BACKGROUND:Communication with mechanically ventilated patients is a major challenge in the intensive care unit (ICU). Ineffective communication may lead to heightened negative emotions in patients and increase potential safety risks. Eye-tracking devices mainly use optical recording methods to capture the dynamic trajectory of eye movements and gaze positions, thus realising the interaction between the brain and external information. Although eye-tracking devices show promise for facilitating communication, they are only used in a few ICUs. AIM:This paper presents a scoping review of the application of eye-tracking technology in communication with mechanically ventilated patients in the ICU. The objective is to identify its current applications and characteristics, as well as provide direction for future research in this field. STUDY DESIGN:A systematic literature search was conducted across PubMed, Web of Science, Embase, Cochrane Library and Scopus databases, covering records from the inception of each database up to 23 January 2025. The included literature was summarised and analysed. RESULTS:A total of 11 papers were included. The use of eye-tracking technology in ICU mechanical ventilation communication mainly included communication of the content of needs and symptom assessment. The main outcome indicators were communication feasibility, satisfaction, psychosocial status and somatic symptoms. CONCLUSIONS:Eye-tracking devices are effective in facilitating communication about basic needs and in supporting symptom assessment among mechanically ventilated patients in the ICU. These devices enable personalised non-verbal communication and provide a more objective approach to symptom evaluation. Future research should focus on enhancing device functionality and conducting multicentre, large-sample randomised controlled trials to further explore and validate their role in ICU patient care. RELEVANCE TO CLINICAL PRACTICE:Effective communication with mechanically ventilated patients is essential in the ICU. The use of eye-tracking devices can improve communication efficiency and patient safety. ICU nurses should receive training in communication strategies and the practical use of such devices to optimise patient care.

BACKGROUND:Delirium is a significant concern for mechanically ventilated patients in intensive care units. Non-pharmacological strategies may help prevent delirium, but without a standard protocol, interventions are inconsistent. AIM:This study assessed existing evidence on non-pharmacological interventions for decreasing delirium in mechanically ventilated ICU patients. STUDY DESIGN:We applied evidence summary reporting standards and the '6S' pyramid model, searching key databases and webpages with a top-down focus on high-level evidence about non-pharmacological delirium prevention. The search covered literature published up until March 13, 2025. RESULTS:Eighteen documents were included: two guidelines, three expert consensuses, seven systematic reviews, three randomised controlled trials and three clinical decision analyses. The integrated evidence was grouped into six domains: assessment and diagnosis, positive internal experience, environment control, physical function recovery, traditional Chinese medicine (including five-animal play, five-element music therapy and acupuncture) and bundled interventions. This resulted in the development of 26 evidence-based recommendations-20 Grade A (strong recommendation) and six Grade B (weak recommendation), indicating a high degree of consensus and clinical feasibility. CONCLUSIONS:We synthesised 26 of the highest-quality studies from six domains to generate a comprehensive framework for non-pharmacological delirium prevention in mechanically ventilated ICU patients. These evidence-based suggestions provide practical clinical advice that healthcare professionals can adapt based on local resources and clinical contexts to guarantee safety and efficacy. RELEVANCE TO CLINICAL PRACTICE:This study reviewed the best evidence for the non-pharmacological prevention of delirium in mechanically ventilated ICU patients, from which it derived a comprehensive framework for clinical practice. This framework can reduce the frequency and length of delirium episodes, improve patient health outcomes and improve overall nursing quality. REGISTRATION:This review was submitted by Fudan University's Evidence-Based Nursing Center with registration number ES20246510.

