Objective To explore the impact of a stepwise analgesia and sedation nursing strategy guided by multimodality neuromonitoring（MMM） on intracranial pressure（ICP） changes and prognosis after decompressive craniectomy in patients with large-area cerebral infarction. Methods A total of 84 patients with large-area cerebral infarction who underwent decompressive craniectomy and were admitted to the neurology ICU of a tertiary hospital in Changchun from January 2022 to December 2024 were selected by convenience sampling and randomly divided into a control group and an experimental group using block randomization. The control group received conventional analgesia and sedation，while the experimental group adopted a stepwise analgesia and sedation nursing strategy guided by MMM. The average ICP within 7 days after surgery，the proportion of time within 72 hours that ICP reached the target，mechanical ventilation time，ICU stay，Barthel lndex at 72 hours after surgery and at discharge，and Modified Rankin Scale（mRS） score at 90 days were compared between the two groups. Results The average ICP in the experimental group was lower at 7 days post-operation（12.76±2.45 vs 14.91±4.56 mmHg，P=0.002），and the rate of reaching the ICP target within 72 hours was higher than the control group（52.4% vs 33.3%，P=0.038），with an absolute risk difference increase of 19.1%，which mean that for every 5.2 patients treated，one more patient could reach the target. The hospital stay in the experimental group was shorter than that of control group（21.93±2.51 vs 23.60±3.91 days，P=0.006）. There was no statistically significant difference in mechanical ventilation time and Barthel Index score at 72 hours post-operation（P=0.104，P=0.714），but the Barthel Index score at discharge was higher in the experimental group（35.83±21.04 vs 24.76±24.69，P=0.022）. The proportion of patients with mRS≤3（mild to moderate disability） at 90 days was higher in the experimental group（30.9% vs 14.8%），and the propor-tion of patients with mRS≥4（moderate to severe disability and death） was lower（40.5% vs 52.4%，P=0.036）. Conclusion The stepped analgesia and sedation protocol based on MMM can optimize ICP management，shorten ICU stay，and improve neurological prognosis，which provide a basis for the care of patients undergoing decompressive craniectomy for large-area cerebral infarction.

Objective From a gender perspective，to investigate the longitudinal relationships between cognitive，physical，and psychological dysfunction of post-intensive care syndrome（PICS）among ICU survivors within 3 months after being transferred out of the ICU，and clarify the moderating role of gender. Methods 584 critically ill patients transferred from medical and surgical ICUs of a tertiary grade-A hospital in Shandong Province（September 2023-February 2024） was included by convenient sampling. They were grouped by gender，and their cognitive，physical，and psychological dysfunction were assessed at 1 month （T1） and 3 months （T2） post-ICU discharge. A cross-hysteresis model was constructed to explore the longitudinal relationship and gender difference between the three domains of PICS. Results The severity of PICS at the two follow-ups showed a downward trend（Z=-7.431，P <0.01），and this trend was consistent among different gender groups. Autoregressive effects stably maintained longitudinal relationships among the three dysfunctions（β=0.55，0.51，0.39），with positive correlations observed at both time points. Cross-lagged analysis revealed that T1 cognitive impairment significantly predicted T2 physical impairment in both male and female groups. T1 physical impairment significantly predicted T2 cognitive and psychological impairments only in males. Conclusion Longitudinal relationships between cognitive，physical，and psychological impairments vary by sex within 3 months post-ICU discharge. Early and targeted interventions based on gender for ICU patients can effectively prevent the occurrence，maintenance，and deterioration of functional disorders in the later stages.

Objective To identify potential categories of readiness for hospital discharge in patients with acute myocardial infarction（AMI），and comprehensively analyze its heterogeneous characteristics and key influencing factors to establish a theoretical foundation and delineate practical pathways for personalized discharge guidance and sustained care interventions. Methods Using the convenient sampling method，AMI patients after percutaneous coronary intervention（PCI） in the Department of Cardiology of a tertiary general hospital in Shanghai from January to June 2024 were investigated. Data were collected on the day of discharge using paper questionnaires，including general information，the Quality of Discharge Teaching Scale，and the Chinese version of the Readiness for Hospital Discharge Scale. Latent profile analysis based on three dimensions of the discharge readiness scale was used to identify the optimal classification. Univariate analysis and multivariate ordinal logistic regression were performed to explore factors influencing latent categories. Results 202 patients were included for data analysis. Three latent categories of discharge readiness were identified：low coping ability group （n=53，26.24%），low expected support group（n=12，5.94%），and high readiness group（n=137，67.82%）. Multivariate ordered Logistic regression analysis indicated that gender，age，education level，marital status，and quality of discharge teaching were significant influencing factors of latent category membership（all P<0.05）. Conclusion Readiness for hospital discharge among patients with AMI after PCI is moderately high but heterogeneous. Healthcare providers should focus on the low coping ability and low expected support group，and implement stratified individualized interventions for these patients to enhance discharge readiness and post-discharge self-management.

