Objective To investigate the feasibility and safety of family participation in the care of patients with severe pneumonia and its impact on the family of patients. Methods For severe pneumonia and respiratory failure patients admitted to three adult ICUs of a tertiary class A hospital in Gansu Province between March 2019 and March 2023，the patients were divided into an intervention group and a control group based on the preferences of both the patients and their family members. Patients in the control group received routine care. In the intervention group，family members were encouraged to participate in the daily life of patients（washing face，brushing teeth，foot bath，etc.） and participated in the early activities of patients under the guidance of medical personnel. The primary outcomes included the incidence of delirium，cognitive impairment，and 1-year mortality. Results 261 patients were eventually enrolled and assigned to the intervention group（n=134） or control group （n=127）. Incidence of delirium in intervention group and control group were 23.88% and 40.94%，frequency of delirium was （0.61 ± 1.25） vs （1.26 ± 1.82），incidence of cognitive dysfunction 23.88% vs 44.09%，and there were statistically differences（P<0.05）. There was no significant difference in the incidence of ICU acquired weakness，ICU acquired infection and adverse events between groups（P>0.05）. Patients in the intervention group exhibited a higher 1-year survival rate（73.88% vs 59.06%） and quality of life score compared to the control group，and there were statistically differences（P<0.05）. Family members in the intervention group reported lower total illness uncertainty scores than those in the control group（80.11 ± 4.23 vs. 82.91 ± 4.64） and higher overall satisfaction（90.81 ± 5.17 vs. 85.60 ± 4.72），with these differences being statistically significant（P<0.05）. Conclusion The participation of family members in the care of patients with severe pneumonia is not only beneficial to reduce the incidence of delirium and cognitive impairment in patients with severe pneumonia in ICU，shorten the length of hospitalization，improve the quality of life and 1-year survival rate，but also help reduce the uncertainty of disease and improve the satisfaction of family membersn ICU.

Objective To compare and analyze the effects of high-flow nasal cannula（HFNC） and conventional oxygen therapy（COT） on thirst and dry mouth after extubation in mechanically ventilated patients. Methods A prospective cohort study was applied. Conveniently selected 226 patients who underwent mechanical ventilation and were hospitalized in the ICU of a tertiary Grade A hospital in Shiyan City from May 2022 to April 2024 as the study subjects. According to the oxygen therapy plan after extubation，patients were divided into HFNC group and COT group. Propensity Score Matching（PSM） was applied to balance the general information of two groups of patients. The degree of thirst and dry mouth after extubation were compared and analyzed between two groups. Results After PSM，multiple indicators were matched and balanced in both HFNC and COT groups，with improved comparability（P>0.05）. 4 and 24 hours after extubation，the degree of thirst in the HFNC group was significantly reduced compared to the COT group（P<0.05）. However，there was no significant difference in the degree of dry mouth between the two groups. There was no correlation between thirst sensation and oral dryness after extubation among HFNC and COT patients（P>0.05）. Conclusion Compared with COT，HFNC therapy can reduce the intensity of thirst in mechanical ventilation patients within 24 hours after extubation，but has no significant effect on the degree of dry mouth in patients.

Objective To investigate the heterogeneity of adherence to functional exercise in stroke patients and to analyze the influencing factors of different profiles. Methods A convenience sampling approach was employed to recruit 234 stroke patients from Suqian Hospital of Jiangsu Provincial People's Hospital from May 2022 to May 2024. A general information questionnaire，Questionnaire of Exercise Adherence（EAQ），Stroke Self-Efficacy Questionnaire（SSEQ），Hospital Anxiety and Depression Scale（HADS） were applied for survey. The latent profile identification was used to identify heterogeneity of functional exercise adherence，and multivariate logistic regression was used to analyze the influencing factors of different profiles. Results The study included 234 stroke patients with an average age of（65.37 ± 9.28） years，and three potential profiles of functional exercise adherence were identified：negative exercise group（15.8%），lack of advice group（56.4%），and active exercise group（27.8%）. Anxiety，depression，self-efficacy，duration of illness，and use of home aids were influential factors across potential profiles（P<0.05）. Conclusion There are a total of 3 potential profiles of functional exercise adherence in stroke patients，and clinical caregivers can give targeted interventions to improve patient prognosis according to patient characteristics of different profiles.