Background Effective communication with mechanically ventilated awake patients in the intensive care unit (ICU) is a major challenge. Invasive mechanical ventilation deprives patients of their ability to communicate and hinders nurse-patient communication. Effective communication is an important step in building the nurse-patient relationship. Communication tools such as eye-tracking devices have the potential to improve communication between ICU nurses and patients. Objective The aim of this paper was to explore the use of eye-tracking technology for nurse-patient communication with mechanically ventilated patients in the ICU, and to inform its improved implementation in this setting. Methods Using a descriptive qualitative design and following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Semi-structured interviews were conducted from February to May 2025 with 16 mechanically ventilated patients who communicated using eye-tracking devices at least three times during their hospitalization at a hospital in Henan Province. Thematic analysis was employed, guided by the framework developed by Braun and Clarke. Results Three themes were identified: Technical interaction experience, Psychological experience, and the Barriers to using the device. This paper found that eye-tracking devices were feasible in communicating basic needs and provided psycho-emotional benefits. Patients were able to regain a sense of engagement, engage in emotionally supportive interactions, and feel psychologically safe. However, factors such as physiologic fatigue and environmental conditions created barriers to optimal use of the devices. Conclusion Eye-tracking technology can serve as a valuable supportive tool for nurse-patient communication in the ICU. It empowers patients to participate in their daily care and facilitates emotionally supportive interactions. However, barriers to implementation must be addressed to optimize its effectiveness. Future efforts should focus on refining these communication tools based on these findings to ensure that critically ill patients can fully benefit from them. Implications for clinical practice Eye-tracking devices are used as communication aids to help intubated or tracheostomy patients express basic needs and participate in their own care. To ensure communication effectiveness, clinical practice needs to be optimized in various ways, such as optimizing device performance and providing systematic training and support for caregivers to deal with barriers to device use.

INTRODUCTION:Prior studies have shown that about half of critically ill patients in intensive care units (ICUs) have abnormal blood glucose. Both hyperglycemia and hypoglycemia increase the risk of death in critically ill patients; therefore, controlling blood glucose in such patients is crucial. There is a significant gap between clinical practice and the current best evidence regarding glycemic control in ICU. AIM:This best practice implementation project aimed to improve glycemic control for critically ill patients in a tertiary hospital in China by promoting best practices. METHODS:This project was conducted according to the JBI Evidence Implementation Framework, which is based on an audit and feedback strategy. Four audit criteria were developed for the baseline and follow-up audits. An implementation protocol was designed based on the barriers and facilitators identified in the baseline audit. Nursing documentation from patients' medical records and interviews with nurses were used to assess the baseline and follow-up audit compliance rates. RESULTS:The results showed improved compliance with the four criteria in the follow-up audit. Except for only slight improvement in Criterion 2 (increasing from 15.3% to 26.6%), the three other criteria all achieved significant improvements. The compliance rate for Criterion 1 increased from 43.8% to 70.0%, Criterion 3 increased from 0% to 100%, and Criterion 4 increased from 46.8% to 65.8%. CONCLUSIONS:This evidence-based implementation project successfully increased nurses' compliance with best practice recommendations for glycemic control in critically ill patients. SPANISH ABSTRACT:http://links.lww.com/IJEBH/A338.

BackgroundSpecialist nurses represent an important pathway through which registered nurses transition toward advanced practice nurse roles, and their development and clinical practice are essential for addressing contemporary healthcare challenges. However, in countries such as China, substantial gaps remain in the training and practical implementation of specialist nurses. Despite more than two decades of specialist nurse training in China, systemic issues such as unclear role definitions, insufficient designated positions, and limited decision-making authority continue to constrain their clinical practice.ObjectiveTo investigate healthcare professionals' perceptions and experiences of specialist nurse practice in ICU to identify their roles, impacts, challenges, and suggestions for improvement.SettingA 25-bed ICU in a tertiary hospital in central China has been conducting under the specialist nurse practice model for six months.ParticipantsA purposive sampling survey recruited 18 nurses (14 ICU registered nurses and 4 specialist nurses) and 3 ICU physicians, all with more than one year of ICU work experience.MethodsA qualitative descriptive design using semi-structured interviews was adopted.FindingsThree major themes emerged from the analysis: 1) being a versatile and core force; 2) leading nursing quality and professional transformation; and 3) facing challenges and pursing a path to growth.ConclusionSpecialist nurses play a pivotal role in ICU nursing, driving quality improvement and professional development. However, systemic barriers such as resource constraints and role ambiguity limit their full potential. Addressing these challenges through workflow optimization, clear role definition, and policy reforms is crucial for advancing specialist nurse practice globally.

