Objective To construct a scientific，systematic，and clinically applicable predictive indicator system for feeding intolerance in critically ill patients，providing a basis for early identification of high-risk patients and the development of predictive models. Methods Evidence on existing predictive factors was integrated through a systematic review，and indicators were screened via two rounds of Delphi expert consultation. A meta-analysis of 27 studies was conducted，and 17 experts in critical care medicine，nursing，and nutrition were invited to rate the importance of indicators using the Likert 5-point scale. Indicators were selected based on mean score，coefficient of variation，and full-score rate. Results A predictive indicator system comprising 6 first-level indicators and 29 second-level indicators was established，covering individual characteristics，disease severity，biochemical indicators，treatment factors，nutritional support strategies，and gastrointestinal function factors. The expert authority coefficients were 0.920 and 0.923，and the coordination coefficients were statistically significant（P<0.05）. Key indicators，including APACHE Ⅱ score，SOFA score，mechanical ventilation，intra-abdominal pressure，and antral motility index，achieved high consensus. Conclusion This study systematically integrated evidence-based findings and expert consensus to develop a clinically applicable predictive indicator system for feeding intolerance in critically ill patients，providing a scientific foundation for precise nutritional management. Future research should focus on model development and clinical validation to translate the system into practical tools.

Objective To construct a risk prediction model for complications of midline catheters（MC） in neonates using machine learning methods，verify and compare the performance of various models，and provide a reference for the prediction and early prevention of MC complications in neonates. Methods The clinical data of 243 neonates who received MC insertion in the neonatal intensive care unit of a provincial tertiary general hospital in Bengbu City，Anhui Province from August 2020 to December 2023 and met the inclusion and exclusion criteria were retrospectively collected，including general neonatal information，underlying diseases，catheterization-related information，etc. The research subjects were randomly divided into a training set of 170 cases and a testing set of 73 cases in a 7：3 ratio. Recursive feature elimination algorithm was used to initially screen the features，and five machine learning algorithms，including logistic regression，random forest，support vector machine，least absolute shrinkage and selection operator，and extreme gradient boosting，were used to construct the prediction models. Model parameters were optimized through cross-validation，and the performance of different models was compared to select the best model for internal validation and to construct a nomogram. Results Among the 243 neonates with MC insertion，37（15.23%） developed complications. In the training set，all five models had good fitting degrees，among which the RF model had the largest AUC（0.843），specificity（0.916），PPV（0.613），accuracy（0.882），and F1 value（0.655），outperforming the other models. In the test set，the RF model also outperformed the other models in terms of AUC（0.881），specificity（0.937），PPV（0.636），accuracy（0.904），and F1 value（0.666）. In the RF model，the top five most important clinical features were birth weight，catheter tip position，gestational age，smoothness of catheter insertion，and puncture site. Conclusion The RF model for predicting the risk of MC complications in neonates based on machine learning has certain accuracy and practicality. The nomogram is helpful for clinical medical staff to identify high-risk neonates in advance and take targeted preventive measures.

Objective To identify latent profiles of symptom burden in patients with acute coronary syndrome （ACS） after percutaneous coronary intervention（PCI） and to explore factors associated with different profiles，so as to provide evidence for stratified nursing management. Methods A convenience sampling method was used to recruit 261 patients with ACS who underwent PCI at a tertiary hospital in Chongqing，China，between November 2024 and August 2025. Data were collected using a general information questionnaire，the Cardiac Symptom Survey，and the Seattle Angina Questionnaire. Latent profile analysis was conducted to identify latent classes of symptom burden，and multinomial logistic regression analysis was performed to examine factors associated with different profiles. Results Three latent profiles of symptom burden after PCI were identified，including low symptom burden（62.8%），ischemic symptom dominant type（18.4%），and cardiopulmonary symptom dominant type（18.8%）. Multinomial logistic regression analysis indicated that age（≥65 years） and multiple stent implantation（≥2） were significantly associated with the cardiopulmonary symptom-dominant profile（P<0.05），whereas female was independently associated with the ischemic symptom dominant profile（OR=2.453，P<0.05）. Conclusion Symptom burden after PCI in patients with ACS shows marked heterogeneity. In clinical nursing practice，high-risk patients should be identified based on symptom profile characteristics，and stratified management and targeted interventions should be implemented.