Objective To analyze the risk factors of subsyndromal delirium（SSD） in Intensive Care Unit（ICU） patients with sepsis，construct and validate a risk prediction model for SSD，and provide an effective predictive tool for clinical practice. Methods The sepsis patients admitted to the intensive care unit（ICU） of a tertiary Grade A hospital in Xiamen，China were selected as research objects from April 2021 to October 2023. The delirium status of the patients was comprehensively evaluated using the Intensive Care Delirium Screening Checklist and the Confusion Assessment Method for the ICU，and the patients were divided into the SSD group and the non-delirium group. Univariate logistic regression analysis and LASSO regression were used for variable selection，and multivariate logistic regression analysis was conducted to establish a risk prediction model for SSD and construct static and dynamic nomograms. The predictive value of the model was comprehensively evaluated using calibration curves，receiver operating characteristic curves（ROC curves），and decision curve analysis（DCA）. Results The results of logistic regression analysis showed that age（OR=1.045），smoking history（OR=3.100），physical restraint（OR=3.611），remifentanil use（OR=0.040），and Richmond Agitation-Sedation Scale score（OR=0.244） were identified as independent risk factors for SSD in ICU patients with sepsis. The internal evaluation and validation results of the model showed that the areas under the ROC curves of the modeling group and the validation group were 0.877（95%CI：0.839~0.914） and 0.812（95%CI：0.718~0.906），respectively，indicating that the model had high predictive accuracy. The P values of the Hosmer-Lemeshow test were 0.548 and 0.623，respectively，indicating that the model fit well. Conclusion This study constructed a risk prediction model for SSD in ICU patients with sepsis，which is helpful for clinical medical staff to identify SSD early and take preventive measures，thereby reducing the risk of SSD in ICU patients with sepsis.

Objective To investigate the effects of the goal-oriented mobilization based on the Johns Hopkins Highest Level of Mobility in ICU patients with difficult weaning from mechanical ventilation. Methods Patients with weaning difficulties from ICU of a tertiary class A hospital in Guangzhou City from July 2023 to December 2024 were selected as the experimental group，and early mobilization based on the Johns Hopkins Highest Level of Mobility was implemented. Patients with weaning difficulties admitted from January 2022 to June 2023 were selected as control group，and routine rehabilitation training was carried out. The incidence of ICU acquired weakness，length of stay in ICU，duration of mechanical ventilation and success rate of weaning were compared between the two groups. Results 96 patients completed the study，including 48 in the control group and 48 in the experimental group. The incidence rate of ICU acquired weakness and weaning success rate of the experimental group were higher than those in the control group，and the differences were statistically significant（P<0.05）. The length of stay in ICU and mechanical ventilation time of the experimental group were lower and the differences were statistically significant（P<0.05）. Conclusion Goal-oriented early mobilization based on the Johns Hopkins Highest Level of Mobility can effectively reduce the incidence of ICU acquired weakness，shorten ICU stay and mechanical ventilation duration，improve weaning success rate，and accelerate patient recovery.

Objective To explore the motivation types in coronary heart disease（CHD） patients during cardiac rehabilitation and to provide strategies for improving rehabilitation adherence and behavior change. Methods Using a descriptive qualitative research method，semi-structured interviews were conducted with 20 CHD patients from two tertiary class A hospitals in Daqing City. Directed content analysis was applied to the data analysis. Results Three themes with nine subthemes emerged. ①Autonomous motivation：rehabilitation cognitive restructuring，therapeutic alliance communication synergy，positive feedback on the sense of benefit，psychological resilience empowerment；②Controlled motivation：authority compliance and family guilt-driven；③Amotivation：lack of self-management，avoidance-based defense mechanisms，and doctor-patient trust crisis. Conclusion CHD patients demonstrate varying degrees and types of rehabilitation motivation during cardiac rehabilitation. Healthcare providers should promptly assess the type of rehabilitation motivation and take targeted intervention measures to promote the internalization of cardiac rehabilitation motivation by meeting the basic psychological needs of patients，thereby improving cardiac rehabilitation compliance.

