BACKGROUND:Enteral nutrition intolerance (ENI) is common among critically ill patients and may interfere with the effective delivery of enteral nutrition. Identifying patients at increased risk and potentially modifiable care-related factors may help inform more targeted nursing management. AIM:This study aimed to identify independent risk factors for ENI in critically ill patients, evaluate nurse-modifiable protective factors and develop risk-stratified nursing optimization strategies. METHODS:A single-centre retrospective cohort study was conducted, including adults patients receiving EN for ≥ 72 h in the ICU (January 2023 to December 2025). The primary outcome was a composite endpoint of ENI. Independent predictors were identified using multivariable logistic regression. Risk stratification was performed based on predicted probabilities. Population attributable fractions (PAFs) were calculated to estimate potential benefits from modifying modifiable factors. RESULTS:ENI incidence was 44.6%. Age, APACHE II score and mechanical ventilation were independent risk factors (OR = 1.037, 1.399, 3.432; all p < 0.05). Probiotic use, nasoenteric tube feeding, gastric residual volume (GRV) monitoring ≥ 3 times/day and a head-of-bed elevation adherence rate > 90% were independent protective factors (OR = 0.226, 0.297, 0.252, 0.180; all p < 0.05). In the high-risk group (predicted probability ≥ 0.66), the ENI incidence reached 86.9%, but coverage of protective measures was low (head-of-bed elevation 52.5%, GRV monitoring 27.9%, nasoenteric tube 11.5%, probiotics 24.6%). PAF analysis suggested that delayed nasoenteric tube placement, non-use of probiotics and inadequate GRV monitoring could potentially avoid 55.3%, 53.7% and 48.9% of ENI events, respectively. CONCLUSION:ENI in ICU patients is influenced by age, disease severity and nurse-modifiable factors. Incorporating standardized probiotics, graded GRV monitoring and high head-of-bed elevation adherence into core quality control measures, along with a bundled strategy for high-risk patients, may substantially reduce ENI incidence. RELEVANCE TO CLINICAL PRACTICE:The identified nurse-modifiable factors provide clinically relevant targets for risk-informed enteral nutrition management. Risk stratification may help nurses identify patients requiring closer monitoring and more individualized nutritional care. For patients at high risk of ENI, attention to feeding-route selection, appropriate GRV monitoring, head-of-bed elevation adherence, and probiotic use may help optimize enteral nutrition management.
BACKGROUND:Combining simulation-based training with structured feedback enhances skill acquisition and professional competence. Simulation-based education is essential for preparing nurses and midwives to manage obstetric haemorrhage and other critical emergencies requiring rapid clinical decision-making. AIM:This study was conducted to determine the effect of personalised feedback in simulation on knowledge and skills related to the management of bleeding during pregnancy. STUDY DESIGN:This randomized clinical trial. All students received theoretical training on bleeding management. Simulation sessions used a high-fidelity simulator and standardised protocols. Outcomes were measured using the Student Satisfaction and Self-Confidence in Learning Scale and the Simulation Design Scale. RESULTS:In total 58 students participated, (n = 29 in intervention, n = 29 in control group. Post-intervention theoretical knowledge scores were higher in the intervention group than in the control group (75.6 ± 7.6 vs. 71.7 ± 11.1); however, the difference was not statistically significant (t = 1.588, p = 0.118). Satisfaction and self-confidence scores were significantly greater in the intervention group (44.8 ± 3.0 vs. 38.8 ± 9.0, U = 245.0, p = 0.006). On the Simulation Design Scale, the intervention group scored significantly higher in Nursing Process (33.9 ± 6.5 vs. 29.9 ± 7.0, p = 0.03), Patient Safety (27.1 ± 6.0 vs. 24.5 ± 3.5, p = 0.01) and Reflective Behaviour (19.2 ± 5.1 vs. 16.1 ± 3.3, p = 0.02). CONCLUSIONS:Personalised feedback in simulation significantly improves knowledge, satisfaction and clinical performance. Integration with traditional teaching methods is recommended as a reinforcement strategy for bleeding management education during pregnancy. RELEVANCE TO CLINICAL PRACTICE:Personalised video-assisted feedback in simulation-based training improves midwifery students' knowledge, clinical skills and self-confidence in managing bleeding during pregnancy. This approach supports reflective learning by helping students recognise and correct their own clinical errors. Integrating such feedback into education programmes can enhance clinical competence and preparedness for obstetric emergencies. Ultimately, this may contribute to safer maternal care and improved patient outcomes.