Objective:The usability questionnaire of the English version of the virtual reality system was localized to verify its reliability and validity in ICU patients, providing a scientific assessment tool for clinical practice. Methods:The Brislin translation model was adopted to complete the cross-cultural adaptation of the scale. A total of 331 ICU patients from a tertiary hospital in Zhengzhou City were included through convenience sampling for item analysis, validity and reliability tests. Results:The Chinese version of the scale consists of 3 dimensions and a total of 9 items. The Cronbach's α coefficient of the total scale was 0.821 and the split-half reliability was 0.782. The content validity index at the item level ranged from 0.833 to 1.000, and the average content validity index at the scale level was 0.978. Exploratory factor analysis extracted three common factors, with a cumulative variance contribution rate of 67.017%. The factor loadings of each item ranged from 0.609 to 0.876, and no items were deleted. Confirmatory factor analysis showed that the standardized path coefficients of all items were within the acceptable range. These results indicate that the adapted questionnaire is a psychometrically sound instrument. Conclusion:The Chinese version of VRSUQ has good reliability, validity and cultural adaptability. It not only fills the gap of a VR system usability assessment tool that is both culturally and clinically applicable for ICU patients in China, but also overcomes the limitations of existing international tools. Proven tools can be directly applied to clinical practice to guide the optimization of VR intervention measures, thereby enhancing patient experience and intervention effectiveness. In the future, its universality needs to be verified through multi-center research.

Purpose: To explore the reasons for poor multidisciplinary team (MDT) cooperation of Chronic Critical Illness (CCI) patients and their needs and expectations for carrying out MDT cooperation, with a view to providing references for improving MDT cooperation of CCI patients. Methods: Semi-structured interviews with 15 members of the MDT of CCI patients in a hospital of Henan Province were conducted in September and October of 2024 using a descriptive qualitative design. The data were analyzed using the thematic analysis method developed by Braun and Clarke. Results: Three themes emerged: Theme 1: The collaborative experience of MDT members, with three sub-themes: essential MDT cooperation, absence of specialized MDT, and the nurse's diminished role; Theme 2: Barriers to MDT cooperation, with three subthemes: unclear cooperation process and job responsibilities, lack of effective communication, and insufficient observation and feedback; Theme 3: Facilitators to MDT cooperation, divided into three sub-themes: timely and effective communication, a leading Conclusion: Due to the following deficiencies: unclear cooperation process and job responsibilities, lack of effective communication, and insufficient observation and feedback, it is urgent to take appropriate measures to promote MDT cooperation for CCI patients.

In recent years, the escalating frequency and intensity of infectious disease outbreaks have underscored the profound severity and global ramifications of public health challenges confronting healthcare systems. As frontline responders during emerging infectious disease crises, nurses’ core emergency response competencies critically influence the timeliness and efficacy of outbreak prevention and control measures. Currently, standardized assessment instruments for evaluating nurses’ core emergency response capabilities during major infectious disease outbreaks remain underdeveloped. This study aimed to construct and psychometrically validate a Core Emergency Response Competency Evaluation Scale for nurses during major infectious disease outbreaks. A convenience sample of nurses was recruited from eight tertiary hospitals in Henan Province, China. The three-phase study comprised: (1) item generation (Delphi survey and pilot testing), (2) scale development (item analysis and exploratory factor analysis), and (3) scale validation (reliability and validity assessments). The finalized 45-item scale encompasses eight dimensions: Fundamental Nursing Knowledge, Legal Policy Ethical Practice, Core Nursing Skills, Disease Assessment Monitoring, Emergency Response Coordination, Infection Prevention Control, Nurse Personal Attributes, and Rehabilitation Recovery. Exploratory factor analysis demonstrated an 83.353

