adopted standardized training program to implement the quality management standards of intravenous access care clinics. The control group implemented daily management requirements according to the routine care. The self-management ability of catheters in the two groups was investigated with the PICC self-management scale for tumor patients, meanwhile, the incidence of PICC complications in the two groups was calculated. Results: The incidence of PICC catheter-related bloodstream infection in the intervention group was 1.07%, significantly lower than the control group(1.79%). The total score of self-management ability of catheters and the scores of three dimensions including maintenance compliance, confidence in catheter management and abnormal treatment in the intervention group were significantly higher than those in the control group(P<0.05). Conclusion: The application of quality management standards for intravenous access care clinics is helpful to standardize the behaviors of nurses to implement standardized maintenance services for patients with catheters which can improve the self-management ability of patients and reduce the occurrence of complications, so as to reduce the medical cost of patients.

Objective: To investigate the adversity quotient of young and middle-aged caregivers of patients with cancer,analyze the factors affecting adversity quotient and the correlation between the adversity quotient and the self-perceived burden of patients, and provide basis for young and middle-aged caregivers to formulate targeted intervention strategies.Methods: General data questionnaire, adversity quotient scale and self-perceived burden scale were used to carry out questionnaire survey for 303 patients with cancer and their young and middle-aged caregivers who were admitted into a tertiary A tumor center in Tianjin from January to June 2020. Results: The adversity quotient score of 303 young and middle-aged caregivers was 129.60±21.03, of which the extended dimension score was the lowest（29.57±7.61). The factors affecting adversity quotient included age, occupational, average household monthly income and whether the caregiver has children( P<0.05). Adversity quotient level was negatively correlated with the self-perceived burden of patients ( P<0.05). Among them, emotional factors were more closely related to the adversity quotient level of caregivers（ r=-0.434). Conclusion:Adversity quotient of young and middle-aged caregivers of patients with cancer has a greater influence on the self-perceived burden of patients and needs to be improved. Targeted intervention strategies should be carried out for this population according to relevant factors, so as to improve the ability of caregivers to cope with adversity, reduce the self-perceived burden of patients, construct a harmonious doctor-patient relationship.

 Objective:To understand the job satisfaction of junior nursing staff and construct its structural model. Methods: A total of 296 junior nursing staff with a working life of less than or equal to 3 years were selected. General information questionnaire, nurse occupation identification scale, nurse occupational values scale, nurse job engagement scale and job satisfaction scale were used to conduct surveys, and then constructed the structural equation model of job satisfaction. Results: The total score of job satisfaction of the 296 nursing staff was 21.54±4.57, and the scores of each dimension were ranking from high to low: satisfaction with colleagues, satisfaction with the work itself, satisfaction with the leader, overall satisfaction, satisfaction with promotion, satisfaction with salary. The results showed that in terms of the overall effect, professional identity had the strongest effect on job satisfaction and the path coefficient was 0.741. In terms of direct effect, professional values had the strongest effect on job satisfaction and the path coefficient was 0.376. Conclusion: The job satisfaction of junior nursing staff was at a relatively high level, and professional identity had the strongest overall effect on job satisfaction. It is recommended to formulate a standardized training system, pay attention to the vocational education of junior nurses, guide them to establish correct professional values, enhance their professional identity and professional investment, then improve job satisfaction.

Objective: To provide a theoretical basis for improving the clinical nursing quality of patients with PICC catheterization by investigating the current status of knowledge-attitude-performance(KAP) and self-management ability for catheter maintenance in patients with malignant tumors. Methods: 242 patients with PICC catheterization were selected as the subjects of the study. A cross-sectional survey was conducted using the general information questionnaire, the cancer patients PICC self-management scale(CPPSM) and the KAP questionnaire of catheter maintenance. Pearson correlation analysis was used to process the data. Results: The total score of KAP and ability of self-management for PICC were generally at a medium level.The total score and each dimension scores of patient's catheter self-management were positively correlated with the total score of KAP（ P<0.01）. Conclusion: The level of KAP and self-managemernt of the patients of maligmont tomor with PICC catheterization was medium,there is still a lot of room for improvment. The management ability can improve with the increase of level of KAP of PICC patients with cancer, nursing stuffs should take measures to raise their level of KAP.

Objective: To explore the influence of nurses’ authorization ability and job satisfaction on turnover intention in grade A hospitals, and to clarify the mechanism among them. Methods: From October 16, 2018 to October 29, 2018, a cross-sectional questionnaire was conducted among 508 registered nurses in a grade A hospital in Tianjin by questionnaire stars. Results: Psychological empowerment and job satisfaction were negatively correlated with turnover intention( P<0.05), but there was no significant correlation between structural authorization and turnover intention( P>0.05). At the same time, the structural equation model was constructed, which nurses’ psychological empowerment and structural authorization were taken as independent variables, job satisfaction as intermediary variables, and turnover intention as dependent variables. The results showed that the fitting indexes were CMIN/DF=2.182 < 3, GFI = 0.929 > 0.90, AGFI= 0.905 > 0.90, RMSEA = 0.048 < 0.05.The total effects of structural authorization and psychological empowerment on turnover intention were 0.293 and-0.344 respectively, and the total effect of job satisfaction on turnover intention was-0.320. Conclusion: The turnover intention of nurses in grade A hospitals is still on the high level, the psychological empowerment is the main negative predictor, and structural authorization has the strongest indirect effect on nurses’ turnover intention.