Objective To explore the barriers and facilitators encountered by intensive care unit（ICU） nurses in the prevention and management of mucous membrane pressure injuries（MMPI）. Methods A descriptive qualitative study design was employed. Semi-structured interviews were conducted with ICU nurses from a tertiary Grade A hospital in Nanjing. Thematic analysis was used to organize，code，and analyze the data. The identified themes were then mapped onto the Theoretical Domains Framework（TDF） to systematically identify barriers and facilitators influencing MMPI prevention and management. Results Interviews were conducted with 12 ICU nurses. The coded interview data mapped to 14 theoretical domains，yielding 8 main themes and 23 sub-themes. The promoting factors for the implementation of MMPI included three themes，including physician-nurse cooperation and manager support，knowing the significance of MMPI management，management supervision and personal characteristics. The theme of barriers included four themes，including insufficient cognition and skills of MMPI，decision-making dilemma caused by multiple consequences beliefs，lack of confidence in the effect of prevention management，and negligibility of MMPI. The theme of human resources and prevention materials was not only a barrier factor but also a promoting factor. Conclusion The factors influencing nurses’ prevention and management of MMPI are complex. The findings of this study can inform clinical practice by leveraging facilitators while mitigating barriers，ultimately aiming to reduce the incidence of MMPI in critically ill patients.

Objective To analyze the risk factors for postoperative pulmonary complications（PPCs） following thoracoscopic sleeve lobectomy with standardized pulmonary rehabilitation management，and to provide a basis for precise risk-stratified nursing care. Methods Clinical data of lung cancer patients who underwent thoracoscopic sleeve lobectomy in the Department of Thoracic Surgery of a general class A hospital from December 2018 to April 2026 were retrospectively collected. All patients received standardized pulmonary rehabilitation management. Patients were divided into two groups based on the occurrence of PPCs. Univariable analysis was performed to screen relevant variables，followed by multivariable logistic regression analysis to identify independent risk factors. A predictive model for PPCs after sleeve lobectomy was established based on the multivariable regression results，and its predictive performance and accuracy were evaluated using receiver operating characteristic（ROC） curves. Results A total of 124 patients were included，and 26（20.97%） of them developed PPCs. Multivariate logistic regression analysis revealed that age（OR=5.03，95%CI：1.15~22.02，P=0.03），comorbid COPD（OR=3.70，95%CI：1.07~12.76，P=0.04），operative time（OR=1.02，95%CI：1.01~1.03，P<0.01），and intraoperative blood loss（OR=1.01，95%CI：1.00~1.02，P<0.01） were independent risk factors for PPCs，whereas FEV1（OR=0.21，95%CI：0.05~0.80，P=0.02） was an independent protective factor. Patients aged ≥65 years，with comorbid COPD，FEV1<2.38 L，operative time ≥172.50 min，or intraoperative blood loss ≥135.00 ml had a higher risk of PPCs. Conclusion Under standardized pulmonary rehabilitation management，there remains a considerable proportion of PPCs after sleeve lobectomy. The occurrence of PPCs is the result of multiple interacting factors. Implementing precise，stratified pulmonary rehabilitation management based on these influencing factors may effectively reduce the incidence of PPCs and improve patient outcomes.

Objective To construct a prediction model for aspiration risk in stroke patients，identify the optimal model，and provide a predictive tool for patients at risk of aspiration. Methods A systematic review of literature on aspiration in stroke patients was conducted to identify risk factors，which were then incorporated into a risk factor questionnaire developed with expert consultation. Data from 515 stroke patients at a tertiary hospital in Zhejiang Province were collected. Core factors were determined through univariable and multivariable analyses. Models were constructed using logistic regression，extreme gradient boosting，random forest，support vector machine，and artificial neural network. Model performance was evaluated using area under the curve，Brier score，accuracy，and 10-fold cross-validation. Results Fourteen independent aspiration risk factors were identified，including age，Glasgow Coma Scale score，and feeding position. The extreme gradient boosting model demonstrated optimal overall performance，AUC=0.8071，Brier score=0.123，F1=0.5994 in test set，with good stability after 10-fold cross-validation（AUC=0.792）. Core predictors included feeding position（semi-recumbent），age，and NIHSS score. Conclusion Extreme gradient boosting accurately identifies stroke patients at high risk for aspiration. Core factors provide clear targets for clinical intervention. Future multicenter external validation is needed to enhance generalization capability.