目的 研究重症监护病房俯卧位通气患者发生压力性损伤的相关影响因素和相应的预防护理措施.方法 临床纳入 2021 年 12 月至 2022 年 12 月收治的重症监护病房患者 96 例,根据随机双盲法分组,分为对照组(48 例)、研究组(48 例),研究组予以预防压力性损伤的预见性护理措施,包括对俯卧位通气操作的护理流程、全面评估患者的状态、防止潮湿环境刺激等措施,对照组予以基础护理,两组护理时间均为2周,分析两组护理后发生压力性损伤概率、护理满意度等指标变化;对全部研究对象的临床资料进行回顾性分析,分析重症监护病房俯卧位通气患者发生压力性损伤的相关因素和相应的护理措施.结果 与对照组相比,研究组护理后发生压力性损伤概率大幅度减低,而护理满意程度大幅度提升,差异有统计学意义(P＜0.05);本研究中收治重症监护病房患者96例,发生压力性损伤13例(13.54%),发生压力性损伤与受压迫部位、导管压迫、俯卧位时间、潮湿刺激、患者年龄、护理经验等因素密切相关,差异有统计学意义(P＜0.05).结论 重症监护病房俯卧位通气患者发生压力性损伤的相关因素包括受压迫部位、导管压迫、俯卧位时间、潮湿刺激、患者年龄、护理经验等因素密切相关,临床需要完善各项护理措施,减低压力性损伤的发生.

肠内营养是危重患者的最佳营养支持方式[1],但在实施过程中易出现胃食管反流、腹泻、腹胀等肠内喂养不耐受现象[2],其发生率为 41.27％～73.6％[3].肠内喂养不耐受会导致危重患者肠内营养暂时中断,营养支持不足,住院时间延长和死亡率增加[4].为提高危重患者肠内营养时胃肠道的耐受性,有研究者[5]提出了半固化肠内营养喂养的方法,即模拟正常人进食状态,从肠内营养形态方面入手,在传统肠内营养液的基础上,添加果胶、琼脂和瓜尔胶等半固化剂,使之形成类似经胃研磨过的半固化食糜样状物,接近人体正常的生理饮食状态,利于消化吸收.

通过系统检索国内外肠内营养半固化喂养的相关研究,对其概念、方式和临床效果进行综述,以期为危重患者肠内营养半固化喂养的临床实践提供借鉴和参考.

Objective To explore the relationship between the professional quality of life and work environment among intensive care unit nurses, and identify the influencing factors of intensive care unit nurses' professional quality of life. Methods This study design is cross-sectional and correlational descriptive. Four hundred fourteen intensive care unit nurses from Central China were recruited. Data were collected from three questionnaires of self-designed demographic questions, the professional quality of life scale and the nursing work environment scale. Descriptive statistics, Pearson's correlation, bivariate analysis and multiple linear regression were used to analyze the data. Results A total of 414 questionnaires was collected, for an effective recovery rate of 98.57%. The original scores of the three sub-scales of professional quality of life were 33.58 ± 6.43, 31.83 ± 5.94, and 32.55 ± 5.74. Compassion satisfaction was positively correlated with the nursing working environment ( p < 0.05), job burnout, and secondary trauma were negatively correlated with nursing work in environment ( p < 0.05). Multiple linear regression analysis results show that, the nursing working environment entered into the influential factor model of professional quality of life scale ( p < 0.001). The nursing working environment independently explained 26.9% of the changes in compassion satisfaction, 27.1% of the changes in job burnout, and 27.5% of the changes in secondary trauma. The nursing work environment is an important factor affecting the professional quality of life. Conclusion The better the nursing working environment, the higher the professional quality of life of intensive care unit nurses. Decision makers and managers can focus on improving the working environment of nurses, which may be a new perspective for managers to improve the professional quality of life of nurses and stabilize the nursing team.

对重症监护室(ICU)终末期病人死亡质量的概念、评价方法、测评工具及 ICU 终末期病人死亡质量的影响因素进行综述,建议医护人员关注 ICU终末期病人的死亡质量,积极探索提升 ICU终末期病人死亡质量的护理干预策略,旨在为 ICU 规范开展安宁疗护、提高终末期病人的死亡质量奠定基础.

