Objectives This study was designed to explore intensive care unit (ICU) nurses’ experiences communicating with families of critically ill patients, focusing on role perceptions and communication challenges. Methods Semi-structured interviews were used in this qualitative descriptive study of purposively sampled critical care nurses from three ICUs (medical, surgical, and liver) at a Hangzhou tertiary hospital. Interviews were audio-recorded, transcribed, and analyzed using descriptive thematic analysis. Rigor was incorporated through the use of independent coding, reflexivity through data collection, analysis and interpretation. This process was captured through an audit trail. Findings Thematic analysis of interviews with 22 ICU nurses generated two primary themes: (1) ICU nurses’ perceived roles in family communication and engagement, encompassing physician-family-patient connector, family emotional support provider, and advocate for patients and families; and (2) Nurse-identified sources of difficulty in family communication, including individual (emotional fatigue and stress, tensions surrounding information disclosure), systemic (time pressure amid family expectations, exclusion from decision-making), and interactional barriers (language and health literacy challenges). These challenges were described as compounding, intensifying communication difficulties and associated psychological stress. Nurses described impaired family interactions with increased risk for burnout. Notably, a majority (82%; n = 18) of ICU nurses were rarely or never included in structured family meetings, highlighting a significant deficit and described frustration regarding underutilized communication competencies and limited opportunities to engage in care decision-making. Conclusion ICU nurses play vital yet underutilized roles in family communication as communicators, emotional supporters, and advocates for patients and families, hindered by systemic, individual, and interpersonal barriers that mirror global challenges, particularly cultural competence gaps and role uncertainty. These barriers converge to form a self-reinforcing cycle that impedes nurse-family communication and exacerbates burnout risk, especially among junior nurses, a pattern likely transferable to high-acuity settings worldwide. Implications for Clinical Practice We propose a three-part strategy: (1) structural reforms to formalize nurses’ roles in family meetings and decision-making; (2) psychological support systems to boost communication resilience and reduce burnout; (3) culturally adaptive training to address health literacy gaps, language discordance, and cultural script conflicts. This multifaceted approach will empower nurses as effective facilitators of patient- and family-centered care across diverse clinical settings.

Confronted with the traumatic experience of a child’s liver transplantation, parents may experience positive psychological changes alongside distress. This study aimed to: assess the level of posttraumatic growth (PTG) in this population, and identify factors associated with PTG, focusing on deliberate rumination, intrusive rumination, and social support. This cross-sectional study involved parent-caregivers of young children (≤ 3 years) after their first liver transplantation at a Chinese tertiary hospital (May 2023–June 2024). Data were analyzed using SPSS 25.0. Group comparisons (t-tests/ANOVA), correlation analyses, and a multivariable stepwise linear regression were performed to identify influencing factors associated with PTG. Of 146 parents recruited, 134 provided valid responses (91.8

The increasing volume and complexity of orthopedic surgery have expanded the involvement of ward-based registered nurses in postoperative wound care. Although registered nurses receive foundational wound care education as part of their professional preparation, those without specialist wound care credentials may encounter challenges when managing complex orthopedic surgical wounds. Their experiences, role boundaries, and perceived support needs remain insufficiently explored. This study aimed to explore ward-based registered nurses’ perceptions of their roles and professional boundaries in orthopedic surgical wound management and to identify perceived strategies for supporting their practice. A descriptive qualitative study was conducted in an orthopedic ward of a tertiary hospital in China. Fourteen ward-based registered nurses were purposively recruited and participated in semi-structured interviews. Data were analysed using Braun and Clarke’s thematic analysis approach. Four themes were identified: negotiating professional boundaries within clinical hierarchies, evolving role identity in orthopedic surgical wound care, developing professional capacity for safe and responsive wound management, and sustaining practice development through continuing education and organizational support. Participants described surgical wound care as an expanding but ambiguously defined area of nursing practice. Their accounts highlighted a mismatch between foundational wound care education and the demands of complex orthopedic surgical wounds, variability in physicians’ treatment preferences and local ward routines, limited decision-making authority, and inconsistent interprofessional collaboration. Participants also emphasized the importance of timely nursing involvement, clinically relevant continuing education, standardized protocols, and clearer escalation pathways for supporting safe and coordinated wound care. Ward-based registered nurses without specialist wound care credentials make important contributions to orthopedic surgical wound management through ongoing assessment, timely dressing care, patient education, and communication with physicians and wound care specialists. However, their expanding role is shaped by unclear professional boundaries, variable local practices, limited authority in wound-related decision-making, and uneven access to continuing education. Clearer role delineation, standardized protocols, structured continuing education, and collaborative escalation pathways are needed to support safe and consistent wound care.

