Objective To construct a delirium grading management plan for critically ill patients guided by combined delirium prediction models，and to preliminarily explore its application effects. Methods Through literature review and Delphi expert consultation，a delirium grading management plan for critically ill patients guided by combined delirium prediction models was constructed. Using convenience sampling method，169 patients admitted from December 2023 to February 2024 were recruited as the experimental group，which was intervened according to the constructed management plan，and 147 patients admitted from September to November 2023 were included as the control group and received routine care. The incidence of delirium was compared between the two groups. Results A total of 16 experts completed two rounds of consultation. The response rates of effective questionnaires were 100% and 93.75%，respectively，and the expert authority coefficients were both 0.89. After 2 rounds of expert consultation，the Kendall coefficients of the importance and operability of the items were 0.151 and 0.193，respectively（P<0.01）. The final plan included 10 primary items，31 secondary items，and 34 tertiary items. The application results showed that the incidence of delirium in the experimental group（12.42%） was lower than that in the control group（21.09%），and the difference was statistically significant（P=0.038）. Conclusion The delirium grading management plan for critically ill patients，guided by the combined delirium prediction models，provides theoretical basis and practical guidance for multidisciplinary cooperation in standardized management of delirium in ICU，and can reduce the incidence of delirium in critically ill patients.

Objective To establish a subdelirium nursing program for ICU patients based on the best evidence，and explore its clinical application effect. Methods Based on the literature analysis，the subdelirium nursing program for ICU patients was established. Convenience sampling method was used to select 58 patients who were admitted to the intensive care unit in a tertiary class A hospital in Shandong Province from January to May 2023 as the experimental group，who were given the subdelirium nursing program based on the best evidence. Another 61 patients treated from August to December 2022 were taken as the control group and given routine nursing. The delirium rate and subdelirium rate，length of hospital stay and cognitive function score were compared between the two groups. Results After the intervention，the incidence of subdelirium was 16.07% in experimental group and 34.55% in control group，the difference was statistically significant（P<0.05）. The incidence of delirium was 7.14% in experimental group and 20.00% in control group，the difference was statistically significant（P<0.05）. The length of hospital stay was（6.02±4.00） days in experimental group and（6.44±4.45） days in control group，with no statistical significance（P>0.05）. The cognitive function score of the experimental group was（9.09±0.67） points and that of the control group was（8.31±1.09） points，the difference was statistically significant（P<0.001）. Conclusion The subdelirium nursing program based on the best evidence for ICU patients can help to reduce the incidence of delirium，subdelirium and enhance their cognitive function.

Objective To establish a structured early nursing assessment indicators for critically burned patients and provide assessment criteria for emergency nurses and burn unit nurses. Methods Based on the guidance of emergency nursing assessment framework，preliminary evaluation index item pool was determined by literature research method，two rounds of Delphi expert inquiry were conducted via email，and the results of expert inquiry were analyzed using SPSS 26.0 software. Results The effective response rates of the two rounds of expert questionnaires were both 100%，and the expert authority coefficients for both rounds were 0.92. The coefficients of variation for the opinions obtained from two rounds of expert inquiries were 0.063 and 0.016 respectively，while Kendall’s harmony coefficients were 0.397 and 0.717（P<0.05），indicating a tendency towards consensus among the experts’ opinions. Finally，the early nursing assessment indicators for critically burned patients was formed，consisting of seven primary indicators，thirty-four secondary indicators，and fifty-two tertiary indicators. Conclusion The indicators constructed in this study are scientific，reliable，and feasible，providing guidance for early nursing assessment of critically burned patients.

Objective To describe the experience of patients receiving extracorporeal membrane oxygenation （ECMO） in awake state，and provide basis for formulating intervention plan and improving the physical and mental comfort of patients. Methods The descriptive qualitative research method was adopted. By using purposive sampling，13 patients who received ECMO treatment in a tertiary class A hospital in Zhejiang Province from September 2021 to August 2023 were selected for semi-structured in-depth interviews，and the themes were summarized and refined through content analysis. Results The experience of receiving ECMO in the awake state was distilled into three themes：positive cognition of ECMO in the awake state，negative experience of treatment，and positive self-guidance. Conclusion The staff should pay attention to the experience of patients undergoing ECMO in awake state. To construct a patient-centered intervention program to help patients actively respond to related problems，improve the patient’s treatment experience，and promote the early recovery of patients.