Objective To explore the real perception and experience of patients with implanted left ventricular assist device during their first ambulation out of bed，and to provide evidence for interventions in early postoperative rehabilitation exercise for those patients with implanted left ventricular assist device. Methods A descriptive qualitative study was adopted. Through purposive sampling，18 patients with implanted left ventricular assist device at a tertiary Grade A hospital in Nanjing from June 2024 to March 2025 were selected for semi-structured in-depth interviews. Content analysis was applied to organize and analyze the interview data. Results Four themes with eight sub-themes were extracted：physiological adaptation experience（physical discomfort，motor dysfunction），device adaptation challenges（sense of device constraint，alarm-related anxiety），psychological adaptation process（fear of death，experience of hope），and support system needs（need for medical staff guidance，need for assistive devices）. Conclusion Patients with implanted left ventricular assist device encounter multiple difficulties and complex emotional experiences during their first ambulation out of bed. Medical staff should actively monitor patients’ psychological changes，offer encouragement and health education，develop standardized procedures for patients’ ambulation out of bed，ensure patients’ safety during activities，and facilitate the early postoperative rehabilitation of patients with implanted left ventricular assist device.

Objective To investigate the current status of discharge readiness in patients after surgery for acute aortic dissection，analyze its influencing factors，and explore its correlation with the quality of life after discharge. Methods By the convenient sampling method，patients with acute aortic dissection who underwent emergency surgery in the Department of Cardiothoracic and Vascular Surgery of a Grade Ⅲ Class A hospital in Hebei Province from January 2024 to March 2025 were selected as the research subjects. A general information questionnaire，Discharge Readiness Scale and Quality of Discharge Teaching Scale were used to conduct investigations on the patients within 24 hours before discharge. Short Form Health Survey Scale was adopted to evaluate the patients’ quality of life via telephone follow-up at 30 days and 90 days after discharge. Results A total of 206 patients were enrolled in the study，with the discharge readiness score of（166.84 ± 31.29），the average score of（7.58±1.42）points，indicating a moderate level of readiness. The results of multiple linear regression analysis showed that educational level，quality of discharge teaching and surgical method were the influencing factors of discharge readiness（P<0.05）. Pearson correlation analysis indicated that discharge readiness was positively correlated with the quality of life at 30 days and 90 days after discharge（P<0.05）. Conclusion The discharge readiness of patients after surgery for acute aortic dissection needs to be improved，which is affected by educational level，quality of discharge teaching and surgical method. Improving patients’ discharge readiness is conducive to enhancing their quality of life after discharge.

This paper summarized perioperative nursing experience for a patient undergoing heart transplantation following complex cardiac malformation surgery. Preoperative measures included implementing graded heart failure monitoring and rapid response protocols，and developing volume management strategies tailored to the patient’s anatomical features. Postoperative care focused on strengthening right heart preload and afterload monitoring to prevent right heart failure，dynamic infection risk assessment with precise removal of invasive catheters，targeted interventions for hyperlactatemia and hyperglycemia，and rehabilitation training aimed at social reintegration. The patient was transferred to the cardiac surgery ICU，with tracheal intubation removed after 13 hours. On the 4th postoperative day，the patient was successfully transferred to a general ward and was discharged after 27 days of hospitalization. During the 8-month post-discharge follow-up，the patient recovered well.

This report summarized the nursing experience of a patient who developed primary graft dysfunction （PGD） after heart transplantation using a marginal donor heart. Key nursing interventions included the implementation of a nurse-led early warning system based on the characteristics of the marginal donor heart，the rapid initiation of veno-arterial extracorporeal membrane oxygenation（VA-ECMO） combined with continuous renal replacement therapy（CRRT），the execution of phased and precise volumetric titration management according to dynamic hemodynamic assessments，and the implementation of a right heart-protective ventilation strategy guided by bedside electrical impedance tomography（EIT）-based visualization monitoring. The patient was successfully transferred out of the intensive care unit on postoperative day 16 and discharged on day 22.