BACKGROUND:Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are potentially life-threatening complications in critically ill children, yet nursing awareness, knowledge and management of these syndromes remain poorly understood. AIM:To assess paediatric critical care nurses' awareness, knowledge and management of IAH/ACS and intra-abdominal pressure (IAP) measurement, identifying gaps and barriers to guide training and protocol standardisation. STUDY DESIGN:This is a descriptive cross-sectional study. Paediatric critical care nurses (convenience sample) from nine settings in six Zhejiang Province hospitals were surveyed online (April-May 2025). The survey evaluated IAH/ACS awareness/knowledge (13 items) and IAP measurement practices (12 items). RESULTS:In this study, 235 nurses from nine centres responded (response rate: 61.8%). The survey revealed significant deficiencies in nurses' awareness and implementation of World Society of the Abdominal Compartment Syndrome (WSACS) guidelines: 52.8% were unaware of them, 12.3% reported familiarity, and 44.7% indicated non-adoption in their hospitals. Knowledge of IAH/ACS was limited: 54.9% had never heard of ACS, and 62.6% were unfamiliar with IAH's impact on organ function. Notably, 68.9% had never managed paediatric IAH/ACS cases. In practice, only 23.8% received IAP measurement training, and 26.0% had performed it. Transbladder measurement was most common (96.7%) but lacked standardisation. Main barriers were procedural skill deficits (61.5%), inadequate indication recognition (52.9%) and clinical inexperience (50.6%). Key facilitators included educational training (88.5%), simplified/standardised IAP techniques (88.1%) and evidence-based guidelines (80.4%). CONCLUSIONS:Substantial knowledge-practice gaps exist in paediatric IAH/ACS management, characterised by low guideline awareness, insufficient clinical knowledge and inadequate/unstandardised IAP monitoring. To address these gaps, efforts should prioritise enhancing stratified training, standardising technical practices and implementing guidelines. RELEVANCE TO CLINICAL PRACTICE:There is an urgent need for paediatric critical care nurses to receive standardised training on IAP monitoring, to adopt unit-specific protocols and to lead or participate in the implementation of evidence-based guidelines at the bedside.

ABSTRACT Aim This multicentre cross‐sectional survey aimed to assess the knowledge, attitudes, and practices (KAP) related to surgical incision care, as well as the perceived training needs of non‐wound specialist nurses working in orthopaedic departments in 15 tertiary hospitals across 10 provinces in China. Design A multicentre cross‐sectional e‐survey was conducted. Methods A convenience sample of 437 non‐wound specialist nurses from 15 tertiary hospitals across 10 provinces in China completed a demographic questionnaire, a questionnaire assessing knowledge, attitudes, and practices related to surgical incision care, and a wound‐care training‐needs questionnaire. Descriptive statistics, non‐parametric tests, Spearman's rank correlations, and multivariable models for a continuous outcome were used for analysis. Ceiling effects were assessed as the proportion of respondents achieving the maximum possible score on each subscale. Results The median total KAP score was 117 (IQR 106–122). The median scores for Knowledge, Attitude, Practice, and Training Needs were 16 (IQR 13–19), 45 (IQR 41–45), 60 (IQR 48–60), and 90 (IQR 82–90), respectively. Training Needs was positively associated with total KAP ( ρ = 0.610, p < 0.001), as well as with Attitude and Practice, but not with Knowledge. Substantial ceiling effects were observed in the Attitude (64.5%), Practice (55.6%), and Training Needs (58.6%) subscales, indicating limited discrimination among respondents at the upper end of these score distributions. In multivariable analyses, higher Training Needs scores remained associated with higher total KAP scores. Conclusion Respondents generally reported favourable attitudes and practices regarding surgical incision care, although important knowledge gaps remained. Given the cross‐sectional design and the marked ceiling effects observed in several subscales, these findings should be interpreted cautiously. Structured, competency‐based training programmes may help address identified gaps in knowledge and technical skills in this population; however, the relatively high Attitude and Practice scores should be interpreted cautiously given the observed ceiling effects. Patient or Public Contribution No patient or public contribution.