BACKGROUND:Anaemia is common in critically ill patients and is associated with adverse outcomes. Diagnostic blood sampling is a potentially modifiable contributor to iatrogenic blood loss, yet its cumulative impact is often underestimated. AIM:To evaluate the impact of routine diagnostic blood sampling on haemoglobin decline, anaemia at ICU discharge and transfusion requirements. STUDY DESIGN:This is a retrospective cohort study of adult ICU patients in a tertiary care teaching hospital in India. Haemoglobin levels at admission and discharge, total diagnostic blood loss and transfusion requirements were recorded. Associations between variables were assessed using correlation analysis and multivariable logistic regression. RESULTS:Among the 109 patients included in the study, haemoglobin decreased significantly during ICU stay from 13.1 g/dL on admission to 10.8 g/dL at discharge (mean difference -2.38 g/dL, 95% CI -2.65 to -2.10, p < 0.001). Over half of patients developed anaemia by discharge. Admission haemoglobin was the strongest independent predictor of anaemia (p < 0.001). Total blood volume lost showed a moderate correlation with haemoglobin decline (r = 0.56). ICU length of stay was strongly associated with cumulative blood loss (r = 0.92) and moderately with haemoglobin decline (r = 0.57). Approximately half of patients required red blood cell transfusion. CONCLUSIONS:Routine diagnostic blood sampling contributes to haemoglobin decline in ICU patients, with cumulative blood loss increasing over time. Patients with lower baseline haemoglobin are particularly vulnerable to developing anaemia. Reducing unnecessary sampling and discard volumes represents a simple, low-cost, nursing-led blood conservation strategy that can support patient blood management and reduce avoidable transfusion exposure in critical care settings. RELEVANCE TO CLINICAL PRACTICE:Blood sampling practices represent a modifiable source of iatrogenic harm. Strategies such as minimising unnecessary tests, reducing discard volumes and identifying high-risk patients may help reduce anaemia and transfusion requirements in critical care settings.
BACKGROUND:Patients with spinal trauma and disorders admitted to intensive care units (ICUs) require complex care that combines life-sustaining treatment, spinal precautions, complication prevention and rehabilitation-related support. Although ICU nurses are central to maintaining patient safety, little is known about their experiences of caring for this patient group. AIM:To explore ICU nurses' experiences of caring for patients with spinal trauma and disorders. STUDY DESIGN:A descriptive qualitative study. METHODS:Fifteen ICU nurses from three tertiary hospitals in Hunan Province, China, were recruited using purposive sampling. Data were collected through one-to-one semi-structured interviews between January and April 2026. Interviews were audio-recorded, transcribed verbatim and analysed using Braun and Clarke's thematic analysis. The study was reported in accordance with the COREQ checklist. FINDINGS:Five themes were generated: maintaining spinal safety during ICU care; managing the burden of immobility and high dependency; working under pressure in high-risk spinal care; making care safer through team support; and building specialist competence within ICU practice. Nurses experienced spinal safety as a continuous concern embedded in routine ICU care, including coordinating high-risk logrolling and transfer, recognising neurological changes with limited confidence and balancing positioning, orthosis use and pressure-injury risks. They also described interrelated physiological needs, frequent and precise patient needs, rehabilitation limits, uncertain prognosis, reliance on team support and more vigilant, anticipatory and holistic care. CONCLUSIONS:Caring for patients with spinal trauma and disorders in ICUs requires nurses to balance spinal safety, critical illness management, high dependency care and emotional support. ICU nurses developed anticipatory and holistic approaches, but also experienced uncertainty and pressure when specialist spinal care knowledge was limited. RELEVANCE TO CLINICAL PRACTICE:ICU teams should develop spinal safety checklists, standardised guidance for logrolling, transfer, positioning and orthosis management and practical training programmes. Strengthening collaboration between ICU teams and spinal specialists may improve nurse competence and patient safety.
BACKGROUND:Interprofessional simulation-based education is a collaborative approach to learning that enhances communication and teamwork processes that promote safer, more efficient working while providing complex care in a healthcare organisation. While interprofessional simulation-based education facilitates shared learning among both participants and observers, the extent and nature of this phenomenon as experienced by faculty members remain underexplored. AIM:To illuminate the lived experiences of clinical nurse educators facilitating interprofessional simulation-based education to gain deeper insight on how this approach could influence their future practice. STUDY DESIGN:A purposive sample of eight clinical nurse educators from Scotland, all with experience working in areas that care for acute and critically ill patients, was recruited to participate in an Interpretative Phenomenological Analysis study. Data were inductively analysed using a systematic, step-by-step approach, generating meaningful themes and concepts that can be applied to the context of practice. FINDINGS:Three master concepts were derived from the interpretative analysis: engagement, synergy and collaboration; the power of the debrief for shared learning; and personal and professional growth. There was a recognition of the significance and importance of working, learning and teaching together. CONCLUSION:Facilitating interprofessional simulation-based education cultivated a shared, new understanding of professional roles and responsibilities, including their respective characteristics, knowledge, skills and behaviours. Specific strategies of co-facilitation and co-debriefing create a learning environment that fosters the development of connections and relationships among the faculty and participants, strengthening value and respect in the interprofessional team. RELEVANCE TO CLINICAL PRACTICE:In critical care, interprofessional simulation-based education can provide a safe environment for shared learning that strengthens understanding of multidisciplinary roles and promotes effective collaboration in clinical practice. For clinical nurse educators, facilitating interprofessional simulation-based education aligns with the realities of critical care practices of fostering effective teamwork, enhancing clinical decision-making and contributing to improved patient safety and outcomes in critically ill populations.