Objective To evaluate the application efficacy of the “3+2” air-ground linkage green life channel in the rescue of airport critically ill patients，and provide a reference for the construction of emergency nursing system in large transportation hubs. Methods Using a historical control design，748 patients from Shanghai Pudong International Airport admitted between August 9，2024 and August 8，2025 were selected as the experimental group receiving the “3+2” ground-air coordination model. A total of 701 critically ill patients were admitted between August 9，2023，and August 8，2024，and served as the control group receiving traditional emergency care. The pre-hospital response time，pre-hospital to in-hospital handover time，transportation duration，accuracy rate of critical patient identification，accuracy of critical value identification，emergency training coverage rate，the satisfaction rate of communication with foreign patients，the rate of good humanistic care experience and rescue success rate were compared between the two groups. Results The experimental group had significantly shorter pre-hospital response time，pre-hospital to in-hospital handover time and transportation duration than the control group（all P<0.001）. The experimental group also had higher accuracy of critical patient identification，critical value identification and higher emergency training coverage rate，foreign patient communication satisfaction rate，and good experience rate of patients and families on humanistic care measures（all P<0.05）. There was no significant difference in rescue success rate between the two groups（P=0.353）. Conclusion Based on a digital intelligent information platform and multidisciplinary nursing collaboration，the humanistic care-integrated “3+2” air-ground linkage model can effectively improve the rescue efficiency and treatment quality of critically ill airport patients，which conforms to the professional，collaborative and intelligent development trend of emergency nursing.

Objective To develop an emergency scenario simulation course based on gather-analyze-summarize （GAS） structured feedback and evaluate the preliminary effectiveness in improving the emergency response capabilities of critical care nurses. Methods A GAS-based structured feedback emergency simulation course was developed，comprising six steps：pre-class preparation，theoretical instruction，video viewing，comprehensive simulation exercises，GAS-guided feedback，and a post-class comprehensive assessment. Using a quasi-experimental research design，nurses trained in 2025 were selected as the experimental group（n=120） and those trained in 2024 were selected as the control group（n=121）. Course effectiveness was evaluated through theoretical assessments，cardiopulmonary resuscitation（CPR） skills assessments，teamwork ability evaluations，satisfaction questionnaires，and focus group interviews. Results The experimental group significantly outperformed the control group in theoretical assessment（93.27±5.56 vs 91.24±6.93），CPR skill assessment（92.53±5.57 vs 90.84±6.46），and course satisfaction（P<0.05）. Focus group interviews indicated that the GAS structured feedback emergency scenario simulation course enhanced participants’ depth of reflection. Conclusion The GAS structured feedback emergency scenario simulation course improves the theoretical knowledge and procedural skills of critical care nurses，and promotes the transformation abilities of knowledge into clinical practice through guided reflection，thereby enhancing their emergency competency.

Objective To explore the practical dilemmas in the standardized operation of extracorporeal cardiopulmonary resuscitation（ECPR） team in the emergency department of a tertiary hospital，and to provide a reference for improving standardized operational strategies. Methods A phenomenological research method was adopted. From October to December 2025，18 physicians and nurses involved in ECPR implementation in the emergency department of a tertiary hospital in Jiangsu Province were selected by purposive sampling following the principle of maximum variation sampling for semi-structured interviews. Data were analyzed using Colaizzi’s seven-step method. Results Four themes and 11 subthemes were identified：difficulty in fully implementing standardized procedures under intense time pressure and complex situations；long-term shortage of human resources and heavy workload of medical staff；a training system emphasizing technical operation over systematic competence and an imbalanced competency structure；and prominent psychological stress among medical staff in high-risk，high-cost decision-making situations. Conclusion The standardized operation of emergency department ECPR teams in tertiary hospitals faces practical challenges，including insufficient adaptation to emergency contexts，poor coordination across multiple departments，inadequate staffing and team echelon support，insufficient training support，and lack of psychological support. In promoting standardized operation，hospitals should further optimize key procedures and equipment preparation on the basis of existing technical standards，improve multidisciplinary collaboration and closed-loop information mechanisms，strengthen workforce echelon development and tiered training，emphasize communication with patients and their families，and incorporate psychological support into team building，so as to enhance procedural executability and operational sustainability.

