Table of Content

10 October 2023, Volume 4 Issue 10 Previous Issue    Next Issue

Research Paper

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Effects of two types of blood induction connecting methods on hemodynamics during continuous renal replacement therapy in patients with acute kidney AN Min, CAO Hunan, DAI Xiaomei, ZHANG Jing, CAI Yaqing, LI Lu, HUANG Lixuan 2023, 4 (10):  869-874.  doi: 10.3761/j.issn.2096-7446.2023.10.001 Abstract ( )   PDF (1086KB) ( )   Save Objective To compare the effects of two types of blood induction connecting methods on hemodynamics during continuous renal replacement therapy（CRRT）in patients with acute kidney injury（AKI）. Methods A retrospective analysis was performed on 312 patients with AKI who received CRRT in the intensive care unit of our hospital from August 2019 to March 2022,and 168 patients were selected with 1：1 propensity matching and divided into single connecting group（blood was drawn from the artery end to the venous pot and then connected to the venous end）and double connecting group（device was connected to the arteriovenous end of the catheter at the same time）. We observed hemodynamic parameters before blood induction,at the time of blood induction to the venous pot,10 min after the start of the machine,and the hemodynamic fluctuations within 2 h after the start of the machine in the two groups. The generalized linear mixed model was used to evaluate the influence of different connection methods on hemodynamics of AKI patients and the time change trend during CRRT. Results Whether the model was corrected or not,there were no significant differences in systolic blood pressure,diastolic blood pressure,heart rate and mean arterial pressure between the two groups during the period（before blood induction to 10min after CRRT）（P>0.05）. Systolic blood pressure,diastolic blood pressure and mean arterial pressure decreased significantly during CRRT compared with those before blood induction（P<0.05）,while heart rate had no significant change（P>0.05）. Different connecting methods had no significant relationship with instable hemodynamics within 2 h of CRRT. Conclusion Connecting blood induction itself will affect the hemodynamic stability of AKI patients,and there is no difference in the influence of different CRRT connections on hemodynamics during machine connection and within 2 hours of CRRT. It is suggested that caution should be exercised at the beginning of CRRT and hemodynamics should be monitored more closely,and more rigorous large-sample tests can be conducted to verify the relevant conclusions in this study. References | Related Articles | Metrics

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Construction and application of frailty risk prediction model in maintenance hemodialysis patients YING Jinping, CAI Genlian, CHEN Linglin, PAN Mengyan, ZHOU Yahui, YU Weiping, SHI Suhua 2023, 4 (10):  874-881.  doi: 10.3761/j.issn.2096-7446.2023.10.002 Abstract ( )   PDF (1368KB) ( )   Save Objective To develop predictive model of frailty risk prediction in maintenance hemodialysis patients. Methods Prospective study design was adopted,a total of 876 patients who received hemodialysis in a tertiary class A hospital in Zhejiang Province from March 2020 to April 2022 were recruited,including March 2020 to July 2021 as the modeling group（n=491）and August 2021 to April 2022 as the validation group（n=385）. Univariate and multivariate logistic regression were used to analyze the risk factors of frailty in maintenance hemodialysis patients,and we established a risk prediction model and to draw a nomogram. Hosmer-Lemeshow test and area under receiver operating characteristic were used to evaluate the clinical prediction effect of the model. The bootstrap method sampling method was used to internally validate the model. Results 226 patients（25.80%）had frailty,123（25.05%）in the modeling group and 103（26.75%）in the validation group. Six influencing factors,including age（OR=3.553）,activities of daily living（OR=37.804）,history of stroke（OR=16.434）,serum albumin（OR=4.197）,C-reactive protein（OR=2.633）,and serum creatinine（OR=2.201）,were used to construct the prediction model. In the modeling group,Hosmer-Lemeshow goodness-of-fit test showed χ2=5.667,P=0.772,the AUC was 0.955[95%CI（0.936,0.974）],the sensitivity was 89.7%,the specificity was 87.7%,the Youden index was 0.774,and internal validation C-statistic value was 0.950. In the validation group,Hosmer-Lemeshow goodness-of-fit test showed χ2=44.085,P=1.362,the AUC was 0.914[95%CI（0.882,0.946）],the sensitivity was 85.5%,the specificity was 85.4%,the Youden index was 0.709,and the accuracy was 73.5%. Conclusion The risk prediction model of frailty in maintenance hemodialysis patients can better visually predict the occurrence risk of frailty in patients,providing support for the early identification and intervention of medical staff. References | Related Articles | Metrics

