Objective: To develop a risk assessment scale for iatrogenic skin injury in critically ill neonates, providing an objective tool for effectively evaluating the risk of iatrogenic skin injury in this population. Methods: The initial scale was designed based on a review of similar existing scales, using literature analysis, semi-structured interviews, and expert group discussions. A two-round Delphi method was employed to consult 20 experts and finalize the scale′s items and scoring methods. Results: The recovery rates of valid questionnaires, the expert authority coefficients, and the Kendall′s coefficients of concordance in the two rounds of inquiry were 90.9% and 100%, 0.84 and 0.91, 0.208 and 0.249, respectively ( P<0.001). The final scale consists of six dimensions, including physiological condition, skin condition, current body status, risk factors for medical adhesive-related skin injury, risk factors for drug extravasation injury, and risk factors for medical device-related injuries. The scale includes 22 items, with importance scores ranging from 4.10 to 4.90, coefficient variations ranging from 0.060 to 0.207, and the full score rate between 45% and 90%. Conclusion: The iatrogenic skin injury risk assessment scale for critically ill neonates developed based on the Delphi method demonstrates high scientific rigor and authority. It can be used to assess the risk of iatrogenic skin injuries in critically ill neonates.

t Objective: To analyze the knowledge of neonatal iatrogenic skin injury(NISI) and its high-risk factors among nurses in neonatal ward, and to provide the basis for preparing a scientific and practical risk assessment scale for NISI. Methods: A total of 205 nurses were included from the neonatal units and a self-compiled questionnaire survey were conducted in Tianjin in November 2021. Results: The most common clinical types of NISI were medical adhesive-related skin injury (MARSI), drug extravasation skin injury, and medical device-related pressure injury (MDRPI). Pareto plot and goodness-of-fit test results showed that skin condition, adhesive bonding time, type of adhesive, gestational age and body weight were main risk factors for MARSI, and their cumulative ratio was 78.53% . The main risk factors for drug extravasation injury were the nature of infusion drug, placement, preterm birth and low body weight and type of placement，and their cumulative ratio was 77.62%. The main risk factors for MDRPI were gestational age, weight, mobility, nutrition and skin immersion, and their cumulative ratio was 79.44%. Chi-square test showed that whether nurses have used risk assessment scale related NISI in clinical practice influenced their willingness to apply related scale and their opinion about the effect of application scale on clinical workload and quality of nursing( P<0.01). Conclusion: MARSI, drug extravasation injury and MDRPI were the most common types of NISI in the clinic. Different types have different kinds of high-risk factors, while gestational age and body weight are their common high-risk factors. Nurses in neonatal ward believe that the clinical application of injury risk assessment scale can reduce the nursing workload and improve the quality of nursing care to some extent, and they have a willingness to use such scale in clinical practice. Therefore, it is necessary to compiling a scientifically practical scale to predicting the risk of developing neonatal iatrogenic skin injury.

Objective: To establish a quality evaluation index system for nursing care in neonatal non-invasive positive pressure ventilation in order to provide basis for nursing quality management. Methods: Based on the "structure-process-outcome" three-dimensional quality model, a comprehensive method, including literature review，semi-structured interviews, Delphi method, and analytic hierarchy process, was adopted to establish a quality indicator system for nursing in neonatal non-invasive positive pressure ventilation. Results: 2 rounds of expert consultations resulted in the effective response rates of 80% and 100%, with the authority coefficients of both 0.90, and the coordination coefficients of 0.367 and 0.357(P<0.001). The final evaluation index system for nursing quality in neonatal non-invasive positive pressure ventilation consisted of 3 first-level indicators, 12 second-level indicators, and 66 third-level indicators. Conclusion: The quality evaluation index system for nursing care in neonatal non-invasive positive pressure ventilation is scientific and reliable, which can provide science-based references for evaluating the clinical nursing quality in neonatal non-invasive positive pressure ventilation.

Objective: To analyze the status and influencing factors of maternal-fetal attachment in pregnant women during third trimester. Methods: 210 pregnant women during third trimester who were treated in the obstetrics clinic of a tertiary Class A hospital in Tianjin were selected by convenient sampling from August to December 2019.The general data questionnaire, maternal antenatal attachment scale(MAAS) and other research tools were used to survey.Multiple linear stepwise regression analysis was used for multivariate analysis. Results: The MAAS score of pregnant women during third trimester was 75.93±6.03. Multiple linear stepwise regression analysis showed that per capita monthly income, depression, negative coping and perceived social support were the influencing factors of maternal-fetal attachment( P<0.01).43.3% of the total variance was explained. Conclusion: The level of maternal-fetal attachment of pregnant women during third trimesteris at a high level, which is affected by many factors.Medical staff can take measures to improve the quality of maternal-fetal attachment and promote maternal-fetal health by improving their positive coping ability and social support level.