Objective To evaluate the gas monitoring performance，wearability，and comfort of smart safety helmets in disaster rescue simulation scenarios to further ensure the on-site safety of rescue nursing personnel. Methods Through laboratory tests，the monitoring sensitivity and anti-interference gas performance of the intelligent safety helmet for hydrogen sulfide（H₂S） and carbon monoxide（CO）were evaluated. From February to March 2026，18 medical staff volunteers were recruited and randomly divided into two groups（each group consisting of 9 members） using a randomized controlled crossover design. The subjects wore the intelligent safety helmet，and the ordinary helmet equipped with an independent toxic gas detector in sequence. There was a 5-day washout period between the two stages. The wearing time and wearing comfort of the two sets of equipment were compared. Results The intelligent safety helmet had excellent anti-interference performance against H₂S and CO. The accuracy rate of CO monitoring and alarm was 100.0%，with a false alarm rate of 0. The average response time was 38.5 seconds. The wearing time of the intelligent safety helmet group was （15.67 ± 1.58） seconds and （15.89 ± 2.09） seconds，which was significantly shorter than that of the ordinary helmet combined with gas detection instruments group，which was （28.44 ± 2.30） seconds and （28.56 ± 2.13） seconds. The comfort score was （4.51 ± 0.23） minutes and （4.60 ± 0.14） minutes，which was significantly higher than that of the ordinary helmet combined with gas detection instruments group（3.51 ± 0.25） minutes and（3.89 ± 0.27） minutes. Conclusion The smart safety helmet offers advantages inclu-ding high-precision monitoring，efficient donning，and superior comfort，meeting practical requirements in disaster medical rescue operations and showing great potential for widespread application. Further expansion of pilot programs and optimization of equipment design are needed to promote standardized use in disaster rescue settings.

As a new type of teaching tool，virtual simulation technology has been increasingly applied in nursing skills training. This paper summarizes the application status and optimization paths of virtual simulation technology in emergency disaster nursing training from four dimensions：application scenarios，empirical effects，existing challenges and development trends，aiming to provide theoretical reference and practical guidance for the modernization transformation of disaster nursing emergency capacity evaluation and training system in China.

Objective To define the concept of risk incidents during helicopter emergency medical services （HEMS） transfer，and to provide a reference for early risk prevention and control. Methods A systematic search was conducted on PubMed，Web of Science Core Collection，ProQuest，Embase，CINAHL，China National Knowledge Infrastructure，and Wanfang Database，with a timeframe from January 1，2006 to November 30，2025. Rodgers evolutionary conceptual analysis was applied to analyze the included literature. Results Risk incidents during HEMS included three conceptual attributes，including real-time interaction between aviation and healthcare environment，interprofessional team emergency response collaboration，and immediate damage transmission. The antecedent factors involved patient factors，crew factors，equipment factors，environment factors，and management factors. The posterior outcomes were that，in the event of a risk incident not being promptly controlled，they may jeopardize the patient’s life and prognosis，exacerbate the physical and mental strain on medical personnel，and even compromise the sustainability of the helicopter medical rescue system. Conclusion Helicopter medical transportation is susceptible to various uncertainties，including aviation noise，acceleration，and spatial constraints，which may lead to risk incidents such as patient deterioration，crew safety impairment，and deviation from medical objectives. Future research may integrate artificial intelligence to develop predictive models for risk incidents during HEMS transport，quantifying key risk factors and their threshold indicators. This would enable the formulation of targeted prevention and control strategies，thereby enhancing transport quality and patient safety.