Special Planing—Application and Management of New Technologies in Critical Care

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Evaluation of the safety and effectiveness of using a shifting machine for patients with prone position ventilation WANG Yun, XIA Liuqin, YANG Xiangying 2023, 4 (10):  882-886.  doi: 10.3761/j.issn.2096-7446.2023.10.003 Abstract ( )   PDF (833KB) ( )   Save Objective To evaluate the safety and effectiveness of using a shifting machine for patients with prone position ventilation. Methods A research study was conducted with a total of 100 severe ARDS patients treated with prone position ventilation from the critical care department of a tertiary class A hospital in Hangzhou from December 2022 to February 2023. The patients were randomly allocated into the experimental group consisting of 50 cases and the control group consisting of 50 cases by the random number table. In the experimental group,prone position ventilation was administered by using a shifting machine,and implemented for a total of 500 times. The control group received prone position ventilation by using traditional method,and it was implemented a total of 510 times. The study compared several outcome indicators between the two groups,including the time required for prone position implementation,the number of medical staffs involved,the occurrence of adverse events such as tube displacement,tube slippage,tube obstruction,and joint dislocation,as well as the satisfaction of medical staffs. Results The time required for prone position ventilation in the group using shifting machine was （300.24±11.88）seconds which was less than that in the group using traditional method （357.50±20.36）seconds,the difference was statistically significant（P<0.001）. The number of medical staffs required for prone position ventilation in the group using shifting machine was 3（3,3）,which was less than that in the group using traditional method 5（4,6）,with statistically significant difference（Z=-28.450,P<0.001）. The total satisfaction score of medical staffs in the group using shifting machine was 8（8,9）points,which was higher than that in the group using traditional method 7（7,8）points,with statistically significant difference（Z=-6.177,P<0.001）. No adverse events occurred in either group during the application period. Conclusion The use of a lying shifting machine can not only improve the efficiency of prone position ventilation treatment without increasing medical risks but also reduce the workload of medical staffs and improve their satisfaction. References | Related Articles | Metrics

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Development of an intelligent follow-up system and management practice in children with short bowel syndrome LING Yun, MEI Lingli, ZHU Jihua, HU Yan, YE Yingying, CHEN Baohai 2023, 4 (10):  887-892.  doi: 10.3761/j.issn.2096-7446.2023.10.004 Abstract ( )   PDF (1542KB) ( )   Save Objective To explore the development of an intelligent follow-up system and its management experience in children with short bowel syndrome. Methods An intelligent follow-up system was designed and developed. By convenience sampling,the system was applied to 34 children with short bowel syndrome admitted to the Neonatal Surgery Department of a tertiary Grade A children's hospital in Zhejiang Province from January 2021 to December 2022. The incidence of complications,family satisfaction with medical care services and awareness rate of health education were compared before and after the use of follow-up system. Results After the application of the intelligent follow-up system,the satisfaction of the family members of the children with medical care service increased year by year,which was significantly higher than that of the control group（P<0.05）. The family members' knowledge of catheter care,diet and nutrition,complications and emergency treatment in the observation group was higher than that in the control group,and the differences were statistically significant（P<0.05）. Conclusion The intelligent follow-up system has realized the precise,professional,intelligent and closed-loop follow-up service led by nurses,effectively reduced the incidence of complications of children,and improved the satisfaction of family members with medical care services and the awareness rate of health education. References | Related Articles | Metrics