Objective To construct an evaluation index system for the core competencies of advanced practice nurses in the ICU，providing a reference basis for the training and ability evaluation of advanced practice nurses in the ICU. Methods Based on the literature analysis method and semi-structured interview method，the draft of the evaluation index system for the core competencies of advanced practice nurses in ICU was initially drafted. From November 2024 to January 2025，the Delphi expert consultation method was used to systematically construct the content of the evaluation index system for the core competencies of advanced practice nurses in ICU，and the analytic hierarchy process was adopted to calculate the weights of each level of indicators. Finally，the construction of the core competency evaluation index system for advanced practice nurses in the ICU was completed. Results A total of 16 experts participated in the two rounds of consultation. The recovery rates of the questionnaires in the two rounds were 80% and 100% respectively，and the expert authority coefficient is 0.904. After two rounds of consultation，the harmony coefficient of the first-level indicator was 0.338，that of the second-level indicator was 0.317，and that of the third-level indicator was 0.357，the differences were all statistically significant（P<0.05）. Ultimately，a core competency evaluation index system for advanced practice nurses in the ICU was formed，consisting of 5 first-level indicators，12 second-level indicators，and 36 third-level indicators. Conclusion The core competency evaluation index system for ICU advanced practice nurses is scientific and reliable，with good practicality and promotion value. It can provide a reference for the training，selection，and competency evaluation of ICU advanced practice nurses.

Objective To establish a standardized training system for nurses in rapid response teams（RRT），to provide a reference for RRT nurse training. Methods A preliminary RRT nurse training system draft was developed through literature review and semi-structured interviews. Then two rounds of expert consultation with 18 experts were conducted using the Delphi method to finally determine the training system. Results The questionnaire recovery rate was 90% and 100%，the expert authority coefficient was 0.905，and Kendall’s W coordination coefficient is 0.346 and 0.407（P<0.05） The RRT training system was finally established，including 5 first-level indicators，22 second-level indicators and 84 third-level indicators. Conclusion The RRT nurse training system built in this study is highly scientific and reliable，providing theoretical support and practical guidance for RRT nurse training，and further promoting the wide application of RRT in clinical practice.

Objective To establish an evaluation index system for emergency response capabilities of nurses performing extracorporeal membrane oxygenation（ECMO），providing reference for the training and evaluation of emergency response capabilities of ECMO nurses. Methods From January to May 2025，using the 4R crisis management theory as the theoretical framework，literature review，semi-structured interviews，Delphi method，and analytic hierarchy process were used to determine the content and weights of the ECMO nurse emergency response capability evaluation index system. Results The effective questionnaire response rates for the two rounds of expert inquiry were 88.46% and 86.95%，respectively. The authority coefficients of the experts were 0.937 and 0.95，and the Kendall harmony coefficients were 0.205~0.467 and 0.210~0.616，respectively（P<0.05）. The trajectory changes of the average and standard deviation of the first and second level indicators in the second round of expert inquiry，as well as the fountain chart of the third level indicators，showed that the expert opinions tended to be consistent. The final ECMO nurse emergency response capability evaluation index system included 4 primary indicators，13 secondary indicators，and 40 tertiary indicators. Conclusion The constructed ECMO nurse emergency response capability evaluation index system is scientific and practical，and can provide reference for the emergency capability training and clinical practice evaluation of ECMO nurses.

