Objective This study developed and validated a risk prediction model of central venous catheter-associated skin injury（CVC-CASI） in patients in the intensive care unit. Methods Using convenience sampling，clinical data were obtained for ICU patients who were admitted to a tertiary grade A hospital in Guangdong Province between January 2023 and October 2023. Independent risk factors for CVC-CASI were identified by univariate and binary logistic regression analyses. And a risk prediction model was constructed. The discrimination and calibration of the model was evaluated by the area under the receiver-operating characteristic（ROC） curve and calibration curve，and the clinical effectiveness was assessed by the clinical decision curve. Results 68 of the 434 patients who were included in the study developed CVC-CASI，giving an incidence rate of 15.7%. 74 cases of CVC-CASI occurred，with non-infectious exudation accounting for 54 cases（73.0%）. Model variables included catheter dwelling time，catheterization site，prone ventilation，skin edema，serum albumin，prothrombin time，activated partial thromboplastin time，and puncture frequency. The model validation results showed that the area under the ROC curve was 0.838（95% confidence interval 0.784-0.893） with a sensitivity of 77.9% and a specificity of 81.1%. The Youden index was 0.59. Conclusion The incidence of CVC-CASI in ICU patients is relatively high. Our prediction model has good prediction efficiency and can provide theoretical basis for early identification of high-risk populations and timely intervention for clinical medical staff.

Objective To develop and test the Knowledge，Attitude and Practice Questionnaire for ICU Nurses on the Prevention and Management of Oral Mucosal Pressure Injuries（OMPI） in Orotracheal Intubation（OTI） Patients. Methods Based on the theory of knowledge，attitude and practice，the first draft of the questionnaire was developed through a literature review，semi-structured interviews，2 rounds of Delphi expert correspondence，and a pre-survey. 441 ICU nurses were recruited to take the survey from January to February 2024，the items were analyzed and reliability and validity were tested. Results A final questionnaire consisting of 3 dimensions and 36 items was developed. The exploratory factor analysis revealed that the cumulative variance contribution rate of the four common factors was 81.330%. The confirmatory factor analysis demonstrated that the chi-square degrees of freedom ratio（χ²/df） was 2.557，the root mean square error of approximation（RMSEA） was 0.084，the root mean square residual（RMR） was 0.040，the incremental fit index（IFI） was 0.912，the comparative fit index（CFI） was 0.912，and Tucker-Lewis Index（TLI） was 0.903，indicating good model fit. The average content validity index（CVI） of the questionnaire was 0.993，with item-level CVIs ranging from 0.875 to 1.000. The overall Cronbach’s alpha was 0.965，with split-half reliability of 0.730 and test-retest reliability of 0.981. Conclusion The questionnaire developed in this study has good reliability and validity and is suitable for investigating the current status of ICU nurses’ knowledge，attitude and practices regarding the prevention and management of OMPI in OTI patients.

Objective To understand the actual experience of fear of disease progression among patients with aortic dissection and explore its influencing factors. Methods Through the purposive sampling approach，semi-structured in-depth interviews were conducted with 13 patients with aortic dissection admitted to the cardiovascular surgery department of a tertiary class A hospital in Nanchang City from January to March 2024. Data were analyzed using Colaizzi’s phenomenological method. Results Six themes were summarized，including fear of recurrence，stimulating factors，illness uncertainty，impact of fear on daily life，coping styles，and support systems. Conclusion Medical staff should pay attention to the psychological experience of fear of patients with aortic dissection，enhance patients’ cognition，reduce disease uncertainty，improve self-efficacy，promote positive changes in coping，meet their health management needs，reduce the fear of recurrence，and thereby enhance their quality of life.

