Objective This study seeks to explore the experiences of emergency nurses in providing care to patients nearing the end of life and to identify the needs of emergency nurses in the palliative care (PC) process. Methods A qualitative meta-synthesis approach (following Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines) was implemented to systematically review relevant qualitative studies. A comprehensive search was conducted across multiple databases, encompassing PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature; (CINAHL), PsycINFO, Web of Science, CNKI (China National Knowledge Infrastructure), Wanfang database and Scopus. The search duration was from database inception to March 2025. Results In total, 22 studies complied with the inclusion criteria and were included in the meta-synthesis. Three main themes were identified: (i) needs for emergency palliative care (EPC) and current practice in emergency departments (EDs); (ii) emotional, ethical and communication experiences of nurses in providing PC in EDs; (iii) nurses’ perceived needs for training, support and system coordination. Across studies, EPC in the ED was described as occurring alongside acute life-saving care. Nurses’ experiences and attitudes towards EPC varied significantly, ranging from positive engagement to perceived incompatibility with their roles in emergency care. Conclusion This meta-synthesis highlights the complexity of providing PC in EDs and the urgency of implementing systematic interventions. To enhance the effectiveness and quality of EPC, it is necessary to provide systematic support and targeted strategies, thereby helping emergency nurses better meet the needs of patients at the end of life. PROSPERO registration number CRD420251008755.

Background Falls are among the most common adverse events in hospitals, causing significant harm to patients and increasing healthcare costs. In 2023, over 160 000 falls were reported in China, with 62.5% of hospitalised patients suffering fall-related injuries. Falls not only prolong hospital stays but also negatively impact nursing quality and healthcare system efficiency.Objective This study explored the lived experiences of nurse managers in preventing and managing inpatient falls in hospital settings and examined the contextual and managerial factors influencing fall prevention practices.Methods We conducted a qualitative study using a phenomenological approach to explore the lived experiences of nurse managers in managing inpatient falls. Semistructured interviews were conducted with 16 participants from a tertiary hospital in Shanghai. While data collection followed phenomenological principles to elicit rich experiential narratives, thematic analysis was guided by grounded theory coding techniques to inductively identify and categorise themes. NVivo 12 software was used for data management.Results Six interrelated themes emerged, reflecting nurse managers’ experiences across the stages of patient admission, hospitalisation and discharge. At admission, participants emphasised the limitations of existing fall risk assessment tools and the need for multidisciplinary collaboration and intelligent technologies to achieve precise stratification. During hospitalisation, they described ongoing challenges in conducting dynamic reassessments, implementing personalised interventions, managing limited staffing and environmental constraints and promoting patient compliance through effective education. In the discharge phase, nurse managers reflected on the emotional and ethical tensions between ensuring patient safety and respecting autonomy, underscoring the importance of cultivating a strong safety culture and reinforcing nurses’ sense of responsibility. Collectively, these findings reveal that fall prevention is not merely a procedural task but a dynamic, interpretive process shaped by professional accountability, emotional strain and systemic limitations.Conclusion Nurse managers’ experiences reflect the complex interplay between managerial responsibility, cultural caregiving norms and organisational limitations in fall prevention. Strengthening multidisciplinary collaboration, integrating intelligent technologies and promoting a proactive safety culture are crucial for improving fall management. Policymakers should also consider China’s evolving caregiver-free ward initiatives to transition towards more nurse-led and patient-centred safety systems. Future research should further explore patient and family perspectives and evaluate strategies for sustainable cultural and structural change in fall prevention.