Objective To explore the current status and influencing factors of ethical competence among emergency department nurses. Methods A cross-sectional survey was conducted using a convenience sample of 623 nurses from the emergency departments of five tertiary hospitals in Shenzhen，Fuzhou，Zhangzhou，and Zhuhai. Data were collected online using a general information questionnaire，the Ethical Competence Support scale（48 items），the Ethical Competence scale（27 items），and the Ethical Safety scale（11 items）. Results The high-level proportions for ethical competence support，ethical competence，and ethical safety among emergency department nurses were 72.23%，70.14%，and 60.51%，respectively. Multivariate analysis showed that the influencing factors of ethical competence support were educational background，professional title，working years，having participated in ethical-related training，family members engaged in ethical-related work，and encountering ethical-related issues（P<0.05）. The influencing factors of ethical competence were educational background，professional title，working years，nurse rank，having participated in ethical-related training，family members engaged in ethical-related work，and actively acquiring ethical knowledge（P<0.05）. The influencing factors of ethical safety were educational background，professional title，working years，nurse rank，having participated in ethical-related training，family members engaged in ethical-related work，and actively acquiring ethical knowledge（P<0.05）. Conclusion The overall level of ethical competence among emergency nurses is good，but ethical safety needs improvement. Managers should strengthen systematic ethics education and build supportive ethical environments；nurses themselves should proactively acquire ethics knowledge and reflect on ethical practices to comprehensively enhance their ethical competence and professional identity.

Objective To systematically evaluate and synthesize qualitative studies on the nursing experiences of extracorporeal membrane oxygenation（ECMO） nurses，aiming to provide a theoretical foundation for the high-quality development of ECMO nursing practice in China. Methods Computerized searches were conducted across PubMed，Web of Science，the Cochrane Library，Embase，CINAHL，CNKI，Wanfang Database，VIP Database，and the China Biology Medicine disc（CBM） to identify qualitative studies on the nursing experiences of ECMO nurses，from the inception of each database until March 18，2025. The methodological quality of the included studies was assessed using the Joanna Briggs Institute（JBI） Critical Appraisal Checklist for Qualitative Research. Findings from the primary studies were synthesized using meta-aggregation. Results Seven studies were included，yielding 43 themes. These themes were grouped into 10 categories，culminating in 4 synthesized findings：experiences and uncertainties of ECMO nurses，challenges and dilemmas，deficiencies in support systems and support expectations，professional development and growth gains. Conclusion The demanding and highly specialized nature of ECMO nursing imposes unprecedented psychological stress and experiences of burnout on nurses. Simultaneously，it facilitates their professional growth and gains. To enhance ECMO nurses’ sense of professional identity and promote high-quality development in the specialty，future ECMO nursing practice requires managers to continuously improve nurses’ social support systems. This should include providing psychological counseling support services from multiple dimensions such as emotional support，information support and tool support，diversified training and professional development platforms，opportunities for multidisciplinary communication and collaboration，and effective incentive mechanisms.

To summarize the nursing experience of a patient with refractory hypokalemia caused by methanol poisoning. The patient ’s history of toxic exposure was unknown，and there were multiple complex conditions such as refractory hypokalemia，optic nerve injury and emotional disorders. Nursing points included the use of critical thinking for in-depth inquiry of medical history，combination of clinical manifestations and poison detection to determine the diagnosis of methanol poisoning，formulating and implementing individualized precise potassium supplementation program，and implementing hemoperfusion to dynamically correct metabolic acidosis，establishing a multi-modal monitoring and early warning system to prevent complications such as arrhythmia，the combination of Chinese and Western medicine and specialist nursing intervention to promote the recovery of optic nerve function，implementing structured psychological support to relieve anxiety and depression. After careful treatment and nursing，the patient was in stable condition and discharged. The patient was followed up for 1 month after discharge，and the prognosis was good.

To summarize the nursing experience for a child with congenital insensitivity to pain with anhidrosis complicated by sepsis and status epilepticus. Key interventions included dynamic condition assessment using the Phoenix Sepsis Score and early identification of sepsis high-risk state and vigilance against septic shock，multidisciplinary collaborative convulsion monitoring and emergency care，refined temperature management for anhidrosis-related dysregulation and advancing high fever risk prevention，addressing the issue of pain sensation loss by enhancing self-harm behavior protection to reduce infection and fracture risks，and family-centered discharge care guided by a care map. The child achieved stable condition and was discharged after 14 days of standardized intervention.