Sarcopenia significantly compromises outcomes in infants undergoing liver transplantation. Effective nutritional care, crucial for combating sarcopenia, is primarily managed by family caregivers. The aim of this study was to explore the real experiences and needs of family caregivers for infants who underwent liver transplantation with preoperative sarcopenia during the nutritional care process, and to provide a reference for formulating targeted intervention strategies for nutritional rehabilitation and catch-up growth. A descriptive qualitative study was conducted. Between June and September 2025, 15 family caregivers of infants who underwent liver transplantation with preoperative sarcopenia were purposively sampled from a liver transplantation center at a tertiary hospital in Hangzhou, China. In-depth semi-structured interviews were conducted twice per participant (one day before discharge and 2–3 weeks after discharge). The interview data were analyzed and summarized via content analysis. Three themes and seven subthemes were identified: (1) nutritional knowledge deficits and fragmented information sources (subthemes: cognitive blind spots regarding the nutrition-disease relationship, fragmented and non‑professional knowledge acquisition); (2) dualities of nutritional care: burden and growth (subthemes: emotional burden and financial burdens, synergistic support networks and positive growth); and (3) unmet needs: deficiencies in the nutritional support system (subthemes: lack of systematic nutritional course training, discontinuity in follow-up after discharge, insufficient nutritional assessment services). Family caregivers of infants who underwent liver transplantation with preoperative sarcopenia experience multifaceted strain that compromises nutritional care. Our findings underscore the critical need to address the interconnected gaps in knowledge, caregiver burden, and healthcare system support to promote catch-up growth and optimal development in this vulnerable population. Not applicable.

Caregivers of acute leukemia (AL) patients face heavy physical and psychological burdens, yet few stress coping theory-based interventions address their positive experiences and coping needs. We aimed to explore the effects of a nursing intervention based on stress coping theory on primary caregivers of AL patients. This is a non-randomized controlled trial. Participants were selected via convenience sampling. Eighty primary caregivers of AL patients hospitalized between October 2023 and December 2024 were enrolled and assigned to an intervention group (n = 40) and control group (n = 40). The intervention group received a 5-week stress coping theory-based nursing program in addition to routine care, while the control group received routine care only. Caregiver outcomes were assessed at baseline and one week post-intervention using the Positive Aspects of Caregiving Scale, Social Support Rating Scale, Simplified Coping Style Questionnaire, and Zarit Burden Inventory. Between-group comparisons were performed using independent samples t-tests or Mann-Whitney U tests. Within-group comparisons were conducted using paired t-tests or chi-square tests. A significance level of 5

BACKGROUND:Young adult patients with cancer are particularly vulnerable to psychological distress due to various unique developmental challenges. AIM:This study explored the network structure of psychological distress and its interconnections with associated factors with the aim of further ascertaining targets for precise prevention and control of psychological distress. METHODS:This is a descriptive, cross-sectional study. Eight questionnaires were distributed to capture demographics, anxiety, depression, social support, illness perception, cancer coping strategies and psychological distress among participants. Multivariate linear regression analysis was used to investigate the main factors influencing psychological distress. Network analysis was further used to visualize the network model and to calculate the centrality indexes, network stability and accuracy. RESULTS:A total of 924 young adult patients with cancer (59.2% male; 48.4% aged 31-40 years) participated in this study. Significant factors for psychological distress were consequences, symptom identity, emotional representation, avoidance and suppression, resignation, fantasy, catharsis, severity of anxiety and severity of depression. The emotion domain of psychological distress was the most central factor in the network model, with the highest strength, betweenness, and expected influence. Anxiety exhibited the highest closeness, while depression had the highest bridge expected influence. CONCLUSION:Psychological distress is a complex system in which emotions, anxiety, and depression play distinct and critical roles. To effectively alleviate overall distress, clinical interventions should prioritize emotion regulation, target the central influence of anxiety, and disrupt the bridging role of depression.