Objective To investigate the clinical characteristics and status of unplanned return to the ICU for patients with acute pancreatitis in general wards，and analyze risk factors to provide a theoretical basis for preventing ICU readmissions. Methods A retrospective analysis was conducted on the medical records of 298 patients primarily diagnosed with acute pancreatitis，transferred from the ICU to general wards between January 1，2020，and February 1，2024，from 170 wards in four campuses of a tertiary hospital in Zhejiang Province. The unplanned ICU return rate was calculated，and patient demographics and disease-related information were collected. According to the occurrence of unplanned return to the ICU，the patients were divided into the return to the ICU group and the non-return to the ICU group. Univariate and logistic regression analyses were employed to identify risk factors for unplanned readmissions. Results Among the 298 patients，47 experienced returns to ICU，resulting in a rate of 15.8%. Binary logistic regression showed that age（OR=1.039），number of comorbidities（OR=1.244），and presence of respiratory failure（OR=3.283） were independent risk factors for unplanned ICU return in acute pancreatitis patients. Conclusion The rate of unplanned return to ICU among acute pancreatitis patients was relatively high in this group of patients. Clinicians should pay special attention to patients with advanced age, complex comorbidities and heart failure，thereby preventing return to ICU.

Objective To construct a nutritional management program based on the disease trajectory for severely injured patients and explore its application effects. Methods A non-synchronous before-and-after control study was conducted. Severely injured patients admitted to a tertiary class A hospital in Hangzhou from April to June 2023 were conveniently selected as the experimental group，and those admitted from January to March 2023 as the control group. The control group received a goal-directed early nutritional management program，while the experimental group received a nutritional management program based on the disease trajectory of severely injured patients. Nutritional-related indicators were compared between the two groups. Results A total of 84 patients were included in the experimental group and 87 in the control group. After the intervention，the experimental group had shorter initiation time for enteral nutrition support（t=2.335，P=0.017），fewer feeding interruption episodes within 7 d（Z=3.194，P=0.024），shorter feeding interruption duration（Z=3.865，P<0.001），lower blood glucose variability coefficient within 72 h（t=-2.432，P=0.016），and lower total insulin dosage（t=-4.664，P=0.035），and a lower incidence of feeding intolerance（χ²=5.554，P=0.021） compared to the control group. The 7 d target energy achievement rate（χ²=7.875，P=0.009） and serum prealbumin levels（t=4.129，P=0.016） were higher in the experimental group. Body composition analysis showed that the phase angle of the experimental group was higher than that of the control group（t=1.976，P=0.040）. There were no statistically significant differences in lean body mass，mechanical ventilation time，ICU length of stay，or improvement in the condition. Conclusion The program improve the implementation and quality of enteral nutrition，shorten the time to start enteral nutrition，enhance the target caloric achievement rate，and improve the nutritional status of severely injured patients，promoting their recovery.

Objective To explore the effect of cockpit resource management model in emergency treatment of severe trauma patients. Methods We constructed the emergency treatment mode of severe trauma patients based on the concept of cockpit resource management，including the establishment of trauma rescue team，the optimization of intelligent system，the transformation of environmental zoning，the visual management of items，and the development of treatment process list of severe trauma patients. We used convenience sampling to select 119 cases of severe trauma patients admitted to the emergency department of a tertiary class A hospital in Hangzhou from January to May and from August to December 2023 as the study subjects. The experimental group（n=61） received the severe trauma treatment model constructed based on the concept of cockpit resource management，and the control group（n=58） received the conventional treatment model. The treatment process timeliness indexes，medical resource utilization and treatment effects were compared between the two groups. Results The venous or intraosseous opening rate within 5 min and the time of endotracheal intubation in experimental group were improved，but there was no significance compared with the control group（P>0.05）. Focused assessment with sonography for trauma（Fast） compliance rate and triage accuracy rate of the experimental group were significantly better than control group（P<0.05），the time from admission to operation and the length of stay in the resuscitation room were significantly shorter than control group，and the treatment cost was less than the control group（P<0.05）. 48h outcome and self-care ability after 3 months in the experimental group were significantly better than the control group（P<0.05）. Conclusion The use of cockpit resource management to severe trauma patients can strengthen the continuity and systematization of treatment，shorten the duration of treatment，improve the treatment effect and patient outcome，and save medical resources.