To summarize the postoperative nursing care in a patient with short bowel syndrome and antithrombin Ⅲ deficiency undergoing living donor small intestinal transplantation. To address recurrent bleeding during the early postoperative anticoagulation period，and multiple severe postoperative complications，the following measures were implemented，including enhancing risk management and monitor for postoperative bleeding and thromboembolic events，early initiation of fluid resuscitation to optimize intestinal perfusion，dynamical assessment of graft intestinal function and implementation of stepwise nutritional support，comprehensive infection prevention with emphasis on intra-abdominal infections，establishment of electronic case records and implementing continuity of nursing care. Through the transplant team’s treatment and precision nursing，the patient was successfully discharged 36 days postoperatively. The patient was readmitted 61 days postoperatively for closure of the transplant stoma. 30-month follow-up after discharge has demonstrated good recovery.

To summarize the nursing experience of a patient with neurogenic orthostatic hypotension and associated supine hypertension. To address the issues of the patient’s positional blood pressure changes，susceptibility to fall and lack of knowledge about multiple chronic diseases，measures such as multidisciplinary-green channel treatment，“position-volume-medication” pressure control，“feedforward-real time-emergency-feedback” whole-process fall prevention，“assessment-prescription-monitoring” personalized exercise rehabilitation and checklist-guided precision empowerment of health education were adopted. After 7 days of treatment and care，the patient’s condition stabilized and discharged from the hospital. After a 3-month follow-up after discharge，the patient’s condition was good.

To summarize the perioperative nursing experience of a child with liver-brain-type mitochondrial DNA depletion syndrome undergoing liver transplantation. Given the child’s energy synthesis abnormalities and metabolic disorders，the risk of metabolic storm before surgery，instability in hemodynamics and increased risk of hypothermia during the operation，as well as complex and diverse postoperative complications，the following measures were taken. A reasonable fasting strategy was developed preoperatively. Monitoring of hemodynamics was enhanced and hypothermia prevention measures were implemented intraoperatively. Postoperatively，a low-dose titration method for medication was adopted to accurately adjust drug doses and fluid strategy was dynamically adjusted to manage refractory ascites，and the individualized follow-up was conducted. After careful treatment and nursing，the child was discharged on the 38th day after the liver transplantation. After 6 months of outpatient follow-up，he recovered well.

Objective To construct a list of low-value care items for critically ill patients based on evidence-based evidence，so as to provide a reference for the de-implementation of low-value care items in critically ill patients. Methods Systematic searches were conducted in Chinese and English databases，and guidelines related websites，with the search time limit from January 1，2015，to March 1，2025. Two researchers independently performed quality evaluation，extracted and summarized the nursing items explicitly not recommended in the literature. A list of low-value items in critical care was formed through two rounds of expert consultation. Results A total of 26 literatures was included，including 10 guidelines，1 evidence summary，and 15 expert consensuses. The effective response rates of the two rounds of consultation questionnaires were 88.89% and 100%，respectively，with expert authority coefficients of 0.897 and 0.925. The Kendall’s concordance coefficients for item importance were 0.247 and 0.394（P < 0.05）. Finally，60 low-value care items were formed. Conclusion The list of low-value care items for critically ill patients constructed based on evidence-based evidence can guide critical care staff to reduce the implementation of related items in their work，improve nursing quality，and avoid resource waste.

Objective To conduct a clinical audit on structured triage for emergency chest pain patients，establish evidence-based audit indicators，systematically analyze barriers and facilitators，and develop action strategies. Methods Using the Joanna Briggs Institute（JBI） Evidence-Based Healthcare Model as the theoretical framework，clinical questions were defined，and an evidence-based team was formed to systematically retrieve，evaluate，and synthesize evidence. Audit criteria and methods were developed. A clinical audit was conducted from January 1 to March 1，2025，using the Evidence-Practice Integration Strategy to analyze barriers and facilitators in clinical practice and formulate corresponding change strategies. Results A total of 18 best evidence items were included，and 15 audit indicators were developed. Among them，10 indicators had an implementation rate of <80%，and 3 indicators were 0. Major barriers to evidence-based practice included insufficient knowledge of chest pain triage，insufficient dynamic monitoring due to triage overload，and the lack of electronic templates and quality-control linkage mechanisms. Key facilitators included managerial support for evidence-based practice，the developmental potential of intelligent triage systems，and a nursing team with strong professional competence and motivation to learn. Based on these factors，targeted strategies were formulated，including the development of a structured electronic triage pathway，tiered nurse training with scenario simulation，integration of triage standards into the quality-control system，and establishment of a multidisciplinary collaborative improvement mechanism. Conclusion There is a significant gap between the best evidence and the current clinical status of structured triage for acute chest pain. Promoting evidence translation requires standardized pathway tools，tiered nurse training，and enhanced informatics construction to improve the quality of emergency nursing care.