Background:Vigilance and executive functions are integral to nursing practice. Prolonged working hours are associated with heightened fatigue and increased nursing errors. However, the impact of work duration on the vigilance and executive function of ICU nurses remains unexplored. Objective:This study aims to elucidate the association between ICU nurses' working hours, vigilance, and executive function. Design:A cross-sectional study. Setting. Intensive care medicine department of a tertiary hospital in Zhengzhou, China. Participants. A total of 51 registered nurses who participated in 12 h shifts in the ICU completed the survey. Methods:E-prime software was employed to develop four test tasks to measure the vigilance and executive functioning of ICU nurses. The test was performed before the start of the shift and after 4, 8, and 12 h. Results:The analysis revealed no statistically significant differences in the response time of vigilance for ICU nurses across shifts (p=0.503) or working hours (p=0.078). However, a significant difference existed in lapses across working hours (p=0.005), significantly increasing after 8 and 12 h. The analysis indicated a significant difference in Flanker effect size across different working hours (p=0.035). The analysis revealed no significant differences in the switch cost (p=0.200) or response accuracy (p=0.479) of the task switching across working hours. The response accuracy for the 2-back task differed significantly (p=0.003) across working hours. Conclusion:Limited evidence demonstrated that vigilance and specific aspects of executive functioning (inhibitory control and working memory) of ICU nurses were negatively correlated with the duration of their work in a real clinical setting. Furthermore, no vigilance and executive function differences were identified between day and night shifts. Implications for Nursing Management. Nursing administrators should reconsider scheduling 12 h shifts, shortening shifts, or implementing short rest periods to reduce fatigue and cognitive load. In addition, flexible scheduling and rationalizing the order of work may help reduce the possible risks associated with prolonged work.

目的 探讨ICU经口气管插管清醒患者口渴体验与护理需求,为构建相关护理干预方案提供依据.方法 采用目的抽样法,选取 2022 年 9 月至 10 月在河南省某三级甲等综合医院ICU住院的 16 例经口气管插管拔管后患者进行半结构式访谈,运用现象学研究中的Colaizzi 7 步分析法对访谈资料进行分析和主题提炼.结果 ICU经口气管插管清醒患者的口渴体验可归纳为 5 个主题:口渴强度高、口渴持续时间长、口渴的不良影响、患者口渴需求难以表达、口渴干预措施未达患者需求.结论 口渴使ICU经口气管插管清醒患者感到严重不适,影响其身心健康.护士应重视ICU患者的口渴症状,给予有效的止渴措施.

口渴是ICU经口气管插管患者普遍存在的严重不适症状,影响患者的身心健康.文章从ICU经口气管插管患者口渴的现状、影响因素、评估和干预措施等方面进行综述,以期为ICU经口气管插管患者口渴的护理提供参考.

ObjectivesThis study sought to investigate nurses’ knowledge, attitudes and practices, and analyse the influencing factors for subsyndromal delirium (SSD).DesignA descriptive cross-sectional survey.SettingE-questionnaires were distributed to intensive care unit (ICU) nurses from 20 tertiary-grade, A-class hospitals in Henan Province, China.ParticipantsA total of 740 ICU nurses participated in the questionnaire survey.Main outcome measuresEach dimension score is converted to a percentage scale. A score of ≤60% on each dimension of the questionnaire was considered a negative score, <80% was considered a intermediate score and ≥80% was considered an excellent score.ResultsA total of 733 questionnaires were included in the study. More than half of the nurses were at the intermediate level, and a few nurses were at the excellent level. Nurses self-assessed their level of knowledge was intermediate. In the attitudes dimension, nurses’ attitudes were negative. The results of the practical dimension showed that most nurses could carry out the clinical practice. Multiple linear regression analysis showed that educational level and received SSD training were influencing factors.ConclusionsICU nursing staff overestimated their knowledge of SSD and showed a negative attitude towards it. Various forms of education and training are necessary.

Enteral Nutrition-related Diarrhea (END) is an extremely common complication in Intensive Care Unit (ICU) patients. However, it is currently unclear whether the patient’s gut microbiota is disturbed. Our study aimed to explore the characteristics of gut microbiota changes in END patients. We divided ICU patients into no-END group (n = 7) and END group (n = 7) according to whether they had END, then stool samples were collected separately. The V3-V4 region of stool bacterial 16S rRNA gene was amplified by PCR and sequenced on an Illumina MiSeq PE300 platform. Microbiome data obtained by quality control were analyzed, including microbial community composition, diversity and gene function prediction.The results showed that the dominant gut microbiota in ICU patients who were given total enteral nutrition were Firmicutes, Proteobacteria, Bacteroidetes, Actinobacteria, and Verrucomicrobia. Bacterial richness and diversity in END patients were all significantly lower than those in no-END patients. In addition, END caused significant changes in bacterial composition. LEfSe found 34 biomarkers represented by Bacteroidetes and Subdoligranulum in the no-END group as well as 11 biomarkers represented by Enterococcus and Klebsiella in the END group. Finally, through PICRUST function prediction, we found that diarrhea led to abnormal changes in numerous KEGG pathways mainly related to immunity and metabolism. In short, ICU patients with END have severe gut dysbiosis, and our study provides a reliable experimental basis for the patient’s microbiota therapy.