Objective To investigate the current status of self-management activation among patients with permanent pacemaker implantation，and analyze its influencing factors to provide a reference for the targeted development and implementation of corresponding nursing interventions. Methods From December 2023 to April 2024，a convenience sampling method was used to select 144 patients with permanent pacemaker implantation from a tertiary class A hospital in Kunming as survey participants. The survey was conducted among patients using a general information questionnaire，the Patient Activation Measure，the Readiness for Hospital Discharge Scale，and the Quality of Life Instrument for Patients with Pacemaker. Results The total score for patient activation among patients with permanent pacemaker implantation was（53.01±7.86），indicating an overall level two of activation. Correlation analysis showed that the total score of patient activation was positively correlated with the total score of readiness for hospital discharge and the quality of life（P<0.01）. Multivariate regression analysis revealed that patients' family per capita monthly income，the presence or absence of comorbid chronic diseases，the readiness for hospital discharge，and quality of life were the main influencing factors of self-management activation among patients with permanent pacemaker implantation（P<0.05）. Conclusion The level of self-management activation among patients with permanent pacemaker implantation urgently needs to be improved and is influenced by numerous factors. In addition to considering demographic and disease-related variables，healthcare providers can enhance self-management activation by improving discharge readiness and quality of life，and by developing targeted nursing interventions for patients with permanent pacemaker implantation to improve their self-management activation level.

Objective To investigate the current situation and influencing factors of transitional care needs of patients after surgery for aortic dissection，with a view to developing an optimal continuity of care practice program for patients. Methods Using convenience sampling，222 patients after surgery for aortic dissection who were about to be discharged from the Department of Cardiovascular Surgery of a tertiary class A general hospital in Wuhan，Hubei Province，from March 2022 to June 2022 were selected as the study subjects，and a self-designed questionnaire on the transitional care needs of patients after surgery for aortic dissection was applied to conduct the survey. Results In this study，the total of transitional care needs of patient after surgery for aortic dissection was（116.8±112.54） and the mean score of the total entries was（3.77±0.40）. The item with the highest mean score of each dimension was the need for safety，followed by love and belonging needs，and physiological needs. The highest demand for service channels in the transitional care for patient after surgery for aortic dissection was telephone follow-up，with 168 cases（75.67%）. The need of staff for transitional care service was mostly the medical and nursing staff of the inpatient hospital，accounting for 152 cases（68.47%）. The start of the transitional care service was mostly within 2 weeks after discharge from the hospital，accounting for 154 cases（69.37%）. The frequency of transitional care services was mostly once every 1 month，accounting for 176 cases（79.28%），and the duration of transitional care was mostly 6 months，accounting for 94 cases（42.34%）. 129 patients（58.11%） were willing to pay for transitional care services，of which the majority of patients chose to pay by item，accounting for 78 cases（60.47%）. The results of the multivariate analysis showed that the factors influencing the scores of patients' transitional care needs were age，education level，employment，per capita monthly household income，and open surgery（P<0.05）. Conclusion The transitional care needs for patient after surgery for aortic dissection is moderately high，with the need for safety being the most significant，and the ways in which patients' transitional care needs services are diverse. The transitional care needs for patient after surgery for aortic dissection is influenced by multiple factors. This suggests that healthcare professionals should actively develop targeted and diversified transitional care services to meet the individual needs of patients.