To summarize the nursing experience of a patient with familial hypertrophic cardiomyopathy complicated with liver failure undergoing combined heart-liver transplantation. To address complex challenges such as dynamic changes in perioperative coagulation function，inter-organ interactions，immunosuppression management，and delayed functional recovery of combined transplanted organs，the following measures were implemented：coagulation function monitoring and nursing care for secondary neurological complications，management of transition from extracorporeal circulation to extracorporeal membrane oxygenation，precise titration and monitoring of minimal effective tidal volume，management of delayed functional recovery in transplanted organs，balance and meticulous monitoring of immunosuppression，and precision nutritional support guided by intra-abdominal pressure. After 34 days of intensive care，the patient was successfully transferred out of the ICU and discharged after recovery.

Objective To investigate the rate and influencing factors of in-hospital door-to-balloon time delay in patients with acute ST-segment elevation myocardial infarction（STEMI）. Methods PubMed，Cochrane Library，Web of Science，Embase，CBM，CNKI，Wan Fang and VIP were systematically searched for related literature on the rate and influencing factors of in-hospital door-to-balloon time delay in patients with acute ST-segment elevation myocardial infarction，the search period was from the establishment of the databases until July 31，2025. Meta-an-alysis was performed using Stata 18.0 and RevMan 5.4. Results A total of 20 studies were included. The meta-analysis results showed that the in-hospital door-to-balloon time delay rate was 42%. The identified risk factors included rural residence（OR=3.12），non-ambulance admission（OR=2.52），presentation on non-working days（OR=2.15），history of gastrointestinal diseases（OR=2.79），female（OR=1.41），advanced age（OR=1.39），self-payment（OR=1.07），history of diabetes（OR=1.17），history of renal diseases（OR=1.64），history of peripheral vascular diseases（OR=1.22） and higher education level（OR=0.39）. Conclusion The in-hospital door-to-balloon delay rate in STEMI patients is relatively high and affected by multiple factors. For these high-risk populations，healthcare providers should conduct structured screening，prioritize triage protocols and establish a 24-hour on-call system for the interventional team. Meanwhile，multidisciplinary collaboration processes in chest pain centers should be systematically optimized，and the construction of chest pain referral networks in rural areas should be improved. This study provides an evidence-based basis for developing individualized intervention strategies and achieving the guideline-recommended goal of door-to-balloon delay≤90 minutes.

Objective To conduct a scoping review of domestic and international research on hypoactive delirium in critically ill cardiac surgery patients，summarizing the current status，influencing factors，and assessment tools for hypoactive delirium in this population to inform clinical prevention and management strategies. Methods Using a scoping review framework，we systematically searched PubMed，the Cochrane Library，EMBASE，CINAHL，Web of Science，CNKI，Wanfang Database，VIP，and the China Biomedical Literature Database for studies on hypoactive delirium in critically ill cardiac surgery patients. The search covered the period from database inception to May 6，2025. Two researchers independently extracted and analyzed data. Results Twelve studies were ultimately included. The incidence of hypoactive delirium in critically ill cardiac surgery patients ranged from 21.57% to 92.00%. Clinical manifestations primarily included impaired verbal communication and disorientation，with most cases occurring within 72h postoperatively. Most studies conducted assessments around 08：00，with 1-3 evaluations per day. Diverse assessment tools were used，with the ICU Confusion Scale and Richmond Agitation-Sedation Scale being commonly employed. Independent influencing factors included history of alcohol consumption and duration of mechanical ventilation. Conclusion Hypoactive delirium exhibits a high incidence rate following cardiac surgery，with complex influencing factors and assessment tools lacking specificity. There is a need to develop targeted evaluation instruments and standardize assessment protocols. Concurrently，clinical manifestations，risk factors，and the onset or duration of low-activity delirium in critically ill cardiac surgery patients should be prioritized for early prevention and management to improve patient outcomes.

To summarize the nursing experience of cerebral hemorrhage during dialysis in a maintenance hemodialysis patient. In view of the patient’s critical condition，special surgical and rehabilitation conditions and other difficulties，the nomogram and “balance，eyes，face，arm，speech，time”（BE-FAST） dual tools were used to jointly identify cerebral hemorrhage，the nursing emergency echelon was initiated for safe disembarkation，rapid transport and emergency treatment. The phased anticoagulation strategy under multidisciplinary cooperation was implemented，and hospital family transitional care was carried out. After multidisciplinary team treatment and refined whole process nursing，the patient was discharged 35 days after hospitalization. After one month of follow-up，the right muscle strength recovered from grade Ⅱ to grade Ⅲ，and the language function basically recovered.