To evaluate the nutritional risk of the different types of COVID-19 patients and the factors influencing the progression of COVID-19 patients. A total of 305 COVID-19 patients were enrolled in this retrospective study. Enrollment was from December 17, 2022 to January 18, 2023. Basic information, nutritional screening, and laboratory values were obtained from patient care records, electronic medical records, and related examinations. Forty-six patients experienced progression of COVID-19, while 259 patients experienced no progression. In the nutritional screening of patients with COVID-19 progression, an NRS2002 score of 3–4 was observed in 56.5

Background: Intra-abdominal hypertension has been proven to be an independent risk factor for death in critically ill patients. Accurate monitoring of intra-abdominal pressure is of great significance for early identification and timely intervention of intra-abdominal hypertension to prevent further progression to abdominal compartment syndrome. Paediatric critical care nurses play an important role in constant observation and recognition of subtle and dynamic changes in intra-abdominal pressure of critically ill children. Objectives: The objective of this study was to explore paediatric critical care nurses's views on the barriers and facilitators in clinical practice of intra-abdominal pressure measurement. Methods: A qualitative, open-ended, and exploratory study was conducted in the paediatric intensive care unit of a tertiary hospital in China. Semistructured interviews were conducted with nurses and nursing managers who were involved in the management of intra-abdominal pressure. The interview guide was developed using the Theoretical Domains Framework to explore the barriers and facilitators to intra-abdominal pressure measurement in the paediatric intensive care unit. Data analysis followed the framework approach, drawing on the Theoretical Domains Framework. Results: Fourteen participants (10 nurses and four nursing managers) were interviewed. We identified seven domains related to intra-abdominal pressure measurement mapping to six "barrier" domains and four "facilitator" domains. The six "barrier" domains were knowledge, social influences, behavioural regulation, beliefs about consequences, beliefs about capabilities, and environmental context and resources, and the four "facilitator" domains were social influences, beliefs about consequences, environmental context and resources, and social/professional role and identity. Conclusions: The findings confirm the need for interventions to support paediatric critical care nurses in their intra-abdominal pressure measurement practices, with a particular focus on increasing knowledge, improving skills and measurement equipment, promoting nurse-physician interprofessional collaboration, providing a standardised measurement process, and establishing a supportive environment. Using the Theoretical Domains Framework will enhance the design of a targeted intervention, which should facilitate the standardised management of intra-abdominal pressure in the paediatric intensive care unit. (c) 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

To create a nomogram for early intra-abdominal hypertension (IAH) detection in pediatric patients following liver transplantation (LT). This prospective, observational study was conducted in a tertiary hospital’s Liver Transplantation Intensive Care Unit (LICU), prospectively recruiting a cohort of 425 children undergoing liver transplantation between January 2022 and December 2024. Perioperative parameters were electronically extracted via the hospital information system. Intra-abdominal pressure (IAP) quantification employed the standardized transvesical technique. To identify clinically relevant predictors, a LASSO-based feature selection algorithm was applied, leveraging regularization to shrink coefficients of non-informative variables toward zero. The retained covariates were then integrated into a multivariable logistic regression model for nomogram construction. Internal validation included three domains: (1) discrimination performance evaluated by area under the ROC curve (AUC), (2) calibration accuracy by Hosmer-Lemeshow test with calibration curves, and (3) clinical utility assessed through decision curve analysis (DCA) across probability thresholds. Three independent predictors were identified: Graft-to-Recipient Weight Ratio (GRWR), duration of mechanical ventilation (MV), and central venous pressure (CVP), integrated into a predictive nomogram. DCA showed a significant net benefit, and temporal validation confirmed the nomogram’s reliability. The nomogram displayed superior predictive accuracy (AUC = 0.831) with adequate calibration (Hosmer-Lemeshow test p > 0.05). DCA revealed favorable clinical applicability across threshold probabilities, showing positive net benefit values ranging from 10