Cardiovascular disease is an escalating global health concern, leading to an increasing demand for cardiac surgeries. Nutrition plays a critical role during the perioperative period. Enhanced Recovery After Surgery (ERAS) protocols emphasize the importance of early gastrointestinal function restoration. Among nutritional metrics, protein intake is more closely associated with improved outcomes than total energy intake. This study aims to assess perioperative protein intake in cardiac surgery patients and identify factors associated with malnutrition. In this prospective observational study, 197 patients undergoing elective cardiac surgeries at two hospitals in Shanghai were enrolled. Protein intake during the first 7 postoperative days was measured using 24-h dietary recall. Nutritional status was evaluated using the NRS-2002 score and serum albumin levels on admission, as well as on postoperative day 3 and 7. Generalized estimating equations (GEE) were used to identify predictors of malnutrition. The average protein intake was 0.58 ± 0.24 g/kg/day, which was below the recommended 1.5 g/kg/day, with only 4.1

近年来我国洪涝灾害频发,为切实保证人民生命安全,洪涝灾害药学服务应急保障体系亟需发展与完善.现对我国洪涝灾害现场常用应急药品、储备及药学服务应急体系现状作一综述,并从应急药品管理组织机构主要职责、应急药品国家储备形式等方面分析美国药学服务应急体系特点,以期为我国实际性药学服务应急保障发展提供参考建议.

AIMS AND OBJECTIVES To explore the effects of the health failure mode and effect analysis (HFMEA) used in intrahospital transport (IHT) of critically ill patients from emergency department (ED) to the intensive care unit (ICU). BACKGROUND Patients who were transported from ED to ICU is highly critical. IHT of these patients is potentially risky, which may associate with adverse events (AEs). The concern of safe IHT can be addressed by performing proactive risk assessments using HFMEA and implementing the findings after the ED of our hospital being reconstructed. DESIGN A qualitative action research study combined with a quantitative cross-sectional method. METHODS According to the HFMEA method, the failure modes of IHT were identified and analysed, and the effect of alterations was verified. We built a project team, drawn up a IHT flow chart, defined steps of IHT, classified the failure modes, calculated risk priority number and analysed by the decision tree, then formulated an action plan and verified the effects of the alterations. Incidence of AEs of transport was compared before and after HFMEA.SQUIRE 2.0 checklist was chosen on reporting the study process. RESULTS The HFMEA outlined a total of 5 major steps and 16 sub-steps in the IHT process. From this, 64 potential failure modes were identified, with 17 modes having a RPN score higher than 8. Determined by the decision tree, there were 20 priority control failure modes, of which 16 involved 8 IHT alterations. Notable work-flow alterations included use of a three-stage hierarchical transport strategy based on patients' condition assisted by the intelligent assessment system. Incidence of AEs was significantly decreased from 19.64% to 7.14% after the implementation of HFMEA (p < 0.05). CONCLUSION Application of the HFMEA in optimising IHT process can improve the safety of transportation, which is worthy of promotion. Hierarchical transport scheme can reduce the incidence of AEs in IHT of critical emergency patients, which mainly includes the integration and construction of the transport team, equipment configuration and patient information system based on the classification of patients' condition. RELEVANCE TO CLINICAL PRACTICE Nurses play a crucial role in the IHT process. HFMEA can be adopted for proactive risk assessment of critically ill patients' IHT from ED to ICU which involves multiple processes. The IHT hierarchical strategy based on the results of failure mode analysis should be more widely used to further verify its clinical effects.

目的 构建我国急诊护士灾害护理能力评价指标体系.方法 通过理论材料及相关文献选定评价指标体系框架,结合专家访谈了解急诊护士灾害护理能力的相关概念、职责和评价指标.运用Delphi法对30名专家进行两轮函询,构建急诊护士灾害护理能力评价指标.结果 两轮函询问卷有效回收率均为100.00％,专家的权威系数为0.883,判断系数为0.886,熟悉程度为0.880.两轮函询协调系数重要性W值为0.507与0.481,可行性W值为0.437与0.441,均具有统计学意义(P<0.01).最终确立了包含4个一级条目、10个二级条目、54个三级条目的急诊护士灾害护理能力评价指标.结论 根据函询专家的权威意见修订形成的急诊护士灾害护理能力评价指标内容具有科学性、可靠性及实用性,结合心理护理能力,细化急诊护士灾害护理能力,为未来进一步研究奠定科学依据及基础,可以在临床推广应用.