Objective To understand the current situation of self-compassion and caring ability of emergency and critical care nurses and explore their correlation. Methods From March to April 2025，334 emergency and critical care nurses from 7 tertiary grade A hospitals in Beijing were selected using the convenience sampling method. A questionnaire survey was conducted using the general information questionnaire，the Self-Compassion Scale，the Caring Ability Inventory. Results The total score of self-compassion for emergency and critical care nurses was （89.62±12.22），including self-criticism（16.34±3.61），over-identification（12.27±3.04），universal humanity（14.28±2.55），isolation（13.10±3.03），self-kindness（18.60±3.30），and mindfulness（15.02±2.76）. The score of caring ability was（181.69±21.52）. There was a positive correlation between self-compassion and caring ability（r=0.611，P<0.001）. Conclusion The self-compassion of emergency and critical care nurses is at a medium level. Self-compassion is positively correlated with caring ability. The higher the level of self- compassion，the stronger their caring ability. It is suggested that the management can enhance the caring ability of emergency and critical care nurses by cultivating their self-compassion level.

Objective To explore the real psychological experience of ICU nurses in coping with the injurious behaviors of patients with delirium after cardiac and major vascular surgery，and to provide empirical evidence for the development of targeted psychological support and occupational safety protection strategies. Methods Using a descriptive phenomenological research design and purposive sampling，17 nurses in the ICU of a tertiary hospital in Zhejiang Province who had directly suffered from injurious behaviors of patients with delirium were selected as study subjects from January to February 2025. Data were collected through semi-structured in-depth interviews，and the Colaizzi 7-step analysis method was used to code，summarize，and refine themes. Results Four core themes and eight sub-themes were distilled. Four themes included the conflict between instinctive defense mechanisms and professional roles in stress responses（instinctive protective reactions and vigilance in threatening situations，behavioral restraint driven by professional responsibility），psychological states and professional belief crises caused by traumatic events（persistent psychological abnormalities triggered by traumatic memories，weakened and questioned professional value recognition），the demand for safety reconstruction during trauma recovery（the urgent need for security measures，the intense craving for workplace emotional understanding and response），and the integrated demand for a multi-dimensional support system（spiritual reliance on family emotional care，professional support from organizational systemic assistance）. Conclusion Managers should establish a phased intervention mechanism to address the multiple challenges nurses face when dealing with harmful behaviors of delirious patients：balancing instinctive defense mechanisms and professional restraint under stress，alleviating trauma-induced psychological abnormalities and reshaping professional identity，strengthening safety guarantees and emotional responses to support trauma recovery，and integrating family and organizational support to form a collective effort，thereby preventing the accumulation of trauma and ensuring the mental and physical health and professional stability of nurses.