To summarize the nursing experience in managing a patient with deep neck infection complicated by diabetic ketoacidosis（DKA），which progressed to a malignant mediastinal abscess. Addressing challenges including high surgical coordination demands of endoscopic ultrasound-guided fine needle aspiration，significant difficulties in infection control，pharyngolaryngeal dysfunction，and severe negative emotions，a multidisciplinary team developed a comprehensive perioperative management plan. Interventions included a multidisciplinary approach to coordinate the entire surgical process，multifaceted nursing strategies to control infection risks，optimized glycemic management，transitional nutritional support，as well as music therapy and emotion-focused therapy to enhance psychological support. The patient was discharged successfully after 26 days. Follow-up at two months indicated favorable recovery and successful reintegration into society.

To summarize the nursing care of a patient who developed severe acute respiratory distress syndrome （ARDS） after liver transplantation due to co-infection with pneumocystis jirovecii and cytomegalovirus. To address multiple challenges including severe pulmonary infection，complex medication management，significant risks associated with extracorporeal membrane oxygenation（ECMO），and a prolonged recovery process，the following targeted interventions were implemented. Those included implementing bundled protective strategies to actively prevent secondary infections，refined medication management to enhance the efficacy of ECMO treatment，multidimensional monitoring and nursing care to sustain the safe operation of ECMO，dynamical assessment of nutritional indicators and a stepwise nutritional support plan，conducting early rehabilitation exercises and implementing phased recovery strategies. Through active treatment and meticulous nursing care，the patient recovered smoothly and was discharged.

To summarize the postoperative nursing experience of two children with progressive familial intrahepatic cholestasis who underwent parental liver transplantation. For children with severe cholestasis，persistent itching，malnutrition，and metabolic disorders，the nursing key points included establishing a dynamic monitoring system for cholestasis，strengthening comprehensive interventions for persistent skin itching，implementing individualized nutritional management plans，enhancing early identification and management of acute rejection reactions，implementing preventive care for metabolic bone disease. After active treatment and careful nursing，two children recovered after the surgery and were discharged from the hospital，the follow-up of more than 8~12 month showed good prognosis.

Objective To translate the Newcastle Laryngeal Hypersensitivity Questionnaire（NLHQ） into Chinese and validate the reliability and validity of the Chinese version of the NLHQ scale in critically ill mechanically ventilated patients. Methods After obtaining permission from the original author，the NLHQ was translated using the Brislin translation model. A total of 285 critically ill mechanically ventilated patients admitted to a tertiary hospital in Suzhou between July 2023 and January 2025 were selected to validate the reliability and validity of the questionnaire. Results The Chinese version of the NLHQ scale consisted of 3 dimensions and 13 items. The Cronbach’s α coefficient was 0.853，the split-half reliability was 0.827，and the content validity index （S-CVI/Ave） was 0.973. Exploratory factor analysis extracted 3 common factors，with a cumulative variance contribution rate of 67.67%. Confirmatory factor analysis showed good model fit. Criterion validity indicated that the Chinese version of the NLHQ scale score was negatively correlated with the Chinese version of the Hull Airway Reflux Questionnaire （HARQ） scale score（r<0，P<0.05）. The ROC curve analysis revealed that the AUC of the NLHQ score for predicting extubation failure in critically ill mechanically ventilated patients was 0.895（95%CI：0.844-0.946），with an optimal cutoff value of 39 points. Conclusion The Chinese version of the NLHQ scale demonstrates good reliability and validity and can be used as a tool to assess laryngeal discomfort in critically ill mechanically ventilated patients in China. It also has certain predictive value for extubation failure.

Objective To explore the mediating effect of workplace friendship on the professional resilience and professional well-being of emergency department nurses. To provide references for nursing managers to improve the professional well-being of emergency department nurses. Methods A convenience sampling method was used to select 642 emergency department nurses from 25 hospitals in Beijing，Hebei，Zhejiang，Guangdong，Sichuan，Henan and Jilin as the research subjects. A self-designed general information questionnaire，Workplace Friendship Scale，Professional Resilience Scale and Professional Well-Being Scale were used to investigate them，and the influencing factors were analyzed. Results The professional resilience score of emergency department nurses was（19.54 ± 4.04） points，the workplace friendship score was（44.90 ± 9.94） points，and the professional well-being score was（83.93 ± 22.57） points，all of which were at a moderately high level. Professional resilience was positively correlated with workplace friendship（P<0.001），professional resilience was positively correlated with professional well-being（P<0.001），and workplace friendship was positively correlated with professional well-being（P<0.001）. Workplace friendship played a partial mediating role between the professional resilience and professional well-being of emergency department nurses. The effect size was 0.197，with the mediation effect accounting for 59.7% of the total effect. Conclusion Workplace friendship plays a mediating role in promoting professional well-being through professional resilience. Nursing managers should focus on enhancing the professional resilience of emergency department nurses. By providing reasonable organizational support and fostering a positive culture，they can promote the development of workplace friendships，thereby improving the professional well-being of emergency department nurses.