Objective To explore the dynamic changes of symptoms after discharge among patients undergoing daytime lung cancer surgery and analyze their influencing factors. Methods A longitudinal study was conducted in a tertiary hospital in Zhejiang Province，enrolling patients who underwent daytime lung cancer surgery between October 2023 and January 2024. Postoperative symptoms were assessed using a lung cancer symptom scale on days 1，3，14，and 30 after discharge. Group-Based Trajectory Modeling（GBTM） was used to identify the post-discharge symptom trajectory categories among patients. Patient characteristics among different trajectory groups were compare，and the mean symptom response index was used to analyze the longitudinal changes of individual postoperative symptoms. Results Three trajectory groups were identified：mild symptoms-slowly decreasing group（n=184， 89.32%），severe symptoms-rapidly decreasing group（n=19，9.22%），and mild symptoms-worsening group（n=3，1.46%）. Significant differences were observed among these post-discharge symptom trajectory groups in terms of age，surgical approach，and tumor type（P<0.05）. On the first day after discharge，cough and pain were the most common symptoms，occurring in 180 cases（87.38%） and 197 cases（95.63%） respectively. Cough remained the predominant symptom on day 30 post-discharge（n=129，62.62%）. In the mean symptom response index，constipation increased from 7.9 on day 1 to 9.2 on day 3，while dyspnea increased from 2.7 on day 1 to 6.7 on day 14. Conclusion There is significant heterogeneity in the dynamic symptom changes after discharge among daytime lung cancer surgery patients. Medical and nursing staff can formulate targeted care strategies based on differences in patient characteristics across the trajectory groups and changes in the mean symptom response index for individual symptoms，thereby improving patient rehabilitation and providing high-quality，whole-course nursing care.

Objective To evaluate the relevant evidence of bedside sitting in ICU awake patients with mechanical ventilation，so as to provide a reference for clinical medical staff to implement their practice of bedside sitting. Methods Based on PIPOST，evidence-based questions were identified，search strategies were developed，and all guidelines，evidence summaries，best practice information books，recommended practices，systematic reviews and original studies on bedside sitting of mechanically ventilated awake patients in ICU were searched by computer in professional guide networks，association networks and databases at home and abroad. The quality evaluation，evidence extraction and evidence summary of the included literatures were carried out by the evidence-based team. Results 14 literatures were included，including three guidelines，a systematic review，an evidence summary and nine original studies. 25 pieces of evidence were summarized into 11 dimensions，including the establishment of multidisciplinary team，bedside sitting education，bedside sitting assessment，bedside sitting start time，bedside sitting preparation，bedside sitting mode，bedside sitting frequency，ventilator mode selection，patient placement，bedside sitting monitoring management，and termination standards. Conclusion Bedside sitting in awake patients with mechanical ventilation in ICU has important practical significance. Medical staff should scientifically manage bedside sitting according to the heterogeneity of bedside sitting，strengthen the quality control of bedside sitting，and ensure the safety of patients.