目的:分析ICU患儿发生谵妄的危险因素,为临床早期预防ICU患儿谵妄的发生提供参考依据.方法:计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国生物医学文献数据库、中国知网、维普数据库及万方数据库,收集关于ICU患儿发生谵妄危险因素的文献,检索时限为从建库至2020年7月10日.由2名评价人员按照标准独立进行文献筛选、资料提取和质量评价后,采用Stats?14.0软件进行Meta分析.结果:共纳入7篇文献,包括3398例研究对象,病例组808例,对照组2590例,共26项危险因素.Meta分析显示,发育迟缓、机械通气、苯二氮卓类药物及年龄是ICU患儿发生谵妄的重要危险因素.结论:基于现有证据,发育迟缓、机械通气以及使用苯二氮卓类药物的ICU患儿发生谵妄的可能性较大,且谵妄的发生风险与年龄呈反比,年龄越小发生谵妄的风险也就越高.目前关于ICU患儿谵妄危险因素的研究证据尚不充足,且各研究样本量、使用的评估工具及评估频次也存在较大差异,后期尚需要更多高质量的研究进行验证.

上海市东方医院自2010年起,由上级卫生主管部门正式授权开始组建卫生应急救援队伍.本文介绍了该队伍的建设模式,从体制、机制、专业、能力、设备、战略等六个方面以单一医院独立整建制的形式建设紧急医学救援队,实现了"应急管理-医护技-后勤辅助"一体化的科学组队,以及队伍的统一管理、统一培训、统一调度、统一补给,极大地提高了战斗力和凝聚力.该模式取得了显著成果:东方医院救援队在2012年成为首批国家紧急医学救援队,2016年成为世界卫生组织认证的首支国际应急医疗队,其后又指导多家国内外单位通过了世卫组织的评估,对提升我国应急医疗的国际地位和影响力,乃至推动人类社会医学抗灾能力的提升做出了贡献.

Objective:To construct a scientific and practical micro-course content framework of cross-cultural nursing hospice care from the perspective of attention, relevance, confidence and satisfaction (ARCS) model.Methods:The research team was established in November 2018. Using Delphi method, 16 experts in cross-cultural nursing, hospice care, nursing management, nursing education and other fields were consulted for 3 rounds of correspondence. According to scores of experts, the index weights were calculated to form micro-course content framework of cross-cultural nursing hospice care from the perspective of ARCS model.Results:The positive coefficient of experts surveyed by the questionnaire was 100%, the average value of expert authority coefficient was 0.81. The determined importance values of the first and second level indexes were all greater than 4.00. The coefficient of variation was 0 to 0.12, which were all less than 0.25 and met the requirements. In the end, a content framework containing 3 first-level indexes of professional concepts, professional knowledge and professional skills and 19 second-level micro-course content framework of cross-cultural nursing hospice care were formed.Conclusions:Based on the perspective of ARCS model, the construction process of content framework of the cross-cultural nursing hospice care micro-course is scientific and the setting is reasonable, which has a good guiding significance for the development of training for hospice care nurses.

Objective:To construct a cross-cultural nursing quality sensitive indicator system, so as to provide a basis for the hospital's cross-cultural nursing quality evaluation and monitoring.Methods:Based on the Donabedian model and the sunrise model, this study adopted the literature analysis method and the research team discussed preliminary screening indicators. From May to June 2020, 15 nursing and medical experts from a university hospital in Shanghai were selected as the subject of the consultation by using the method of convenience sampling. The Delphi method was used to conduct two rounds of expert consultations to determine the content of sensitive indicators of cross-cultural nursing quality.Results:The positive coefficients of the two rounds of consultations were 100%, and the authority coefficients were 0.883 and 0.893. The constructed cross-cultural nursing quality sensitive indicators included 3 first-level indicators and 20 second-level indicators.Conclusions:The cross-cultural nursing quality sensitive indicator constructed based on the Delphi method is scientific and representative, which can provide a reference for nursing quality evaluation and continuous quality improvement evaluation.