Objective To develop the “Expert consensus on anticoagulation nursing operations for continuous renal replacement therapy in adult critical care patients”（hereinafter referred to as the consensus），to standardize the implementation and monitoring of anticoagulation techniques in continuous renal replacement therapy（CRRT） for adult critical care patients，and to summarize the key points of nursing for anticoagulation techniques in CRRT for adult critical care patients. Methods Literature related to anticoagulation techniques in CRRT was reviewed both domestically and internationally，and combined with the work experience of clinical nursing experts，a preliminary version of the consensus was formed. Through two rounds of expert consultation，the document was organized and revised to form the final version of the consensus. Results The consensus includes the mechanisms of action of systemic and local anticoagulants in CRRT，the formulation of anticoagulants，the connection between systemic and local anticoagulants，the connection between CRRT and extracorporeal membrane oxygenation（ECMO） and anticoagulation care，anticoagulation monitoring during anticoagulation，and observation and care of common complications. Conclusion The consensus has certain scientific and practical significance，and can provide clinical guidance for anticoagulation nursing and operations in CRRT for adult critical care patients.

To summarize the emergency nursing experience of a child with dilated cardiomyopathy caused by a gene mutation complicated by ventricular electrical storm undergoing multi-strategy therapy. Given the extremely high risk of ventricular electrical storm and sudden cardiac death，the key nursing measures included multi-parameter dynamic early warning and emergency response for ventricular electrical storm；continuous monitoring of circulatory status，tissue perfusion，and myocardial electrical stability during extracorporeal membrane oxygenation therapy；continuous monitoring of the child’s heart rhythm after cardiac resynchronization therapy defibrillator implantation；risk management during epicardial radiofrequency ablation therapy；assessment of medical-related traumatic reactions and individualized psychological intervention；dynamic risk identification and continuous care for children after epicardial radiofrequency ablation therapy. The patient was discharged after 62 days of hospitalization，and the malignant arrhythmia was controlled. After discharge，the condition remained stable during follow-up.

To summarize the emergency nursing experience for a child with encephalomyopathic mitochondrial DNA depletion syndrome complicated by septic shock and severe dehydration. Based on critical challenges including energy metabolism failure，multi-organ involvement，and infection-induced perfusion crisis，we implemented fluid resuscitation and volume management guided by dynamic assessment，bundled infection control and internal environment management，sequential lung-protective ventilation and airway clearance techniques，meticulous medication management to prevent mitochondrial crisis，stepwise nutritional support based on metabolic demands，and predictive monitoring of complications. After 15 days of intensive care，the child successfully survived the acute critical phase with stabilized condition，was transferred to a general ward with home non-invasive ventilator support，and was discharged after 37 days of hospitalization.

This paper summarized risk warning and checklist-based nursing care for a patient with abdominal aortic mural thrombus who developed new-onset cerebral infarction during the perioperative period of hip arthroplasty. The patient underwent recent percutaneous coronary intervention and left femoral head replacement，with previous ischemic stroke，preoperative asymptomatic cerebral infarction，and abdominal aortic mural thrombus. New lacunar infarction in the left cerebellum and suspected new lacunar infarction in the left parietal lobe were reported on postoperative day 3. Nursing care focused on explicit handover of the four high-risk factors and confirmation of the preoperative neurological baseline，continuous neurological monitoring during the symptomatic period，lesion-directed assessment of abdominal aortic mural thrombus，monitoring of antithrombotic therapy-related risks，multidisciplinary bedside handover checklist management，and symptom-tolerated graded rehabilitation. No new disturbance of consciousness，speech，swallowing，or limb function occurred. No thrombus dislodgement-related manifestations or bleeding complications were observed，and the patient was transferred to a rehabilitation institution on postoperative day 6.

To summarize the identification and nursing experience of isolated persistent left superior vena cava（PLSVC） during PICC insertion in the right upper limb. The patient had no known vascular anatomical abnormalities before catheterization and no typical P-wave changes during intracardiac electrogram localization for PICC insertion. Isolated PLSVC was successfully diagnosed by identifying initial PICC malposition，adjusting ECG monitoring，assisting the patient with limb and body position coordination，and recognizing special ECG manifestations. After catheterization，a multidisciplinary discussion was held on the feasibility and safety of retaining the PICC. Finally，the patient retained the catheter，successfully completed intravenous infusion therapy，and was discharged.