Objective To understand the influencing factors of short video science popularization on the public’s willingness to perform cardiopulmonary resuscitation，thereby providing the basis for a more accurate short video science popularization education in the future. Methods By using purposive sampling method，16 short video users were selected as interviewee. Based on elaboration likelihood model，the interview outline was used to conduct semi-structured depth interviews. After the interviews，Colaizzi data analysis method was used to analyze and extract data. Results The influencing factors of short video science popularization on the public’s willingness to perform cardiopulmonary resuscitation could be summarized into 2 themes and 6 sub-themes. Video quality is the core factor that affects the willingness to rescue：the suspense and interest at the beginning of the video are necessary prerequisites for stimulating the willingness to rescue；the operability of the video is a source of self-efficacy that enhances the willingness to rescue；the pace of the video is an important factor that affects users’ ability to learn skills and enhances their willingness to rescue；relevant legal knowledge in the video is a reliable way to reduce rescuers’ concerns and increase their willingness to rescue. Information source quality is a external factor affecting the willingness to rescue：the platform’s penetration rate affects the spread of the video and the degree of user acceptance，promoting the willingness to rescue；the credibility of the source affects users’ emotional and cognitive responses，creating an immediate effect on the willingness to rescue. Conclusion This study actively expands the scope of information-based popular science education and supports health education initiatives on cardiopulmonary resuscitation in the new media era. It should emphasize the combination of core and external factors influencing short video science popularization，and enhance the quality of short video content，which will significantly boost the public’s willingness to engage.

To summarize the emergency nursing experience of extracorporeal cardiopulmonary resuscitation in a child with congenital complete tracheal rings who suffered from asphyxia and cardiac arrest due to tracheal malformation. For the child with respiratory failure，difficult tracheal intubation，secondary cardiac arrest and other critical conditions，we took measures such as establishing a multidisciplinary team，maintaining efficient cardiopulmonary resuscitation，rapidly establishing extracorporeal membrane oxygenation，timely head hypothermia treatment，and airway clearance nursing. After active rescue，the child was transferred back to the general ward 7 days later with good condition.

The role of first responder intervention is critical for improving survival rates in patients with out-of-hospital cardiac arrest（OHCA）. The potential role of mobile applications in OHCA has garnered significant attention，yet there is a lack of research in China regarding their use in first responder interventions for OHCA. This paper reviewed the development of mobile applications in OHCA，their application status in first responder interventions，effectiveness evaluations，application challenges，and suggestions，providing a reference for the development of emergency response networks in China.

Objective To summarize，evaluate and analyze the related systematic reviews/meta-analyses of the application of targeted temperature management（TTM） in patients with cardiac arrest（CA），so as to provide evidence support for clinical medical staff. Methods CNKI，Wanfang，VIP，CBM，PubMed，Embase，Web of Science，Cochrane Library and CINAHL databases were searched by computer. Systematic reviews/meta-analyses evaluating the application effect of TTM in patients with CA were included. The search time limit was from the establishment of the database to January 15，2024. Two researchers independently screened the literature and extracted the data，assessed the extent of original study overlap by calculating Corrected Covered Area（CCA）. AMSTAR 2 tool，PRISMA 2020 reporting standard and GRADE evidence grading system were used to evaluate the methodology，reporting and evidence quality of the included studies，respectively. Descriptive analysis was used to present the results. Results A total of 23 systematic reviews/meta-analyses were included. The original studies were highly overlapping by calculating a CCA of 10.32%. The results of AMSTAR 2 evaluation showed that 2 articles were of high quality，2 articles were of medium quality，8 articles were of low quality and 11 articles were of very low quality. The results of PRISMA 2020 evaluation showed that 12 reports were relatively complete，and 11 reports had certain defects. The GRADE evaluation results showed that 8 of the 55 evidence bodies were medium quality，25 were low quality，and 22 were very low quality.The results of descriptive analysis showed that TTM has potential benefits for CA patients in terms of improving neurological function recovery，improving survival rate，reducing mortality and improving quality of life，but its effects on cost-effectiveness and length of hospital stay need to be further confirmed. Conclusion TTM has potential benefits in improving neurological recovery and survival，decreasing their death rate and improving their quality of life in CA patients，but the optimal body temperature has not yet been clarified and the quality of related systematic reviews/meta-analyses needs to be improved. Future scholars should aim to explore personalized treatment strategies and improve the level of knowledge and practice of TTM among clinical nurses，so as to ensure the effectiveness of TTM treatment and improve the prognosis of CA patients.