目的 通过医院危急值信息系统建立,提高重症监护室护理人员对危急值信息的处置效率和质量.方法 通过回顾性分析我院重症监护室2019年1～5月危急值病例纸质版登记单(对照组)与2020年1～5月采用信息化接收危急值的病例(观察组),收集检验科上报危急值时间到护士站接收时间差T1、护士站接收到医生工作站接收时间差T2、上报规范性、上报完整性、上报准确性等结果,并采用SPSS23.0进行统计学分析.结果 T1、T2时间均缩短(P＜0.05);规范率、完整率、准确率均显著提高(P＜0.05).结论 危急值信息系统在监护室应用取得良好效果,可以缩短信息传报时间,保证传递信息准确性,提高护士工作效率.

Objective:To understand the real experience and feeling of Intensive Care Unit (ICU) nurses after delirium assessment using Cornell Assessment of Pediatric Delirium (CAPD) , so as to provide reference and evidence for improving pediatric ICU delirium assessment.Methods:Using the purposive sampling method, a total of 11 ICU nurses who used CAPD for pediatric delirium assessment in a ClassⅢ Grade A children's specialized hospital in Shanghai from February to April 2020 were selected as the research objects. Phenomenological research method in qualitative research was used to conduct face-to-face and semi-structured in-depth interviews with the research subjects. Colaizzi 7-step analysis method was used to collect and sort the data and analyze and refine the topics.Results:ICU nurses' cognition in pediatric delirium assessment could be classified into four themes, including changes of ICU nurses' cognition of pediatric delirium assessment, obstacles to pediatric delirium assessment, promoting factors for pediatric delirium assessment, and ICU nurses' concern about the collaborative intervention of medical team after the positive delirium assessment.Conclusions:The main manifestations of ICU nurses in this study are the lack of understanding of the evaluation of delirium, the obstacles encountered in the evaluation process, and the lack of collaboration between the medical and nursing team. In order to improve the convenience and accuracy of ICU nurses' assessment of delirium, it is recommended to strengthen the training of medical staff for delirium, gradually optimize the obstacles to the implementation of the assessment, encourage the cooperation of medical teams and develop a delirium assessment process in line with children's ICU according to the working situation and mode of ICU.

谵妄是一种急性脑功能障碍综合征,儿童谵妄的发生率为4％～47％,谵妄既增加了儿童的住院时间及治疗费用,也会导致非计划拔管、坠床等意外事件的发生.谵妄的早期识别和及时处理可逆转住院患儿的负性结局.该文对早期识别儿童谵妄的危险因素、评估工具,以及个性化护理干预、医护协作下的药物管理及集束化护理方案的干预策略进行综述,以期为临床医护人员选择合适的儿童谵妄评估工具、采取有效的干预措施提供临床依据.

A mandatory 14-day 'centralized medical quarantine' has been instituted in Shanghai, China, to prevent secondary transmission of imported COVID-19. Here, we summarize our experiences and describe the work flow and disinfection measures in our quarantine centre.

目的 分析家庭临终关怀对晚期癌症患者生活质量(QOL)及心理状况的影响.方法 选取在我院就诊的晚期癌症患者104例,随机分为对照组和观察组,各52例.对照组行常规治疗及照护,观察组在常规治疗照护基础上再指导家属开展家庭临终关怀.两组患者均照护观察3个月.对两组患者入组前、后的肿瘤病人生活质量评分(QOL)、汉密尔顿抑郁平分(HAMD)和汉密尔顿焦虑评分(HAMA)进行测评并行护理前后及组间比较.收集整理两组患者观察期间治疗的毒副反应并比较.结果 (1)两组患者入组时QOL各维度及总评分比较差异无统计学意义(P＞0.05),照护1个月后,两组患者精神、家庭理解与配合、自身对癌症的认识、对治疗的态度、面部表情及QOL总分较治疗前上升,食欲、疲乏、疼痛、治疗的副作用较治疗前下降,上述各项指标观察者高于对照组患者(P＜0.05),睡眠、同事理解与配合、日常生活护理前后比较差异无统计学意义(P＞0.05);(2)对照组患者护理3个月后,HAMD、HAMA评分较护理前上升,观察组较治疗前下降,观察组低于对照组(P＜0.05).(3)两组患者治疗期间毒副反应率比较差异无统计学意义(P＞0.05).结论 家庭临终关怀可提升晚期癌症患者的精神状态及心理状态,增强其与疾病和谐共处的能力,降低其负性情绪,综合提升患者的生活质量及心理健康,具有较高的临床价值.