Objective To develop a national emergency medical rescue team nurse training program based on nurses’ disaster literacy and validate its effectiveness. Methods The training program and items for national emergency medical rescue team nurse training were developed through a literature review，team discussions，and Delphi expert consultation. An empirical study was conducted among 30 nurses who received training in Zhejiang Province from January to December 2024，and indicators such as disaster literacy levels were compared before and after the training. Results The developed training program comprised five primary items（training content，methods，assessment and etc.），20 secondary items，and 63 tertiary items. After training，the scores for functional，interactive，and critical disaster literacy were（96.17±3.59），（79.93±2.78） and（102.47±9.86），respectively，indicating the program improved the level of nurses’ disaster preparedness literacy. Conclusion The developed training program demonstrates scientific validity and reliability，providing guidance for standardized and homogeneous professional development of emergency medical rescue team nurses.

Objective To retrieve and evaluate literature on the management of mechanical ventilation in patients with sepsis，summarize the findings，and provide an evidence-based basis for clinical nursing practice. Methods Based on the 6S evidence resource pyramid model，relevant literature on the management of mechanical ventilation in patients with sepsis was searched from computerized decision-making systems，guideline websites，professional society websites，evidence-based databases，and original research databases，with the search period ranging from the inception of the database to August 3，2025. Three Researchers screened and evaluated the included literature to extract relevant evidence. Results 14 articles were included，comprising 6 guidelines，2 clinical decisions，5 expert consensuses，and a systematic review. Thirty-two best practice recommendations were synthesized across five aspects：timing of initiation，monitoring and assessment，oxygenation goals，ventilation strategies，and precautions，respectively. Conclusion This study provides a summary of the best evidence for the nursing management of mechanical ventilation in patients with sepsis. It offers an evidence-based foundation for healthcare professionals to develop standardized and effective nursing interventions and facilitate the early recovery of patients with sepsis.

Objective To summarize evidence on de-escalation strategies for nurse-patient violence in emergency departments and provide a basis for clinical practice. Methods Evidence on de-escalation strategies for nurse-patient violence in emergency departments was systematically retrieved from guideline websites，professional association websites，and domestic and international databases，from inception to March 20，2025. Eligible evidence included guidelines，evidence summaries，clinical decision support，best practice recommendations，systematic reviews，and expert consensus. Two researchers independently conducted quality appraisal，evidence extraction，and synthesis. Results Twelve literature were included，including two guidelines，a clinical decision，an expert consensus，and eight systematic reviews. Evidence was categorized into 38 findings across five dimensions：communication strategies，emotion regulation and support，risk identification and assessment，intervention actions，and safety maintenance. Conclusion This study summarizes evidence-based de-escalation strategies for nurse-patient violence in emergency departments，offering guidance for clinical practice. In practical application，it should be combined with the departmental context and nurses’ competence，supported by systematic training and institutional guarantees，so as to improve the feasibility of implementation.

Objective To conduct a scoping review of risk prediction models for cognitive impairment after ischemic stroke both domestically and internationally，aiming to provide references for clinical nursing practice and subsequent research. Methods A comprehensive search was conducted in 9 Chinese and English databases from the establishment of the databases to March 2，2025. The incidence of cognitive impairment after ischemic stroke，the predictive factors included in the models，the modeling methods，and performance indicators were extracted and summarized. Results A total of 24 studies were included. The incidence of cognitive impairment after ischemic stroke ranged from 30.4% to 57.4%. The number of predictive factors included in each study ranged from 1 to 17，with age and education level were the most frequently included factors. The modeling methods were logistic regression and machine learning. The area under the curve（AUC） values of the included models ranged from 0.65 to 0.98. Conclusion The existing models generally have a high risk of bias and significant performance differences. In the future，the quality of models should be comprehensively enhanced through reasonable inclusion of predictive factors，proper handling of missing data，and strengthening of internal validation and external validation.

Community integration of stroke patients is generally limited. Restricted community integration can increase the disconnection between physiological，psychological，and external environments，reduce the quality of life of patients，and ultimately lead to poor rehabilitation levels and increased readmission rates. This article mainly introduces the concept，theoretical model，and evaluation methods of community integration. Focusing on the level and influencing factors of community integration in stroke patients，this article aims to provide reference for medical staff to conduct relevant research and develop intervention plans for community integration in stroke patients.