Objective To construct nursing quality evaluation index system for severe trauma care and provide an evaluation basis for the monitoring and control of nursing quality in the whole process of trauma care. Methods Based on the frame work of the three-dimensional “structure-process-outcome” quality model，this study used literature review，Delphi method and analytic hierarchy to determine the content and the weight of indicators. Results A total of 20 medical，nursing and management experts from 16 hospitals at national，provincial，city and county trauma care systems were included，and two rounds of consultations were conducted. The effective recovery rates were 100% and 95%，respectively. The expert authority coefficients were 0.897 and 0.911，respectively. The variation coefficients of each item ranged from 0.045~0.291 and 0.045~0.217. The Kendall harmony coefficients were 0.273 and 0.206（P<0.001）. In this study，a total of 54 nursing quality indicators for severe trauma care were formed，including 19 structural indicators，25 process indicators and 10 result indicators. Conclusion The evaluation indicators are scientific and practical，which can provide objective，scientific and effective evaluation basis for the quality control of trauma care，and provide data support for the construction of trauma database and data-oriented trauma treatment quality control system.

Objective To systematically evaluate the experiences and needs of nurses involved in rescue care for mass casualty incidents. Methods The qualitative studies on the experiences and needs of nurses involved in mass casualty incidents care were searched from domestic and international relevant databases. The retrieval time was from the inception to April 30，2024. The JBI Center for Evidence-Based Health Care qualitative research critical appraisal tool was used to evaluate the included articles，and the pooled integration method was applied to integrate the results. Results This study encompassed 15 articles，which were analyzed to generate 13 categories，integrated into 3 synthesized findings：the impact of mass casualty events on nurses（enhancement of professional value and identity，psychological stress and negative emotions，and increased role load）；difficulties and challenges faced by nurses during mass casualty rescues（lack of knowledge and skills of rescuing，lack of communication and cooperation，insufficient supply of human resources，lack of training and drills，and complexity of on-site treatment environment）；and the needs of nurses in mass casualty rescue（mental health support，effective team communication and cooperation，human resources and material support，training programs and drills，and support for hospital management and leadership）. Conclusion Hospital administrators need to pay attention to the physical and mental health of nurses，improve teamwork and cohesion，standardize the mass casualty rescue process，conduct regular training exercises，and improve the quality of treatment by using high-tech means.

Objective To search，evaluate and summarize the relevant evidence of the application of tourniquet in pre-hospital trauma treatment，and provide reference and evidence-based basis for pre-hospital treatment practice. Methods Chinese and English databases，guideline websites and professional association websites were searched. The retrieval period was from January 2015 to December 2023，and the literature types included clinical decision support，guidelines，systematic reviews，randomized controlled trials or quasi-experimental studies，and so on. Two researchers respectively evaluated the quality of the literature and extracted the evidence. Results A total of 16 literatures were included，including a clinical decision，a guideline and 3 expert consensuses，4 systematic reviews，3 randomized controlled trials and 4 quasi-experimental studies. Twenty-two pieces of evidence were summarized from 12 aspects，including indications for tourniquet use，contraindications for tourniquet use，rapid assessment of bleeding severity，selection of tourniquet，location and method of dressing，effective criteria and pressure settings of tourniquets，time settings，dynamic evaluation，clear marking，removal，monitoring and re-evaluation of tourniquet，and recording. Conclusion The evidence summary of tourniquet application in pre-hospital trauma treatment is scientific and practical，which can provide evidence for pre-hospital trauma treatment practice，provide reference for popularization and training of first aid knowledge.

As an integral part of trauma care，trauma nursing care plays a crucial role in the treatment of trauma patients. This article introduces the current situation and characteristics of the trauma care system，the process and content of trauma nursing care services，the role and training of trauma nurses，and the management of the quality of trauma nursing care in China and Germany，with the aim of providing insights and reflections for the continuous development and optimization of trauma nursing care in China.