Objective To investigate the current status of postoperative quality of life of pediatric liver transplant recipients and to analyze its related factors. Methods A total of 273 pediatric liver transplant recipients who were followed up in the outpatient clinic of a tertiary class A hospital in Zhejiang Province from August 2023 to September 2024 were selected by continuous sampling method，and the quality of life survey was conducted using the general information questionnaire and the Pediatric Quality of Life InventoryTM（PedsQLTM） 3.0 transplant module. Pearson correlation analysis was used to analyze the factors affecting the quality of life of pediatric liver transplant recipients. Results A total of 281 questionnaires were distributed，and 273 qualified questionnaires were recovered. Among 273 pediatric liver transplant recipients,the total quality of life score was 72.28（61.41，86.41） for recipients aged 2~4 years，68.48（58.15，75.00） for recipients aged 5~7 years, and 71.96（60.98，94.57） for recipients aged 8~18 years. The results of univariate analysis showed that the total quality of life score of urban recipients was higher than that of rural recipients（P<0.05），and the quality of life of recipients with high monthly household income was higher than that of recipients with low monthly household income（P<0.05）. There were statistically significant differences in the three dimensions of “adverse drug reactions”“worry” and “self-perception of appearance” of questionnaires among different age groups（P<0.05）. The results of correlation analysis showed that there was positively correlation between post-transplant time and two dimensions of “drug compliance” and “post-transplant social relationship”（r=0.214，P<0.001；r=0.167，P=0.006），and the height of the recipient was positively correlated with the two dimensions of “adverse drug reaction” and “anxiety treatment”（r=0.242，P<0.001；r=0.145，P=0.016），and the weight of the recipient was positively correlated with the two dimensions of “adverse drug reaction” and “anxiety treatment”（r=0.183，P=0.002；r=0.151，P=0.013）. The results of Z-score method showed that 48 recipients had growth and development disorders，including 46 cases at the age of 2~4 years old，and 1 case at the age of 5~7 years and 1 case at the age of 8~18 years. Conclusion The quality of life of pediatric liver transplant recipients needs to be improved. Different resident types and monthly household income were the influencing factors for the quality of life of pediatric liver transplant recipients. The time after transplantation，height and weight are all related to the quality of life.

To summarize the perioperative nursing experience of a child with end-stage heart failure undergoing left ventricular assist device bridging heart transplantation. The key points of nursing included adjusting the appropriate blood pump speed，optimizing the volume management and taking remedial anticoagulation strategies before the surgery to create favorable conditions for heart transplantation；early recognition and treatment of primary graft dysfunction，large donor heart syndrome and potential complications of acute rejection after the surgery to improve post-transplant survival. After 47 days of careful treatment and nursing，the cardiac function of the child recovered to grade Ⅱ without serious complications and was discharged.

This study conducted a retrospective analysis of clinical data from children with hypertrophic cardiomyopathy who underwent the modified extended Morrow procedure at a center between January 2023 and November 2024，to summarize the postoperative nursing experience. In response to the surgical complexity and the elevated risk of postoperative complications，nursing interventions were implemented，including strict monitoring of heart rate and rhythm after surgery and correcting of electrolyte imbalances，arrhythmia prevention through pacemakers or beta-blockers and calcium channel blockers；optimization of volume status guided by blood pressure，central venous pressure，and echocardiography findings to avert low cardiac output syndrome，enhancement of cardiac function with vasoactive agents；respiratory tract management during and after ventilator weaning to prevent post-cardiac surgery hypoxemia；ongoing assessment of drainage volume，stringent coagulation function monitoring and heightened awareness of bleeding events. Thanks to meticulous nursing interventions，all 24 children were safely discharged from the ICU，offering invaluable insights for perioperative nursing care in similar cases.

Objective To retrieve，evaluate，and integrate evidence for the cooperation of bedside fiberoptic bronchoscopy in mechanically ventilated patients. Methods The decision support system，synthesized evidence summaries，guidelines，systematic review and studies on nursing cooperation with bedside fiberoptic bronchoscopy for patients with mechanical ventilation were searched by computer in domestic and foreign databases and related professional websites. The literature search period was from December 31，2014 to December 31，2024. The literature quality was independently evaluated by 2 researchers. The evidences were extracted and summarized according to the topic. Results According to the inclusion criteria，a total of 11 literatures were selected，including 5 synthesized evidence summaries，3 guidelines and 3 expert consensuses. Through literature reading，evidence extraction and classification，33 pieces of evidence were summarized from 11 topics，including indications，risk assessment，patient preparation，substance preparation，operator management，respiratory management，sedation and analgesia management，complication identification and management，post-examination assessment，infection control management，equipment handling. Conclusion This study summarizes the best evidence for the cooperation of bedside fiberoptic bronchoscopy in mechanically ventilated patients，which can provide reference for nurses to carry out clinical practice. Nursing staff should carefully select and apply evidence in the context of the clinical situation to ensure patient safety and reduce the incidence of related complications.