This article summarized perioperative nursing for a patient with a rare giant retroperitoneal leiomyosarcoma involving the lumbar spine who underwent latissimus dorsi turnover flap transplantation after massive intraoperative hemorrhage. To balance circulatory instability and flap perfusion，triple monitoring （vital signs，urine output，flap） and goal-directed fluid therapy were implemented within 72 h. Multimodal quantitative flap perfusion assessment，a graded emergency protocol，meticulous positioning management，multidimensional vasospasm prevention，and design of a fenestrated lumbodorsal brace were applied. The patient was discharged after 15 days with a favorable prognosis at the 6-month follow-up.

To summarize the experience of pulmonary rehabilitation nursing for a patient with myofibrillar myopathy caused by BAG3 gene mutation who had difficulty in weaning from mechanical ventilation. In response to the muscle weakness and respiratory muscle involvement caused by this rare disease，as well as the patient’s anxiety and depression issues，a multidisciplinary team was established to develop and implement an early activity plan centered on four-level movement，staged weaning training，personalized diaphragm exercise under ultrasound guidance，and psychological intervention incorporating positive psychology theories. After 33 days of systematic pulmonary rehabilitation nursing，the patient successfully weaned off mechanical ventilation and was discharged smoothly.

Objective To explore the experiences of catheterization laboratory nurses in recognizing and respond-ing to clinical deterioration during emergency percutaneous coronary intervention in patients with ST-segment eleva-tion myocardial infarction，providing evidence for optimizing nurses’ clinical judgment and improving patient out-comes. Methods Guided by Tanner’s Clinical Judgment Model，a phenomenological approach was used. Semi-structured interviews were conducted with thirteen catheterization laboratory nurses in a tertiary hospital in Nanjing，China，from January to February 2025. Interview data were analyzed using Colaizzi’s seven-step method. Results Six themes and eight subthemes were identified：patient observation（including the salience of objective indicators and the predictive value of symptoms and signs）；valuing experience（trusting intuition and integrating knowledge）；information synthesis（clinical reasoning and filtering interference）；prioritization of interventions；team cohesion （collaboration and coordination，execution and review）；and reflective growth. Conclusion The identification and responding of clinical deterioration by catheterization laboratory nurses during emergency percutaneous coronary intervention constitute a dynamic process characterized by the close integration of theoretical knowledge，intuitive judgment，rapid decision-making，and team collaboration. Nursing managers should establish training systems that integrate objective indicators with non-quantifiable cues，promote the transformation of nurses’ experiential knowledge，and enhance clinical judgment capacity through clearly defined interprofessional roles and responsibilities，optimized collaborative deci-sion-making processes and reflective mechanisms，comprehensively enhanced nurses’ clinical judgment abilities，thereby ensuring patient safety.

Objective To develop a nursing checklist for extracorporeal membrane oxygenation （ECMO） in adult ICU patients and evaluate its clinical applicability，thereby providing a reference for clinical ECMO safety management. Methods Based on a literature review and an investigation of current clinical practices，an initial draft of the checklist was formulated. The checklist was subsequently revised and refined through two rounds of the Delphi expert consultation method，and the final version was established through a pilot study. Results The effective questionnaire recovery rates for the two rounds of expert consultation were 100% and 94.74%，respectively；the authority coefficients were 0.831 6 and 0.898 7；the Kendall’s coefficients of concordance were 0.334 and 0.356 （all P<0.001）；and the coefficients of variation ranged from 0.032 6 to 0.225 1 and 0.033 5 to 0.225 9，indicating a convergence of expert opinions. The final ECMO nursing checklist for adult ICU patients comprised two parts：a shift handover checklist and a daily operation checklist. The shift handover checklist consisted of 13 first-level indicators and 52 second-level indicators；the daily operation checklist consisted of 8 first-level indicators and 29 second-level indicators. Conclusion The checklist developed in this study is scientific，comprehensive，and highly clinically applicable. It can standardize ECMO management，improve nursing quality and the safety of diagnosis and treatment，and serve as a reference tool for clinical ECMO safety management.

