BackgroundA better understanding of the perceptions of family members in making surrogate decisions for loved ones during intensive care is needed to inform the development of targeted supportive interventions.ObjectiveTo examine and synthesize qualitative data on family members' perceptions of surrogate decision-making in the intensive care unit.DesignWe conducted a systematic review and qualitative data synthesis. Eligible studies contained family members' quotes about surrogate decision-making experiences and perceptions in adult intensive care units, published in English or Chinese, in a peer-reviewed journal up to February 2022. Data sources included Embase, PubMed, ISI Web of Science, PsychINFO, CINAHL, Biomedical Literature Service System, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Journal.MethodsThe searches yielded 5974 identified articles, of which 23 studies were included. At least two different reviewers independently assessed the study quality and extracted data into a Microsoft Excel spreadsheet. A thematic synthesis was performed by classifying all text units into one of the broad themes and subsequently analyzed to inductively develop the first-, second-, and third-order themes. Six family members with experience in intensive care unit surrogate decision-making contributed to the analysis.ResultsThe qualitative data synthesis resulted in five major themes. The following key new insights into family members' perceptions of surrogate decision-making in the intensive care unit were obtained: in individual systems, family members suffered from emotional distress and psychological stress; different cognitive styles emerged; some family members reshaped a new order of life in the disruption; in family systems, the family as a whole was closely connected with each other; and in medical systems families perceived asymmetry in relationships with clinicians, many factors influencing trust, the necessity for role-specific mediators and issues with operations and environments not being sufficiently humanized.ConclusionThis qualitative synthesis showed that individuals' emotions and cognition underwent complex processes during surrogate decision-making. The family as a whole, with disparate functional states, also faced different processes and outcomes under the crisis situation. At a broader level, the decision-making process reflected society's perceptions of the medical system. Future studies should use these insights to further explore and optimize the many aspects of surrogate decision support measures for families of critically ill patients and include the measurement of outcomes after interventions at multiple layers of the individual, family, and medical systems.Registration number: The protocol was prospectively published on International Prospective Register of Systematic Reviews (PROSPERO)—CRD42022316687.Tweetable abstractFamilies of critically ill patients undergo a complex interactional process within the individual, family, and medical systems during surrogate decision-making.

Purpose: To develop a dynamic nomogram of subsyndromal delirium (SSD) in intensive care unit (ICU) patients and internally validate its efficacy in predicting SSD. Patients and Methods: Patients who met the inclusion and exclusion criteria in the ICU of a tertiary hospital in Zhejiang from September 2021 to June 2022 were selected as the research objects. The patient data were randomly divided into the training set and validation set according to the ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were used to screen the predictors of SSD, and R software was used to construct a dynamic nomogram. Receiver operating characteristic (ROC) curve, calibration band and decision curve were used to evaluate the discrimination, calibration and clinical effectiveness of the model. Results: A total of 1000 eligible patients were included, including 700 in the training set and 300 in the validation set. Age, drinking failure, constraint, dexmedetomidine, and propofol were predictors of SSD in ICU patients. The ROC curve values of the training set was 0.902 (95% confidence interval: 0.879-0.925), the best cutoff value was 0.264, the specificity was 78.4%, and the sensitivity was 88.0%. The ROC curve values of the validation set was 0.888 (95% confidence interval: 0.850-0.930), the best cutoff value was 0.543, the specificity was 94.9%, and the sensitivity was 70.9%. The calibration band showed good calibration in the training and validation set. Decision curve analysis showed that the net benefit in the model was significantly high. Conclusion: The dynamic nomogram has good predictive performance, so it is a precise and effective tool for medical staff to predict and manage SSD in the early stage.

目的 调查ICU护士临床决策能力现状及其影响因素,为提高ICU护士的临床决策能力提供依据.方法 采用方便抽样法,选取172名ICU护士为研究对象,采用一般资料调查表、一般决策风格量表和护理临床决策测评工具进行调查,采用单因素分析、多元线性回归分析临床决策能力的影响因素.结果 ICU护士临床决策能力总分为150.0(145.0,159.0)分.ICU护士的决策风格维度得分从高到低依次为理智型4.4(4.0,4.8)分、依赖型3.6(3.4,4.2)分、直觉-冲动型3.2(2.8,3.4)分和回避型2.8(2.2,3.2)分.多元线性回归分析结果显示,理智型决策风格是ICU护士临床决策能力的正向影响因素,回避型决策风格是ICU护士临床决策能力的负向影响因素(P均<0.001).结论 ICU护士的临床决策能力受理智型和回避型决策风格影响.护理管理者应加强针对性培训促使其理智型决策风格的形成,从而提高临床决策能力.

Objective:To summarize the best evidence for anxiety and depression management in adults with coronary heart disease (CHD).Methods:Evidence regarding anxiety and depression management of adults with CHD was retrieved from the British Medical Journal best practice, UpToDate, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guideline Network, Registered Nurses Association of Ontario, Cochrane Library, the Joanna Briggs Institute (JBI), PubMed, Embase, Medline, Web of Science, China National Knowledge Infrastructure, and WanFang Data. These publications included guidelines, systematic reviews, expert consensus, and evidence summaries. The data retrieval time was from the establishment of the databases to September 13, 2021. The search terms included coronary heart disease, psychology, anxiety and depression, and the data was sorted on September 14-23, 2021. Two researchers evaluated the quality of the literature and extracted data independently according to both AGREE Ⅱ and the evaluation tools of the JBI evidence-based healthcare center. The evidence level was graded by using the evidence preliminary classification system and the evidence recommendation level system of the JBI evidence-based healthcare center. The recommended strength of the evidence was determined with the guidance of JBI′s evidence structure and the discussion within the research group and expert opinions, and then the best evidence for anxiety and depression management in adults with CHD were extracted, summarized and analyzed. Results:A total of 22 articleswere included, including 5 clinical guidelines, 14 systematic reviews, 2 expert consensuses and 1 evidence summary. Three articles of the guidelines were graded B with the up-mentioned recommendtation standard, and the other two were graded A. In the systematic reviews, five articles were rated as grade B, the other nine articles as grade A, and 95% of the items were evaluated as “yes”. The evaluation results of all items in the expert consensuses were “yes”, and the quality grade was A. The evidence summary involved 32 pieces of best evidence regarding five aspects (mental health management mode, risk factor assessment and prevention, psychological problem identification and screening, psychological adjustment and intervention, drug treatment), of which 60% were class 1 evidence, and 34% were recommended with strength A.Conclusions:The overall quality of the literature and the level of evidence regarding anxiety and depression management in adults with CHD are high. The key to anxiety and depression management in these patients is innovating the mode of mental health management and implementing effective risk factor assessment and prevention, psychological problem identification and screening, psychological adjustment and intervention, and drug treatment.