Objective To comprehensively search，evaluate and summarize the best evidence of blood pressure management in the acute phase of ischemic stroke，to provide reference for blood pressure management and monitoring. Methods Based on the 5S model of the evidence hierarchy，a systematic search was conducted across major domestic and international databases，relevant evidence-based resources，and professional association websites to retrieve all pertinent evidence，including clinical decision-making，best practices，evidence summaries，clinical guidelines，and systematic reviews. The search time limit was from the establishment of databases to December 10，2024. Two researchers independently evaluated the quality of the literature，extracted and summarized the evidence. Results A total of 22 studies were included，including 2 clinical decision-making resources，4 guidelines，and 16 systematic reviews. The best evidence included 20 recommendations in 5 aspects，including blood pressure management principles and objectives，blood pressure management during intravenous thrombolysis，mechanical thrombectomy，non-reperfusion treatment，and recovery phase management. Conclusion This study summarized the beat evidence of blood pressure management in the acute-phase of ischemic stroke. The overall level of the quality and level of the evidence is high，which has guiding significance for clinical medical staff to carry out scientific and effective blood pressure management. It can formulate targeted blood pressure management plans according to the actual situation of clinical work，and improve the blood pressure of patients.

Objective To systematically review the influencing factors for acute gastrointestinal injury（AGI） occurrence in critically ill patients. Methods PubMed，Web of Science，Cochrane Library，CNKI，Wanfang Data，VIP，and CBM were searched for studies related to influencing factors of AGI occurrence in critically ill patients from inception to March 12，2 024.Two researchers independently screened literature，extracted data，and assessed the quality of included studies. Meta-analysis was performed using R software（version 4.3.3）. Results A total of 17 literatures were included，with a total of 187 686 subjects，involving 47 influencing factors. Meta-analysis showed that fast plasma glucose （OR = 154.28， 95%CI = 21.79-1 092.42， P < 0.01），procalcitonin （OR = 26.82， 95%CI = 1.26-568.82， P = 0.03），D-lactate （OR = 3.33，95%CI = 1.87-5.96，P < 0.01），lactic acid （OR = 1.41， 95%CI=1.15-1.73， P < 0.01），insulin resistance index （OR = 81.74， 95%CI = 12.26-545.14， P < 0.01），intra-abdominal pressure （OR=3.03，95%CI = 1.31-7.03，P < 0.01）， multiple organ dysfunction syndrome （OR = 5.26，95%CI = 1.65-16.69，P < 0.01）， heart failure （OR = 2.93，95%CI = 1.53-5.60，P < 0.01）， hypotension （OR = 5.24，95%CI = 1.94-14.13，P < 0.01）， mechanical ventilation （OR = 3.52，95%CI = 2.19-5.67，P < 0.01），length of ICU stay （OR = 1.64，95%CI = 1.14-2.35，P < 0.01），acute physiology and chronic health evalua-tion scoring system Ⅱ score （OR = 1.11，95%CI= 1.00 - 1.23，P < 0.05） and sequential organ failure assessment score （OR=1.12，95%CI=1.03-1.21，P<0.01） were risk factors for AGI in critically ill patients. And antral motility index （OR=0.33，95%CI=0.17-0.62，P<0.01） was a protective factor. Conclusion There are many factors affecting the occurrence of AGI in critically ill patients. Healthcare professionals should identify relevant factors as early as possible，and implement targeted prevention and treatment measures to reduce the incidence of AGI and related complications，so as to improve the clinical prognosis of critically ill patients.