Objective To conduct a meta-analysis to understand the prehospital delay rate and influencing factors in patients with acute myocardial infarction. Methods Literature related to the prehospital delay rates and risk factors in patients with acute myocardial infarction was retrieved from CNKI，VIP，Wanfang，China Biomedical Literature Database，PubMed，Cochrane Library，Embase，and Web of Science databases. The search time limit was from establishing the database to March 2024. Analysis was performed using Rev Man 5.4 and Stata 18.0. Results A total of 20 articles were included，involving 49 041 patients with acute myocardial infarction. The occurrence rates of prehospital delays were 61%（95%CI：53%-69%） at 2 hours，58%（95%CI：43%-72%） at 3 hours，and 40%（95%CI：30%-50%） at 6 hours. Factors influencing prehospital delay included sociodemographic factors included educational level（OR=1.50），age（OR=1.58），gender（OR=0.68），living alone（OR=2.40），and place of residence（OR=2.24）；disease-related factors were history of diabetes（OR=1.54），atypical symptoms（OR=1.42），history of coronary heart disease（OR=1.72）；and other factors included mode of admission（OR=0.49），onset during the day（OR=0.62），symptom attri-bution（OR=4.97）. Conclusion The prehospital delay rate of patients with acute myocardial infarction is high，and factors affecting it cover various aspects such as sociodemographic and disease-related factors. Further research is needed to explore the relationship between influencing factors and prehospital delay to effectively reduce the occurrence of prehospital delay in patients with acute myocardial infarction.

Objective To explore the application effectiveness of a new diagnostic and treatment model combining virtual cloud billing with unaccompanied care in the management of critically ill emergency patients. Methods Starting from January 2021，a new treatment model involving interdisciplinary and multi-department cooperation was implemented and continuously optimized in the emergency rescue room of a tertiary class A hospital in Zhejiang Province. This retrospective study analyzed the treatment data of 36 551 patients from January 2020 to December 2023. The patients were grouped according to different stages of the treatment model，including traditional period（2020，n=6 931），new model exploration period（2021，n=8 501），new model improvement period （2022，n=10 095），new model stabilization period（2023，n=11 024）. Statistical analysis was conducted on the differences in emergency room stay time，blood test waiting time，medication waiting time，CT scan waiting time，total number of billing settlements and total instances of outstanding payments among the groups. Results There were statistically significant differences among the periods in terms of emergency room stay time，blood test waiting time，medication waiting time，CT scan waiting time，and total number of billing settlements（P<0.001）. There was no significant difference in the total instances of outstanding payments among the groups（P=0.998）. Conclusion The establishment of this new diagnostic and treatment model is of great significance in improving the refined management of patients in emergency rescue room and enhancing the medical experience.