BACKGROUND:This nationwide survey aimed to assess hematology nurses' knowledge, attitudes, and practices (KAP) and its influencing factors on preventing and controlling multidrug-resistant organisms (MDROs) infections. METHODS:This cross-sectional study surveyed hematology nurses at 185 hospitals across 26 provinces and municipalities in mainland China. Descriptive analysis, correlation tests, generalized linear models, and decision tree modeling were used to assess the current status of KAP and influencing factors. RESULTS:A total of 1,984 nurses participated. The median scores for KAP, management, and surveillance in preventing and controlling MDROs infections among study subjects were 44 (out of a total of 53, 83%), 60 (out of a total of 60, 100%), 210 (out of a total of 210, 100%), 53 (out of a total of 58, 91%), and 10 (out of a total of 10, 100%), respectively. Correlation analyses revealed significant positive associations between MDROs infections management and KAP dimensions. The generalized linear models and decision tree analysis showed MDROs infections management and hematology nurses' attitudes were strong predictors of their practices, especially the perceived importance of MDROs infections management (β = 1.13, P < .001), key process management (β = 1.17, P < .001), and staff training (β = 1.90, P < .001). CONCLUSIONS:This study highlights strong hospital MDROs management boosts nurses' KAP, enhancing MDROs infections control and prevention in hematology settings.

Background Caregivers of children with liver transplantation bear a huge care burden and mental stress during the process of caring for the children. The benefit finding, as an important branch of positive psychology, can effectively help caregivers relieve care stress and improve the quality of life of both them and their children. However, a limited number of studies have reported. The study aimed to identify the trajectories of benefit finding and the predictors associated with trajectory classes in carers of children with liver transplantation. Methods This study included 144 caregivers of children who underwent liver transplantation at the Liver Transplantation Centre of a tertiary hospital in Hangzhou. The following questionnaires were completed at pretransplant, 1 month posttransplant, 3 months posttransplant, and 6 months posttransplant: the Benefit Finding Scale, the Simplified Coping Style Questionnaire, the Perceived Social Support Scale, the Zarit Caregiver Burden Interview and the Life Orientation Test-Revised Scale. The latent growth curve model (LGCM) and the growth mixture model (GMM) were used to examine the development of benefit finding. Univariate and multivariate logistic regression analyses were used to examine the predictors of the benefit-finding trajectory categories. Results The benefit finding for carers of children with liver transplants was moderate and first increased but then decreased over time. Four benefit-finding trajectory categories were identified: the high-level stable group (18%), the medium-level gradual decline group (29%), the medium-level stable rising group (24%) and the low-level persistent group (29%). The multivariate logistic regression analysis suggested that caregiver gender, family monthly income, coping style, caregiving burden and social support were associated with the trajectory classes of benefit finding in caregivers of children who underwent liver transplantation. Conclusion There was population heterogeneity in the benefit finding of caregivers of children with liver transplantation. Medical workers need to develop targeted nursing interventions according to the characteristics of different classes of caregivers to effectively improve benefit finding.

OBJECTIVE:This review aims to assess evidence regarding the effectiveness of family-provider communication interventions. METHODS:We searched six databases (PubMed, PsycINFO, Web of Science, EMBASE, CINAHL and the Cochrane Library). Two researchers independently extracted data and assessed bias. Data were analyzed using Stata software and Review Manager. RESULTS:Nineteen studies were included. Communication interventions had a moderate effect on family needs (SMD = -0.43, 95 % CI: -0.81 to -0.06, P = 0.025), small effects on 6-month psychological distress (Overall: SMD = -0.14, 95 % CI: -0.34 to -0.04, P = 0.04; Anxiety: SMD = -0.16, 95 % CI: -0.28 to -0.05, P = 0.004), and reduced symptom prevalence (Anxiety: RR = 0.78, 95 % CI: 0.65-0.94, P = 0.009; Depression: RR = 0.79, 95 % CI: 0.65-0.97, P = 0.022; PTSD: RR = 0.70, 95 % CI: 0.53-0.94, P = 0.015), with a small ICU stay reduction (SMD = -0.10, 95 % CI: -0.20 to -0.01, P = 0.036). Face-to-face (FTF) with print supplements had a moderate effect on family needs (SMD = -0.53, 95 % CI: -0.69 to -0.36, P < 0.001), small effects on 3-month anxiety (RR = 0.59, 95 % CI: 0.44 to 0.79, P < 0.001) and depression incidence (RR = 0.62, 95 % CI: 0.44 to 0.89, P = 0.009). Conversely, FTF with digital supplements yielded small effects on communication quality (SMD = 0.28, 95 % CI: 0.05-0.52, P = 0.01), 6-month psychological distress (Overall: SMD = -0.19, 95 % CI: -0.34 to -0.04, P = 0.01; Anxiety: SMD = -0.22, 95 % CI: -0.34 to -0.10, P < 0.001; Depression: SMD = -0.17, 95 % CI: -0.29 to -0.04, P = 0.007; PTSD: SMD = -0.18, 95 % CI: -0.34 to -0.02, P = 0.03). CONCLUSION:Family-provider communication interventions effectivelyimprovefamily needs and communication quality,enhancelong-term psychological outcomes, andreduceICU stays. Print materials excelled in immediate information delivery andacute distress alleviation, while digital communication tools were superior for sustained communication and long-term distress management.Notably,despitenurses assumingmultifaceted communication roles, robust evidence for their intervention effectiveness remains lacking. IMPLICATIONS FOR CLINICAL PRACTICE:ICU providersshould consider utilizingprint materials for immediate information delivery and digital tools forongoing psychological support. Future studies must validate nurses' communication roles and develop optimized strategies to enhance these interventionsto fully leveragenurses' professional expertise.

