ABSTRACT
【Objective:】 To understand the moral dilemma, coping style of frontline nurses and their correlation during the COVID -19. 【Methods:】 From March to April, 2021, 651 nurses working in designated hospitals for COVID -19 were selected by convenient sampling, and the Chinese version of Moral Distress Scale-Revised (MDS-R) and Chinese version of Coping Style Questionnaire (CSQ) were used for investigation. 【Results:】 Frontline nurses’ MDS-R score was 91.0, "value conflicts" was the moral dilemma with the highest frequency and intensity, more than half (51.0%) of the respondents had considered leaving their position because of moral dilemma. "Problem solving" and "seeking for help" were the major coping strategies adopted by the nurses. Nurses who directly provide medical services for COVID -19 patients, dissatisfied with hospital-related training and adopted negative coping strategies had higher moral dilemmas than other nurses. 【Conclusion:】 The moral dilemma of frontline nurses is at a high level during the period of epidemic prevention and control. Nursing managers should pay attention to guiding and helping nurses to establish positive coping styles and improve their ability to respond to major public health emergencies.
ABSTRACT
Objective To systematically evaluate the association between frailty and risk of postoperative delirium.Methods Systematic review of literature was conducted using eight electronic databases:PubMed,Embase,CENTRAL,Web of Science,CNKI,CBM,VIP and Wanfang Data,and prospective cohort studies about association between frailty and postoperative delirium published before March 2017 were included.Two authors independently screened the literature,extracted the data,and assessed the quality using NOS Scale,and meta-analysis was conducted by RevMan 5.3 software.Results A total of eight studies involving 846 patients were included in this review.Meta-analysis showed that:frailty was associated with higher risk of postoperative delirium [OR=3.63,95％CI (2.06,6.40),P＜0.001].Subgroup analysis showed that:①Frailty assessment tool:Fried frailty criteria and other frailty assessment were associated with increased risk of postoperative delirium[OR=5.81,95％CI(3.54,9.77),P＜0.001],[OR=1.76,95％CI(1.06,2.92),P=0.03].②Age:frailty patients aged 60～74 had increased risk of postoperative delirium [OR=5.05,95％CI (3.14,8.12),P＜0.001],but for patients aged ≥ 75,frailty wasn't associated with postoperative delirium [0R=1.73,95％CI (0.99,3.00),P=0.05].③Type of surgery:for cardiovascular and non-cardiovascular surgery patients,frailty was associated with increased risk of postoperative delirium [OR=3.40,95％CI (1.64,7.05),P＜0.001],[OR=4.95,95％CI (2.41,10.16),P＜0.001].Conclusion Frailty can increase the risk of postoperative delirium.In consideration of quantity and quality of included studies,the conclusion needs to be validated by multi-centered prospective cohort studies with large sample size.