Objective To translate and test the reliability and validity of Nurse Intuition Patient Deterioration Scale（NIPDS），and to verify the predictive role of the scale in emergency patients’ deterioration. Methods The Brislin translation method was used to translate the NIPDS literally，back-translate and cross-culturally adjust to the Chinese version of the NIPDS. A total of 232 patients admitted to the emergency department were conveniently selected，and NIPDS registration was performed when the on-duty nurse intuited the deterioration of the patient’s condition，so as to evaluate the reliability and validity of the scale. Results The Chinese version of Nurse Intuition Patient Deterioration Scale was a single dimension scale with 9 items in total. The total Cronbach’s α coefficient was 0.891，and the broken half reliability was 0.848. The content validity of the scale was 0.920，the item content validity was 0.840~1.000，and the cumulative variance contribution rate was 54.305%. Standardized factor load coefficient was 0.544~0.790. When area under the receiver operating characteristic（ROC） curve was 0.753（95%CI =0.656~0.850，P<0.001），truncation value was 6 points，Youden index was 0.483，sensitivity was 0.622，specificity was 0.861，and scale validity was good. Rasch model analysis showed that the item reliability and sample reliability are 0.980 and 0.770 respectively，the item difficulty load ranges from -2.534 to 1.439，and the item difficulty was suitable. Conclusion The Chinese version of NIPDS has good reliability and validity，and is an effective and accurate tool，which can be used as an auxiliary supplement to the existing early warning system to help nurses make early judgment on the deterioration of emergency patients.

To summarize the nursing experience of a patient with glycogen storage disease complicated with sepsis and cold agglutination phenomenon. Glycogen storage disease is a rare metabolic disorder，factors such as fever and infection can easily induce acute metabolic crisis，and the patient was accompanied by cold agglutination，its treatment and nursing were complicated. The key points of nursing care included blood sugar and nutrition management，acidosis correction，infection control，evidence-based target body temperature management，ensuring safe blood transfusion. After 8 days of active treatment and careful nursing care，the patient’s condition improved and she was discharged. After 6 months of follow-up，she returned to the hospital as scheduled，the recovery was good.

To summarize the nursing care of a patient with a rare area postrema syndrome of neuromyelitis optica spectrum disorders，combined with respiratory depression. Given the patient’s central respiratory depression，intractable hiccup and vomit，nutritional disorders，electrolyte disorders，anxiety and insomnia，and other problems，comprehensive symptom management was carried out，including early detection of respiratory depression and mechanical ventilation，symptomatic care for intractable hiccup and vomit，care for anxiety and insomnia，as well as medication care of high-dose corticosteroids. The patient was transferred out of the ICU on the 16th day of hospitalization and was discharged on the 36th day of hospitalization.

To summarize the nursing care of a patient with complex diffuse cervical arteriovenous malformation after surgery for anterior mediastinal tumors. In response to issues such as the lesion being located in the airway，high risk of bleeding，unpredictable timing of intubation，and physical and psychological complications，multidisciplinary cooperation has been implemented to prevent airway bleeding，monitor complications of embolic agent use，and provide psychological treatment to improve patient quality of life. The tracheal intubation was removed successfully after 103 days of intubation. On the 5th day after extubation，the patient’s condition was stable and discharged. The patient was followed up for 3 months，and the patient’s condition was good.

Objective To develop and implement a perioperative evidence-based care protocol for 8 patients with end-stage heart failure with implantable left ventricular assist devices（LVAD）. Methods Based on multidisciplinary collaboration，addressing the priorities and difficulties of care，we searched relevant guidelines，systematic reviews and expert consensus. After evaluation and integration of evidence，it was applied to 8 patients with end-stage heart failure undergoing LVAD implantation. Results A total of 9 articles were finally included，including a clinical decision，six expert consensuses，a guideline and a cohort study. Based on the actual clinical problems of patients and the suggestion of multidisciplinary team，nursing plans were formulated，including goal-oriented circulation management，dynamic anticoagulation management，early warning of intestinal obstruction complications，transmission system infection management，device alarm management. After 35-68 d of treatment and rehabilitation，all functions of the patient recovered well and they were discharged. Conclusion For patients with LVAD implantation，evidence-based methods are used to provide scientific and effective nursing measures，which promote patient rehabilitation.