ABSTRACT Objective To investigate the status and influencing factors of caring readiness among parents of children undergoing liver transplantation transitioning from the intensive care unit, and to explore the associations between caring readiness and other variables. Design A cross‐sectional study. Methods A total of 126 parents of children who underwent liver transplantation at a tertiary hospital in China took a questionnaire survey via convenience sampling. Independent t ‐test, ANOVA and correlation analysis were conducted to analyse the data. Multivariable stepwise linear regression was used to analyse the influencing factors of caring readiness. The PROCESS macro (Model 4) was used to verify the mediating effect of caregiver burden between social support and caring readiness. Reporting Method The STROBE checklist was used as a guideline in this study. Results The mean score of caring readiness among parents of children who had undergone liver transplantation and were transitioning from the intensive care unit was 23.62 ± 5.34. Multivariable stepwise linear regression analysis indicated that experience with caregiving, intensive care unit length of stay, social support and caregiver burden were the factors associated with caring readiness, explaining 18.6% of the variance in caring readiness among parents. Caregiver burden partially moderated the relationship between social support and caring readiness (20.93%). Conclusion The study shows caring readiness was moderate among parents of children who have undergone liver transplantation and are transitioning from the intensive care unit. It reveals that lack of caregiving experience and children's short intensive care unit length of stay should be emphasised, preventing inadequate readiness of parents. Furthermore, enhancing social support interventions and burden‐reduction strategies are important for improving parents' caring readiness. Implications for the Profession and/or Patient Care The findings demonstrate that health care professionals should provide timely and appropriate intervention strategies to enhance parents' caring readiness, which could potentially be achieved by increasing social support and reducing caregiver burden. Patient or Public Contribution Parents of children who underwent liver transplantation participated in this study via a questionnaire survey.

OBJECTIVE:To determine the characteristics and effectiveness of nurse-led family communication interventions in the ICU. DATA SOURCES:PubMed, Web of Science, PsychInfo, CINAHL, Embase, Cochrane Library, and relevant article citations from January 1995 to July 2025. STUDY SELECTION:We included randomized controlled trials (RCTs) and quasi-experimental studies evaluating nurse-led family communication interventions in adult ICUs. DATA EXTRACTION:Two independent reviewers assessed evidence levels and risk of bias using the Cochrane tool and the Joanna Briggs Institute's Critical Appraisal Tools. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines, and interventions were summarized with the Template for Intervention Description and Replication Checklist. DATA SYNTHESIS:Seven RCTs and seven quasi-experimental studies were included. The most common nurse-family communication model was an in-person, structured, and dynamically tailored intervention during the patient's ICU stay. Nurses played five core roles: information delivery and clarification, emotional support, family assessment, family meeting facilitation, and transitional support. Bedside ICU nurses led information delivery and multidimensional family assessments. Internal research nurses handled information clarification, structured needs assessment, and family meeting coordination. External research nurses focused on family meeting support, structured emotional support, and transitional care. Although the interventions may improve communication quality (standardized mean differences [SMD] = 0.26) and reduce hospital length of stay (LOS) (mean differences [MD] = -3.87 d), they appear to have limited effects on psychologic distress, satisfaction, ICU LOS, or mortality; they may also increase family meeting frequency/duration and lower overall costs. CONCLUSIONS:The conclusions of our systematic review are limited by considerable heterogeneity in intervention intensity, implementer profiles, and adaptation descriptions. Future interventions should define optimal dosage and outline best practices for evidence-based intervention tailoring and implementation. Healthcare institutions should integrate specialized nursing roles, such as training bedside nurses or establishing dedicated communication facilitators. This approach may leverage nurses' expertise to enhance communication quality and improve outcomes.