To summarize the nursing experience of intercostal pseudoaneurysm rupture secondary to thoracocentesis tube placement and drainage in a patient with lung cancer. For the patient’s condition progressed rapidly and critically，we implemented early identification and timely treatment of active intrathoracic hemorrhage，assessment and implementation of the treatment of acute hemorrhagic coagulopathy，correct implementation of perioperative nursing care of intercostal artery embolization，and use of the “5E rehabilitation management model” to carry out early rehabilitation guidance. After 18 days of treatment and care，the patient was discharged with stable condition. During one month follow-up，the patient was in good condition.

To summarize the nursing experience of a patient undergoing small intestine combined with partial colorectal transplantation and anal anastomosis. In view of the nursing problems of patients with postoperative rejection，nutrition，blood glucose，hemodynamics，infection and postoperative follow-up management，real-time monitoring and precise immunosuppressive therapy were adopted，perioperative whole-process nutrition management was carried out，blood glucose monitoring strategies were optimized，refined fluid management was implemented，and personalized follow-up management plans were formulated. After 59 days of active treatment and careful nursing，the patient was discharged from the hospital successfully，and the ostomy was restored 4 months after the transplantation to restore intestinal continuity.

To summarize the nursing experience of agitated behavior after falling from height in a patient with Alzheimer’s disease. Nursing points included strengthening the prevention and management of self-injury and injury，recognition therapy to meet the needs of the patient，emotional support by simulating the presence of family members，touch therapy to relieve patients’ tension，improving multidisciplinary consultation to find effective treatment plans. After 72 hours of careful emergency nursing，the patient recovered well and became awake，and was discharged successfully. During the telephone follow-up one year after discharge，the agitated behavior of the patient occasionally appeared，and the caregiver was instructed to pay attention to the safety of the patient and accompany the patients for regular visits to the neurology clinic.

To summarize the nursing care of a patient with fatal pulmonary thromboembolism undergoing extracorporeal membrane oxygenation under high bleeding risk. Key points of care included bleeding risk management during extracorporeal membrane oxygenation in periods of high bleeding risk. Observation and nursing during the period of low anticoagulation included the implementation and nursing of individualized low anticoagulation program，emergency nursing strategy for insufficient extracorporeal membrane drainage caused by small thrombus，and keeping the distal perfusion tube of lower limb open in the state of high coagulation to avoid lower limb ischemia. And the observation and nursing after percutaneous pulmonary embolectomy with extracorporeal membrane lung support was implemented. After active rescue，careful treatment and nursing，the patient improved and was discharged from the hospital. During the follow-up，the patient recovered well.

Objective To summarize and analyze the controller alarm data of 12 patients after implantation of left ventricular assist device（LVAD），so as to provide basis for formulating targeted measures to improve nurses’ response and processing ability to left ventricular assist controller alarm. Methods A total of 12 patients who received implantation of LVAD in the Department of Cardiovascular Surgery of Jiangsu Province Hospital from July 1，2 021 to August 9，2 023 were selected as investigation objects，and their controller alarm types，percentage，causes and nursing measures during ICU were classified and summarized，and then subgroup analysis of "suction alarm" was performed. Results A total of 1 080 alarms were generated during the ICU hospitalization among 12 patients. Single power supply alarm accounted for 76.9%，suction alarm accounted for 19.5%，the others included single battery low capacity and high power alarm. All of patients had a single power supply alarm with 831 times totally，5 people had suction alarm with 211 times totally，4 patients had single battery low capacity alarm with 36 times totally，and two persons had high power alarms with two times. There were no significant differences in preoperative body weight，body surface area，preoperative left ventricular end-diastolic diameter（LVEDD） and blood pump speed between suction alarm group and no suction alarm group，but there is a significant difference in the postoperative left ventricular end-diastolic diameter reduction（LVEDD-R）（P<0.05）. Conclusion The incidence of suction alarm was closely related to the short-term decrease of LVEDD after LVAD implantation. The analysis of alarm data is helpful to grasp the alarm status of LVAD and formulate targeted intervention measures.