Objective To understand how ICU medical staff cognize the nursing quality evaluation of airway management in prone position mechanically ventilated patients so as to provide reference for construction of a nursing quality evaluation index system for airway management in prone position mechanically ventilated patients. Methods The purposive sampling method was used to conduct semi-structured interviews with 16 ICU medical staff from a tertiary class A hospital in Guangdong Province from February to June 2023.The interview data were analyzed and retracted according to the Colaizzi 7-step analysis of phenomenological data. Results Three themes and nine sub-themes related to airway management quality evaluation in prone position mechanically ventilated patients were extracted. Themes related to structural quality evaluation included sufficient resource support，excellent professional quality，scientific and effective operation specifications and quality standards. Themes related to process quality evaluation included implementation of dynamic nursing assessment，standardized implementation of nursing operations，timely and effective treatment of related risks，good cooperation of team members.，And themes related to outcome quality evaluation included multi-dimensional continuous monitoring of relevant data，close attention to patient safety. Conclusion The themes for airway management quality in prone position mechanically ventilated patients from the perspective of medical staff can provide reference for further construction of a nursing quality evaluation index system.

Objective To explore the trauma recovery path of ICU nurses who experience patient safety incidents as second victims，and to provide a reference for constructing supportive intervention strategies. Methods Using gounded theory research approach，in-depth interviews were conducted with 23 ICU nurses in a hospital of Zhengzhou City who have undergone patient safety events in the recent three years. Data analysis and model construction were conducted using Strauss and Corbin’s grounded theory. Results The trauma recovery path of ICU nurses who experienced patient safety incidents included four stages：accident response period（trade-offs，coping behaviors），stress period（stressors，psychological experiences，physical symptoms，behavioral experiences），adjustment period（support needs，self-repair，occupational cognition，organizational safety climate），reintegration period（negative survival，positive growth，impact duration）. The recovery model revealed the process and mechanisms of second victim growth. Conclusion The trauma recovery process of ICU nurses as second victims is relatively phased. Organizational safety climate and leadership support are critical external drivers for the transition from the stress phase to the adjustment phase，while professional cognition and self-healing ability are intrinsic factors that foster reintegration and growth. Nursing managers should provide corresponding interventions based on the trauma recovery path to promote the positive growth of ICU nurses as second victims.

Objective To evaluate the effect of phase I exercise rehabilitation on cardiac rehabilitation in patients with acute decompensated heart failure（ADHF）. Methods Two researchers independently searched and screened PubMed， Web of Science， Embase， Cochrane Library， CINAHL， CNKI， VIP， Wanfang Database and SinoMed for the randomized controlled study on the effect of phase I exercise rehabilitation on cardiac rehabilitation of patients with acute decompensated heart failure until October 2023. RevMan5.3 software was used for data extraction and analysis. Results A total of 8 RCTs involving 681 patients were included. Meta-analysis results showed that phase I exercise rehabilitation could improve the 6-minute walk distance[MD=56.80， 95%CI（20.82， 92.78）， P<0.01] and physical function [MD=1.25， 95%CI（0.61， 1.89）， P<0.01]， reduce all-cause readmission[OR=0.49， 95%CI（0.26， 0.91）， P=0.03]， improve quality of life[MD=-15.74， 95%CI（-20.03， -11.44）， P<0.01] of ADHF patients compared with routine care. However， there was no difference in NT-proBNP[MD=-74.36， 95%CI（-248.60， 99.87）， P=0.40] and 3-month rehospitalization[OR=0.48， 95%CI（0.16， 1.50）， P=0.21]. No adverse events occurred in the two groups during the intervention period. Conclusion Phase I exercise rehabilitation is helpful to improve the exercise tolerance and quality of life of patients with ADHF， and it is effective and safe to improve the 6-minute walk distance and short physical performance score. However， there was only an improvement trend in NT-proBNP level and 3-month rehospitalization rate， and there was no statistical power. Large sample and high-quality studies are still needed to evaluate its individual response and long-term effects.