Objectives To provide a comprehensive overview of current research on intensive care providers’ awareness, knowledge, and practices regarding IAP/IAH/ACS, as well as barriers to IAP measurement. Methods This scoping review was guided by the framework of Arksey and Malley. Eight databases were searched to identify research published after 2007, including MEDLINE Complete, EMBASE, Web of Science, Cochrane Library, CINAHL Complete, ProQuest Health & Medical Complete, CNKI, and WANFANG. Two researchers reviewed and screened potentially relevant studies based on title and abstract. Full-text articles were independently assessed for eligibility based on predefined inclusion criteria. Results Nineteen articles were included. Overall, pediatric intensive care providers demonstrated a lower awareness and knowledge of IAH/ACS compared to adult intensive care providers, particularly regarding the consensus definitions of IAH/ACS in critically ill children. IAP measurement has not been adequately integrated into clinical practice, with 18.0–73.0% of intensive care providers reporting they have never measured it. The frequency of IAP measurements and the criteria for determining which patients necessitate such measurements exhibited significant variability across different hospitals. The most frequently mentioned barriers to IAP measurement include a lack of knowledge regarding IAP measurement among adult intensivists, an overreliance on physical examination among pediatric intensivists, uncertainty in interpreting IAP data among adult intensive care nurses, and challenges in identifying populations at high risk of IAH among pediatric intensive care nurses. Diuretics were mentioned most often in the management of IAH/ACS, followed by administration of vasopressors and inotropes, decompressive laparotomy, and judicious administration of fluids and blood products. 37.0–66.3% of adult intensivists would choose a decompressive laparotomy in cases of ACS, whereas pediatric intensivists were less inclined to opt for the same approach. Conclusions Since the publication of the WSACS consensus in 2007, there has been an improvement in awareness and knowledge regarding IAP/IAH/ACS among intensive care providers. Nevertheless, the understanding of the consensus definitions regarding IAH/ACS remains inadequate, particularly among pediatric intensive care providers. It is imperative to advocate for the implementation of WSACS guidelines in hospitals through targeted training programs and to promote the routine practice of IAP measurement in clinical settings.

Objectives: To explore the experience of post-traumatic growth among parents of children with biliary atresia undergoing living-related liver transplantation.Methods: Participants were recruited within 2 weeks of their child's transplant surgery using purposive sampling. Transcripts were analyzed using Colaizzi's descriptive analysis framework, with collaborative analysis conducted using NVivo 12 software and a post-traumatic growth model.Results: Five themes were identified: (a) experiencing a devastating blow, (b) cognitive reconstruction under overwhelming pain, (c) an arduous journey of decision-making, (d) rebirth in adversity and (e) post-traumatic growth. Parents undergo significant post-traumatic responses to their child's diagnosis of biliary atresia and liver transplantation, marking two major traumatic events. During the diagnostic stage, parents experience intense post-traumatic reactions characterized by emotional fluctuations and intrusive thoughts. The early treatment phase represents a crucial time for parents to transition from `denial of reality' to `accepting diseases'. The process of liver transplantation is also a significant traumatic event, accompanied by a final hope. Parents in the stable period after liver transplantation feel fortunate, hopeful and grateful, and their post-traumatic growth manifests gradually.Conclusions: Parents' experience of post-traumatic growth involves dynamic changes. Tailored intervention strategies should be developed for different stages to enhance their post-traumatic growth and psychological well-being. During the early treatment stage, mental health professionals could provide cognitive interventions to encourage parents to express their negative emotions and guide them to develop positive cognition toward traumatic events. The coping strategies and increasing personal growth are also important. In the postoperative stage, mental health professionals need to fully evaluate the coping styles of parents, and encourage them to establish effective internal coping strategies, while classic gratitude interventions could be given during the post-traumatic growth stage. Future research could involve a longitudinal qualitative study to explore parents' post-traumatic growth experiences at different stages of their children's transplantation process.