目的 探讨预立医疗照护计划在血液透析患者中的应用效果.方法 采用便利抽样法,选取2020年10月—2021年6月在郑州市某三级甲等医院就诊的80例血液透析患者作为研究对象,使用随机数字表法分为试验组和对照组各40例.试验组实施4周预立医疗照护计划干预,对照组实施常规护理.干预前后分别采用死亡态度描绘量表、生命意义感量表中文版和患者尊严量表比较两组死亡态度、生命意义感和尊严感差异.结果 干预前两组死亡态度描绘量表、生命意义感量表中文版和患者尊严量表得分差异无统计学意义(P>0.05);干预后试验组患者死亡态度转为正向态度,生命意义感量表中文版得分高于对照组,患者尊严量表得分低于对照组,差异具有统计学意义(P<0.05).结论 实施预立医疗照护计划干预能够帮助血液透析患者转变为正向死亡态度,增加生命意义感,维护患者尊严.

Abstract Background Surgical incision, endotracheal intubation, structural changes in the oral cavity, and other factors lead to a divergence in oral care between patients after oral surgery and ordinary inpatients. High-quality oral care can reduce the incidence of incision infection and ventilator-associated pneumonia. However, there is a lack of guidelines or expert consensus on oral care after oral cancer surgery. Therefore, the aim of this study was to assess the practicing situation of nurses in the intensive care unit (ICU) for postoperative patients with oral cancer and their need for training. Methods A multicenter cross-sectional study design was conducted in 19 ICUs of 11 tertiary hospitals from Henan province in China. Data were collected from 173 nurses and 19 head nurses online using a structured questionnaire. Mann–Whitney U and Kruskal–Wallis H tests were performed to analyze the data using SPSS (Version 25.0). Results Seven ICUs (36.8%) developed evaluation regulations for the oral care of postoperative patients with oral cancer, and eight ICUs (42.1%) described the operating standards. A total of 173 nurses completed the questionnaire, and the median score was 75 (68, 78). Almost all of the examined nurses (91.2%) assessed patients’ oral hygiene at a fixed time, while in 52.0% and 28.3% of nurses, the first oral care and frequency of oral care after surgery was determined based on the individual patient’s situation. More than half of the nurses (55.5%) spent approximately 5–10 min conducting oral care for patients. Physiological saline solution (82.7%), swabbing (91.9%), and oral care package with cotton ball (86.1%) were the most popular oral care mouthwash, method, and tool, respectively. Nurses sought help from senior nurses (87.3%) and doctors (83.8%), mostly to solve difficulties of oral care. Moreover, 76.9% of the nurses believed that the lack of knowledge and skills surrounding oral care was the main barrier for nurses to implement oral care. The majority of participants (69.4%) had never received continuing education or training in oral care for postoperative patients with oral cancer, and almost all (98.8%) of the respondents stated their preference to receive training in standardized oral care skills. Indications and contraindications (84.4%), tools (81.5%), and mouthwash (80.9%) of oral care were the items that the respondents were most eager to learn about. Approximately three quarters of nurses preferred scenario simulation practice as the training method. Conclusion Although the participants had high oral care scores for postoperative patients with oral cancer, there was great diversity in the practice. The lack of oral care knowledge was deemed the main barrier in delivering quality oral care, and the educational need was stated by almost all participants. We suggest that a standard protocol or clinical practice guidelines for oral care for postoperative patients with oral cancer should be developed, and nurses should be educated to equip them with professional knowledge and skills.