Objective To systematically summarize the relevant evidence of post-extubation oxygen therapy methods for mechanically ventilated patients，so as to construct a flow chart of oxygen therapy methods based on the best evidence，for providing the reference for clinical staff to make oxygen therapy decisions. Methods We systematically searched the literature on the post-extubation oxygen therapy methods for mechanically ventilated patients in guideline websites and databases（inception of the database to January 12，2024）. The literature was evaluated according to the corresponding evaluation criteria，and the evidence was extracted and integrated. Results A total of 13 literature incorporated，including three clinical decisions，five guidelines，an evidence summary，an expert consensus，a systematic review，and two randomized controlled trials. The 24 pieces of best evidence were summarized from 4 aspects，including basic principles，application indications，application methods，precautions. The post-extubation oxygen therapy flow chart for mechanically ventilated patients was constructed. Conclusion This study summarized the best evidence of post-extubation oxygen therapy for mechanically ventilated patients and constructed the flow chart of oxygen therapy，which can provide a basis for clinical standardized selection of post-extubation oxygen therapy methods.

Objective To systematically analyze the nurse-led post-extubation dysphagia management program for tracheal intubation，and to provide a reference for the prevention and management of post-extubation dysphagia in patients with acute and critical illness. Methods According to the research specifications of scoping reviews，a systematic search was conducted in English databases including Cochrane Library，PubMed，Embase，Web of Science，and Chinese databases such as CNKI，Wanfang Data，and Chinese Biomedical Literature Database. The search period was from the establishment of the databases to January 31，2024. Relevant literature on the management of post-extubation dysphagia was selected and systematically reviewed. Results A total of 22 studies were included，of which 2 studies were related to the assessment and intervention of post-extubation dysphagia，14 studies related to the screening and assessment of post-extubation dysphagia，6 studies related to the prevention and intervention of post-extubation dysphagia. The prevalence rate of post-extubation dysphagia ranged from 3% to 54.2%，the timing of assessment was mostly started 2-24 h after extubation，and the tools used included Functional Oral Intake Scale，Repetitive Saliva Swallowing Test，etc. Some studies combined multiple tools for screening，and positive patients received 1 or 2 reassessments at 24 h before referral to rehabilitation or speech therapist. Prevention and intervention methods included oral exercises，compensatory strategies，ventilator strength training，health education，and cold spray therapy，with interventions mostly starting 24 h after extubation and continuing for at least 10 d or until discharge. Conclusion Nurse-led dysphagia management is feasible and safe，reduces the waiting time for oral feeding，decreases the risk of aspiration pneumonia，and compensates for the lack of resources for speech therapists in the ICU. However，there is a lack of standardized assessment and intervention protocols，and there is heterogeneity in the timing of assessment，assessment tools，and intervention protocols. High-quality clinical trials are needed to inform the development of comprehensive management strategies.

Orthotopic heart transplantation is the gold standard for the treatment of patients with advanced heart failure（AHF），but the scarcity of organs limits its application. Left ventricular assist device（LVAD） become the important treatment for AHF patients. However，most LVAD implanted patients develop moderate to severe malnutrition due to disease progression. This article reviews the causes of malnutrition in patients with LVAD implantation，the significance and content of nutrition assessment，nutrition assessment tools and whole-course nutrition management，so as to help medical staff to provide a reference for early nutritional assessment and whole-course nutrition management in patients with LVAD implantation.

Opioid induced postoperative respiratory depression refers to the serious life-threatening symptoms of slow respiratory rate，reduced ventilation，hypoxemia，hypercapnia，and drowsiness after surgery in patients who use opioid drugs. Early identification of respiratory depression and active intervention is a key focus of clinical nursing work. This article provides a review of the evaluation and prevention of postoperative respiratory depression induced by opioid drugs，and combines with China’s national conditions to summarize the work priorities of nurses in systematic evaluation，dynamic monitoring，personalized alarm settings，rigorous preoperative screening，strict control of transfer standards，standardized hospital transportation，and emphasis on nurse patient cooperation，providing reference for early warning and predictive intervention.