Objective To systematically evaluate the impact of gastric juice reinfusion on enteral feeding intolerance in critically ill patients. Methods A systematic search was conducted in PubMed，Web of Science，Cochrane Library，Ovid，CINAHL，Embase，China National Knowledge Infrastructure，Wanfang Data，and VIP Database for randomized controlled trials（RCTs） regarding the reinfusion of gastric juice in critically ill patients receiving enteral nutrition. The search time period was from the establishment of the database to January 2025. Two researchers independently performed literature screening，data extraction，and quality assessment，with RevMan 5.4 software used for meta-analysis. Results A total of eight RCTs involving 574 patients were ultimately included. Meta-analysis indicated that reinfusion of gastric juice was superior to its disposal in reducing the incidence of nausea/vomiting[RR=0.44，95%CI（0.21，0.95），P=0.036]，abdominal bloating[RR=0.49，95%CI（0.31，0.79），P=0.003]，and constipation[RR=0.22，95%CI（0.05，0.99），P=0.048]，with statistically significant differences. However，there were no significant differences in gastric residual volume[MD=-9.55，95%CI（-21.83，2.73），P=0.127]，the incidence of gastric emptying delay[RR=1.09，95%CI（0.72，1.65），P=0.692]，diarrhea[RR=0.60，95%CI（0.33，1.11），P=0.102]，serum albumin（SMD=0.18，95%CI[-0.13，0.49]，P=0.248），plasma total protein（SMD=0.18，95%CI[-0.13，0.50]，P=0.245），or the incidence of hypokalemia（RR=0.75，95%CI[0.47，1.18]，P=0.213）. Differences in hemoglobin（SMD=0.41，95%CI[-0.04，0.87]，P=0.077） and the incidence of electrolyte disturbances（RR=0.56，95%CI[0.29，1.08]，P=0.085） were close to statistical significance. Conclusion Reinfusion of gastric juice is significantly advantageous in reducing the incidence of nausea/vomiting，abdominal bloating，and constipation，while its effects on improving gastric residual volume，gastric emptying delay，diarrhea，nutritional status，and electrolyte levels are not significant. Further validation with more high-quality RCTs is warranted. In clinical nursing practice，it is recommended to implement gastric juice reinfusion strategies gradually based on the specific degree of gastric retention in critically ill patients to improve gastrointestinal symptoms.

Objective To summarize the best evidence on oral feeding management in tracheostomy patients and provide a reference for clinical practice. Methods Systematic searches were conducted in guideline databases，professional association websites，and domestic and international literature databases for evidence related to oral feeding management in tracheostomy patients，with a time frame from January 1，2015，to January 31，2025. Included evidence types comprised clinical decisions，guidelines，evidence summaries，best practices，recommendation，statement，expert consensuses，systematic reviews，and meta-analyses. Two researchers independently evaluated literature quality，extracted data，and synthesized evidence. Results A total of 13 articles were included，consisting of 2 guidelines，5 expert consensuses，1 recommendation ，2 evidence summaries，and 3 systematic reviews. A total of 22 pieces of evidence were synthesized across 7 dimensions：management organization，swallowing assessment，swallowing therapy and training，pre-feeding preparation，feeding guidance，post-feeding management，and complication prevention and management. Conclusion This study summarizes the best evidence for oral feeding management in tracheostomy patients，demonstrating scientific rigor and comprehensiveness. It provides a valuable reference for clinical practice.

Surrogate decision-makers for thrombolysis in acute ischemic stroke often fall into decision-making dilemmas due to multiple pressures，resulting in decision delays. This article reviews the connotation，assessment tools，influencing factors，and coping strategies of the decision-making dilemma of surrogate decision makers for thrombolytic therapy in acute ischemic stroke，proposes the thrombolytic decision-making clinical practice pathway，limitation of current research and suggestions. It aims to provide theoretical and practical basis for early identification of decision-making dilemma risks，AI-enabled formulation of individualized decision-making assistance plans，and further optimization of the treatment process for acute ischemic stroke.

Persistent health issues stemming from post-intensive care syndrome（PICS） compromise the quality of life for patients and their families，imposing a substantial burden. As an emerging care model，post-ICU clinics provide systematic functional assessments and stepped interventions for ICU survivors. This review synthesizes evidence on clinic-based rehabilitation practices and development pathway，demonstrating that multidisciplinary collaboration，family-centered empowerment，and digital health technologies significantly enhance functional recovery rates and reduce readmission risks. To address challenges—including resource constraints，low participation，lack of standardized protocols，and digital disparities—evidence-based solutions and future directions are proposed，advancing the shift in critical care medicine from life-saving to functional restoration.