在应对新冠肺炎疫情期间,神经外科是接诊、诊治急诊患者的重要部门,通过对医护人员进行教育培训、隔离防护,以及实施病区防控策略,确保临床工作安全、有序地进行.

目的 总结新型冠状病毒肺炎定点医院非发热诊区疫情防控管理的应急策略,为进一步做好疫情防控提供借鉴.方法 基于各区域特征,制订新型冠状病毒肺炎疫情的防控标准和应急管理策略,专人分区进行专项督查,根据数据反馈促进各项防控措施的质量改进.结果 院内员工无新型冠状病毒感染发生;医院入口处人员口罩佩戴率为100％,住院患者家属口罩佩戴率为94.62％;各入口体温检测率均为100％;流行病学史筛查率:医院入口为95.93％,门诊、病房入口均为100％;工作人员手卫生执行率为96.14％,手卫生执行正确率为84.78％;患者和家属新冠肺炎防范措施知晓率为95.38％,护工为95.92％;医疗用品、环境消毒率为100％.结论 制订的医院非发热诊区新型冠状病毒感染的应急管理策略切实有效.后期医院入口流行病学史筛查率、住院患者家属口罩佩戴率以及各级人员手卫生和防控知识培训仍须进一步加强.

目的 探讨一体化智能急诊分诊系统在批量伤救治中的应用方法及效果.方法 采用便利抽样法选择某三级甲等医院2008年1月至2019年12月收治的15批342例交通意外伤患者为研究对象,其中2018年1-12月收治的8批175例患者为对照组,采取常规的批量伤救治流程;2019年1-12月收治的7批167例患者为观察组,应用一体化智能急诊分诊信息系统协助开展批量伤救治.比较两组患者的接诊响应时间、平均分诊时间、危重伤员的平均分诊时间及分诊级别符合率.结果 观察组患者的接诊响应时间、平均分诊时间、危重伤员的平均分诊时间均短于对照组患者,分诊级别符合率高于对照组,差异均有统计学意义(均P<0.05).结论 应用一体化智能急诊分诊信息系统进行批量伤员的辅助检伤分诊,有利于提高检伤分诊的时效性以及准确率,早期识别潜在危重患者,为抢救赢得时间.

灾难是对一个社区或社会功能的严重破坏,常对人员、物资、环境及经济带来不同程度的损害,主要包括自然灾害、各类突发公共事件等.护士是灾难救援队伍中不可或缺的组成部分,护士灾难救援贯穿于整个灾难过程,其灾难准备度直接影响灾难救援的效果.本文通过回顾国内外关于护士灾难准备的文献,描述护士灾难准备的相关概念、内容、评价工具、国内外护士灾难准备度现状及存在的问题,以及目前护士灾难准备的相关培训现状,为今后进一步根据我国灾难准备现状研制实用性的灾难培训课程提供参考.

危重患者院内转运是指各种危重患者经过初步处理、在病情相对稳定的情况下,为了明确诊断 ,或得到在目前科室无法得到的专业治疗 ,在院内科室间转运的过程[1 ] ,也是抢救过程的重要组成部分.院内转运可能导致不良事件的发生 ,转运安全是当前国内外的研究热点.本文对近年来危重患者院内转运不良事件的研究进展进行综述 ,以期为相关工作提供借鉴.