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The design and applicability evaluation of virtual reality-based rehabilitation system for ICU patients GAI Yubiao, LIU Qingwei, REN Minglei, HAO Jinze, GUO Xiaojing, WEI Lili 2023, 4 (10):  892-897.  doi: 10.3761/j.issn.2096-7446.2023.10.005 Abstract ( )   PDF (1133KB) ( )   Save Objective A simple and practical rehabilitation system for patients in ICU was developed based on virtual reality（VR）technology to improve patients' rehabilitation compliance and safety. Methods By employing interdisciplinary and literary research methodologies,we employed 3DMax and Maya modeling software,and utilized the Unity 3D game engine for interactive purposes,a VR rehabilitation training system was developed for ICU patients. The convenience sampling method was employed to select 3 conscious patients who were admitted to the ICU of a Grade 3A Hospital in Shandong Province between April and June 2023. These patients were subjected to intervention using the VR rehabilitation system,and the applicability evaluation of VR rehabilitation system was evaluated from the aspects of adverse events,system availability and subjects' application feelings. Results The rehabilitation system designed in this study included upper limbs,lower limbs,cognitive function and strength training. The system was easy to operate,easy to understand and interesting,and no adverse events occurred during the intervention period. Conclusion The study has developed a VR-based rehabilitation training system,which demonstrates a certain degree of efficacy in promoting the rehabilitation of patients in ICU. Moreover,the system exhibits a low cost and a relatively safe implementation process. However,it is imperative to conduct future investigations involving a large sample size and multiple centers to validate its clinical effectiveness. References | Related Articles | Metrics

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Artificial intelligence-based techniques applied to critical ill children：a bibliometric analysis ZHANG Bixia, SHEN Nanping, SHI Songsong, WANG Hao, HAN Ting, SHEN Biyu 2023, 4 (10):  898-903.  doi: 10.3761/j.issn.2096-7446.2023.10.006 Abstract ( )   PDF (1251KB) ( )   Save Objective To explore the research situation and focuses in the field of artificial intelligence-based techniques applied to critical ill children. Methods Web of Science core database was retrieved and Citespace 5.6.R5 visualization software was applied to visualize the trend changes in publication volume,keyword co-occurrence,and emergent words of research in this field. Results Since 2016,there was a continually,rapidly increasing tendency for publication. Keywords “machine learning”,“deep learning”,“artificial neural network”,“mortality”,“risk” and “score” occur frequently. Conclusion Early prediction is the main research frontier and the hot topic in field. At present,many studies are only in the development stage,and large-scale data verification is still needed in the future. References | Related Articles | Metrics

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Current status and prospect of high-tech augmentative and alternative communication systems in ICU mechanically ventilated patients XU Nan, JIANG Zhixia, YUAN Xiaoli, LUO Juan, CHEN Fang, CHEN Qingqing 2023, 4 (10):  904-908.  doi: 10.3761/j.issn.2096-7446.2023.10.007 Abstract ( )   PDF (975KB) ( )   Save This paper briefly introduces the concept and common types of high-tech augmentative and alternative communication systems（AAC）,reviews its application in mechanical ventilation patients in ICU at home and abroad. This paper analyzes the applicable population of different high-tech AAC,the preparation before application and the clinical significance of application,and puts forward the prospect of future research directions,aiming at deepening the understanding of scholars and clinical workers on high-tech AAC,providing references for constructing scientific communication strategies and solving the communication problems of mechanical ventilation patients. References | Related Articles | Metrics

Guideline and Standard

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Clinical practice guidelines for physical restraints among adults patients in intensive care units The Second Affiliated Hospital Zhejiang University School of Medicine, Emergency Nursing Committee of Chinese Nursing Association, Intensive Care Committee of Chinese Nursing Association, Fudan University Centre for Evidence-based Nursing（Writing Committee：CUI Nianqi, ZHANG Yuping, ZHOU Yingfeng, SUN Hong, JIN Jingfen） 2023, 4 (10):  909-912.  doi: 10.3761/j.issn.2096-7446.2023.10.008 Abstract ( )   PDF (843KB) ( )   Save Objective To construct physical restraint clinical practice guidelines which it is appropriate to use among adult patients admitted into intensive care units（ICU）with Chinese context. Methods Based on the CAN-IMPLEMENT approach,which integrated existing high-quality clinical practice guidelines and systematic review evidence,a multidisciplinary team of experts used Grades of Recommendation,Assessment,Development,and Evaluation （GRADE）,and Delphi method to achieve a consensus on the recommendations. Results 15 recommendations were developed for 11 critical clinical questions related to physical restraint reduction based on 8 clinical practice guidelines and 71 systematic reviews. Conclusion This guideline provides evidence in physical restraint management and minimization in ICU for practitioners focusing on nurses. Related Articles | Metrics