Objective To review the related studies on the risk prediction model of extracorporeal circulation coagulation in patients with continuous renal replacement therapy. Methods The searches of Chinese and English databases were conducted to collect relevant literature on predictive models of coagulation risk in extracorporeal circulation in patients undergoing continuous renal replacement therapy that were publicly available from the time of database construction to November 8，2024，and the descriptive statistical analysis was conducted. Results A total of 8 literatures，mostly single-center studies，were included，with a modeling sample size of 79 to 1，752 cases and the number of outcome events ranging from 51 to 558. The model construction methods included cox proportional hazard model，logistic regression model and machine learning，and the area under the receiver operating characteristic curve was 0.732~0.898. The predictors that appeared the most frequently were anticoagulation modality，blood flow rate，APTT and platelet count. Conclusion The risk prediction model of extracorporeal circulation coagulation in continuous renal replacement therapy is of great significance for identifying high-risk patients in advance，guiding clinical decision-making，reducing the incidence of coagulation and improving patient prognosis. The current models had good predictive efficiency，but the model evaluation and validation were insufficient，and the overall risk of bias was high. Future studies need to optimize existing models and develop more stable and clinically applicable predictive models.

Verbal violence in medical setting has emerged as a global issue demanding immediate resolution. This article provides an overview of the concept and types of hospital verbal violence among nurses，the current prevalence and coping strategies. It is found that the incidence of verbal violence among nurses varies significantly across different countries，verbal violence incidents occur frequently in medical settings but nurses have a weak willingness to report such incidents actively，nurses are subjected to dual assaults of verbal violence from both within and outside the organization. The coping strategies primarily include utilizing violence risk assessment tools to enhance nurses' ability to recognize early signs of violence；scientifically conducting specialized violence prevention training to comprehensively improve nurses' skills in responding to violence；and improving the legal framework for workplace violence in medical institutions, with increased penalties for verbal violence，to strengthen the punishment of verbal violence behaviors. The aim of this article is to heighten the attention of the entire society to the verbal violence endured by nurses in medical settings and offer references for further intervention research and the promotion of a safe practice environment for nurses.

Nursing clinical decision-making is a systematic process in which nurses use critical thinking to formulate and implement the optimal scheme for clinical problems based on theory and practical experience. The characteristics of ICU nurses' work is to make rapid and massive decisions under the condition of limited information and time constraints，which make intuitive impact on patient condition. This paper analyzes ICU nurse clinical decision-making from the perspective of behavioral economics，and discusses the formation of clinical decision-making from the theory of bounded rationality，deviation theory and prospect theory，elaborate on the causes of clinical decision-making bias in ICU nurses from bounded rationality，limited willpower，and dynamic preferences. This paper put forward strategies such as introducing large language model to assist decision making，nudge theory，promoting the development of joint decision-making，so as to lay the foundation for improving the quality of nursing decision-making in critical care teams and better serve clinical practice.

Objective To explore the application effect of single-person secondary compression puncture technique of external jugular vein in emergency surgery for patients with shock. Methods A total of 116 patients undergoing shock emergency surgery with external jugular vein puncture between January 2023 and December 2024 were selected as study participants. They were randomly assigned to an experimental group and a control group，with 58 patients in each group. The experimental group established an external jugular vein access using a single-person double-compression puncture technique，whereas the control group established venous access via conventional double-person blind compression of the external jugular vein. Comparisons were made between the two groups in terms of the first-attempt puncture success rate，overall puncture success rate，venous blood return time after puncture，time taken for successful puncture，incidence of infusion obstruction，and incidence of complications. Results The success rates of both first-attempt puncture and overall puncture in the experimental group were significantly higher than those in the control group，with statistically significant differences（P<0.05）. Compared with the control group，the experimental group exhibited a significant reduction in both the time taken for venous blood return and successful puncture，as well as a decrease in the incidence of infusion obstruction，all with statistically significant differences（P<0.05）. Furthermore，the incidence of infusion-related complications was lower in the experimental group（1.72%） than in the control group（12.07%）. Conclusion The single-person secondary compression puncture technique for external jugular vein can significantly improve the first-attempt puncture success rate and total success rate of external jugular vein access establishment in emergency surgery for shock patients，shorten the puncture vein blood return time and puncture success time，reduce the incidence of infusion obstruction and complications，and improve the efficiency and quality of emergency nursing.