Objective To summarize our experience in implementing tracking based multidisciplinary team（MDT） nursing rounds for critically ill patients with comorbidities，and provide reference for related process establishment and clinical practice. Methods A nursing rounds special team for critically ill patients with comorbidities was established to analyze the problems existing in routine nursing rounds，and optimize measures from various aspects such as pre-consultation organizational methods，consultation process and difficult point discussions，post-consultation tracking management，and nursing round summary discussions. A process for tracking multidisciplinary team（MDT） nursing rounds was established and quality control was carried out，which was applied in seven departments. Results From June 2022 to May 2024，we conducted tracking based MDT nursing rounds for 18 critically ill patients with comorbidities，the length of hospital stay of critically ill patients in the experimental group[（18.50±2.15） d] was shorter than that of the routine nursing rounds group[（19.72±2.08） d]. The incidence of inconti-nence dermatitis decreased from 30.56% to 5.56%，and the incidence of oral mucositis decreased from 19.44% to 0，nursing job satisfaction score increased from（41.72±3.44） points to（47.22±2.53） points. Conclusion The application of tracking based MDT nursing rounds can shorten the hospitalization time of critically ill patients with comorbidities and reduce the incidence of nursing related complications，improve satisfaction with nursing care.

Objective To establish an information-based early warning system for post-pyloric enteral nutrition and evaluate its effect on enteral nutrition in patients with severe neurological diseases. Methods A multidisciplinary team was established to build an information-based early warning system for post-pyloric enteral nutrition based on aspiration risk assessment and nursing quality indicators. The system was used to warn the risk of aspiration and to remind the post-pyloric enteral nutrition. The differences in indicators related to post-pyloric enteral nutrition were compared between control group （June to December 2022） and experimental group （February to July 2023）. Results The incidence of aspiration pneumonia and the delay time of nasointestinal tube insertion were significantly lower than those in the control group after the implementation of the information-based early warning system（P<0.05）. The rate of post-pyloric feeding，the rate of timely nasointestinal catheterization and the re-evaluation timeliness rate of aspiration risk assessment in the experimental group were significantly higher than those in the control group（P<0.05）. There was no significant difference in the initial assessment timeliness rate of aspiration risk assessment and the implementation rate of early enteral nutrition（P>0.05）. Conclusion The establishment and implementation of the information-based early warning system for post-pyloric enteral nutrition is conducive to the early adoption of post-pyloric enteral nutrition in high-risk patients with aspiration as soon as possible. It can reduce the incidence of aspiration and aspiration pneumonia and ensure the safety of patients.

Objective To systematically evaluate the psychological feelings and real experiences of ICU nurses caring for extracorporeal membrane oxygenation（ECMO） supported patients，providing references for developing targeted intervention strategies. Methods The qualitative studies on the experiences of ICU nurses caring for ECMO-supported patients were searched from domestic and international relevant databases. The retrieval time was from the inception to May 31th，2024. The quality of the included studies was evaluated using the 2020 version of the Joanna Briggs Institute’s critical appraisal tool for qualitative research. The results were analyzed and integrated using a pooled integration method. Results A total of 12 articles were included，and 44 research results were extracted and summarized into 6 categories. It was integrated into three major themes：core emotional responses of ICU nurses when caring for ECMO patients，perceived barriers in the care process of ECMO patients，coping strategies used by ICU nurses in the care process. Conclusion Nursing managers should optimize the multidisciplinary team collaboration model and nursing support system，pay attention to the emotional experiences of ICU nurses in the process of caring for ECMO patients. Additionally，clinical guidelines and training programs related to ECMO care should be developed to provide scientific and systematic evidence for the promotion of ECMO specialization.