Emergency Care Research

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Nursing care of a case of achondroplasia Dwarfism with massive liver cancer LIN Weixi, XU Juehua, XU Caijuan, LIU Shuai 2023, 4 (10):  913-916.  doi: 10.3761/j.issn.2096-7446.2023.10.009 Abstract ( )   PDF (733KB) ( )   Save To summarize the nursing experience of a patient with achondroplasia Dwarfism accompanied by massive liver cancer with spontaneous rupture and bleeding and colon perforation. Targeting the special physiological structure and critical condition of patients,predictive care for liver cancer rupture and bleeding was taken,and emergency plans for major bleeding was formulated. We implemented goal-oriented nursing strategies and carried out sequential individualized nursing,established a second plane method for hydrocolloid dressings to maintain the stoma,implemented comprehensive management of delirium and promoted accelerated recovery,implemented individualized psychological care and discharge continuity guidance. After 18 days of meticulous treatment and nursing care,the patient recovered and was discharged from the hospital. After a 2-month follow-up,his recovery was good. References | Related Articles | Metrics

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Nursing care of a child with recurrent acute liver failure and treated with extracorporeal liver-assist ZHAO Shiguo, HE Weimei, XIE Qianru, ZHANG Chenmei 2023, 4 (10):  916-919.  doi: 10.3761/j.issn.2096-7446.2023.10.010 Abstract ( )   PDF (702KB) ( )   Save To summarize the nursing experience of a child with recurrent acute liver failure. In order to solve the problems of acute liver function loss,extremely high mortality and lack of evidence-based nursing scheme,the combination of emergency therapeutic plasma exchange and continuous renal replacement therapy was adopted for extracorporeal liver-assist,and regional citrate anticoagulation scheme was selected. After 32 days of treatment and nursing,he was cured and discharged without liver transplantation. References | Related Articles | Metrics

Critical Care Research

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Preoperative nursing of separation surgery in a case of symmetrical abdominal conjoined twins SUN Meiqin, LUO Feixiang, FAN Xiaoyan 2023, 4 (10):  920-922.  doi: 10.3761/j.issn.2096-7446.2023.10.011 Abstract ( )   PDF (605KB) ( )   Save This case involved the care of premature symmetrical abdominal conjoined twins,and preoperative nursing for one newborn with complex congenital heart disease. The nursing points included planning the bed unit well and selecting a cultivation box with a large spatial area to maintain the stable body temperature of the twins,ensuring proper identification through careful labeling,using appropriate props for position management to reduce the incidence of head deformities,arranging the position of the non-operative twin according to examination requirements,implementing prevention measures to avoid infection related to the conjoined anatomy,evaluating the physiological status of the twins and providing individualized care,accurately measuring the weight of the conjoined twins to provide a basis for nutritional and medication strategies. The separation surgery was successfully performed on day 41 of hospitalization,and newborn A was discharged smoothly on the 8th day after surgery,and newborn B was discharged from the hospital on the 41st day after surgery. References | Related Articles | Metrics