Objective To comprehensively evaluate the current evidence on the effectiveness of cardiopulmonary resuscitation（CPR） training for first responders in cases of out-of-hospital cardiac arrest（OHCA） through an overview of systematic reviews，thereby providing a reference for optimizing training strategies. Methods Cochrane Library，PubMed，Web of Science，Embase，Wiley，CNKI，and Wanfang Database were searched to identify systematic reviews related to CPR educational strategies for first responders. The search period spanned from the inception to January 2025. The methodological quality was assessed using AMSTAR 2（Assessment of Multiple Systematic Reviews 2），and the quality of evidence was evaluated using the GRADE（Grading of Recommendations Assessment Development and Evaluation） system. Results 14 systematic reviews were included，10 were of high quality，3 were of moderate quality，and one was of low quality. Outcomes for training effectiveness were categorized into four aspects - CPR skill performance，CPR-related knowledge and overall performance，learner attitudes and perceptions and real-world event outcomes. The evidence quality assessment involved 63 evidence bodies，2 of high-quality，7 of moderate-quality，26 of low-quality，and 28 of very low-quality. Conclusion Current CPR training methods could enhance the knowledge，skills，and awareness of first responders. However，the overall quality of the evidence remains low，and there is still a notable lack of long-term effectiveness data and real-world outcome reports. Future researches should incorporate the characteristics of first responders and localized settings to more rigorously evaluate the efficacy of different training approaches through higher-quality studies，standardize the evaluation system for training effectiveness，and strengthen the reporting of real-world outcomes.

Objective To retrieve，evaluate，and summarize the best evidence on the application and management of nafamostat mesilate（NM） anticoagulation in continuous renal replacement therapy（CRRT），providing an evidence-based foundation for clinical practice. Methods Systematic searches were conducted in domestic and international evidence-based resources and databases，including BMJ Best Practice，UpToDate，Cochrane Library，JBI EBP Database，PubMed，Embase，CNKI，Wanfang Data，and VIP. The search included guidelines，evidence summaries，systematic reviews，expert consensuses，and randomized controlled trials（RCTs） on the use of NM for anticoagulation in CRRT. The search timeframe was from database inception to July 30，2025. Two researchers independently performed literature quality appraisal and evidence extraction. Results A total of 21 publications were included，comprising four guidelines，three expert consensuses，five systematic reviews，five randomized controlled trials，and four observational studies. Twenty-seven best evidence statements were ultimately summarized across six domains，including indications for anticoagulation，contraindications，medication regimens，key monitoring points，complication management，and nursing practice. Conclusion Nafamostat mesilate，as a broad-spectrum serine protease inhibitor，offers distinct advantages for CRRT anticoagulation in patients at high risk of bleeding. Healthcare professionals are advised to develop a standardized administration protocol，implement meticulous monitoring，and adopt a multidisciplinary collaborative management model，tailored to the patient’s specific condition. This approach aims to maximize the therapeutic benefits of nafamostat，minimize complications，ensure the smooth implementation of CRRT，and improve patient outcomes.

Objective To investigate the current status of accuracy regarding the application of continuous glu-cose monitoring（CGM） in neonatal intensive care units（NICUs） and pediatric intensive care units（PICUs）. Methods Following the scoping review framework，a systematic search was conducted in the Cochrane Library，Embase，PubMed，Web of Science，CNKI，Wanfang，and VIP databases from their inception to April 8，2025. Results A total of 23 articles were included. The primary accuracy assessment indicators included the mean absolute relative difference（MARD），error grid analysis（EGA），Bland-Altman analysis，and Pearson correlation coefficient. The accuracy of CGM in critically ill neonates and pediatric patients varied widely. MARE ranged from 7.1% to 28.3%，the clinically acceptable zone in EGA ranged from 89.0% to 100%，and the bias in Bland-Altman analysis ranged from -0.38 to 1.76 mmol/L. Conclusion The application of CGM in PICU/NICU remains in its preliminary stages，and clinical implementation requires caution. Future efforts should focus on establishing standardized protocols for CGM use and developing specialized accuracy assessment criteria for critically ill pediatric patients.