Objective:This study explored symptom clusters and sentinel symptoms among recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) during the recovery period, with the aim of identifying clustering patterns and establishing a clinical reference framework for early detection and management. Methods:A convenience sample of 209 hematologic oncology recipients who had completed allo-HSCT and were in the recovery phase, attending regular outpatient follow-up in China between December 2024 and March 2025, was recruited. Data were collected using a general information questionnaire and the Chinese version of the Memorial Symptom Assessment Scale. Symptom clusters were identified through exploratory factor analysis, and sentinel symptoms were determined via association analysis using the Apriori algorithm. Results:A total of 209 allo-HSCT recipients were included, with a median age of 39.6 years (interquartile range [IQR] 33.7-48.2) and a median time from diagnosis to transplantation of 6.0 months (IQR 4.8-9.8). During recovery, recipients reported a median of 5 symptoms (IQR 3-9), with a maximum of 18 concurrent symptoms. The most prevalent symptoms were lack of energy (56.5%), worrying (43.5%), and difficulty sleeping (42.1%), with median severity scores of 3.0 (IQR 1.0-4.0), 3.0 (IQR 1.0-4.0), and 2.0 (IQR 1.0-3.0), respectively. Exploratory factor analysis (Kaiser-Meyer-Olkin [KMO] ​= ​0.737; Bartlett's χ 2 ​= ​1269.134, P ​< ​0.001) identified four symptom clusters-psychological, fatigue, digestive, and neurological-explaining 68.4% of the total variance. Association rule analysis using the Apriori algorithm revealed anxiety as the sentinel symptom of the psychological cluster, difficulty sleeping as the sentinel symptom of the fatigue cluster and itching as the sentinel symptom of the neurological cluster; no sentinel symptom was identified for the digestive cluster. Conclusions:Recipients of allo-HSCT continue to experience diverse symptoms during recovery, which aggregate into distinct clusters. Importantly, three sentinel symptoms act as early indicators that markedly impair quality of life. Nurses should prioritize these sentinel symptoms as key intervention targets to guide precision nursing strategies, mitigate symptom progression, and improve clinical outcomes.

Objectives: This study aimed to assess the knowledge, attitudes, and practices (KAP) and the training requirements of pediatric intensive care nurses regarding intra-abdominal pressure (IAP) monitoring, in order to provide a reference for the development of relevant training programs and operational procedures in clinical practice. Methods: This descriptive cross-sectional survey was conducted from April 2023 to June 2023. A convenience sample was created by recruiting 212 pediatric intensive care nurses in eight hospitals in Zhejiang Province. A self-developed IAP monitoring KAP assessment tool was used for evaluation, which included knowledge (14 items), attitude (6 items), and practice (8 items), three dimensions, 28 items. Results: The overall KAP score was 60.73 ± 8.35; the knowledge score was 7.84 ± 2.35, with a scoring rate of 56.0%; the attitude score was 25.16 ± 3.23, with a scoring rate of 83.9%; and the practice score was 28.44 ± 6.46, with a scoring rate of 69.3%. Nurses wh-o have received IAP monitoring training have higher KAP score, knowledge score and practice score than those who have not received it (P < 0.05). Nurses aged ≤ 30 showed better knowledge of IAP monitoring than those aged > 30 (P < 0.05). Among the participants, 55.7% of the nurses believed the current knowledge was insufficient to perform IAP measurement effectively. Difficulty in identifying the high-risk population of intra-abdominal hypertension (IAH) (64.6%), unfamiliarity with the operation process of IAP measurement (55.6%), and unreasonable nurse-patient ratio allocation (52.8%) were the main obstacles for nurses to monitor IAP. Conclusions: Pediatric intensive care nurses have a positive attitude towards IAP monitoring, but the knowledge level and practical behavior still need to be strengthened. In particular, the knowledge of published consensus definitions, measurement techniques, and frequency for IAP monitoring is inadequate. It is necessary to implement tailored IAP monitoring training based on their training needs and potential obstacles to promote the standardization and scientificity of IAP monitoring.