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Nursing of anti-neutrophil cytoplasmic antibody associated vasculitis treated with extracorporeal membrane oxygenation ZHANG Runjie, GUO Hongyan 2023, 4 (10):  923-926.  doi: 10.3761/j.issn.2096-7446.2023.10.012 Abstract ( )   PDF (718KB) ( )   Save To summarize the nursing experience of ECMO for a patient with anti-neutrophil cytoplasmic antibody（ANCA）associated vasculitis complicated with diffuse alveolar hemorrhage. It was difficult to maintain oxygenation and the alveolar bleeding continued,so vein-vein extracorporeal membrane oxygenation was used as adjuvant therapy. The key points of nursing included infection prevention and control,prone ventilation care,precision volume management,close monitoring of clotting and bleeding,phased early mobilization,personalized psychological support. Monitoring of applicability in the early stage of anticoagulant therapy and management after anticoagulant therapy were the characteristics and focus of this case. The patient was successfully removed from ECMO on the 11th day and withdrew from mechanical ventilation 2 days later,and he was transferred out of ICU on the 30th day and discharged successfully 17 days later. References | Related Articles | Metrics

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Perioperative nursing of a patient with cholangiocarcinoma undergoing ex vivo liver resection combined with autologous liver transplantation XU Juehua, LIU Shuai, YAN Sheng, ZHANG Qiyi 2023, 4 (10):  926-929.  doi: 10.3761/j.issn.2096-7446.2023.10.013 Abstract ( )   PDF (692KB) ( )   Save To summarize the perioperative nursing experience of one patient with cholangiocarcinoma undergoing ex vivo liver resection combined with autologous liver transplantation. Nursing points：goal-oriented precise venous anticoagulation nursing one week after operation,observing the drainage fluid dynamically by Raúl colorimetric card to actively prevent and identify sentinel bleeding,controlling intra-abdominal pressure and doing a good job in fluid management within 24 hours after operation to ensure effective liver perfusion and reduce liver ischemia and reperfusion injury,comprehensively preventing and observing the occurrence of small liver syndrome during perioperative period,paying attention to the recovery of gastrointestinal function after operation and implementing the staged nutrition program. After careful nursing,the patient was discharged 45 days after operation. References | Related Articles | Metrics

Quality and Safety

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Study on moral courage and its influencing factors of emergency nurses WANG Tiantian, SU Qingqing, ZHANG Yaoyao, LI Qi, LÜ Jing, LI Haiyan 2023, 4 (10):  930-935.  doi: 10.3761/j.issn.2096-7446.2023.10.014 Abstract ( )   PDF (781KB) ( )   Save Objective To investigate the status and its influencing factors of moral courage among emergency nurses. Methods Using the convenience sampling method,a total of 596 emergency department nurses who were worked in three general hospital of Qingdao from December 2022 to February 2023 were selected as the research objects. General data questionnaire,Nurses Moral Courage Scale（NMCS）,Utrecht Work Engagement Scale（UWES）,Sense of Coherence Scale（SOC-13）,and Organizational Justice Scale were used to conduct the questionnaire survey. Results The total score of moral courage among nurses in emergency department was （71.92±17.30）,the total score of Utrecht work engagement was（55.94±12.72）,the total score of sense of coherence was（68.08±14.41）,the total score of organizational justice was（67.89±10.63）. The total score of moral courage of emergency department nurses was positively correlated with the total score of Utrecht work engagement,sense of coherence and organizational justice（P<0.001）. Multiple linear regression analysis showed that working years,average monthly income,work engagement,sense of coherence and organizational justice were the factors affecting the moral courage of nurses in emergency department（P<0.05）. Conclusion The moral courage level of emergency department nurses is above average,nursing managers should pay more attention to emergency department nurses with short working experience,low average monthly income,low level of work engagement,low sense of psychological consistency and low level of organizational justice,and take targeted intervention measures to improve the moral courage of nurses in the emergency department,in addition,emergency department nurses should also pay attention to self-cultivation and strive to enhance their professional moral courage. References | Related Articles | Metrics