Objective To retrieve，evaluate，and summarize the best evidence for swallowing rehabilitation training in ICU patients with post-extubation dysphagia，providing a reference for clinical application. Methods To address the issues related to swallowing rehabilitation training for ICU patients with post-extubation dysphagia，we systematically searched the clinical decision-making systems，guideline websites，professional association websites，and databases for clinical decisions，guidelines，best practice，expert consensus，evidence summaries，systematic reviews，and original studies. The search period was from database inception to September 9，2024. Four evidence-based trained researchers independently conducted quality assessment of the literature and evidence extraction. Results A total of 20 studies were included，and 22 pieces of evidence were summarized across six dimensions：multidisciplinary teams for swallowing rehabilitation，training assessment，training measures，outcome evaluation，health education，and precautions. Conclusion The best evidence summarized in this study for swallowing rehabilitation training in ICU patients with post-extubation dysphagia demonstrates scientific rigor and practicality. In clinical practice，evidence should be applied selectively based on specific circumstances to improve patient outcomes and enhance the quality of care.

Aortic valve stenosis is a common valvular heart disease in the elderly. Transcatheter aortic valve replacement（TAVR） is the primary treatment for severe cases. As TAVR use extends to a wider patient population，growing attention has focused on post-procedural cognitive function changes. This article reviews the preoperative cognitive function status of TAVR patients，postoperative cognitive changes，related influencing factors，and preventive strategies for cognitive decline. The aim is to provide clinical nurses with a reliable basis for observing the cognitive function of TAVR patients；however，a unified and standardized assessment system still needs to be further developed and refined.

Objective To conduct a scoping review of the status on subsyndromal delirium in ICU patients at home and abroad，systematically elaborate the related concepts，assessment methods and influencing factors of this syndrome，and provide reference for ICU nursing staff to implement effective interventions，in order to reduce the incidence and adverse effects of subsyndromal delirium. Methods This study followed the framework of systematic literature review established by Arksey and O’Malley，the literature search was performed in PubMed，Web of Science，Embase，CINAHL，Cochrane Library，CNKI，Wanfang Database，VIP Database，China Biomedical Literature Database，and guideline network，with a time limit from database establishment to May 5，2024. Results A total of 27 articles were included，most were prospective studies. Three assessment tools were included，the Confusion Assessment Method of Intensive Care Unit（CAM-ICU），Intensive Care Delirium Screening Checklist（ICDSC） and Delirium Rating Scale（DRS-R98）. Higher incidence of subsyndromal delirium was observed in ICU patients. The main influencing factors included age，gender，APACHE II score，surgery，medication，environment，etc. Conclusion Medical staff should pay more attention to subsyndromal delirium，strengthen the identification and screening of its influencing factors，prevent it from progressing，so as to improve the quality of nursing and promote the early rehabilitation of patients.

Objective To conduct a scoping review of relevant studies on hypoactive delirium in critically ill patients at home and abroad， to sort out the current status of hypoactive delirium， risk factors， assessment tools， timing of assessment， and intervention methods， etc.， so as to provide scientific basis for the prevention and management of hypoactive delirium in critically ill patients. Methods Based on the scoping review framework，a systematic search was conducted for relevant studies on hypoactive delirium in critically ill patients in Pubmed， the Cochrane Library，CINAHL，Web of Science，China Knowledge Network，Wanfang Database，China Biomedical Literature Database，and VIP database，with a timeframe of the construction of the database to December 2024. Data extraction and summary analysis of the included literature were performed by two researchers. Results 21 papers were eventually included. The prevalence of hypoactive delirium in critically ill patients ranged from 6.60% to 92.00%. Two assessment tools， ICU Ambiguity of Consciousness Assessment Method and Richmond Agitation-Sedation Scale，were mainly applied， and most of the studies assessed once a day，focusing on around 8:00-9:00 and 18:00. Factors influencing hypoactive delirium in critically ill patients included advanced age， diabetes，history of alcohol consumption， emergency surgery， and restraint use. Early integrated nursing interventions for patients were implemented. Conclusion Hypoactive delirium has a high incidence and serious adverse effects in critically ill patients，with complex and varied influencing factors， fewer types of assessment and diagnostic tools and lack of specificity，inconsistencies in the timing and frequency of assessment，and fewer intervention studies and a single design. It is recommended that healthcare professionals should deepen their research on assessment and diagnostic tools，assessment timing and intervention methods to provide a scientific basis for the prevention and management of hypoactive delirium.