Evidence Synthesis and Practice

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Summary of best evidence for intra-abdominal pressure measurement by the intravesical route HAO Guihua, LI Yousheng, WANG Pengfei, GU Fen, DAI Jingjing, HOU Lili 2023, 4 (10):  936-942.  doi: 10.3761/j.issn.2096-7446.2023.10.015 Abstract ( )   PDF (960KB) ( )   Save Objective To search,evaluate and summarize the best evidence of intravesical measurement techniques of intra-abdominal pressure in adult patients. Methods According to the "6S" pyramid model,a systematic search of domestic and foreign databases and websites was conducted on intravesical measurement techniques of intra-abdominal pressure for adult patients,including guidelines,evidence summaries,clinical decision,systematic reviews,expert consensuses. The timeframe of data search ran from the inception of the database to December 31,2022. Two trained researchers in systematic evidence-based knowledge evaluated the quality of the literature and extracted data independently,and summarized the evidence combined with professional judgment. Results A total of 17 articles were enrolled,including 4 guidelines,2 expert consensuses,1 systematic review,2 recommended practice,4 evidence summaries,1 cross-sectional study,3 diagnostic tests. Finally,21 items of best evidence were synthesized into 6 categories including measurement approach,measurement timing,measurement methods,measurement tools,interference factors,and personnel training. Conclusion This study summarized the best evidence of intravesical measurement techniques of intra-abdominal pressure,which provided evidence-based information for healthcare professionals. It is suggested that clinical application can be tailored according to specific clinical scenarios,to improve the accuracy and standardization of clinical measurement of intra-abdominal pressure. References | Related Articles | Metrics

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Information needs of ICU patients' families：a qualitative Meta-integration LIANG Hui, WANG Jianning, ZHANG Yi, LI Liqun, LUO Jing 2023, 4 (10):  943-950.  doi: 10.3761/j.issn.2096-7446.2023.10.016 Abstract ( )   PDF (1103KB) ( )   Save Objective To evaluate the qualitative studies of information needs of family members of ICU patients,and to provide strategies for meeting the information needs of family members and promoting barrier-free communication among nurses,patients and family members. Methods Databases such as CNKI,Wanfang Data,VIP,CBM,PubMed,CINAHL,Web of Science,Embase,Cochrane Library and Scopus were searched to collect qualitative research literature on the information needs of family members of ICU patients. The retrieval time was from the establishment of the database to December 31,2022,and the results of literature analysis were integrated by pooled integration method. Results A total of 15 articles were included,43 research results were extracted,12 categories were formed,and finally divided into 4 integrated results：comprehensive medical care,nursing process and cost information of patients;physiological care information;psychological perception information and professional knowledge information. Conclusion Medical staff should timely detect the information needs of family members,share information timely,provide information support with humanized nursing,and help family members to obtain information and meet their needs. References | Related Articles | Metrics

Review

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Research progress on the implementation methods of family-centered rounds in adult ICU ZHANG Jiajia, DING Zhuyu, GONG Xiaoyan, SUI Weijing, QIU Jiayao, HAN Wenwen 2023, 4 (10):  951-955.  doi: 10.3761/j.issn.2096-7446.2023.10.017 Abstract ( )   PDF (719KB) ( )   Save Family-centered rounds refers to a model in which family members participate in information sharing and medical decision-making together with the medical team,which can improve doctor-patient communication and patient outcomes. This article reviews the implementation methods of family-centered rounds in adult ICU,including preparation before implementation,implementation（including team composition,timing,length of time and frequency,place and station,process and auxiliary tools）,management after implementation and dilemmas of implementation,in order to provide a reference for the application of family participation in ward rounds in adult ICU. However,the mode of ward rounds suitable for the national condition still needs to be further refined and improved. References | Related Articles | Metrics

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Research progress of family participatory humanistic nursing care in preventing post-ICU syndrome in critically ill patients GU Ruiyuan, HU Qiaoshu, JIN Ke, GU Ruimeng, CHEN Jia 2023, 4 (10):  956-960.  doi: 10.3761/j.issn.2096-7446.2023.10.018 Abstract ( )   PDF (712KB) ( )   Save Family participatory humanistic nursing refers to a new nursing intervention mode in which family members participate in the treatment and rehabilitation process of critically ill patients in order to prevent post-ICU syndrome. This article reviews the connotation,application mode and application effects of family participatory humanistic nursing in order to provide reference for further optimizing the practice of family participatory humanistic nursing in the field of critical illness in China,and to effectively reduce the occurrence of post-ICU syndrome and improve the outcome of patients. References | Related Articles | Metrics